0208-233 (SFD)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 .�,• led o ,
License # Lic. Class Exp. tlate
78:2550 D fit;:
Date -1�`y Signature of Contractor's-^
� J
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
per 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 OTATE BUND Policy No. 1614122.01
(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 fgrthwith comply with those,prrovigions.
Date: �" 2 -! ;+''r Applicant`14
r�.
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.
r,
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.
�r Signature (Owner/Agent) ry� r"'�`f� Date's
BUILDING PERMIT PERMIT#
t9-2.13
DATE tr VALUATION LOT 4 TRACT
I V - Ira 4JOB SITE
ADDRESS �tit
NF APN
OWNER �? S i• CONTRACTOR / DESIGNER / EN (NEER
2.9395 R,KGk'ARA ROAD #10 9 cA05 .A'CrOURAROAD #204
JAGOURAHVIA Ch 91301 AGOT-W, MUS CA, 913 M
(818;8794800 CSTA 2811
USE OF PERMIT
b 1 l MYS
SUPPLEMMI'1 M, TO P;t;.RMIT 0101.1.1i
k1U1y:.1 INO PERMIT
Wr?,
1811'titlsAUD cost col COMMUCHO i 0XV
CONSTRUCTION M 101-000,478-000
1!r1kCI ANICALVER 101_000-421-000 1i&5.50
:E1LFW a.9C.J1L PEE 1, 01 5111.06
?'l:aii�11 �11�i 0 T'?S:E 1 i1,1 �(S'1C3i9�11; �•iiQR3 $ B. Sid. SC
TA - AT, QQNSTRUCITI0a'N WO PLM (1422= $1,228.56
n AA n n LE2118 11RE-PA1D 1"'E $0.00
DEC 13 2002 �' XIERN ��� TEE'S DUE 4OW �3,
CITY OF LA QUINTA
RECEIPT DATEt
. �g 6 J I BY `�D �E�I� L63 INS E R
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
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 APPROVALS.
POOLS -SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Neater 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
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)
COMMENTS:
WESTERN INSULATION, L.P.
4211 Latham Street, Riverside, California 92501
Tel. (909) 686-8760 Fax (909) 686-8786
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: THE LAURELS @ PGA WEST #29122/PHASE 1
LOT#: 4
SITE ADDRESS: 55198 LAUREL VALLEY. LA QUINTA, CA
------------------------------------------------------------------
EXTERIOR WALLS @ 2X6 FRAMING:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 6 3/4 " R -VALUE: R-19
EXTERIOR WALLS @ 2X4 FRAMING:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 5/8 " R -VALUE: R-13
CEILINGS: BATTS BL"OW
MANUFACTURER: GREENSTONE THICKNESS: 8.1 R -VALUE: R-30
CEILINGS: BATTS V BLOW
MANUFACTURER: JOHNS MANVILLE THICKNESS: 11 R -VALUE: R-30
GENERAL CONTRACTOR: GREENEWAY DEVELOPMENT, INC.
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, L.P.
LICENSE NUMBER: 794484
BY:
TITLE: PRPbUyetION MANAGER
DATE JUL 11, 2001
/ g8
Laurels pl. 2
INSTALLATION CERTIFICATE (PAGE 1 OF 8) CF -6R
SITE ADDRESS PERMIT NUMBER
AN INSTALLATION CERTIFICATE IS-REQWBE POSTED AT THE•BUILDING SITE OR'MADE"AV ABLE FOR ALL APPROPRIATE
INSPECTIONS. (THE INFORMATION PROVIDED ON THIS FORM IS REQUIRED; HOWEVER USE OF THIS FORM TO PROVIDE THE
INFORMATION IS OPTIONAL.) AFTER COMPLETION OF FINAL INSPECTION, A COPY MUST BE PROVIDED TO THE BUILDING
DEPARTMENT (UPON REQUEST) AND THE BUILDING OWNER AT OCCUPANCY, PER SECTION 10-103(b).
HVAC SYSTEMS:
HEATING EQUIPMENT CEC CERTIFIED MFG. #OF 1,"18PFICIENCY DUCT DUCT OR HEATING HEATING EQUIP
NAME IDENTICAL (AFAU ETC.) . LOCATION PIPING LOAD CAPACITY
TYPE AND SYSTEMS CF -IR VALUES (ATTIC ETC.) (R -VALUE) (BTU/HR) (BTU/HR)
HEAT PUMP MODEL #
FAU CARRIER' 58STX070112
FAN COIL FIRST CO. SPF19HX3-E
2 80% ATTIC ' 4.2
1 80% ATTIC 4.2
87K 70K
COOLING EQUIPMENT
EQUIP CEC CERTIFIED COMPRESSOR # OF EFFICIENCY DUCT DUCT COOLING COOLING
TYPE PKG UNIT MFG NAME AND IDENTICAL (SEER ETC.) LOCATION R VALUE LOAD CAPACITY
HEAT PUMP MODEL NUMBER SYSTEMS (CF -1R VALUE) (ATTIC) (BTU/HR) (BTU/HR)
A/C CARRIER 3814DC0363 2 12SEER ATTIC 4.2 36K 36K
HP YORK BPO 18X1221 1 12 SEER ATTIC 4-2 18K 17AK
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 CERTIFICATE OF COMPLIANCE FORM (CF -1R) SUBMITTED FOR
COMPLIANCE WITH THE ENERGY EFFICIENCY STANDARDS FOR RESIDENTIAL BUILDINGS, AND (3) EQUIPMENT THAT MEETS OR
EXCEEDS THE APPROPRIATE REQUIREMENTS FOR MANUFACTURED DEVICES (FROM THE APPLIANCES EFFICIENCY REGULATIONS ON
PART 6), WHERE APPLICABLE.
��oafi 016'
SIGN TURF, DATE
WILLIAMS HEATING CO.
INSTALLING SUBCONTRACTOR (CO NAME)
OR GENERAL CONTRACTOR (CO NAME) OR OWNER
a
,'� THERMOSTATIC EXPANSION VALVE (TX'I)
AYES THERMOSTATIC EXPANSION VALVE (OR COMMISSION APPROVED EQUIVALENT) IS INSTALLED AND ACCESS IS PROVIDED FOR INSPECTION.
❑ NO'
YES IS A PASS PASS FAIL
COPY TO: BUILDING DEPARTMENT
HERS PROVIDER (IF APPLICABLE)
BUILDING OWNER AT OCCUPANCY