SFD (0311-045)50440 Los Verdes Way
0311-045
LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
c11IH Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
LLU Professionals Code, and my License is in full force and effect.
O =) M k: Anse # Lic. Class Exp. Date
r-- CY LO
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It 0- 7`77( 'n' F 4801 4
oZ Date 1 Signature of Contractor
ZO 0 j
p OWNER -BUILDER DECLARATION
J
W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ U) License Law for the following reason:
Z ( ) 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
LO
N Date Signature of Owner
0 N
Q)
CJ Q 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
01
permit is issued. My workers' compensation insurance carrier & policy no.' are:
Carrier Policy No.
141iHM711' M MUM, Ir
'ar'.t1 E2T 0+ li,C3i 1'FTt
(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 provisions. +•,
Date: I / Applicant y
* %'Warning: Failure to secure Workers Compensation coverage is unlawful and
shall subject an employer to crlmi'nal 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.
C
Signature (Owner/Agent)
Date
N
BUILDING PERMIT PERMIT#
DATE VALUATION LOT a.tj TRACT
JOB SITE
APN
ADpRF$$
50-446 LGN WI-WES WAY
OWNER
CONTRACTOR / DESIGNER / ENGINEER
tiJ.:ZWIt3 V'
VX 1.5ts'P.4i 1.':'
21 Flu -!n wig' -x, !4100
'PYl. ) 21 F -IR m) WIC ?J1,16 01 oC)
kis i..' "DESW'.I R -T CA 922160
P.6,114 MMT CA 922,50
(7 iUfril v Ci I 3 2
USE OF PERMIT
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ZINC"., Y Ye, N i'.7 Z M(!
WD . ;J,)T 99, PERMIT SLOCr, .
WALL8, F0014 ' ls: i >' .l.dRi;' ?'e4,Y A PPROACH 15% Rit'DUt:'E ION M PLAW
QHRCK 1FMVAUE TO , ,!Ua'd. TIPLUY I53fY.WNCE OF SAME P&AW
CUSTOM -', ,;9i$°ftU1!TI<aJ l 2,'516 '1i Q
u—i d'
N C .-
M.60 SF
P 0 RC WOR N,
r 4AR &GY .` ; 'V OU 1' 4145.110 y1:'
R1101"W"r Y1* WWII AIN
CONMUKMON FIR, 3 (111 -000-41 N-000 slfom,30
PLAN CHECK Rrl W1-000-439-319 -211 i4
'R EC 4AI41K.AL FE9 101.000-121-W) $124,50
lylCTRIC1.1, F'faZ101-i1W11 S 20_000
'LUMElINO RM Q1 -ON-419-000 1;t94Z
STRON13MOTIOX !tlMD Iv'J_iLloo-w4¢-000 $22.99
{1ktlI,'13W FER 101.001-6,2".'-900 VAN
ART N PUBLIC PLA`U", #tk',F'IL 270-000-445-000
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TOW.., '.'R.VUT IFUN DUX X`i'r3`W
$4:d '1ta,44
RECEIPT
DATE
BY
DAT I LED'
INSP TppR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
nderground Ducts
Forms & Footings A
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck y
Exhaust Fans
O.K. to Wrap
.A.U.
Framing iy4ely_
ressor
Vents
Insulation
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final v"
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APP OV I
Gas Test
lectric Final
Waste Lines
eater Final
Water Piping
0Plumbing 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:
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)
LT/60 39dd
WESTERN INSULATION, L.P.
42111 atham Srreet, Riverside, California 92501
Tel. (9511 686-8750 Fax (951).686-8786
CF6R 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:
TRACT/PHASE: MOUNTAIN VIEW CC.- VILLAS / PHASE 6
LOT 98
SITE ADDRESS: 50-440 LOS VERDES WAY - LA QUINTA, CA
------------------------------------------------------------------
CEILINGS: BATTS
MANUFACTURER: JOHNS MANVILLE THICKNESS: 11° R- VALUE: R-30
EXTERIOR WALLS • BATTS
MANUFACTURER: • JOHNS MANVILLE THICKNESS: 6%0 R- VALUE: R-19
PLUMBING BAYS: BATTS
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 112" R- VALUE: R-11
GENERAL CONTRACTOR: TOLL BROTHERS, INC.
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, L.P.
BY:
TITLE: PR I 1
DATE: SERTEMBER 3,
NOI1tiinSNI N831S3M
98LB989T96 LE:EZ b00Z/L0/60 -