0103-198 (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
177699 P, W30/2(
Date 1 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.
(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, 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 $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made ti the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this.application is made & each person at
Whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for.inspectio�n, rposes.
Signature(Owner/Agent)f'/�f%'''`"J Date a`tJ�• .A��
BUILDING PERMIT PERMIT#
DATE of VALUATION LOT TRACT
1�J e / v &W- k 49 J.4.2; 24 29349A
JOB SITE
APN
ADDRESS
a81_�2,40.,XT 09rOl$ 011
i67•-�l9tp-f,1"24
OWNER
CONTRACTOR/DESIGNER/ENGINEER
C1 I `"
TI
TOLL 1n�+�IC�`�j
1'pp')):, ],fyyi}}-
1 /,����pp��y {��{(..�,�� y.y��,�yyy��iM` � f¢1 �Mp
7gyp`-9AM.M w �OVELY IdtNFK•WW CJ'{J":ME2-l�2
��',,�irtl�'a,`�1`/�[��E�IS
� �?�{ {v�'
4-923 �.Ck.I'i.{:(:Z..�Y .�u�.�E b.+"3'Wig UUTHEYs-220
;t''A.i.M.D,k?, .i• T CA 1.42260
PALIAOrLS .ERT C;.P :422,60
(,'760)6-14.9659 t- MA 3832
USE OF PERMIT
S.IK13-PLAN PMENDOCINO L 7r 24 - P19R' IT DOES NOT .IIC IAJI2E BWC K . .
WA.L1, POOY.i,9PA A DRIVEV 'AY 4P,t,PROA.C.i j5i6 PLANCHECI _
Q
017ffrfOM CO1+1S'1`ROCT1011 30$0100 OF
'
2 8 2001
P09,013J;£as�'S' O 5�" -IN S
+;3.A'E@,AC UCA1'UPOrT (S'* 1.4,15t,30
CITY
OF LA OUINTA
FINANCE DEPT
306,914M
xymaAmm COs ' Off' C;an9`lwC�,Ct?n
COWSIITRU0' 071 ON FEZ )01-000-418-0101101 $1,344.00
k� � 1 l°`Tr p4ex If.49 101-01100-439-318 4 020.90
MECHANICAL nX 101.000.421-000 109,50
�
kLEC."r.PJC.F L ii'Z 101-M)-420-000 4175.31;
PLUKD1110 a 101t-000419-000 $160.00
STRO'It10 Nd•7TION,, PY-VAD 101-000-241-0W $30.69
OR,AS5i1<1O`lW $20,00
0WV.4)PKR IMPACT PEE $3 900.00
A.l11' rN PUBLIC, PL&CsES = RENK 701.000-255.000 5267.:19
' Cq .PX1?, [:1:''.ATA.S T UC I4OW
$4,294,70
RECEIPT
DATEf
BY
DATE FINALED
INSPECTOR
i
.
, G , "" /'
I
I
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Forms & Footings
Set.BacksA/,
Slab Grade
/�Ducts
"' e-,;& z
Underground Ducts
Return Air
Steel
Roof Deck
O.K. to Wrap
Framing. , '
_ _
-� _
- f -
_
/ _
'Combustion Air
Exhaust Fans. ,
F.A.U.
Compressor
Insulation".
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wail Firewall
Exterior Lath
Drywall - Int. Lath
A/r9_��
_
Final lQ%' /rJG�
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
Waste Lines '/'
`'
Gas Test
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/�/
��
Encapsulation
Gas Piping
Gas Test
Appliances
_
f. g�G`boft
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS,
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Vottage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final Utility Notice (Perm)
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 at y
1
81-240 KINGSTON HEATH, LA QUINTA, CALIFORNIA 92253
I TBI 24
CEILINGS:
TYPE: Fiberglass BATTS MANUFACTURER: Owens/Corning THICKNESS: R-30 9 1/2" BLOW
WALLS:
TYPE: Fiberglass Batts MANUFACTURER: Owens/Corning THICKNESS:R-19 6 1/2"
GENERAL CONTRACTOR: TOLL BROTHERS, INC
BY: TITL
ems'
S C H M I 81f1; ION CONTRACTORS, INC.'
BY: TITLE:
!'!
LICENSE:
LICENSE #221517 C-2
PRODUCTION MANAGER DATE: 1/17/02
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
f
81-2410 KINGSTON, HEATH, LA QUINTA, CALIFORNIA 92253
.1 TBI 24
CEILINGS:
TYPE: Fiberglass BATTS MANUFACTURER Owens/Corning THICKNESS: R-30 9 1/2" BLOW
WALLS:
TYPE: Fiberglass Batts MANUFACTURER: Owens/Corning THICKNESS: R-19 6 1/2"
GENERAL CONTRACTOR: TOLL BROTHERS, INC. LICENSE #
BY: TITLE:
SCHMID IN 6 ATION CONTRACTORS, INC. LICENSE #221517 C-2
BY 4", TITLE:PRODUCTION MANAGER DATE: 1/17/02
XMIlleraSons
Al Miller & Sou; Rooting,
Boonng inel., 6a tb'e ralSILCil t 11r.
Cathl�dral C;ily, est
Fi
Gary / Andy,
We have inspected al
Deserve), All vents
specifications and peo
'Thank you;
Russ Miller
Phone: 760/3,16-1.21.4
Fwx! 760/321-7097
Brothers PGA West
the Roofs at PGA West (Vistas and
are installed per the O'Hagin
your plans
s
r.ra
Gciu / t�
Fa~x*
,777-1.596
From:
Russ Miller
Date:
1/26710-7-
7 -
Re:
R e.,
Inspection
Pages„ 3.
I.
Gary / Andy,
We have inspected al
Deserve), All vents
specifications and peo
'Thank you;
Russ Miller
Phone: 760/3,16-1.21.4
Fwx! 760/321-7097
Brothers PGA West
the Roofs at PGA West (Vistas and
are installed per the O'Hagin
your plans
1
I ,
I
`brothers GInc.
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 #�,�
Project: istas Tract # 19349-1) -or- Reserve (Tract 429348-2) (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 any further information, please let us know.
Sincerely,
Andy Fraser
Project Manager
Toll Brothers @ PGA West
74-923 Howley Lane East, Suite 2-220 Palm Desert, CA 92260
760-674-969-) Fax 760-674-9081
Certificate of Occupancy
City of La Quinta
Building and Safety Department*
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:
��•��..-v . ..... v..�vv. V 1 LTV 1\IIY\JV 1
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of Construction: VN
Owner of Building: TOLL BROTHERS INC
Building Official
Bldg. Permit No.: 0103-198
Land Use Zone: RL
Address: 74-923 HOVELY LANE EAST STE 2-220
City: PALM DESERT, CA., 92260
By: BILL GORDON
Date: 1/29/02
POST IN A CONSPICUOUS PLACE