0006-155 (SFD)�• LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
c%I W CK. Professionals Code, and my License is in full force and effect.
M License # Lic. Class Exp. Date
W LO 777099 I'1 0413012(
r,Lo Z r- Date '4�� Signature of Contractor --
co O -
r` F- o 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).
( ) 1, 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.
((,r/ I• -17a a 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 f. ENERA b ACCI1.I-NI Policy No. ` 010461102-07
(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 Sectio 3700 of the Labor
Code, I shall Orth '6h comply with hose WS119 S.
Date: _3 pplicant_�
Warnin ::Fail re to secure Workers' Compensation coverage is unlawful and
shall subjecfan 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 atto'rney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
fora 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 inspection purpose
ate
Sinnntura (Ownar/AnentlgDate
BUILDING PERMIT PERMIT
,.g 55
DAT LOT •I& TRACT 29349-1
e� .�,�n'6CVTALUATIIO�Nivy yY�y+f420
JOB 61YEADDRESS `0�.Rh�,•1 ffQu"If 3«A i
APN'
l0_ols,
OWNER
CONTRACTOR/DESIGNER/EN (NEER
TOLD, BROTEMPS INC
'.j OLL BR(YYrHEER►i INC
14.9231ROVM.Y'J,J EEASTEUGF2.220
74.92:1IIOVE;i.YLA'NEEAST 31HI.'I2-220
F'Ai ; TSE E1(�T CA 92260
PALM T3ESFRT CA 92260
(760)674.9699 CI L# 3932
USE OF PERMIT
OLE FA1uILY TW& -WO
SILO PLA.N:MMD0C1#40 LDTAS PIERMIT OO.F.S NOT INCJUDX BLOCK
WAU.J OR POOL
CUSTOM COYIST'RUCTIO14 x,630.00 SP
PORCHIP.ATIO 3$8.00 SF
GARA.GMAaRPORT (:1I) 14,750.$0
ESTI V AMED COSI' OF S `OxNSTRUC110K
306,91.¢4,20
CONOTRUCTION FRED 101.000-118000 $J,364,00
PLAN CHECK FEE 101-000.429.318 St'"d .96
W;:I1.1i1•IICAL FEP, „ 101.000-921.000 $98,50
EIA?C.T12JCAL IBI: 101-000.420-0C?(? $176.31
PLU@►7H11`10 FEE 101.000.419.000 5160100
STRONOMOTI01iFEE -R.FS,ID 101,000-241.000 $50.69
4I1MING .k'&B 101.000*423-000 $20.60
DMLOPLM. IMPACT IEEE
ART 1114 PUBLIC PLACES - RI::SM 701-000.255.000 $267,20
FEE DEPOSIT 101-000-439-318 ."0.00
SUFI-TarAL 0.0-14 Tf UC LM AND 1PLAX MEM_ '
$5,107.15
��'ss R,"4I'AJ..OTrF�'?:�
• 750,00
Z OfALL I'E1rdME MIMS ME, .NOW
","7,75
41
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
4
Underground Ducts
Forms & Footings
Ducts
Slab Grade
_
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
_ iy�
Compressor
Insulation
Z
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
S p/
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
Appliances
Final
COMMENTS -
f' , . _cmc alo,
Final
Utility Notice
4e—
� f�
(Gas)
W44
ELECTRICAL APPROVALS
NJn
1
Temp. Power Pole
Underground Conduit
nst
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 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: 81-360 KINGSTON HEATH
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of Construction:
Owner of Building: TOLL BROTHERS INC
Building Official
Bldg. Permit No.: 0006-155
VN Land Use Zone: RL
Address:
74-923 HOVELY LANE ESTE 2-220
City:
PALM DESERT, CA., 92260
By:
DANIEL P. CRAWFORD JR.
Date:
9/25/01
POST IN A CONSPICUOUS PLACE