0106-253 (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-imfull force and effect.
License # Lic. Class Exp. Date
777699 a
/�.
Date? ' _" 1,. Signature of Contractor i• -! p
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).
( ) I am exempt under Section , B&P.C. for this reason.
Date 's " ; , s. Signature of Owner '/�/) J
WORKER'S COMPENSATION DECLARATION
' J
I hereby affirm under penalty of perjury one of the following declarations:
and will maintain a certificate of consent to self -insure for workers'
cQm. e,nsation, 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 I Policy No.
(This section need not be completed if the permit valuation is for $100.00 or less).
—H-1-certify-that-in-the-performance-of-the_work-for_which this_permit is issued,
.1 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,ISh 11 forthwith comply with those,pr"ovlslo S. >t
Date:. f\ . Applicant—
Warning:
pplicant Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706,
of the Labor Code, interest and attorney's fees. M
IMPORTANT, Application is hereby -made to the Director of Building and Safety
for a permit subject to the. conditions and restrictions set forth on his
application. - -
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
`any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work,,' for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to Comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for.%rpe fjo9purposes.
Signature (Owner/Agent) 1 Date 4A
r Y r
.�4
BUILDING PERMIT PERMIT #
to
.
DATE VALUATION LOT TRACT
r::3$e `Y1 iG + 2.1 449,-I
JOB SITE
APN
ADDRESS
tq1 ,��C yyt���'_i .q(d.ry�r�ra�••+���7��, j�yyg�y�t, ryry����pp��
(7F�`•.a.�FFn7 A�1.o��r{e7r`3T'4dFi A.1 KA71b�A.
MAO
1,troe-
r4P`�)^•''�:'ii"'�.k✓•+$
OWNER
CONTRACTOR/DESIGNER/ENGINEER
TOY i.RPItJ'l UKRZ,.INTIC
Toll, B O7!°1r M INC
x4-923;F.O'Vlr�'? Id-OIa;=31'MMMI.220
74.922511C» YJAW,EAVrSUM-420
PAI U MWAT CA 12260
1?AI,,.3+�g�M917.�'�1' ' 9}2pp�aa.�;0iN
ggyy 3+y
USE OF PERMIT
�.�:�
�Sy���,,ff�� 2211 y�A�, �•y� ty� �q � pry
�LbV'L:��.aL'r .S`J:71'YJLStrA�l.+�' �•lr��\.i"
v 9 xe�a t
�E.1i1 'ireef2ah.:Wf�.f9�IF .�:``'-
SYO a ?=r 9 }?&&H'y ENTAAd`1'A.4057 - PE.RMI`i' BONS NOT }iv"'UDE
CUSTOM OYNSTRUC110H 4,07.0 8F
PORCHIPA.TIO 314,00 Sig
r6VLXdCr"in"fi XY- 706,00 SYS'
XMN#b'I" CC}MW COAS1'.s�UCUO
CONOTRUCTION FU 101-000-418-000 $1,460.0
P(,AN C.� EC`6C FXF, $�Jf - Ffi •3�-�* 1 R
MECYLANICAI. 1i11,f13i 21�t1U0 X9^,0€t
Z=TRICAL FEE $249.0
PLUMBING TEE 1191-t 00.419,M0 116159
S'1`laDHO MOTION ME 1 AWSID . 101 -00&-241 -000 $33.67
cfiaaS� j"1:I1 t :�� 101A000-42.3-000 420,00
1.'3I�'i�•i.�1�1.''r%, J�1i�A:��"i. ' 1'�#'0`3�.., ' �➢y31��l.flS.i
T IN Rjw�.r w1 -opo -2,s&000 $1M130
�� TD PLM itN AN
$5 400.??
a tJ } I.E..} 41�I.�,�D XG
-1 3
r
$0.00
1 1
RECEIPTDATE—
BY
D FOIA
b
SPECTO
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms &Footings,///�
Slab Grade
Steel
Roof Deck
O.K. to Wrap
Framing
Insulation_
Fireplace P.L.
Fireplace T.O.
Party Wali Insulation
_
/D/ •, � /
l�
_
/3�b
��-� lL�
Ducts / _ Q -
Return Air /
Combustion Air _
Exhaust Fans _
F.A.U. _ IV—
Compressor
Vents _
Grills
Fans & Controls
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
_
�///,����
i4_ 4
Final /�70 _ �../
BLOCKWALL APPROVALS
Final
POOLS - SPAS
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
Electric Final
Waste Lines
Water Piping
���� 6�
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
Pool Cover
Gas Piping
Gas Test/�3/�v
,�/�¢QO!✓
Appliances
Final
COMMENTS:
7
Final
Utility Notice (Gas) �' 3/%
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service _q _
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors /
Temp. Use of Power
Final
Utility Notice (Perm) '�/_
04/;12/2002 15:32 9092920'-q
SCHMID CONTRACT -VG
INSULATION CERTIFICATE
This is to certify that insulation has been it stalled in conformance with the current energy
regulation, California Administrative Code! Title 24, State of California, in the building at
C-ii1--165KINGSTON HEATH , LA QUINTA, CALIFORNIA 92253
a _ _ TBI 6
PAGE 02/09
TYPE: Fiberglass BATTS MANUFACTURER: Owens/Coming THICKNESS: R-38.2" BLOW
WALLS:
TYPE: Fiberglass Batts MANUFACTURER: Owens/Coming THICKNESS:R-'1 5 1/2"
GENERAL CONTRACTOR: TOLL BROTHERS, INC. LICENSE:
BY: TITLE:
SCHMID INSULATION CONTRACTORS INC, LICENSE#221517 C-2
TITLE: PRODUCTION MANAGER DATE: 4 12!02
INSULATION CERTIFICATE
This is to certify that insulation has been it
regulation, California Administrative Code,
811-165 KINGSTOI
CEILINGS:
TYPE: Fiberglass BATTS MANUFACTU
WALLS.
TYPE: Fiberglass Baits MANUFACTUR
GENERAL CONTRACTOR: TOLL,;SROTI
BY:
d in conformance with the current energy
24, State of California, in the building local :d at
HEATH, LA QUINTA, CALIFORNIA 92253 -
TBI 6
Owens/Corning THICKNESS: R-18 42" BLOVW,•*
Owens/Coming THICKNESS: R-21 5 1/2"
ERS, INC. LICENSE #
TITLE:
SCHMID INSULATION CONTRACTORS, INC. LICENSE #221517
1''—��TITLE: - PRODUCTION MANAGER DATA;: 4/12/1
August 8, 2001
City of La Quinta
Building &Safety Department
P.O. Box 1504 is
La Quinta, CA 92253
Fax: 777.7011
+I.
Re: Lot
Project: ista (Tract !.# 29349-1) -or-
To Whom It May Concern:
This letter serves to advise you the O'Hagin r
representative. The vents are�,as per plan to of
Should you require any fuithe-r information, p
S incerely,
Andy Fraser
Project Manager
Toll Brothers @ PGA West
'`oint-l"S, GInc.
torn es by Design 0
Reserve (Tract #29348-2) (circle one)
f vents have been inspected by the Toll Brothers'
satisfaction.
se let us know.
74-923 Hovley Lane East,I Suite 2-220 Palm Desert, CA 92260
1
n -,'A -Q Igg Fn•; ?„n_; ,,_on1
� r
L
N miner & Sons
Al Miller & sons i?c)orlip
Roofing in
6u-76o sumjnil Dr. Phone: 760/3�1f,-]'LJ.4
CO Cathedral Cily, C419223,1 FM: 760/321-7097
r o �
F.acsimile
'fix Gary / Am1y@V, 611 Bw- tiuev p —wA West
r.
Fax:,, 777-I.5,%
Fron-i: R ss Tiller
Dater
Re: Inspection �o
Pages: �.
Gary / Andy,
WP- have inspected all the Roofs at PGA West (Vistas and
Reserve), All vents are installed per the Q'Hagin
specificAons and per your plans
Thank you,
Ij
Russ Miller