0307-362 (RPL)79735 America Ct
0307-362
LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
N W Professionals Code, and my License is in full force and effect.
5 M License # Lic. ClassExp. Date
o Z r— Date Signature of Contractor
AAY
O 1` - h f i.
r- I.— ' OWNER -BUILDER DECLARATION
W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ a License Law for the following reason:
Z_ ( ) 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
LO
N Date Signature of Owner
ON
rn
FL Q WORKER'S COMPENSATION DECLARATION
C:) cc I hereby affirm under penalty of perjury one of the following declarations:
Lo H O () I have and will maintain a certificate of consent to self -insure for workers'
X W LL• compensation, as provided for by Section 3700 of the Labor Code, for the
Om J Q performance of the work for which this permit is issued.
Q O (f) I have and will maintain workers' compensation insurance, as required by
OU Q Section 3700 of the Labor Code, for the performance of the work for which this
rn I— permit is issued. My workers' compensation insurance carrier & policy no. are:
I T Z Carrier 1 X UAPy' Policy No.
w Z)
r` C3
Q (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,,provisions.. f
,,,[Ate: f_" '_' .,
, Applicant `
.
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to crimin_ l,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. f
,,.Signature (Owner/Agent,)—.---r i k+Date
f
PERMIT #
BUILD NOPERMIT
MOT -Wil
DATE • VALUATION 'S2Mk* LOT TRACT
JOB SITE
ADDRESS V-.7.35 AMM, 11_'A COURF
APN _ r
OWNER
CONTRACTOR / DESIGNER / ENGINEER
.HMET-1
, C @:'1 ►. C.A. 922,53
.13 DIO CA 92201
i'6iJ)w3 •; CSV6 537
USE OF PERMIT
P011A."WOR 31"Al.
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1K0.P X',T10:N, RQUIPM, M.NT MAU (41AIRE NOT NC4.(11 ED
POOLANWO;R.SH,
X617MAXED COST (W C0X8*rU1lJC-'rf0K
Fxvmif "Mr, 9UIVUAAT?.Y
PIAN 0111WK Yrs
coNs'T' vc,ttO"e ru, 3011 /3 1 i-A2 Oi3r 1"a4.iJ
YAMIRAi ICAL r7K -- PCA",%i. 101 -WO -M-000
f:It9.'►I+••"tt6 RffIGAI, VES •n F 00L 9 Ol 3 ' s1 u v-OQCs $45A*
r u
AUG 0 61003
CMC._is:: _T.4 J
E1'a"3-71"O'CAL i°ORS"MRM: CN. AWA TAY A'1i' UHWE.
$41.82.10
II IIIIIIIIIIIIIIIIIII II 30
IE
RECEIPT
DATE
BY / t {
DATE FINALED INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms 8 Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
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
BLOCKWALL APPROVALS
POOLS -'SPAS
Steel
Set Backs
Electric Bond ft
Footings
Main Drain - /
Bond Beam
Approval to Cover
Equipment Location NJ
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
li'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. 1
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
Z00 'd WeSS:ZS 60/6Z/40 TZZ44t609L stood wm ivo3W
IIIIIIIIIIIIIII IIIIIIIII 31
IE
INSULATION CERTIFICATE
This is to certify that insulation has been installed in conformance with the current energy
„Lregulation, California Administrative Code, Title 24, State of California, in the building located at:
79-735 America Court, Lot 27, Monticello -Classics, La Quinta, California
CEILINGS:
TYPE: BLOW MANUFACTURER: Certainteed Thickness: R-38
WALLS:
TYPE: BATTS MANUFACTURER: Certainteed Thickness: R-13
GENERAL CONTRACTOR: CE Y CROWELL COMMUNIT ES ICENSE # , % d
BY: TITLE: / r
PA GON SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072
BY: TITLE: ADMINISTRATIVE ASSISTANT DATE: 12/5/2002
} CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page 1 of 7) CF -4R
Prdject Title /
== = EkfE QLQVA 2
1kCr LADlJ Id 7A
Project Address
❑
tJ o X06 I d
772- 3 15 0
Builder Contact
Telephone
I e- f j R
( 760) 'S( 4,2 a 4 -
HERS
Telephone
Tat
verified that actual installation matches values in CF -1 R and
Cenih,in' Si_nature
Harp
Firm: E5E2T LIEiZ ( ER /I E
Street Address: c) Yc (vZ I
Copies to: Builder, HERS Provider
I 5T0D ►'I 4-10 2
Dat— e --I
6-E:IJTtJ2-r inn E5
Builder Name
FLA ,d 5x
Ian Number
GI
PC v
Sample Group Number
1.0 T -0- 27 75735 Aftiew ICA
Sample House Number
HERS Provider: (f,
City/State/Zip: } Iw_ {v rj, A!,t_ °A,0) 77o
HERS RATER COMPLIANCE STATEMENT
The house was: ❑ Tested RApproved as part of sample testing, but was not tested
As the HERS rater providing diagnostic testing and field verification, I certify that the houses identified on this form comply
ith the diagnostic tested compliance requirements as checked on this form.
❑ The installer has provided a copy of CF -6R (Installation Certificate.
❑ Distribution system is fully ducted (i.e., does not use building cavities as plenums or platform returns in lieu of ducts)
❑ "'here cloth backed, rubber adhesive duct tape is installed, mastic and drawbands are used in combination with cloth
backed, rubber adhesive duct tape to seal leaks at duct connections.
❑ :vIININIUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT
Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage)
Measured
Duct Pressurization Test Results (CFM @ 25 Pa) values
Test Leakage Flow in CFM
If fan flow is calculated as 400cfm/ton x number of tons enter calculated
value here
If fan flow is measured enter measured value here
Leakage Percentage (100 x Test Leakage/Fan Flow) _
Check Box for Pass or Fail (Pass=6% or less) ❑ ❑
Pass Fail
❑ THERMOSTATIC EXPANSION VALVE
❑ Yes ❑ No Thermostatic Expansion Valve is installed and Access is
provided for inspection
❑
❑
Yes is a pass
Pass
Fail
❑ MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT
❑ Yes ❑ No RCCA Manual D Design requirements have been met (rater has
verified that actual installation matches values in CF -1 R and
design on plan.
~❑ Yes ❑ No TXV is installed or Fan flow has been verified. If no TXV,
verified fan flow matches design from CF -I R.
Measured Fan Flow =
❑
❑
Yes for both I and 2 is a Pass
Pass
Fail
Compliance Forms August 2001
A-16