SFD (0306-078)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
1,J111 699 F, -4/3COM
Date Signature of Contractor—
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 & __ppo�li�cy no. are:
Carrier LiBSIRTY M11Tlt.rt►L I�: Policy No. VAMIDD0472' 4012TL
(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.
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 r
& hold harmless the City of La Quinta, its officers, agents and employees. L
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.
_ I Signature (Owner/Agent)
Date
BUILDING PERMIT PERMIT
DATE VALUATION 1310,-+ o. LOT TRACT 2*1* 'e_.
JOB SITE
ADDRESS
APN-0-Qq
OWNER
CONTRACTOR / DESIGNER / ENGINEER
TOLL BRMUMS NC
'D ': ,L BRCPT14FR9 IANC
7'3.1121 FRED ''Nt1"1�d 11.40 100
71; ! 21 F12M W ARIN>` 4100
PAI" DFURT CA 922A0
PAli. M DEMTt CA 921&-,
,,kl)614-9f,9 i MAI 3432
USE OF PERMIT
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NFU • L4,J / A� J ,l, hVL!!:•.3f5. PI -Mal / 0VZ3 M0 i : f -R .. v 'r,
WA.UA .POC?LG SP.A O I;'ItlVl W.kY A#'PROACH, —ii �,1'i.rDUCTIOW TO PL.AW
CiiF,f`,K Fft I)UX pIt. t U1'vI,T1PtA W UA.H C Z OF RAM E. ?.h.N 'S' PfC
ODSTOU `(.)HJ*fRt C1Ti0N 3,,14C'--) OF
ACI k.,N131'0RT
Ir STI'P7.A1[S.i!'1..4fXYO
iV
FERMYr WE 8TJ.k1AM.41RY
CONSTRUCTION r+IM 1 (11.OM)-4'.• $'--M) $11IM100
PLALA CHICK Mr4 1014100439-313 llrn.x
IriW-114 LAICAL IEEE: 101-(M-4Zl � W"
W..CTRXAL F91. 101-00"20••f!i>•''> 241.t►If
PLUMBIWO Mit 101-000-419-000 31A1;.t�A
S"TRc 140 MOTION Vii' 101-M)-24 i -W.) $31.06
G A.I D10 MF 101 -K* -423.00f* $1511110
DYV'1lr.WPKF? IMP.1kc, PrE $1,,405.00 .
ART IN PUBLIC P,La+-M - i*:. 8111 0-000.445-010:1
STJB-'(XGAL CONTMUG'`21t' 9 AWi <.+.ANC�.CK
'Ni
LF t" PRE -PATI FFM
{:t..')n
JUN 18 2003
CITY OF LA QUINTA /
FINANCE DEPT.. ✓
RECEIPT
DATE
BY +
DATE F� D�
INSP TQR
//
GIV��
/ J,
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
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
Z d
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
POOLS - SPAS
BLOCKWAL
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 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
I
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)
U4/2b/ 2004 10:26 9096868786
WESTERN INSULATION -
WESTERN INSULATION, L. Pe
4211 Latham Street, Rivcrsidc. ChWornia 92501
Tel. (909) 686-8760 Fax (909) 686-8786
CFbR. INSULATION- CERTIFICATE
PAGE 05/07
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. MUIRFIELD @ PGA WEST 1 PHASE 1
LOT#: 8
SITE ADDRESS: 81-205 MUIRFIELD VILLAGE, LA QUINTA, CA
---------- -------------------------------------------------------
CEILINGS-
BATT
MANUFACTURER: JOHNS MANVILLE
THICKNESS: 11" R- VALUE: R-30
EXTERIOR WALLS:
BATTS
MANUFACTURER: JOHNS MANVILLE
THICKNESS: 6 3/4" R- VALUE: R-19
GABLE ENDS 4 -PLUMBING BAYS
BATTS
MANUFACTURER: JOHNS MA°NVILLE
THICKNESS: 3112" R- VALUE: R-11
GENERAL CONTRACTOR: TOLL BROTHERS
BY:
TITLE:
DATE:
LICENSE N
BY:
TITLE: PRO
DATE: APR!
1)
0
WESTERN INSULATION, L.P.