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0402-129 (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 Prof-;�:--sionals Code, and my License is in full force and effect. . License # Lic. Class Exp. Date ` `777699, 2 4/30/04 Date o� a/ Signature of Contractor✓,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: ( ) 1, 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 I, 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 ninsurance, 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 z Policy No. LIBIRTY WIT UAL 1K (This section need not be completed if the permit valuation is for $100.0&or less). ( ) I certify that in the performance of the work for which this permit is issued, 1 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 sh II fhwith comply with thos is fson Date:'' A Applicant /. r 7- Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation,. damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set .forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnity & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such .permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have. read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building' construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. Signature (Owner/Agent)". Date �e••� d� BUILDING PERMIT PERMIT# DATE VALUATION LOT 040429 TRACT /'. - �,!3foe.I9 140 30357 ' JOB SITE DAPN ADDRESS OWNER CONTRACTOR / DESIGNER / EN INEER 'POLL 131aMUMRS WC TOLL AT1110TISEMS INC 73.120 1FRI%1'7WAMN(.343.00 73«121 %RRL)NV AR! 0100 RAL.° M"Eller CA 92260 ,E''.?1LWDESFRT CA 922-40 ,700)674.9699 tMYJ1 — 3832 I USE OF PERMIT r t SFD - I:OT tails, V'2-NTA.k3AA4'/cry. PERMIT DOES W011 INCIIUDE. , OLOCY WAL,I. % POOt„, SPA Oil DP11V w7WAY A"RC1,AC11, CCT.37bm C0113'I'K UCTIO—.4 4,364, DO SP 650.00 SF Gi12ACRIt;A.13.FORT 7s9.AitLqF - . Emmv��A: W �.{0A: iJ.� CON= SON •7FJa6t`��•g�� PEPWr.1:'Y'R SUS ' f si,.$)my a0 tO3��s'�p'�RUCr+'T1•Of�3[�.i¢iaEE,101-f1ir�J0-11113.000 .�A..fl.Fl.��F: C;IC S•C.L'r ! 4J t ",!,%W.1�.7 �'.7 i tS �,�pia�'J.�3;. , MEC;HP.NTtY'AL FEE 101-000-421-000 �1So'. iii XLECTRICAL °: 101-000-420-000 PLUMBIi OIEEE 1011-000.419.000 $213.00 ST OW0 MOTIOXF 112-S - iMlt) )05-000-241-000' $35.29 GRADINO :FEE 101.000.423•-000 $1,5100 EVELS::tPE IMPACT T''L°:L� ca,al�$.tti7 W ART IN PUBLIC PIACES - MESIE 270-000-445-000 8407.22 OA"��MU.I,Y.-f.TL�.tiC.,113:�1'� IMS PRi�=�'"AiT91±RES $0.00 ! I YEMM- �1a:8 DUE N "FFB� &6,279.94 2 3 2004. Cliff OF LA QUINTA PINANdE DEPT. RECEIPT DATE / BY DAT7IN ED �) INSPECT(JR, INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVA S MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings IV Ducts Slab Grade _ Retum Air _ Steel Combustion Air Roof Deck Exhaust Fans _ _ _ _ O.K. to Wrap `� _ _ F.A.U. _ _ _ Framing Compressor Insulation —� _ _ _I _ Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Ir 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 AP. ROVA Gas Test _S Electric Final Waste Lines T 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 Appliances Final C6MMENTS: 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) Jj • WESTERN INSULATION, L.P. 4211 Latham Street, Riverside, California 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 f , LOTM 140' SITE ADDRESS: 80-576 VIA TALAVERA , LA QU INTA, 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:, ` 3112" R- VALUE: R-11 GENERAL CONTRACTOR: TOLL BROTHERS, INC. BY: TITLE: DATE: INSULATION CONTRACTOR: WESTERN INSULATION, L.P. LICENSE N E '79 TITLE: PROVErION PANAPER DATE: AUG(&T 30, 2004 LZ/L0 39Vd NOIiv-lnSNI N631S3M 98L8989196 LZ:Z0 b00Z/06/80 t, 08/30/2004 04:18 FAX. 7149212187 ALLIANCE MECHANICAL X1019 INSTALLATION CERTIFICATE (page 1 of 13) CF -6R L I ,AN Off DqsIZA SSite Address (� b� 57 S"�1� Permit Number An installation certificate is required to be posted at the building site or made available for all appropriate inspections. (Tire information provided on this form is required; however, use of this form to provide the information is optional) Ager 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: Headng Egmoment of Efficiency Duct= Duct at Hatitag HaftP Typpee (pkg: CEC Certified Mfr Name Ideparal-(AFUH, �)h Location Piping Load CBpaeiry ., -... t u_wh.- f rt~ (Bru tr) C G E ' menl 0o Rg 9mp equip-CEC Certified Compressor p of Effie eY Duet Coating cocift T1Rx (pkg• Unit Mfr Name and Identical (SEER, etyt Location Duct Loadbus OWPI aP MKvRierns.IRvalu ttdhe l . > reads greater than or equal to_ [, the undersigned, verify that equipment listed above is: 1) is the aculal equipment installed, 2) equivalent to or more efficient than that specified in the certificate of compliance (Form CF -IR) submitted for compliance with the Envy Efficiency Standards for residential buildings, and 3) equipment that meets or exceeds the appropriate requirements for manufactured devices (froa Appliance Efficiency Regulations or Part 6), where applicable. ALLIANCE MECHANICAL HVAC aturc, Date Installing Subcontractor (Co. Name) • ° ' OR General Contractor (Co. Name) OR Owner •_ WATER HEATI G SYSTEMS: ` Distribution if Recir- N of Rated` Tonle Erfi- F-urmal Hcaw CEC Certified Mfr Type (Std, culation. Idcntip) lnput(kW Volume ciency' Standby Inwluian Type Name & Model Number Point -0f --Use) Control Type Systems or Btwhr) (gallons) (EF. RE) toss M R•valuer 2 For small gas storage (rated input of less than or equal to 73,000 Bmithr), el "ale reskmisce and heat pump water heaters. list Energy Factor. For large gu storage water pmters (rated input of grcoter than 75,000 BaAr), list Recovery Efficiency, Standby Loss and Rated Input. For instantaneous gas water heaters, list Recovery Efticirncy and Rated Input. 3. R-12 cxtemal inaulotion is mandatory for storage water heaters with an eoergy factor of less %W 038. Faucets & Shower Heads: All faucets and showerheads installed are certified to the Commission, pursuant to Title 24, Pan 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 -IR) submitted for compliance with the Energy Efficiency Standards for residential buildings; and 3) equipment that meets or exceeds the appropriate requirements for u mufacture d devices (from the Apphance Effrcieney Regulations or Pan 6), where applicable. Signature, Date Installing Subcontractor (Co, Name) OR General Contractor (Co. Name) OR Owner COPY TO: Building Department HERS Provider (if applicable) Building Owner at Occupancy Compliance Forms August 2001 A-23