0103-192 (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
'277699 ,13 fo'.0 30/2(
bate Signature of Contractor
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 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:
Carrier Policy No.
FACIFFIC EMPUMV Mil C-4170941414
( ) 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, I shall forthwith comply with those provisions.
Date: Applicant
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.
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 autorize representatives of this City to enter upon
the above-mentioned property for insp potion purposes.
Signature (Owner/Agent) r I"i �•• PAI Date
PERMIT PERMIT#
_BUILDING
DATE r VALUATION LOTTRACT
JOB SITE `""�-•
APN
ADDRESS
OWNER
CONTRACTOR / DESIGNER / EN INEER
TOLL xi iCr
?�) ie:F3c<O1:I G;r "a C
74-923 YTONW7 LANE LALKI: WI2°220
74.9231103MY LAM WIT 9f(J!'M 220
CA W1260
P.M BFATri tiT CA 92260
(3eSi3) 514-9699 :SLO 363.z
USE OF PERMIT
:an?..PLNd .MENDOCIND 1.10'I' -9 - P,SR.R@311' }.,30,1"; TSL?'] INCLUJ
77
CUSTOM CO OTRUCITION %&.so,00 sp MAR
2 8 2001-
FC!RCCHI-PATIO 588.00 Si'
10AU0PX,AKP0Wf (ff) 9. t1
CITY
OF LA DUINTA
FI
ANCE DEPT
1MMAT.ED t'd7ST Ole C01071"RTIM019
,914.20.
CONSTRUCTION FEE 1011.000.418.000 $1,364,00
PI: AIS CHECK 0194 slro83.96
ELTi",C�".fI'Ea+it`�,I77,�y,(�jFEE 2
�fl'�
�'�i�3JM13t' O w'1: E 301 rQCi)�� r✓4iCFM $1�� ryi
r
3TRONCII ?LOTION FEE -.&IP ID 101 -000-24.1
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.
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$5,107.75
RECEIPT
DATEj BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATIONDATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings r
Slab Grade
./� (_
Underground Ducts
Ducts r
`Return Air
Steel
Combustion Air
Roof Deck
���d�
Exhaust Fans
O.K. to Wrap
_ m
� ���DI
F.A.U.
Framing
/-17
Compressor
Insulation
9/d� m
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wail Firewall
Exterior Lath
Drywall - Int. Lath
_ �
Final
�//'� �/ �iAd�
BLOCKWALL APPROVALS
Final
POOLS -SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location .
Underground Electric,
Underground Pibg. Test
Final
I I -
Gas Piping
PLUMBING APPROVALS
_
Waste Lines����� �G'�/L
Gas Test
Electric Final
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
_
�(,1/p/ �L/,PSL
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
_
Final
Utility Notice (Gas)
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)
Certificate of Occupancy
City of L'a Quinta
Building and Safety Department, ,�E°`
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code,
certifying that, at the time of issuance, this structure was in compliance with the various ordinances
of the City regulating building construction or use. For the following:
PI III ninlr AnnRFc(z• Ql-'))ti IclnercTnnl uIZATu
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0103-192
Occupancy Group: R-3 Type of Construction: VN Land Use,Zone: RL -
Owner of Building: TOLL BROTHERS INC
l -o'er
Building Official
Address: 74-923 HOVELY LANE EAST STE 2-220
City: PALM DESERT, CA., 92260
By: BILL GORDON
Date: 2/7/02
POST IN A CONSPICUOUS PLACE
`doll �Br6thers, IInc.
Quality Homes by Design®
August 8, 2001. .
City of La Quinta
Building & Safety Department'
P.O. Box 1504
La Quinta, CA 92253
Fax: 777.7011
Re: Lot # Q
Projectista (Tract# 29349-1) -or- Reserve (Tract 929348-2) (circle one)
To Whom It May Concern:
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 an further information lei se let us know.
q Y p
Sincerely,
Andy Fraser
Project Manager
Toll Brothers @ PGA West
74-923 Hovley Lane East, Suite 2-220 Palm Desert, CA 92260
760-674-9691 Fax 760-674-9081
i
y Al ZViitler Sc Sins mmmemSOUS
ltc)ornp
Romminco 68-7.60 Summit Dr.Phone: 760/316-121.4
Cathedral Cily, Ca 9223.1 1 wx., 760/321-7097
L
i
wimiLo
,.ftx ,Gtry / Ano,@Troii BruthQS P`TA west
Fax: 1777-1.a% �
lion:,Russ Miller
Gate: zlioJoZ.
Re: Inspection, LOT 9 U/5 77,4�
Pages;; 1.
Gary / Ancly,
We have inspected all the Roofs at PCA West (Vistas and
Reserve). All v,ents fare installed per the C'Hagin
specificati�6ns and per, your plans
Thank you, .'
cc ,n
Russ Miller
INSULATION CERTIFICATE
4
This is to certify that insulation has been ii
regulation, California Administrative Code,
81-225 KINGSTON
�d in conformance with the current energy
24, State of California, in the building at
TH, LA QUINTA, CALIFORNIA 92253
TBI 9
TYPE: Fiberglass BATTS MANUFACTURER: Owens/Corning THICKNESS: R-30 9 1/2" BLOW
WALLS:
TYPE: Fiberglass Batts i MANUFACTURER: Owens/Corning THICKNESS:R-19 6 1/2"
GENERAL CONTRACTOR: TOLL B
BY:
SCHMID INS fiIOR CONTRACTORS, IN,
HERS, INC. LICENSE:
E:
LICENSE #221517 C-2
BY: 19` TITLE: PRODUCTION MANAGER DATE: 1/17/02
INSULATION ICERTIFICATE
This is to certify that insulaticin has been installed in conformance with the current energy
regulation, California Administrative Code, Title 24, State of California, in the building located at
81-225 KINGSTON HEATH, LA QUINTA, CALIFORNIA 92253
1 TBI 9
CEILINGS:
TYPE: Fiberglass BATTS MANUFACTURER: Owens/Corning
WALLS:
TYPE: Fiberglass Batts MANUFACTURER: Owens/Corning
GENERAL CONTRACTOR: TOLL BROTHERS, INC.
BY: TITI F-
SCHMID INS ION CONTRACTORS, I
BY: TITLE:
THICKNESS: R-30 9 1/2" BLOW
THICKNESS: R-19 6 1/2"
LICENSE #
LICENSE #221517 C-2
RODUCTION MANAGER DATE: 1/17/02
I
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