0310-130 (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
Processionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
717176ZC L3 ,.� % 4 F3 0010 4
Date 1 .7— Signature of Contractor �'� Q- •�
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 Sectiori 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 Aich 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 L-1PI!. iT xl MVTWaI.. F Policy No. '��:r'1:E2!?�l�s')'
(This section need not be completed if the permi!'valuation is for $100.00 or less).
( ) I certify that in the performance of the woFk 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 provision 'of Sectio
��700 of the Labor
Code, I sh9ll forthwith comply with those prod§ions. �.-r-
.Date: f. a l:Applicant .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.
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),r Date �f'r✓�/�
J
BUILDING PERMITPERMIT p
DATE / VALUATION NaT7ly.��r'� LOT t TRACT 3010151
JOB SITE
ADDRESS f* -.V0 rP AUAA WRA
APN
OWNER
CONTRACTOR / DESIGNER / EN (NEER
T(;1A.BS" OT.Elc'' ll:s 01C
TOIL: A-frMit , Wit"
73-121 Tx � �.'h�lhuKx9400
73.1.21 ItIMVIM114041q- 0 -
PAxM IDEMRT
PAI.1vf I"+EJSI,'.'1' CA 911260
`7150)674�9699 CMA ?812
USE OF PERMIT
••iG..F'iF'/6(i
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�Ln L.i � L{.4L Fii: W:.UJA, F'.:::. 1TJ•�!l J.P\.:;ri:Al' JV tJ�.1��4J JIAS:. .
BLOCK WAI.3A, 0,000 OR DRr'V•Wr Y A..i'i'ROA.CH
CiUNT ,`.0 CGINSTRU CTIOIT' 3M 1" SIF
PO CHP.[AY10 435.07 SW
0ARA'--TYCAI VOPT 711,1'In SF
ESTMA` ID. " +} .s SAF i'iiMMA,!C11,,0N
1."190
'Imus bs.M su IJ:M&M,
t"'ONSTR.UCTIONX VFW 0 -UPJ,-418.000 $1,346,50
316 ISI,109-65
ts+!'Fv'�3rr+?4IC4:�. sr ?i 1 �' s,000-421 -000 SI039
ZLE:'i R IC A.11 F- P'`h a i" 2 2C- O i 9t, 94
P't1.17,+iNCIr' 1f J �10C� �l 19»ODiI X21, i3
STlit; AQ NlC9';10.1 )00 � lc. . I ?
.
ORA.VINO'FiR 10 1 .1..I%:-423, 000 VADI1
nI+VW:)PZP. JIWPACT ?F1Z $2,.40.5.uo
ART TN 'PUBLIC! I'LhM, RkSii 000 b
�i'�- ��`t�.�.. c :�c�:v��c��.r�::rj��a�a• ht�J� ra>�Ais � �:�:�;�
MD
NOV 0 4 2003
UIP TA
CITY OM LA ®CF
lEINADATE
"' '
.,
BY
I
DAT FI ALED
INSPECIiR
114/ 41
i/
6Cr
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs A
Underground Ducts
Forms & Footings
Ducts
Slab Grade i
Return Air
Steel
Combustion Air
Roof Deck _
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing _
Insulation _
Fireplace P.L.
Compresqdr
Grill
Fireplace T.O.
F s & Controls
Party Wall Insulation
ondensate Lines
Party Wall Firewall
Exterior Lath r,
_
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 APPR VALS
Gas Test
Electric Final
Waste Lines _ ' _
Water Piping �Q
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
OX 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 Notioe (Perm)
COMMENTS:
_
WESTERN INSULATION2 L.P.
4211 Latham Strect, Riverside, California 92501
Tel. (951) 686-8760 Fax (951) 686-8786
QF6R 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 — RESERVE I PHASE 8
LOT 7 31
SITE ADDRESS: 80-590 VIA TALAVERA, LA QUINTA, CA
CEILINGS: BATTS
MANUFACTURER: JOHNS MANVILLE THICKNESS:1� R- VALUE' R-30
EXTERIOR WALLS: BATTS
MANUFACTURER: JOHNS MANVILLE THICKNESS:! 63/41, R- VALUE: R-19
PLUMBING BAYS, BATTS
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 YT R —VALUE: R-11
GENERAL CONTRACTOR: TOLL BROTHERS
BY;
TITLE:
DATE:
INSULAMON CONTRACTOM WESTERN INSULATION, L.P.
LICENSE U R 4484
BY:
TITLE: PRP)bIZCTIqN MANAGER
DATE: SE TEMB 15, 2004
IT/80 39Vd NOIiv-lnSNI N831S3M 98L8989T96 zt7:To 1700Z/ST/60
jt5
09/15/2004 20:42 JPAX 7149212187 ALLIANCE MECHANICAL
INSTALLATION CERTIFICATE (P
t {t:
t
X1005
0
1 of 13) CF -6R
Site Address Permit Number
An installation catifiCilkte is required to be posted at deo building site or trade available for all appropriate inspections. (The
information provided on this form is mquiteQ however, use of this form to provide the information is optional.) After
completion of final inspection, a copy must be provided to the building dgamnent (upon.mquest) and the building owner at
occupancy, per Section 10-103(b).
HVA YSTEM,:
Heating Equipmeht
EquiHadut
Typki CECCcrdnedMfr Namo td�) (MEU etc.)' Location PiN of Effldcocy. Duct ping g L"d capacilY
_as _ �^— — 4.2Output
Furn
qtr N LU l i
CooUng Equipment
Equip•,EC eardfred compressor # of Effid ncy Dun Cooling Cooling
Type (pkg Unit Mfr NBtne std Identitsl (SEER, eta)' L *09a oust LIMA cap.ctty
Atr a .–
lilk—t�d - Igo, 4 -2—
I > reads greater that or equal to.
1, rhe 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 -1k) submitted for compliance with the Energy
Efficiency Standards for residential buildings, and 3) equipment that meets or exceeds the appropriate requirements for
m factored devie (fro a Ap lance Efficiency Regulations or Part 6), where applicable,
r . I ALLIANCE MECHANICAL HVAC
0&'ikfiiri, Date `Installing Subcontractor (Co. Name)
OR General Contractor (Co. Name) OR Owner
WATER HEATING SY57EMS:
DWil;tWon If Reeir- 0 of Ratcd' Tank Err,- Extenul
Heuer CEC ccrOcd Mfr Type (514 eululoa. IdtattW Input (kW Volume ciency' suadw Insulauoe
Type N►me & Model Number Poiuof-Usel Control Type Sn!Mj or Btuft)_(jallons) (EF. REl Loss I%) R -value'
2 For *mail ger storage (rated Input orleaa than of equal to 15AW Btufhr), electric nststanee lad beet pump water neetcn. list Energy Factor.
For tarps tea storage water beaten (rated Input of grata dm.75,tltlo BtuA4 Ibt Rceorery Fmcitney, Standby Lou and Aatcd input.
For Itsuentsoeoua gas water beaters. lint Rtravay-ER ck*cy BAA Road Input.
3. R-12 esteinal insuledon u mandatary for uonge wata hewrg with aA energy facwt of leas assn 0.5 g.
Faucets do Shower Heads:
All faucets and showerhedds installed are certified to the Commission, pursuant to Title 24, Pan 6, Section 111.
I, the undersigned, verify that equipnuntlisted above my signature is: J) the actual equipment installed; 2) equivalent to
or move cfFicient than that specified in the certificate of Compliance.(Form CF -I R) submitted for compliance with the
Energy Efftcle cy Standard; for -residential buildings; and 3) equipment that meeu or exceeds the appropriue
requirementsfor manufactured devices (from the appliance Efficlenty Regulations or Part 6), whcm-applicable.
Signarusc, Date - Installing Subconuactor (Co. Name) OR
General Contractoc(Co. Name) OR Owner
COPY TO; " Building Department
HEM Provider (if applicable)
Building Owner at Occupancy