SFD (0203-026)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
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
675709 sr? 1/0,-
Date— Signature of Contractor
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 i
O I am,,exempt�under Section B&P.C.rfor this reason
Date Signature of Owners �••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.
V), 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:
Carver MERICW P'R.'D"1',W Policy No. 1S.E,1,0%)5g70
(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 forthy�ith comply with those,provisions.
Date: �~�^' Applicant ;�1 ...+.•- , (�'. _, +—
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 personat
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.' C
2. Any permit issued as a result of this application becomes null and void if L
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) 4 fi.',_ Date - ^'
A.
BUILDING PERMIT PERM T#
0,20-36-016
DATE VALUATION 0M LOT TRACT 2JOB gr
ADDRESS 56>-10) . T� TWN ,1DVV i& ►.G' i i
APN 762-39"D
OWNER
CONTRACTOR/ DESIGNER // EEN61NEER
a
USCO H yVVO dbfi YJy:r,,Z1-j3 i Y RCIE i
VON ii.�+.�'UVS%�13,�` & ;37� Ey,��� 200
DIVI�•:(SON OFDII�.iIC'��. ON
y,1694 yyyyy,,0�� rPI��P
A.CCYVlbWP' C -A S?2606
�q 7y C
.[lC�6rINE C..A 92606
(949) 42.6199 %:ft
USE OF PERMIT
1.914 IX FAWLY DWMAJUG
S l) • LUTI A PLAN 9b •k T . J YN NOT kttijc 1az WAI,I.,3,
POOIM 111PA. OR DR1VKi)i" APPROACH. 75% REDUCTION TO PIAN
CIizcic rEr, VOR MUL`I'1P1:E WSt1K NCS OF :3APA1, Pf.XV TYPE
CUSTOM CO21MRUCTION IVII%PO4 3F
SF
/i<Y<�31ri�:1CI-11bi��ft#`T.IF€7 pT tl91*11.00
0Ar1 StihiJ7d�l%i'�H9)..POSi.1, - 810.00 S
MWAT-.0 C05f O.F WKSTR1t3 0.110N
X-41726.00
11E171l41i T ,FhW 8TJ1hi. AMtY'
CONSTRUCTION FEE 101 -000 -418 -ID OO 31,427B
PLAN CHECK MR 1C1.000 -X1.30-319 $20,00
'flLIE'.C1•IANNICAL FEE, 101-000421-000 S124-01111
F.LFXVUr_ALYPEIE 101•-G00-4.20-000 $ 03,86
P'LUM�1f��1c13RCLiFEE1til-000.410.000 $199,75
�Ys �Cn9yq
STRO1401�t0` 10N }•frau RESID 101-600-241-000 $32.41
CRADINO FEE 101-000-423-000 $20,00
DEVELOP= IMPACT F'W,, $1,90,00
ART 1N PUBLIC PLACES-, RESIL 2700000 445.000 $311.92
1 ��p /'4�5��� �y
�(y' ry, App .�.y ,,t�ry�-� CMP
S.�CiD-170rfAL t, -:V.1 f6SiS.Nt�iLIONAN'D PJ.AW W.GC.t.el\.
•7H+_�:�r
UM 'FRE-PAWYM
" u g TO;Y'AL P1;:1Z:iaQIJr rKES D(TE X6W1.
n sJL
,511.31,10
CITYOFIAQUINrA
FINANCEDEK..
03 pe
RECEIPT
DATE.. �f�i p{
BY is
T IIS} f1 INSP TOR
0I
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
d
Return Air
Steel
Combustion Air /
Roof Deck
1
Exhaust Fans
O.K. to Wrap
3 trL
F.A.U.
Framing
Compressor
Insulation
Vents ol
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 APP OVALS
Gas Test
Waste Lines
�` 2
Electric Final
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
COMMENTS:
�lFialL �s�iG --� TMJ
Utility Notice (Gas).
- —
ELECTRICAL APPROVALS
�/-
Temp. Power Pole
Underground Conduit
_
g
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
(/
Temp. Use of Power
_
Final
I — —
Utility Notice (Perm)
ro;,F2.30.2002 (11:x`_ 17602?340Si ILkYER ROOFING
A Q
Corporate Office:
P.0, box 46:890 B ® e
Escondido, (;A 920.6
L icenRc # 663iX I
WESTERN PACIFIC HOUSING
LA QUTh" TA
760-564-7022 (FAX)
Att•n: JO'H N
#3484 E.008/011
e
too
Roofing on "LEGENDS Cal P.G.A. WEST" Ph 4A LOT #2011
Phone: •(760) 737-8888
FAX; (760) 737-0350
09-30-02
Mayer Rooting has supplied and installed " 19 1101hagin cloaked roof dent% , on lot # 2011
at. 56-100-MUIRF1EL;D VILLIACiE; Tile vents have been installed per manufacturers .
specifications. -- - -
Note: Exact vent locations are determined by builder
RESPECTFULLY SUBMITTED
r`
SCOTT BEECHAM
OPERATIONS MANAGER
Mayer Roofing, Inc.
Nage I of 1
0
58 Libya -.-y Slr.:el . San Fmi-an: o, CA 91340 193 Orange Street . Riverside, CA 92502
(8 18', 8:384'iWA . Fr,ik (8 18) 8 5 -4493 (909) 782.0601 . FAX (909) 782-0864
WESTERN INSULATION, L.P.
4211 Latham Street, Riverside, California 92501
Tel. (909) 686-8760 Fax (909) 686-8786
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: PGA WEST — LA CALA / PHASE 4A
LOT #: 11
SITE ADDRESS: 56-100 MUIRFIELD VILLAGE — LA QUINTA CA.
——————————————————————————————————————————————————————————————————
EXTERIOR WALLS: BATTS
MANUFACTURER: JOHNS MANVILLE THICKNESS: 5.5" R— VALUE: R-21
CEILINGS: BATTS
MANUFACTURER: JOHNS MANVILLE THICKNESS: 13" R— VALUE: R-38
GENERAL CONTRACTOR: WESTERN PACIFIC HOUSING
BY:
TITLE:
DATE:
: WESTERN INSULATION, L.P.
LICENSE NUMBER: 79484
BY:
TITLE: PROD TION AMA(
DATE: SEPTEMBER126 2002
rn.
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESI"ING (Ti ht Ducts) CF -4R
PROJECT INFORMATION
Pr eks Title:
La Cala
Project Address:
La Quinta
Builder Name:
Western Pooifio Homes, MIChelle Lopez Voice 0: 949-�442�199 x 462
Builder Contact:
.
John Ziomen Voice >r : 780-564-7555
Project ID 01:
28838-2
Sample Group
Phase 49
Lot a:
2011
Plan a
Address:
56-100 Muirfieid Village
HERS INFORMATION
HERS Rater.
Scott Johnson Jayme Carden
Cartificafion 0:
CCCSJ614037 CCNJC615167
HERS Firm:
Action Now Voioe 4. 948-531-2274
Address:
2575 Wet3trrtinster Avenue, Costs Mess, CA 92627
HERS Provider:
HER$ Address:
CHEERS Voice 4 : 818407-1500
9400 Topanga Canyon Blvd, Chatsworth, CA 91311
HERS RATER COMPLIANCE STATEMENT
17ET-24 Compliance Credit was Taken for Tight Duds
The ouse was:
x Tested =Approved as a part of sample, but was not tested
x
The 4W*Qor has D—MY—KSd a copy Of OF -GR
x Air Distribution System is Fully Ducted (sheetmetal, ducthoord or flex duct)
Where akrth backed rubber adhesive duct tape Is installed, mastic and drawbands ere used in combination with
oloth backed, rubber adhesive duct tape tc $eal beks at the connections.
MINIMUM REQUIREMENTS FOR DUCT LEAKAGE COMPLIANCE CREDIT
Duct Diagnostic Leakage Terstng Results (Maximum 6% Dud Leakage)
CFA: CFA Leak Max ]Tested Leak f ��
System o r--- J
Indicate the max um a our le Duct Leakage and the oalculatlon used:
0.7 x Floor Area x (0:06) for Climate Zone 8 through 15
C.5 x Floor Area x (0.06) for Climate Zones 1 through 7& to
X 400 x (Cooling Capacity In Nominal Tone) x (0.06) 43
21.7 x (Heating Capaoity in Thousands of Output BTU per hour) x (0.08)
Other
U -u7 Pressurization Test Results (CFM Q 25 PA)
'100 x Teat Leakage / Fen Flow = °h Leakage 9.25
Check Box for Peas or Fait (Pass = e% or Less) Pass r J 8
System [= of w b
Indicate the maximum a lba le Duct Leakage and the calculation used;
0.7 x Floor Area x (0.06) for CAmato Zone 8 through 15
0.5 x Floor Area x (0.08) for Climate Zones 1 through 7 & 16
x 400 x (Cooling Capacity in Nominal Tons) x (0.06) 34
21.7 x (Heating C211120y in Thausands of Output BTU per hour) x (C.08)
Other
uct Pressurization Test Results (CFM Q 25 PA)
100 x Tesl Leakage / Far, Flow e % Leakage
Check Box for Peae Or Fail Pass a 6% or Less) page x a
System rISi of
Indieatethe`nlaxmum- _ _ . - ...
0.7 x FloorAros
0.5 x Floor Area
x 400 x (Cooling C
21.7 x (Heating I
Other
Uu-7 Pressurization Te
100 x Test Leakage i F
Check Box for Peas or
Raters Certiying Signa
r•4uu I-uc ta-va) Action Now T-24CF4RTDrr80ro.xls
�:Ojl�f. Certificate ®f Occupancy
U '
ouiRro
ti
of��Building 1,� p � Safety Department
This Certificate is issued pursuant to the requirements of Section 109 of the California Building
Code, certifying that, at the time of issuance, this structure was in compliance with the
provisions of the Building Code and the various ordinances of the City regulating building
construction and/or use.
BUILDING ADDRESS: 56-100 MUIRFIELD VILLAGE
Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0203-026
Occupancy Group: RR=3 Type of Construction: VN Land Use Zone: RL
Owner of Building: SRHI, LLC Address: 16940 VON KARMAN AVE, STE200
City, ST, ZIP: IRVINE, CA 92606
By: BILL GORDON
Date: 12/4/02
Building Official
POST IN A CONSPICUOUS PLACE