0106-258 (SFD)LICENSED CONTRACTOR DECLARATION
I, hereby. affirm under penalty of perjury that I am licensed 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
M699 .13
04
Date r, "" Signature of Contractorf=
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 & Professionals
Code).
O I amk x mpt under Section• , B&P.C.+for thlsmeason
Date `*`� Signature of Owner
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.
( ) 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 ii� ��1 1*ta� P' t9 �n7bp •Policy No. ��y5 yy r+!,1 �?pp 2!
P A;� M00 -YrSyGi W �A i.r'.N - V� LfiA q'IJV4F018
(This section need not be completed if the permit valuation is for $100.00 or less).
() I certify that in the performance of the work for which this permit is issued,
I .shall not employ any person in any manner so as to become subject to the
workers' compensation laws of California, and agree that. if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code,Pis `all fo� with comply with those.pr isions.
S,r
Date: � Applicant '� �f.� T.,
Warn ng: ,Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as providedsfor in. Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton °agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information,, is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City ,to .enter upon
the above-mentioned property for' pec tion purposes
f.
Signature (Owner/Agen{)fir'
' t
BUILDING PERMIT PERMIT#
DATE VALUATION LOT ()106- TRACT
01;36,714.10 1,0
29349.1
JOB SITE
APN
ADDRESS
8.112 0 MG-W_O?T IM11U.
1 767-49"30
OWNER
CONTRACTOR / DESIGNER / EN (NEER
7 -9 3 �;0O�'' C,� Zr �I�.PsS"'�°��1,�EM-2,20
74-1923 HOMYLAN +NST
WHY -2-220
PALM 1:3F18'1 R11 CA X2.260
P.lJ.M.171;. :RT CA 92260
7:
Q60)614-,9;99 L�
�
383Z
USE OF PERMIT
RN
46) i. TELL;tM AVY.
01.) : I.i' T 30VEN`d°rE12�8�. �2t 57 ,, PERMIT V010' NOT
B��OT 3TniIXUDZ
i;PL�!`!4
MANIC Vi$�h°6U, POOL OR :�i�.1�1'�i�D.%'sir' B�i?�:�.4�R�i�'+�, I3 ro pLAX e.'HW it M
AIDUCTIOA A:PPL*'0 FOR MUL I.Plat SUBMITTALS
CUOTO'I1 CONSTRUCTION 4,037.00 SF
514,W Sir
0ARAGEMARPORT 706106 01F
.
AM4.GR .YJ ER SUMMARY
R. I 0 .,OW -41 S_OOp $1,469,00
RAN CHECK PEE 3 _000-439-31 t o #41.53
1.0�, 1
?uuJL'��.kyyi,++�113''Alk}}yy�pp:.�dYl. iR � tgp197.0`{tL,042,$9100
,
P3ffw nOl l e 101.000,419.001 $16211 0
#"t[Sd1�7CR :t pYS'J LF +7+t FER - REaS D >Y -Okw--241-0 �SJi,�7f
l'111 5I�+i�3 1101-0 00-423-000 MAO
OFIV�cai.9.07Pg4fYla $1,9',s1SAao _ -
♦Nv,P�tAfA:''pd Frv+k�ip% ��tt. �p3 �9p�+y .yfi e9 Rye
5.:41:4.'l 3,R`E 8'�L*.fd.AvdL: B'toR:!tn Crit/ "- Rrat7tN: 7M,4 °'.S�N�W^`Ji,Jsg-000 ✓•t 3a
r�
_1,T0TA1 CO-_
1 r J U L.,��4 . DUE POW°�.3.
GIs! L<f L.� C)LI1N YA
RECEIPT'
DATE
BY yz
j INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
/
Underground Ducts
Ducts
Slab Grade
_
��`62
Retum Air
Steel _ _
Roof Deck ` �� 2 _ _
O.K. to Wrap - - -
Combustion Air
Exhaust Fans
F.A.U.
f
Framing
_ _
Cgppressor
Insulation
Fireplace P.L.
�_ I _
Vents
Grills
_ -
Fireplace T.O.
Fans & Controls
7i
_
Party Wali Insulation
Condensate Lines
T—
Party Wali Firewall
Exterior Lath
Drymall - Int. Lath
I
Final
Final
�—j-- a�
BLOCKWfir_
POOL
APS ROV� _��
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
9
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Waste Lines
g/�1�j2
Electric Final
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
_ _ _
Pool Cover
Sewer Connection
g lZ7 1 Z _
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
W
-
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
_
Temp. Use of Power
Final
Utility Notice (Perm)
v'
i
INSULATION CERTIFICATE
This is to certify that insulation has been installed in conformance with the current energy
regulation, California Administr:3tive Code, Title 24, State of California, in the building located at:
t
81-065 Kingston Heath, Vistas @ PGA West, Lot 1, La Quinta, California
CEILINGS
TYPE: BLOW MANUFACTURER: CERTAINTEED THICKNESS: R-38
+i
WALLS:
TYPE: BATTS MANUFACTURER: CERTAINTEED THICKNESS: R-21
GENERAL CONTRACTOR: Toll Brothers, Inc. LICENSE #
BY: TITLE:
PARAGr SC BUI - ING PRODUCTS, A MASCO COMPANY LICENSE # 632072
}
BY: TITLE: ADMINISTRATIVE ASSISTANT DATE: 4/30/2003
., . n .- .. .f .. ... n � r.. ., r. L,•.'/.: .:rr✓.-� ,:./'a. � ✓:n � 'J b,./Y.!{r,:u%.f:J•�/Lu!:NGYr:Y:b!Y�.9/.L'.r.Ai_y.:a%C`:.... ,rJa: /..!»'. % t v .. ✓.c L r T i.e Y. •. .. L
Y
1
{ ; INSULATION CERTIFICATE
This is to certify that insulation has been installed in conformance with the current energy
regulation, California Administrative Code, Title 24, State of California, in the building located at:
`81-120 Kingstcin Heath, Vistas @ PGA West, Lot 30, La Quinta California
CEILINGS:
TYPE: BLOW MANUFACTURER: CERTAINTEED THICKNESS: R-38
WALLS:
TYPE: BATTS MANUFACTURER: CERTAINTEED THICKNESS: R-21
GENERAL CONTRACTOR: Toll Brothers, Inc. LICENSE #
BY:
TITLE:
PARAG^ N SCHMID BUILDING PRODUCTS. A MASCO COMPANY LICENSE # 632072
�k
BY: _ TITLE: ADMINISTRATIVE ASSISTANT DATE: 4/30/2003
.. r > .� e..�• [....e._:::.r.dr!a.,W?: yv, r./. r , .,..•:a;./....n .m u> ✓.-.r r:..: .r.✓.r...:vi ir.�a...o .: r/,:.m wa
I
Al Miller & sons
At Mitler Sc Sons Roofing
ROOMg ���i!
68-760ISuannit Dr. Phone: 760/346-12.1.4
Cath( -drat C.:ity, ca 9223-1.
Fax: 760/311-7097
ii
Fw: i7nile
y
�4
' T(I G OH BFOUuj-,-, JPGA West
.FaX: 777-15%%
From; Russ i ler
Gate: <b.//,M
o d�
Pe: lrispectien 3�0/tea
Pages: �.
,I
Sy
y
y / AndY,s
We have inslp+ected all the Roofs at PGA WestVistas and
d
Deserve). All vents are: installed per the O'Ha
gin
sf)ecification s and per your plan
,t
r
Flank you,
Buss Miller v
�y
v r
1{
'rqll �Brothers,GInc
s Quality Ho es by Design°
August 8, 2001
City of La Quinta
Building & Safety Department i+
P.O. Box 1504
La Quinta, CA 92253
Fax: 777.7011
, C73 .♦
Re: Lot # 3a
Projecact # 29349-1) -or- Reserve (Tract #29348-2) (circle one)
To Whom It May Conceal:
This letter serves to advise you the: O'Hagin roof vents have been inspected by the Toll Brothers'
representative. The vents are as per plan to our satisfaction.
Should you require any further information, please let us know.
S u'Icerely,
Andy Fraser.
Project Manager
Toll Brothers @ PGA West
74-923 Hovley Lane East, Suite 2-220 Palm Desert, CA 92260
f 760-674-9699 Fax 160-674-9C8.1
i
REGISTERED INSPECTOR'S'WEEKLY REPORT
JON TANDY
78-194 Elenbrook Ct.
Palm Desert, CA 92211
Office (760) 772-7192
Fax (760) 772-7193
Pager (760) 776-3338
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLY
O POST TENSIONED CONCRETE O ASPHALT
❑ REINFORCED MASONRY O FIRE PROOFING
p8Xy
❑ OTHER
JOB LOCATION y p I . j / � �; N
Li ( ` (Z..O �� 1J(y S� ) lei k"�t'�1\
REPORT SEQUENCE NO.
TYPE OFF�STRUCTURE y C �/
Ie f- IFf/-.GV ® o ��1 s1 .,
PERMIT NO. �j •� '7� f�
o7� / - /9 �
DATE �j
10_trl�D/
DAY OF WEEK
MATERIAL DESCRIPTION
ARCHI_ TELT�,
INS �ORQ'
HRS. CHARGED
1
ENGINEER
ASSISTANTS
HRS. CHARGED
INSPECTION
DATE'
GENERAL �c�Q t 1 P� ,�j SUB
- -CONTRACTOR • - 1 �i '�j��Gl, . CONTRACTOR-
�- t�1
a&5�cx;M
Lrlei << s ktV o-r� l -XAeti c N
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o LkS i wG- t M, S o
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COPY SENT TO CLIENT O
CONTINUED ON NEXT PAGE O
PAGE OF
CERTIFICATION OF COMPLIANCE
s'
I HEREBY CERTIFY THAT I HAVE INSPECTED TO 'rHE BEST OF MV
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE
NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED
PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS.
-
SIGNATURE OF REGI
l � I �SPECTORe
C>3 r— lgq((77
DATE OF REPORT REGISTER NUMBER