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0402-233 (SFD)LICENSED CONTRACTOR DECLARATION arses I hereby affirm under penalty of perjury that I am licensed under provisions of CV- ter 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 4130/04 ate Signature of Contractor".f' ��"r�►� °---^•"' (/ 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). O 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 willmaintain 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: Cartier I • Policy No. LIDEI=;TYMUTVA4F:. WA262DW1.723012 E 9(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 shalyforthwithcomply with those pro v' ions. —e-7&lApplicant4_�:, Warning: Failure to secure Workers' Co,6 �ensation 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 fora 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. y, Signature (Owner/Agent)�� Af'`'� Date ✓ r� BUILDING PERMIT PERMIT# DATE VALUATION LOT 04(Y�2 TRACT S:3218 8X.80 143 33357 JOB SITE APN ADDRESS ' • ' ' OWNER "' CONTRACTOR/ DESIGNER / EN INEER . `1011:1 BRC> '(1I+:T�9INC I 011LR(M-MRS WC 73-111 FR17D VIARIKG 4100 `73-) 21 1:1W,.D— WARNOO100 PALM. D.EWWr CA 92260 P.A114DF�gM1V ' CA. 92260, 060)674.9699 M1 1* 3832 - USE OF PERMIT �;r•s� " ;i�D • L04' ,'>~J, INtRE1rt1�3 i+Llfa"x 1�EC,14f.'C L;CD �+tCi ' It3CLlit� ~ BLoCK WALLS, POOL, 'eS A OR DRIVIT"VaAY AP1'it.OAC1f. ; Chi FOM CONSTRUCTION 3,847. 00 8F, POR:i:HM.ATIOr , 531.00 SP v O.Akt.F•>,CiME?►.It1"ORT SF )WIMM-3) CORP JF CONFIRUMMOR so S;C>NOT RUCTIt;31v IrEE 101.000-418.000 $1,416.30 PLAX CHECK FXV: 1Qi=e30Q-139 318 $1,raa.�a t+ �Ei'HMN1C.a LPERI 101.-1300-4•Z1.000 $150,00 s LI.� 5'Rf;S;'.i�:�.,1�'f?L 1 C►1-t100•x.7•a,0-t1U0 �at-05.69 I3Ltt1G4S1 {3 FI 101.000.419-000 $190.00 STR,ONQ Pl10"M©N PSE • 'RESID 101-000-241-000 $132.19 t31'tA13= FEE 1014.000.423-000 Stat' DW MADIMM IHPACT P99 $3,403-09 .MKT IN PUBLIC PLACES - ROME 270-000-445,,000 V404.70 UCTIOM A N � � Tr `63 �5,86.3t3 $0.00 1 u FRE-14AM M— MAR 0 4 1004 1MMn: f= WE NOW �.� CITY OF LA QUINTA _w�ri`«Fhl�fiE DEPT. RECEIPT DATE BY D I ALED INSPEC R INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROV- .S m MECHANICAL APPROVALS Set Backs Forms & Footings_ Underground Ducts Ducts Slab Grade Return Air Steel _ Roof Deck_' Combustion Air Exhaust Fans O.K. to Wrap _ - Framing F.A.U. 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 POOLS - SPAS BLOCKWALL 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 APPROV S 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 Encapsulation Gas Piping Gas Test ,b Appliances Final COMMENTS: Final Utility Notice (Gas) ELECTRICAL APPROVALS ' Temp. Power Pole _ Underground Conduit Rough Wiring _ Low Voltage Wiring Fixtures Main Service Sub Panels O Exterior Receptacles G.F.I. - Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) WESTERN INSULATION9 L.P. 4211 Latham Street, Riveryidc, California 92501 Tel. (951) 686.8760 Fax (95 1) 686-8786 CF6R INSULATION CERTIFICATE THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH THE CURRENT ENERGY REGULATION, CALIFORNIAADMINISTRATIVE CODE, TITLE 24, STATE OF CALIFORNIA, IN THE BUILDING LOCATED AT:, TRACTIPHASE: MT VIEW CC - VISTAS / PHASE 6 LOT#: 143 SITE ADDRESS: 80-535 VIA TALAVERA , LA QUINTA, CA CEILINGS: BATTS , MANUFACTURER: JOHNS MANVILLE THICKNESS: 11" •R- VALUE: R-30 EXTERIOR WALLS: BATTS MANUFACTURER: JOHNS MANVILLE THICKNESS: 6 3/4" R- VALUE: R-1 a PLUMBING BAYS: BATTS MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 1/2" R- VALUE: R-11 CONTRACTOR: TOLL BROTHERS, INC. _GENERAL BY: t TITLE: DATE: INSULATION CONTRACTOR: WESTERN INSULATION; L:P. 7 LICENSE7PR�90CION BY: ;r TITLE: MANAGER = DATE: AU UST 30.2004 ' Li/0Z 39Vd NOIiv-lnSNI Nd31S3M 98L8989ZS6 LZ -Z0 b00Z/06/80 08/30/2004 04:19 FAX 7149212187 ALLIANCE MECHANICAL 0 020 INSTALLATION CERTIFICATE (Page >< of 13) . CF -6R 1"40 SiteAddress e0 V 1A rA,i A y `- JMA Permit Number An installation certificate is required to be posted at the building site or made available for all appropriate inspection$. ('lute 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 dep"ent (upon request) and the building owner at . occupancy, per Section 10-103(b). HVAC SYSTEMS Seating Equipment . Equip.tl of Efficiency Diu DW Or Heating Heating Type (941 UC Certified Mfr Name l_dcotiW (AFUE, ctc.)' Location Piping Load Capadty r I:J .. �r o Cooling Equipment Equip. CEC Certified Compressor a of Efficiancy Dui Cooling Cooling Type (pkg. Unit Mfr Name and Identical (SEER, etc-)' Location Duret Load Capacity est m 1 vat ' R- I c 1 La -3 197n L All` GewD- G �� lL 2 d 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 CI? -1R) submitted for compliance with the Energy Efficiency Standards for residential buildings, and 3) equipment that meets or exceeds the appropriate requirements for factured do ' (from the Appliance Efficiency Regulations or Part 6), where applicable. Z_2 O Q ~3D oaf. ALLIANCE MEIJHANICAL HVAC Signature, to Installing Subcontractor (Co. Name) OR General Contractor (Co. Name) OR Owner WATER HEATING SYSTEMS: I Distribution ` if Recir- k of Rated' Tank Uri- External Hester CHC Certified Mfr Type (Std, culation, Identical Input (kW Volume tient}^ Standby° Insulation Type Name & Model Number Point -of -Use) Control Type Systems or Btwbr) (1pllonsl (FF, RE) Loss M R -valuer 2 For small gas storage (rated input of less than or equal to 75.000 Btu/hr), electric reslsrAnte and bear pump water heaters. list Energy. Factor, For large gas storage water heaters (rated input of greater than 7s,000 BnAr), list Recovery Efficiency, Standby Loss and Rated Input. For Instantaneous eas water beaters, list Recovery Efficiency and Rated Input. 3. R-12 external insulation is mwtdatory for storage water he=r S with an energy facmr of Iess than 0.53. Faucets & Shower Heads: All faucets and showcrheads installed are certified to the Commission, pursuant to Title 24, Part 6, Section 1 11. 1, the undersigned, verify that equipment fisted above my signature is: 1) the actual equipment installed, 2) equivalent to or more efficient than that specified in the certificate of compliant: (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 Pau! 6), where applicable. Signature, Date Installing Subcontractor (Co. Name) OR General Contractor (Co. Name) OR Owner COPY TO: Building Dcpmtmcnt HERS Provider (if applicable) Building Owner at Occupancy A9 Compliance Forms August 2001 A-23