0209-054 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirmunder 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
.01Date - tom 'rte' Signature of Contractors
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.
�) 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 STATE FUND Policy No. 0004638901.01
(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 thosglp, oyisions.
,Date: //'d C= 1 Applicant—,,2:"
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 fi
;.,, ,whose request and for whose benefit work is performed under or pursuantto'
,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 rjull and void if;;;
work is not commenced within 180 days from date of issuance of such; j
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 informationais
correct. I agree to comply with all City, and State laws relating to the buildin
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes'.
nature (Owner/Agent) Date
k:
F'
BUILDING PERMIT PERMIT#
DATE VALUATION LOTi TRACT`,
JOB SITE
DDR SS ��,0fgtC�+J'I��)�IQTiJry y
APN'�,�iw�i
OWNER
CONTRACTOR /D7EElSIIGN�E�RY/EN 1NEEE�RF
ll1 1T�7pA
A'�6)'+. LA Q'(dASF+A,.t' L1.0 -
tThy
T�u1d. S Vif.C.w�i.i�.diL�, 0S 09G 11,7.:
9"s FITMAT PT.I SME 102
7,801,01, al'al-mm-v] 1
CA. 92131
LA QT1DrfA CA 92253
(766)771 X336:3 QTL# 49.72
USE OF PERMIT
d I M2 F.+ MU.;.%r
V0 -LOT K PLAN JAR— PEJti,A1 T ,CIOES° NCYf YNC.1,0DJ? BLOCK
WALLA, P004 „!PA OR t± R IWAY APP3t.O.sir,`H
r�A%�OC1isTR:1t0`I'Yi,71`� : ��7a,�n 3Fr
.
110ACHIPATIO 576, Go. SPR
(MRAGTJe (,'ARPURT t+ vlo SF
f, £OGT O
-
yT}FyPg'FTWA.`)E'U)
S.t�� dfY. i]�C71i1'96�..i ••
Cc:*3d;9'i'RIXT90N :FEE 101.000.418.000 $961.,10
PLA14 *::I'3ECK :FtE 101 _0i10_4 *_318 $097.78
YJiEC11ANTC, AL FE.2 101-0N)-421-000 T911110
3 LECd`RICAl., VEZ 101 4=420-6100 Ur/.48
PLUM40 FEr, 101 -000.419.000 301-21
3=140 MOTION Ftl l-RHSM 10'!-000-241-t? O Um.*
ORADTHO FEE 101-000-4K4-,000 $M.t10
t L�irrY?f,CJP'f 3 IMPACT ICU $;403.01D
r
�j
SM._ -'f U AL CONSIRU'�C�R� A ll +'4 i APd C'�F�k.►;." TG
S4,6_19.? 4
_
: IMS PR.tY"R:'A9 5) Y=0
$0.00
7'C1 T" )?sSl .11,4' ms I)up, 140'1ev
D IN
i
RECEIPT
DATE tj
BY
DATE FINALED
INSPECTO
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
ZZ,-- / - az,
Return Air
Steel
�>
Combustion Air
Roof Deck
- _��
Exhaust Fans
O.K. to Wrap
- ZAY- L
F.A.U.
Framing
Z
Compressor
Insulation
Fireplace P.L.
_ _
/
Vents
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
- -
Final --__Tb
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
Heater Final
Water Piping
c,
`—�
Plumbing Final
Plumbing Top Out
/�
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
_g�� z
Encapsulation
Gas Piping
Gas Test,
_
Appliances
Final
Final C
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring / _Z
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) YES
COMMENTS:
I
APR -01-2003 1529 WESTERN INSULATION
909 686 8786 P.03i19
ESTE iemo LATION, Le Ps
4211 Latham Street, Riverside, California 92501
Tel. (909) 61{fS-8760 Pstx (909) 686-8786
INSULATION CERTIFICATE
THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE W ITH
THE CURRENT ENERGY REGULATION, CALIFORNIA ADMINISTRATIVE CODE, TITLE 24,
STATE OF CALIFORNIA, IN THE BUILDING LOCATED AT:
TRACT/PHASE: TALANTE / PHASE 4
LOT #: 64
SITE ADDRESS: 49-812 RANCHO SAN FRANCISQUITO - LA QUINTA, CA,
EXTERIOR WALM EA77S .
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 1/2" R- VALUE: R-15
.Q%,I 9s:: .'AA 77S
MANUFACTURER: JOHNS MANVILLE THICKNESS: 13" R- VALUE: R-38
G �1 AL C - ANSll EST HOUSING
TITLE:
DATE: 11111--41—
INSULA ION G
LICENSE NUI ig
BY: '
TITLE: PRODUCTI(
DATE: APRJL 1, 2
i WESTERN INSULATION, L.P.
04/28/03 08:03 FAX 7148211831 Alliance
HVAC INSTALLATION CERTIFICATE'cr Tested Ouct Leakage & TXV Pace t cr_ CF -En
SiteAdcress: CAb 54m FRAMC1S90TO
Trac: Number:; 89(A+
Lot Number. tp
All installation "P. tom ra-wrea lc be pcs:e^ at ;-.::unci:;; site v race avahme to ail ecpropnste ,nsoeM cr:.
Ager =mp!etion of anal tntipe=Ori, a copy MU!'. U : -ocee at the Eatdtna Cepar,r,:ent (uaon request) anc ire
owner at occim ncy, per Section 10-103(0).
HVAC SYSTEMS:
Heating Equipment
Equip. CFC Cer'tifed Mir Name
Type and Model Name
# of Efficiencl Duct Heating Fardna
Identice WUE, etc.) Location Du= Load Capat"y
System's (: CF•1 R1 (attle. etc.) Revalue (BTU I H.1 (:iU r Mr)
I I I I
I F0• 70 I Zrrj4 II ^ I
I I I I
I I I I t i
Cooling Equipment
Equip. CE'C Certified Mir Name
Type and Model Number
M EMdency DuC, Caolinc :.Cliq
Icen'te (Eic-q, etc.) Location Duo: Load Ca2seN
sys'er..s (:=CF•1R) (attic, etc.) R -value (5TUIHrt 1-`iJIYr;
I t I I I i
I I 7—P 1 1 14.9 odel
I t f v^ I & I �
I, Me urtlemigneo. vanry tnn OCuwprnant osis_ :cove s: 1) is me ac:u'ol eaulpment !nvatle^_. z; equwa!ent to or rc-e
efficient than that specifIe: in the certificate of wsc„arce (Fvrrn CF -,R) submitie0 for t c^lpliance with t^e E^.ercv
E,ficen. f Stara ams for residanua( builcings, act: "i c--�!-Me7a thal me:!5 or exceeds the accrepriate re^_uirerner2 `::
,--;nW1- ell cvs (fr0.'n t'0 A:Gii:ncv E°5::enCr ;M---jz,-'cns Or Pi,-, ia, where a:a!licazle.
ALLIANCE ME014ANICAL WAC
Dais mfi:,:mng �! contractor I e. ams
CR Gene of Contractor (Ca. Name) OR Cwner
MINIMUM, RE-:1.11REMENTS FOR CI:C' :_=:KALE CCIMPLIANCE CREDIT
Duc: Dia_ncvic Le2kace Testing Re:_:`.s .YE:drri - E=:- Duc* Leekzce
scam, of
incicste :; I! max:, -um ai!owecle Duc: Leaka,e
1 1 0.7 x -,ccr =rea x (0.05) far Ciirra:e Zcre
C.5 x F:Ccr;.rea x (0.055) for C;irm:e Z:res ' .- 7 e tE I
-C^ x (CcC.:ng Ca;sc: y in Ncmmai Tcrs:
2'.7 x (F eaarp ca.acry in Thousancs .' ._ °-J ee•hour : fo C; -;.l
ICS'9r �
C. pre.a::r--;;c. Test Fesuits (CRA g ZE
.CC x Tes: Leaxa;e I Fan =1cw = % Leaxa;e i
Check 5cx fer Pass or Fail (Pass _ 5% or Le.: Part 7 ram
Z- Comcaa nce Credit was Taker, far :,t'.; f,'+` Nas irs:a leo !
ir'dic m j�'T Of
Irdlc3!e the ax:mum a cwaole Ouc: Leak:yE 6': ;.'i UW:
(—, 0.7 x Fincr Area x (O.Qtii for Climate L^re
C.E x F:oo', .res x (O.Ca) for Climate Z: -es ,. .._- i ii ix lI
12' i x (Fie--:rc Cacec:ty it Tncusar,C1 : -
n - _ '! :': is:• x C :?i I
ICI _ I
uc': P-ess -�a::,^ Tast P.esuIts (CTM ` Zt -
*C'x lee: Leax;_e - Fan r:oN = ��o Leaha=9
C'e� -'-.x-'-.x 'v Co- :; Fa' (P3S3 m 7�5 C' L_c3 Fas VI r2.I
---z* Cre_ , nae T 5,.sn'L te_ . _._ e� 1 i
1004