0006-153 (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 R 04/:3012(
Date a Signature of Contractor f ' • .r .. .�. r /`
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.
ave and will maintain workers' compensation insurance, as required by
eotion 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 C3}7'NERALACC;iDW Policy No. WC045i102-017
(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 shallfirth fth comply with those,!rovisipnsr
Date: Applicant r� -�-
Warning.. Fail re to secure Workers' Compensation coverage is unlawful and
shall subjedan-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 authorize representatives of this City to enter upon .
the above-mentioned property for inspection purposes.
Signature (Owner/Agent)'/ • Date 7 {
PERMIT #
p,-,! . BUILDING PERMIT
440.
DATE VALUATION C31(),W.70 LOT " 16 TRACT 29349-1
JOB ADDRESS
APN -767-490-016
767-490-016
OWNER "".
CONTRACTOR / DESIGNER / EN (NEER
TOLL 1PIROMERS Tt+l'C
TOLL BRMHERS WC
74.933 TIM LAM EAS.!"S't 02.220
74.923 HOVELY 1W?_►': EAST MITI -2-220
PAUA DESERT CA 92260
PALM D .,RT CA 92250
(760)674.9699 CBLO 3532
„4a
USE OF PERMIT
SINGLt PAiW1,,Y DiN UN G
51PTa PL AX.&AN T.A. ROMA LOT:16 PERMIT DOES'NO'f' INCLURE BLOCK
WALLS OR POOL,
CUSTOM CONSTRK TION 3,741,00 311'
POR Idi15 T10 321.00 SF
0ARAC3I3K`ARPORT (SF) 14,817.60
199MA' PID COSI' OF COI�T�►'T' UC'1TG1N
37.0,x.70
I' ERMYr I NE SUMUR'Y
C014STRUCTION FEE 101>000.416.000 $1,37 oo
PLAN C:13FECK FU 101-000-439•3I'E $1,09411
MECHKOIC'AL M. 101-000.421-000 sfts0
L"! ECTRICALES ;01-000-4ZQ OOC
l,'1:LIMOM FER 1031-000.419.000 $160,00
�
STRO140 MOTION FEA - I EWD 101-000-241-000 $31.06
�
ORADING M, 101-000-423-000 $20.01
D-EVLLOPER IMPACT ME $499.00
AR! M P-PBLIC € LAC:ES - MK 701-000x255.000 $16.38
SSUR-TOTAL COMYRTICTIONAM PLM CITCK
S5,145,20
ImS M -P W Pte.`$
$0.00
'TOTAL .! RAfff YUS DIVE i4Ciw
. 0.145,29
RECEIPT
DATE
BY 1
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings 34W
Ducts
Slab Grade
Return Air
Steel
Combustion Air
_
Roof DeckAz
Exhaust Fans
O.K to Wrap t
F.A.U.
Framing
Insulation ��
Compressor
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath Q� 4
Driwall - Int_Lat
Final
Final
BLOCKWALL APPROVALS
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
Gas Test
Electric Final
Waste Lines i �T_ _
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Lateral
Pool Cover
Sewe onnection
Encapsulation
Gas Piping
Gas Test _ jf
Appliances
'
Final
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)
COMMENTS:
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:
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of Construction: VN
i
Owner of Building: TOLL BROTHERS INC.
81-365 KINGSTON HEATH
Bldg. Permit No.: 0006-153
Land Use Zone: RL
Address: 74-923 HOVELY LANE EAST
City: PALM DESERT, CA., 92260
1
d• - By: RICHARD K. KIRKLAND
Building Official
Date: 7/6/01
POST IN A CONSPICUOUS PLACE