0106-260 (SFD)- LICENSED CONTRACTOR DECLARATION
I he affirm under penalty of perjury that I amaicensed under provisions of
Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
l.hle
177699 B % J fiWOM
!� ..
Date -6 /q.— ` „y Signature of Contractor �� x
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
sale (Sec. 7044, Business & Professionals Code).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Pfbfessionals
Code).
O I am exempt under Section , B&P.C. forthis're. son
Date , "^,' - Signature of Owner V --
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
( ) I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued. .1c"
,V(?) I have and will maintain workers' compensation insurance, as required by
,Section 3700 of the -Labor Code, for the performance of the work for which this
permit is issued._ My workers' compensation insurance carrier & policy no. are:
Carver Policy No.
() I certify'that in the performance of the work for which this permit is issued,
Pshall not employ any person in any manner so as to become subject to the
Workers' compensation laws of California, and agree tf at -if I should become
subject to the workers' compensation provisions oJ Section 3700 of the Labor..
Code, I shall forthwith comply with those,pQisions�
Date: C � / _^ Applicant i hy- ,�•
I OF
Warning Failure to secure Workers' Compensation coverage is unlawful and
shall subject an enni foyer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in -Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to. the conditions and restrictions set forth on. his
application.
1. Each person upon whose behalf this application is made & each person at
whose request -and for whose benefit work is'performed under or pursuant,to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if .
work is4 not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City; and+State laws relating to the building
construction, and hereby authorize representatives of this City to,, enterr_upon,
the above-mentioned property for inspectio.n� pu"rposes��-
Signature (Owner/Agent) %V�'�.�.,*�^ Dathne
`r
BUILDING PERMIT PERM T/1
DATE VALUATION LOT 010&u60 TRACT
:fit 1 2 8J 32 2.934,9-1
JOB SITE
APN
ADDRESS
81-080 XOGS ON RIPA°/ER
7674MM2
OWNER
CONTRACTOR/DESIGNER/ENGINEER
TON, PM011,1MRS INC
TOLLB11,OTEMS RIC
74^92<31'10 E..Y LANE EMT 'T3 1T' x'2.210
74.923HrjVEU1JAH1:.EALTW.'01T Z-220
PAUd, DESEMT CA 92260
111ALM Dl` altI-Cr CA 92266
C760)674.9699 C.' 144 ".4832
USE OF PERMIT
GM MvWt DWMLWG
4611 Tx:L, t --,R AV F.
PO.:IC)T 32 PLAN MMI)WINQ 3650 ^ PltPWIT V093 N tidl:,` UDLO
0g'at -C.K WALIt POOL OR 0P..EV11iVAY AP3'°ROAC K 15% PLAN CHECK ME, .
11F]DUC't'10N ,A:PPi,lW FOR Ml LT19PLF SUBMITTALS
CUSI'0M COMS'9`RUCTION :0*4.00 8V
508.700 SF
PORR�CA'�/a��JP/.�yTipQ�:�S�/
�o
G A3i.>I'>GE.i+.If'a:L'eS�'J I.i9 3.00 E11
1 111TIE d"M COS' Cil►
C01407UCTIO . 1010.(00.41$,060 51,164,00
pi ml CHECK YNIC i lily ^t1i34�i•3�3^31 3 �.A�it,40
FH.rr' Y1 Ebty, tai'~ 101-000-421-000
MEC` RICA,VstS 101.000-420-000
3t°1.eummo vft 101-000-419-000 �160.Gi1
S"PRONO tAQ1X0N M t ESM 101-000-7,41-000 3a.Fi9
�t�Fn1'lih1CS rah,ia; :. tri .f'1l'i['#_rt /96frare�o
nwi-o'zsrv--�cs.v�nroiu a�VeGi;E
D,X'VK.:V9R IMPACT VW$3,9 I.04
A.R', ` IN. PUBLIC PLA0.f.5 - REStr 701 -000-25;5-0 00 920,29
A3: ,10'OA.AL W149MUC710H AWD,R�.LAl'7 MEM.
S4,294,18
PRE -PAID 1'+'.C,�M
RECEIPT
DATE
BY
DATE FJNALEJDINSPE
R
INSPECTION (RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade F
Return Air
Steel_
Combustion Air
_
Roof Deck
Exhaust Fans
_ _ _
O.K. to Wrap i_
F.A.U.
Framing r —
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath 9
Drywall - Int. Lath
Final
�//
_ -
Final � 173 I
_�
POOLS -SPAS
BLOCKWALL APPROVALS.
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
_
Waste Lines
Electric Final
Heater Final
Water Piping
p 9
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral _
Sewer Connection r2(p `62
— v
Pool Cover
Encapsulation
Gas Piping
Gas Test ��Q3
10
Appliances
Final
COMMENTS:
Final
l7
Utility Notice (Gas)
eS
ELECTRICAL APPROVA
Temp. Power Pole
Underground Conduit
Rough Wiring
"
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power -���
Final /J
2
UtilityTJotice (Perm)
Certificate of Occupancy
T4hf 4 *1 a"
Building &Safety Department
This Certificate is issued pursuant to the requirements of Section 109 of the California
Building
Code, certifying that, at the time of issuance, this structure was in compliance
Provisions of the Building Code and the various ordinances of the City regulatin building
the
construction and/or use. 9► /ding
BUILDING ADDRESS: 81-080 Kinaston Heath
Use classification: Single Family Dwelling
Occupancy Group: R-3
Owner of Building: Toll Brothers Inc
Building Official
Type of Construction: VN
POST IN A CONSPIC
Building Permit No.: 0106-260
_ La;u use Zane: KL
Address: 74-923 Hovely Lane E Ste 2-220
City, ST, ZIP: Palm DesertCA 92260
By: Daniel P. Crawford Jr.
Date: 7/17/03