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0403-019 (SFD)U) 04U) W O C I W I- X o Z � CO 0' ( 0 J L) � LUa I) Z co LO N ON U °) CLa tr r a 0 0 LIJ J J m U,U O rn H It Z cb 5 �p Q J ` 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 777699 13 04/'30/:( Signature of Contractor, Z,/A/ 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 LIBERTY MUTUAL F. Policy No. WAXi'!90472VIM (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 �f. rov slOns._ Date: Applicant f..��-- Warning: Failure to secure Workers' Compensation coverage is unlawful and 9 P 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) te BUILDING PERMIT PERMIT# F DATE VALUATION LOT 0403!.019 TRACT 'Z ,1(� x;323 idilt.,i30 178 f 303:57 JOB SITE APN ADDRESS OWNER CONTRACTOR/DESIGNER/ 73.121 F`RM, WARTNG # 100 73-121 JFRM WAP -Mi Al 00 � PALM DESERT CA 92260 PALM 1; ESM OA 92260 (760)674.9699 3832 USE OF PERMIT I - SWC )L, -L7. IdFq�l SFD R LOT 178, M11 AM0Y3TF,, PERMIT DOa'NOT INCLUDE HLOCK WAL J,% POOL, SPA OR D IVEWAY A.PP C)ACK 751A1'�I?DCJt I10N `!'O PLAP1 CPizf,K nF. DVE TO MULT'IPLE 15Si ANI CE CIF SAME PLAN TYPE C1SMM COA STRIJCTION 31347.00 8F PORCHf1tiATICI 564.00 Sig GARAMUCAIMP(. RT 753.00 kl-F ;�- kbM PLM C'HWX LMS.1 :E'RE-']PIN11) M 0 RECEIPT I DATE ,` / i 't I BY : ,�� DATE FINALED INSPECTOR $3,006.39 $0,00 $51006.391 EMWIVED COST OF IAC NSPIM10'C<"%1011 32i;so3.:c3€3 lPXT1^1? Vr 2s' E MUMMY CONSTRUCTION Fu 101-000-x#18.000 S1,416,20 PL" CrlM :!rOV, 101-000.439-318 $A rZ3I MECHANICAL FEE 101-000-421-000 $I:S0100 9T A.:Cv°d`I'Id (-'AL PEE 101-000.420-000 11209.69 i�ltliiG BI.AI'0'FrIlE 101-700-419.000 $190.00 sTizOW0 MOTION jr6F, - ItESID 101-t.W-241-000 $31.19 (IRADING FEE 101.000.4.23-000 519100 i{ I71:VEL,,OPEP.IMPACT frZIP $%405.00 .ART Ltd PUBLIC PIACM • F1.LME 270.000.445.000 £30A.70 ;�- kbM PLM C'HWX LMS.1 :E'RE-']PIN11) M 0 RECEIPT I DATE ,` / i 't I BY : ,�� DATE FINALED INSPECTOR $3,006.39 $0,00 $51006.391 OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Forms & Footings _ Underground Ducts Ducts Slab Grade Return Air ir Steel z_ Combustion Air Roof Deck kiloT Exhaust Fans O.K. to Wrap _ F.A.U. Framing _ _ _ -Compressor Insulation f- -77ents 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 Pibg. Test Final Gas Piping PLUMBING APPRO ALc _ , Waste Lines Gas Test Electric Final Heater Final Water Piping _ r Rj Plumbing Final Plumbing Top Out _ _ Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral A z_ 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: 08/30/2004 04:13 FAX 7149212187 ALLIANCE MECHANICAL L INSTALLATION CERTIFICATE 1 of 13) 0 007 CF -6R Site Address ,S0-19ra&— && ,DO/LmDo P9_ Permit Number An installation certificate is required to be posted at the building site or made available far all appropriate inspections. (The information provided on this form is requited; 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 Equip.: li of Efficiency Duct Dura or Hedging - Heating Type (pkg_ CEC Ceeofied We Name Identical (AFX ete.)' Location PipiaR Load Capacity • Cooling —Equipment Equip. CEC Certified Compresw b of Efficiency Duct Cooling Cooling Type (pkg. unit Mfr Name and Identical (SEER, etc.)' Location Duct Load Capacity 1. > reads "greater than or equal to. 1, 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 factured dev' s (from the Appliance Efficiency Regulations or Part 6), where applicable. 018 30 0. ALLIANCE MECHANICAL HVAC Signature, riffte Installing Subcontractor (Co. Name) OR General Contractor (Co. Name) OR Owner WATER HEATING SYSTEMS: Distribution If Recir- A or Rated= Tank Etl-i- Extcrml Hooter CEC Certified Mfr Type (Std, culmion. Identical Input (kW Volume cieneyr SrAndby Insulation Type Name & Model Number . Point -of -Use) Control Type Systems or BrAr) (gallons) (EF. RE) LOSS M) R -valuer 2 For S II gas storage (rated input of lees than or equal to 75,000 Bnilhr), electric resistance and beat pump water heaters. list Energy Factor For targe gas storage water heaters (rated input of greater than 75.000 Btufhr), list Recovery Efficiency, Standby Loss and Rated Input For instantaneous gas water heaters, list Recovery Hffciettry and Rated Input. 3. R-12 external insulation is mandatory for storage water heaten with an energy factor of lest tW 0.58. Faucets & Shower Heads: All faucets and showerheads installed are certified to the Commission, pursuant to Title 24, Part 6, Section 111. 1, 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 (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 Appliance Efficiency Regulations or Pan 6), where applicable. Signature:, Date COPY TO: Building Department HERS Provider (if applicable) Building Owner at Occupancy Installing Subcontractor (Co. Namc) OR General Contractor (Co. Name) OR Owner • Compliance Forms August 2001 A-23 • WESTERN INSULATIONf L.P. 4211 Latham Strftt, Riverside, Calitomia 92501 Tel. (951) 686.8760 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: MT VIEW CC - VISTAS / PHASE 6 LOTM 178 SITE ADDRESS: 50-856 EL DORADO DRIVE, LA QUINTA, CA ------------------------------,----------------------------------- CEILINGS: BATTS MANUFACTURER: JOHNS MANVILLE THICKNESS: 11" R- VALUE: R-30 EXTERIOR WALLS: BATTS MANUFACTURER: JOHNS MANVILLE THICKNESS: 6 314" R- VALUE: R-19 PLUMBING BAYS: BATTS MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 1/2" R- VALUE: R-11 GENERAL CONTRACTOR: TOLL BROTHERS, INC. BY. TITLE: DATE: INSULATI CONTRACTOR: WESTERN INSULATION, L.P. LICENSE NU BE 794 RA BY. TITLE: PRO?jCjION ANAGER DATE: AU ST 30, 2 04 LZ/LZ 39VJ NOI1Cif1SNI Nd31S3M 98L8989Z56 LZ:zo b00Z/06/80