SFD (0311-049)50435 Los Verdes Way
0311-049
LICENSED CONTRACTOR DECLARATION
ter,- I herehy 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
FOX4
Date « Signature of Contractor
,• r1ta. ... p, ..rte .. ...
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.
(q) 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.
•WAMD00471.ss14:i l
(This section need not be completed if the permit valuation is for $100.00 or less).
( ) I certify that in the performance of ihe'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 Via•,
Date:r •= 1- - Applicant—
Warning:
pplicant Warning: Failure to secure Workel 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 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, indemnity
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any perrnit•issoed 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) a _'? r J Dater. u
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
TRACT
JOB SITE
APN
ADDRESS
*XW'VW)XSr WAY k
i% R
OWNER
CONTRACTOR / DESIGNER / EN INEER
TOLL tML{»MRS, Yh1: -
iw'f,
3,121 11W Mr , ';I C4C,41W
73-i21'A ITE `WtsPNC3#1'f)0
PALM VE RT CA 92.360
PAIAIL iDr.IRMA ' (P. 922,60
x'/60)674.96(94 C M1'f 3637
USE OF PERMIT
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°l.'Z7'iAi, I'FRWICIT SrE.'ES ID%IE NOW
$4;114,44
RECEIPT
DATE
BYDAF
E Y 41
11INSP
r
It
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROV S
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVAL
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 AP ROV LS/.)
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
Final 4 41
Utility Notice (Gas) 17
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:
k®3
s CITY'OF-LA QUINTA
cF o BUILDING;& -,SAFETY DEPARTMENT
- `_777-7012'
INSPECTION REQUEST LINE
'77i-415`3
Owner TOLL BROTHERS; lNC.
Contractor. T01,1, $RMERS, INC
Permit Number 0311-049
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 50-435 LOS VERDES WAY
SFD - LOT 103, CAMINA-A. PERMIT DOES NOT
INCLUDE BLOCK WALLS, POOL, SPA OR
DRIVEWAY APPROACH.
TYPE OF INSPECTION DATE INSPP,
TEMPORARY POWER
SETBACKS
U/G PLUMBING /WASTE o
U/G ELECTRICAL/ GROUNDING
FOOTINGS / STEEL
CONCRETE SLAB
DO NOT POUR
ROOF NAIL / PRE-ROO
OKAY TO WRAP
t, JGH ELECTRIC
ROUGH PLUMBING
ROUGH MECHANICA
INSULATION
COVER NO WORK U
INTERIOR
EXTERIOR LATHL.
GAS TEST • g, p
SEPTIC ABANDONMENT
SEWER CONNECTION p27
SEPTIC / GREASE INTERCEPTOR
MASONRY INSPECTIONS
FOOTINGS / STEEL
BOND BEAM
POOL / SPA / WATER FEATURE INSPECTIONS
PRE-GUNITE /SETBACKS
U/G'PLUMBING-
U/G AS
U/G ELECTRICAL
PRE -PLASTER ALARMS / BARRIERS
FINAL INSPECTIONS
TEMP. USE OF PERMANENT POWER
ELECTRICAL �, v
PLUMBING
MF INICAL
vvvrnr\o IJCrMFI I IVICIV I I/
COMMUNITY DEVELOPMENT DEPT. I q 1
FINAL / JOB COMPLETED 1 4fz1,d k1
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
CITY OF LA QUINTA
a BUILDING & SAFETY DEPARTMENT
OF r+ 777-7012
'INSPECTION REQUEST LINE
777-7153
Owner TOLL.BROTHERS, INC.
Contractor TOT;T. R DTHERS, INC.
Permit Number 0311-050
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 50-445 LOS VERDES WAY
SFD - LOT 104, SEDONA-A. PERMIT DOES NOT
INCLUDE BLOCK WALLS, POOL, SPA OR
DRIVEWAY APPROACH.
TYPE OF INSPECTION DATE INSP.
TEMPORARY POWER
U/G PLUMBING /WASTE
U/G ELECTRICAL / GROUNDING
FOOTINGS / STEEL
CONCRETE SLAB
DO NOT POUR CONCRETE
NAIL / PRE -ROOF
FO WRAP
NG (COMBINATION)
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH MECHANICAL
INSULATION
RK UNTI
INTERIOR GYP. BD.
EXTERIOR LATH
SEPTIC ABANDONMENT I` `
SEWER CONNECTION
SEPTIC / GREASE INTERCEPTOR
MASONRY INSPECTIONS
FOOTINGS / STEEL
BOND BEAM
POOL / SPA / WATER FEATURE INSPECTIONS
PRE-GUNITE / SETBACKS
U/G PLUMBING
U/G GAS
U/G ELECTRICAL
PRE -PLASTER ALARMS / BARRIERS
FINAL INSPECTIONS
TEMP. USE OF PERMANENT POWER
ELECTRICAL 7P 22.—E—
P! ING
ML. , ANICAL
PUBLIC WORKS DEPARTMENT �.
COMMUNITY DEVELOPMENT DEPT. o
FINAL / JOB COMPLETED /
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
09/17/2004 00:27 FAX 7149212187 ALLIANCE MECHANICAL 0004
a•
INSTALLATION CERTIFICATE (Page I of 13) CF -6R
)
Site Address Permit Number
An installation certificate is required to be posted at the building site or made available for all appropriate inspections. (The
information provided on this form is required; however, use of Nis forest to provide the information is optional.) Ager
completion of final inspection, a copy must be provided to the building deparanent (upon request) and the building owner at
occupancy, per Section 10-103(b).
QAC SYSTEMS:
Xeeit ing Equipment '
Equip.
Type (pkgl CEC Certified Mfr Name
Fumace
0 o Effeienry, Duct Duct or Hewing Htadag
Idemieal rArl IA ..r.-%, n ��..:� _-_ .
Cooling Equipment
Equip, CEC Ccrdfied Compresaor Y of Efficiency Duet Coolie g
Type (Pkg. Unit Mfr Name and Identical (SEEP, MYLocation Duct Load Coelia
heat bump) Model Number Sv tem. rb "C-tb ,.t :a J.__ - . _L� CLPWly
^ t•., � tv i."
-
A r on , r 2� f 2,
I • >_ tends greoler than or equal to.
1, the undersigned, verity that equipment listed above is: 1) is the actual equipment installed, 2) equivalent to or more
efficient than that specified in the certificate of compliance (Fore CF -1R) submitted for compliance with the Energy
Ericiency Standard* for residential buildings, and 3) equipment that meets or exceeds the appropriate requirements for
manufactured devices (I'rom thKz;P111-71fo41
enncy Regulations or Part 6), where applicable.
ALLIANCE MECHANICAL HVAC
*b&7
, Date stalling Subeonteaetor (Co. Name)
WATER HEATING SYSTEMS: OR General Contractor (Co. Name) OR Owner
,•
r
Distribution If Recir. 0 or Ratedr halt IM. External
Noisier CEC Certified Mfr Type (54 eulation, Idmiul Input (kW Volume eicncY Standby' IasuWion
Type Namc & Modal Number Point -of -t.134) Control Type Systems or BnAr) (galloas) (EF, RE) Lots (Ye) R slue'
2 For small gat storage (rated input of lest than or equal to 73,000 awft), tlttrMc rplstanee and pat pomp watt► beaten. list Energy Fa<tor.
For targe gas storage water heaters (tared input or peaty titan 7i 000 DIVA(). list Recovery Efficiency, Standby Loy and Rated input,
For instautaaeous gas water beaters, list Recovery EfFlOMy ant) Rated Input.
3. R-12 eatemal Insulation b mandatory for sturaee water beaten; with an energy factor of Less than o.so.
Faucets & Shower Heads:
All faucets and showerheads installed arc certified to the Commission, pursuant to Title 24, Patz 6, Section 111.
1, the undersigned, verify that equipment listed above my signature is: 1) the actual equipment installed; 2) equivalent to
or mon efficient than that specified in the ceriif►catc of compliance (Form CF -1R) submitted for compliance with the
Energy Efficiency Stendardr for -residential buildings; and 3) equipment that meets or exceeds the appropriate
requirements for manufactured devices (from the 4ppliance %Meleney Reguladow or Pari 6), where applicable.
Signature, pate Installing Subcontractor (Co. Name) OR
COPY TO: Building Dcpartment General Contractor (Co. Name) OR Owner
HERS Provider (if applicable)
Building Owner at Occupancy
M
Compliance Forms August 2001
A-23
0
- Certificate of Occupancy
G OF Building & Safety Department
This Certificate is issued pursuant to the requirements of Section 109 of the California Building
Code, certifying that, at the time of issuance, this structure was in compliance with the
provisions of the Building Code and the various ordinances of the City regulating building
construction and/or use.
' BUILDING ADDRESS: 50-435 Los Verdes Way
Use classification: Single Family Dwelling Building Permit No.: 0311-049
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: Toll Brothers Inc. Address: 73-121 Fred Waring #100
City, ST, ZIP: Palm Desert, CA 92260
By: Daniel P. Crawford Jr.
Date: " Wate of Final Inspection]"
Building Official
POST IN A CONSPICUOUS PLACE