0311-022 (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
,A Nofassionals Code, and my License is in full force and effect.
License "# Lic., Class Exp. Date
s!` i7t3 Z a✓ / �if113/04
Date Signature of Contractor
OWNER -BUILDER DECUARATION
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:
O 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 ?A21! ,;�`;f,T�J3lji�L�" " Policy, No. :�0�11��xY�n�I� �!�
�?FI
(This section"heed not be completed if the permit valuation is for $100.00 or less).
O 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 provis&gns'of Section 3700 of.the Labor
Code, I shall forthwith comply with'those prp<is ons:<'�
,Date: ZZi010rc:.r APPlican_t_,
Warning: Failure to secure WorRe s 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
706 •-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).- Date
.-;BUILDING -PERMIT ' PERMI 0311-0121 ,
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ENOV9°2003 ' 10TA..1;YR {TVIMSDur .1140W
S4,1JI-9.22i
CITY OF LA QUINTA'
FINANCE DEPT:
oe
RECEIPT.
DAT/Er 1
BY
DAT 1
I INSPEC r
INSPECTION RECORD
( OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
OQ
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- r
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wali 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 Pibg. Test
Final
Gas Piping r
PLUMBING APPROV $
Gas Test
)Electric Final
Waste Lines i
Heater Final
Water Piping l'�—
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Laterali
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
'
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring i
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F:I.
Smoke Detectors
Temp. Use of Power
oo
Final
Utility Notice (Perm)
09/15/2004 20:41 FAX. 7149212187 ALLIANCE MECHANICAL Q004
i
INSTALLATION CERT I f CERTIFICATE /y �p�u�y (Page I of 13) / } � + /� C l CF-6I$j�
I+OZlf
1_31b �� SCJy Y 1 y �I �7tl"4e "1 DT.AAI-�7'V -464 3 1 &-- P
Site Address Permit Number
An installation certificate is required to be posted tit the building site or made available for &II appropriate inspections, (The
information provided on this form is required; however, we of this form to provide the information is optional.) Afta
completion of final inspection, a Copy meat be provided to the building depnrtrnent (upon mquest) and the building owner at
occupancy, per Section 10-103(b),
HVAC SYSTEMS:
Heaa og Equlpmeas
Equip, 0 of BtB CK7. Duct Duct or Hating Heating
Typc'(pkg CEC Cerdfied Mfr Nano Identical (AFVE, em)' UQuitaa mptag Load C+11164
Fumaco
_A try
Cooling Equlpirtem
Equip. ,CEc catiGod Coerweeaata
Tyles (pk& unit Mh Num utd
4.2
II of Emdepey Duet Cooling Cooling
'dead=' (OEM Calc 1 ° DUt L++ad Cit�r
Air Cond, Vic—
V ape)
1. > it&& greater than or equal to.
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 -IR) submitted for compliance with the Energy
-Efficiency Standards for residential buildings, and 3) equipment that meets or exceeds the appropriate requirements for
factured devic (fro a AP?Mance Efficiency Regularlons or Part 6), where applicable.
�. ALLIANCE MECHANICAL HVAC
3g
kWuri, Date Installing Subcontractor (Co. Name)
:.� OR General Contractor (Co, Name) OR Owner
WATER HEATING SYSTEMS:
Dwri-bution If Rech. Oaf Rued' Tank Etri- Eitenul
Heuer CEC Certified Mfr Type (Std, + eulatlon. Identical Input (kw Volume cicncy Standby: LnxuuAwn
�Tna Name & Model Number FolawWwll Caatroi Type Syuemr or Botrbr) (tallow) (EF. RE) Lou I% R•nluc,
2 For small gu storage (rated input of Ices dean oreq%W to 75,000 90AW), ekarle raabtaocr and beat pump water haten. list Energy Factor_
For large gu storage water beaten (rated input of pvw!luta 77,000 BdmtA list Kew" Efficiency, Sutndby Lou and Rated Input,
For lastaoeaocow tag .rater beugm, list Recovery ERkimey anti Reread Input.
3. R-12 eitemal insulation is enmwduory for storage .ata heueta with as anagy decor orlesr duan 0.58.
Faucets & Shower Heads:
All faucets and showerheads installed are oatifted to the Commission, pursuant to Title 24, Pan 6, Section I 1 I .
1, the undersigned, verify that equipment listed above my.signature is: 1) the actual equipment installed; 2) equivalent to
or more Mcient 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 manufactured devices (from the ApplWrice Eglelericy XegitWorts or Part 6), where applicable,
Signature, Date d . { ; , Installing Subcontractor (Co. Name) OR
General Contractor (Co. Name) OR Owner
COPY TO: Building Department t
HERS Provider (if applicable)
Building Owner at Occupancy
I
A
TT/L0 39Vd
WES'T'ERN INSULATION,
.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 SEEN 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 — RESERVE / PHASE 8
LOT 130
SITE ADDRESS: 80-580 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-19
PLUMBING BAYS: BATTS
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3Y2" R—VALUE: R-11
GENERAL CONTRACTOR: TOLL BROTHERS
BY: -
TITLE:
DATE:
INSULATION CONTRACTOR, WESTERN INSULATION, L.P.
LICENSE NU 94484
BY:
TITLE; PRO CWJ MI0 MANAGER
DATE: SEPTEMBER 15, 2004
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