0009-101 (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
777699 13 04/30/21
Date. Z741_'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.
4) .have and will maintain workers' compensation insurance, as required by
Sedtion 3700 of the Labor Code, for the performance of the work for which this
permit iso issued. My workers' compensation insurance carrier & policy no. are:
Carrier PACIFIC EMPLO. E: Policy No. WLR C4308431_$
(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 pro luo signs., y
Date: ✓ae ,<r: Applicant -,w ��sI1 a ,r . a..
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 personlat
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 inspectioiWurposes.
Signature (Owner/Agent) Date'
BUILDING PERMIT PERMIT#
'�{10�.�'�6�� �
DAT VALUATION LOT TRACT
�4b;714.1(1 29349.1
JOB SITE.. '
APN
ADDRESS ,�CT.�IG�TQw7, Zt
715749" 21
OWNER
CONTRACTOR / DESIGNER / EN (NEER
TOLL BROi'tll: S We
TOLL RRIOTBIMS b1c
74-923 I-1.0VF-LY LA1 E 9WT =L2-220
74.923 110'UELY LANE EAST SLT112-220
PALM DRMT CA 92266
PALM DESERT CA 9.260
0760)674.9699 CBLO 3832
USE OF PERMIT
SMOIX, FAME.C.X.W&L-U140
SPD- P1.Atd:b."'Fld` V4A LOT:21-PlrRMIT DOES MOT INCLUDY I;LOCICWAL,I.;W
POWDRf VKWAY APPROA .0H
CUSTOM CONSTRUCTION 4,03700 SF
Pd%CHIPATIO P4,00 .file
01AIRAGWA12PO.RT (Si) 13,8'3'7.60
ES1 MIA ZI) COST OF CC,1X9MU(7r10Z4
W,714.10
CONSTliiUG"'I'tON VY -E 101v,000.418"0630 $1,469,00
PLAN CHECK i< " 101»0001 4393 316 i,166.b2 .
Iv1WHANICALW!Z 101.000.421.000 $92.00
8L7IC: PJC.ALFEE- 101*000-420-006 $209,62
PLUMBINO "IF 101.000.419.000 5162.10
'S"VZ NG MOTION FEE • R.I ID 101.040.241.000 X33.157
01 INO 101-6300.423.000 E20,09
IDWELOPER IMPACT 1E1r S1,9a7.4d
ART 11.1 P(MUCC1 ALACLS. - FLUIL 101.000455400 $341,W
SUB -?`di. AL. CC91`3MRUC:`IION AND P1.;74N' 0JM+C.K
$5,400.70
LY.p13 PRE -PAID MW
$0.00
�'Q
PA ID '. IAL -PMG'r "XES "XSDUE nOW
",4((70
OCT o3 2000
" LA
�RECEIPT
DATE' ye;
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
r Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck 6
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
Vents
Insulation 9A6
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath 5 /
D ll - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVA S
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
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 117<1JI
014-1
Appliances
0014YFinal
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) ZEE
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
r-81:300 KINGSTON HEATH, PALM DESERT
_---- ---- - LOT 21
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 LICENSE:
BY: TITLE:
SCHMID INSULATION CONTRACTORS, INC. LICENSE #221517 C-2
TITLE: PRODUCTION MANAGER DATE: 9/4/01
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
81-300 KINGSTON HEATH, PALM DESERT
LOT 21
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 LICENSE #
BY: TITLE:
, INC. LICENSE #221517 C-2
:. PRODUCTION MANAGER DATE: 9/4/01
.. _:.. ,.l.::YY.✓/Y� �w�x.�r-"J.:Tr r,�r irn�i.•r<.;'.: :. .... .1��.... ...Z:^. ,.. _.l.
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:
BUILDING ADDRESS: 81-300 KINGSTON HEATH
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of Construction
Owner of Building: TOLL BROTHERS INC
Ale -
Building Official
VN
Bldg. Permit No.: 0009-101
Land Use Zone: RL
Address: 74-923 HOVELY LANE EAST STE 2-220
City: PALM DESERT, CA., 92260
By: DANIEL P. CRAWFORD JR.
Date: 9/11 /01
POST IN A CONSPICUOUS PLACE
4 '
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