SFD (0311-050)50445 Los Verdes Way
0311-050
LICENSED CONTRACTOR DECLARATION
-t" 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
WPq)fessionals Code, and my License is in full force and effect.
O :) M License # Lic. Class Exp. Date
r- d LO
' W
6 Z r.- Date 10-:4 Signature of Contractor
co 2
CID OWNER -BUILDER DECLARATION
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).
C0() I am exempt under Section B&P:C. for this reason
N Date Signature of Owner
ON
rn
d Q WORKER'S COMPENSATION DECLARATION
p IX I hereby affirm under penalty of perjury one of the following declarations:
Lo O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W compensation, as provided for by Section 3700 of the Labor Code, for the
mJ Q performance of the work for which this permit is issued. ..
Q O 'V) I have and will maintain workers' compensation insurance, as required by
OLO Q Section 3700 of the Labor Code, for the performance of the work for which this
Il 0)H permit is issued. My workers' compensation insurance carrier & policy no. are:
It Z Carver Policy No.
°I.° ) E tIsTiT` 1J'I`).1H i,31': WA2s4MON72:30IriI
J (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 thecworkers' compensation provisions -of Section 3700 of the Labor
Code, I shall forthwith comply'with those -pro4isi'ons.--^:;``-"
Date: k I : 1 A Applicant J ' : i • V11,
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 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 : ` r ' J +. t '' Date Ilvloq
BUILDING PERMIT PERMIT#
DATE VALUATION LOTTRACT
JOB SITE
APN
ADDRESS
y
OWNER
CONTRACTOR/ DESIGNER/ EN (NEER
MD., "BRUaffiR,24 114C
?"R01W N1.9 WC
73-1,27
RP111),T>'%1 . NYG- f) 00
Pis'`.,M CA 92260
T'.aSvt DEMO, CA 922,60
'6(r;" 14-9699 0-111# 9142
USE OF PERMIT
XWO—T.id.'i , lii;ir s Sin . t. [.,N. 04
SM . Lr)'.? PERMIT T.*Vl 12CXf MIC,K U DLv SLOCK
WAl,)1,:,, za001,-y:A...OR DR1YFWPYAd'I'ROACH, 73%?,sDUC IoN TO
PLA4 1CH2r= PE10 DMZ► O h1lUV4' P:L?.153VA1iC1F.O
4,'V MM COMTRUCTION 2,800.00 SF
JAN 06 2004 v.
10£.11>C A41A,110 X•i5 01) SIS
OARACI N,,ARPOW,r 610,04 S117 C
1TY 0-- I.R QU)Y'erA
Ft:L DEPT.
R51MIM-Al
iron" rf li'rE KO 'k
CCM -1,. UC11l10N, i^T z 101 r OS?<? -gid 1 i' -ml O1,10"a,a0 .
PLfM, C:kMOIX Yi3.);• 101-000,439-3113 VV.60
k: PZCFAWI OAL FR M 101-000-421-000 S101.50
ry, y n A{r
ir,L.8C?RJG.A!,
I Ul1Rq ik3v 3'FF; X111 t0 0.419 UOCf Si8/i,K •
STC201M iVI O 10,1 ?'SF ^ RESI a 101 -OLID -241-000 $23.37
!1RA[) RCi HER 101,000.423 -OW 30.00
.
93' VKd.O.Pi `T .li1F? ' e; d tr,'? ? d9°i.fii►
"TIN PPV' I T1 '11,t',C S - ;kE 31r 770-000-1t,43-000 384.,X1 '
:i3?. r r f,CJ `C1k3 T ` rTr' !s'?lti d1231"r a; Ratl Cll t:Z
$4,324.90
LEM PRE -RAID IW13
$0.00
TOTAL FIR "WIT 71MIS DUENOW
S4,32490
RECEIPT
DATE
BY
DATE F A E
INSPE
R
d
r , , ,
ki
INSPECTION RECOR j
- OPERATION
DATE
INSPECTOR
OPE TION
DATE
INSPECTOR
BUILDING
APPROV LS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
—m
F.A.U.
Framing
:—Compressor
Insulation
Vents
Fireplace P.L.
fills
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 APPROVA
Gas Test
Electric Final
Waste Lines
i
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
17
Pool Cover
Sewer Connection
Gas Piping
I
Encapsulation
Gas Test
Appliances
_
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring 10
Fixtures.
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) p
COMMENTS:
-
I mo'
Contractor jai I $jR-(-)TFfF,Rsl 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 I DATE I INSP.
TEMPORARY POWER
SETBACKS
U/G PLUMBING / WASTE o
U/G ELECTRICAL/ GROUNDING
FOOTINGS / STEEL
CONCRETE SLAB
DO NOT POUR CONCRETE
ROOF NAIL / PRE -ROOF
OKAY TO WRAP
F -Ft -G COMBINATION
'
TGH ELECTRIC
ROUGH PLUMBING I
ROUGH MECHANICAL
INSULATION W
COVER NO WORK UN B E WHED
INTERIOR GYP. BD. DRYWALL
EXTERIOR LATH
GAS TEST j', •p
SEPTIC ABANDONMENT
SEWER CONNECTION p
SEPTIC / GREASE INTERCEPTOR
MASONRY INSPECTIONS
FOOTINGS /STEEL
BOND BEAM
POOL / SPA / WATER FEATURE INSPECTIONS
PRE-GUNITE / SETBACKS
U/G PLUMBING
U/G dAS
U/G ELECTRICAL
PRE -PLASTER ALARMS / BARRIERS
FINAL INSPECTIONS
TEMP. USE OF PERMANENT POWER
ELECTRICAL I a, 'L, 2,i v -AT
PLUMBING
MF NICAL
PU,-.,, WORKS DEPARTMENT Z j
COMMUNITY DEVELOPMENT DEP 01 195Ew
FINAL / JOB COMPLETED l" / -"
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
o a
- CITY OF LA QUINTA
t opo`` BUILDING & SAFETY DEPARTMENT
r
777-7012
'INSPECTION REQUEST LINE
777-7153
Owner TOLL.BROTHERS, INC.
Contractor TC)T,T, RROTTIERS, 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 I DATE I INSP.
TEMPORARY POWER
SETBACKS
U/G PLUMBING /WASTE
U/G ELECTRICAL/ GROUNDING
FOOTINGS / STEEL
CONCRETE SLAB
DO NOT POUR CONCRETE
ROOF NAIL / PRE -ROOF
0' lTO WRAP
FA`, -4(ING (COMBINATION
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH MECHANICAL go - _Ili i
INSULATION
COVER NO WORK UN
INTERIOR GYP. BD. (DRYWALL)
EXTERIOR LATH
SEPTIC ABANDONMENT` `
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
P/. ING
M'L- -AANICAL
PUBLIC WORKS DEPARTMENT Z .
COMMUNITY DEVELOPMENT DEPT.
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 la 005
INSTALLATION CERTIFICATE age I of 13) CF -6R
L ► o D- L I/cf s °t 2 -6
Site Address Permit Number
An installation certificate is required to be posted at the building site or made available for all appropriate inspections.(ihe
rm
information provided on this form is required; however, use of this form to provide the infoadon is optional.) After
completion of final inspection, a copy Dual be provided to the building department (upon request) and the building owner at
occupancy, per Section 10-103(b).
1TVAC SYSTEMS:
hleadng Equipment
TYEq (Pk& CEC CenlBed Mfr Name o Ef5cieaey't Duct Dues or Heating Hadag
{AFUE, ate.) Loc"oa Piping load capacity
a A Output
Furnace p p Attic —
Cooling Equipment
Equip, XEC Ctatifted Compressor so( emcfency
TYK (134 Unit Mfr Name and Identical (SEER, etc )' Lautioa Duct LoaCooling Cooling
heat oumnl Model M-6— 4.,.,...,. .--_ --- . - - Capacity
Air on . ZZ .
greater than or equal to.
I, the undersigned, verify that equipment listed above is: 1) is the actual equipment installed, 2) equivalent to or more
efficient than that specified in the eeltiftcatc of compliance (Form CF -IR) submitted for compliance with the Energy
Efficiency Standards for residential buildings, and 3) equipment that meets or exceeds the appropriate requirements for
manufactured devir ( m the Appliance Efficiency Regulations or Pan 6), Where applicable.
A10148 j )a &'pi I1 ALLIANCE MECHANICAL HVAC
Signature, Date `' Installing Subcontractor (Co. Name)
WATER HEATING SYSTEMS• OR General Contractor (Co. Name) OR Owner
01Wbudon If Reetr• 0 of Rated' Tank Etfi• External
Heater CEC Certified Mfr Type (Std, eukdon, Wcatial Input (kW Volume cieac? StWdW lawlauon
Typc Nurse a Model Number Point-of-Usel Control Type System or aturArl (gallons) (EF RE) Lou (X) R valuer
2 For small gas storage (rated input of less tW or equal to 71,000 04ft), electric resistance and beat pump Witter beaten, list Enaly Factor.
For tmrgc
For twmogtaseouaas ra waterheaters(rated Input of greats that 75,000 8 Whr), list Rccovary Efficiency, Standby Lou and Rated Input,
g erbeaten, list Recovery Efficiency and Rued Input.
3. R-12 euerrgl insulation is mandatory for storage Crater halm with an eDWV factor of less than O.5l,
Fauttts & Shower Heads:
All faucets and showerheads installed am certified to the Commission, pursuant to Title 24, Par 6, Section 111.
I, the undersigned, verify that equipment listed above my signature is: 1) the actual equipment installed; 2) equivalent to
or more efficient than that specified in the certificate of compliance (1 OM CF -IR) submitted for compliance with the
Energy Effclency Standards for residential buildings; and 3) equipment that meets or exceeds the appropriate
requirements for manufactured devices (from the Appliance efficiency Regulatioar or Pan 6), where applicable,
Signature, Date
COPY TO: Building Department
HERS Provider (if applicable)
Building Owner at Occupancy
Installing Subconuactor (Co. Name) OR
General Contactor (Co. Name) OR Owner
Compliance Forms August 200)
A-23
Certificate of Occupancy
T?- i tf 4
`,(INaoronhn
✓ roar
G OF'r1Building & 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: 50-445 Los Verdes Way
Use classification: Single Family Dwelling Building Permit No.: 0311-050
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.
_tea'
Date: "[Date of Final Inspectionl"
Building Official
POST IN A CONSPICUOUS PLACE