0103-196 (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
MJ599 'e, 104/30M
Date 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 PACIFIC EM1111iblvio Policy No. MR C43084318
(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,1 shall forthwith comply with those provisions.
Date: Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject all employar to crllninal penalties and civil fines up to $100 n00 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
4 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 iinspec.tiqn purposes.
Signature (Owner/Agent) /` 1,, *!� Date " a- X
BUILDING PERMIT PERMIT#
DATE J� VALUATION LOT 0- 3-196 TRACT
29349-1
JOB SITE"
ADDRESS
1-2W, X-i:�TGar70WRICA '
7457-4"-0,22
[:�:
OWNER
CONTRACTOR / DESIGNER /EN NEER
'Mx LM0"� ..£LS :tAI'O
'I'OUL 13Rf)MERS WC
74.,92? 110V Y1.J F HIUM UTi`iI2-220
741-923 HOVE1'.lyLI :ms's' RTI'1°l12.220
M-14 IDES3dLRT CA 42260
PALM DM"RT CA 92260
6i3�G'��m964 =4 3832
USE OF PERMIT
SN 'GLE :RAWLY DWRT j LTG
SPO -P AN SA24 A ROSA ,LOT 22 - PF;<ZfAIT OQNS NOT 04C,LUDE Br t)CK
1tr£.•DU T..1034 MDR I *ilH).i•1NCY OF SAME PLAN TYPE
(n,
CUSTONI CONSMUCTION 3,741.(OF F M A
R 2 8 2001
P0i3C§ii`PATIO 3?0i,613 Si'
C
TY OF LA QUINTA
FINANCE DEPT
1.5S`1C.+`1 .'VED CO.� O.F
.1104, ,70
PLAN CHECK FM 101-000-439-318 $7)3.70
WMCHA23it;f6.I.IEZ 3.01.000421-000 55100
k" .2C.5'PUCA:, WEV, 101.000-420-000 $179.36
I3I..nJAAUNO FRE 101-000-419-000 t101100
ST.R0Nt"1MUPION M!, =RX911V 101.000-241-000 $31.06
GRADM(l M- X I Q 1 *000--A23-CUi9 WAD
.VfrV Si5.�19"'l1;1Q RYd'kl°a4d 1'P.rS� ®ipniv.vW
,ART IN P011,1C PLACM - RES11I: 701.000-255.000 $276,58
(MTOTP1 CONSIR CUON AND P1 CVt C)r-,,
LMS :i'.rk,-PAMRMS
$0.00
'TOTAL ,FERII'M= DTIE 1ATOW
RECEIPT
DATE�+o
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
I DATE
I INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings ,�_
(o
Underground Ducts
Ducts
Slab Grade
oo-
Return Air
Steel/
Roof Deck
0. K. to Wrap
_
�l�j(b
I !_
Combustion Air
Exhaust Fans
F.A.U.
Compressor
Vents
Grills
Fans & Controls
-�/✓? -d�
Framing TS --gZg, _ _
InsulationI� �d 9 ��
Fireplace P.L.
Fireplace T.O.
Party Wail Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
ld`r n
Final
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 /a3�/
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
_�3 �/
_
Encapsulation
Gas Piping
Gas Test/�i
Appliances
_
Final
COMMENTS:
Final
UU14 Notice (Gas)
ELECTRICAL APPROVALS
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
Utility Notice (Perm)
mmmerg'sons
Rodngine,
Al Miller & Sc►m lic?ofitiP,
6i-760 Summit Dr. Phone: 760/316-121.4
Cathedral city, ca 92'23,1 F -II ! 760/321-7497 —
1
II
Jrtx 'lid'r'3' , l AIV
Y
1['ax.:
777-1.596
I`rom:
Russ Miller
Date:
Ike:
nspection
Pages: 3.
I,
r
Brcttbet-s PGA West
I
Gary / Andy,
We have inspected all the Roofs at PGA West (Vistas and
Reserve), All vents are installed per the O'Hagin
specifications and per your plans
Thank you,
Russ Miller
INSUL
This is to certify that insulation has been ii
regulation, California Administrative Code,
81280 - KIN
)N CERTIFICATE
A in conformance with the current energy
24, State of California, in the building at
I HEATH,`
LOT 22
TYPE: Fiberglass BATTS MANUFACTURER: Owens/Corning
WALLS:
TYPE: Fiberglass Batts MANUFACTURER: Owens/Corning
GENERAL CONTRACTOR: TOLL BROTHERS
THICKNESS: R-30 9 1/2" BLOW
THICKNESS:R-19 6 1/2"
LICENSE:
BY: I TITLE:
f{ r
:SCHMID I N CONTRACTORS, INC. LICENSE #221517 C-2
TITLE: PRODUCTION MANAGER DATE: 9/4/01
INSULATION CERTIFICATE
This is to certify that insulation has been ins' I lied in conformance with the current energy
regulation, California Administrative Code, Title 24, State of California, in the building located at
81280 'KI1{NGSTON HEATH, ..._... ____...
I , LOT 22 /.4- 59"o;4171 -9 -
CEILINGS: 11
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 LICENSE # t
BY: TITLE:
LSCHMID INSU - ONTRA ORS, INC. LICENSE #221517 C-2
TIT E: i PRODUCTION MANAGER DATE: 9/4/01
i
I!
.r woil brothers, Inc.
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 # 2Z
Project: Vist (Tract # 29349-1) -or- Reserve (Tract #29348-2) (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 fiirthe`r information, please let us know.
Sincerely,
Andy Fraser
Project Manager
Toll Brothers @ PGA West
14
Certificate of Occupancy
City of La Quinta
Building and Safety Department OfTM
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:
I BUILDING ADDRESS: 81-,280 KINGSTON HEATH
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0103-196
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
vvvner of Buil1ding: - T0LL SRV i 'no ERS INC
Address: 4-,923 I-IOVELY LANE EAST STE 2-20
City: PALM DESERT, CA., 92260
By: BILL GORDON
Wiz, Date: . 1/23/02
Building Official
POST IN A CONSPICUOUS PLACE
an a