SFD (0203-025)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] j Exp. Date µ
DateSignature of Contractor
.Y
OWNER -BUILDER
I hereby affirm under penalty of perjury tl;,dt 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). j
( ) I am exempt under Section B&P.C,y for this reason
Date r_' -/r-- tn"-' Signature of Owner 4-t x : rM..,,,,_
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.
Sec( ) I have and will maintain workers' compensation insurance, as required by
tion 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 AMLtiWC'.k N PROM' Policy No. SBRO933470
(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 pqrovisionstof Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
PP j
Date: er. • r. A licant e!�
Warning: Failure to secure Workers' Compensation overage 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:k
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 allfCity, and,State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property fof' inspection purposes. >
/
Signature (Owner/Agent) .i frt �+ ' -- Date
BUILDING PERMIT PERMIT#��
DATE VALUATION' 24, 726AX) LOT 10 TRACT 28838.2
JOB SITE S +j 30 F � a i Wi tl��
ADDRESS
APN '762.39k"10
OWNER
CONTRACTOR / DESIGNER / EN (NEER
:s FA IWI,
LAMCOHOMWO WEMMM PAC2111 F
16940 V014.AM W17, 200
DiM011OFfi.'ILTI�'+1� CWT
IRVINE CA 92606
... CA 92606
WE
I��(949)442-6199
e��j CC 11
USE OF PERMIT
:113 GLE FAM LY DWk3LLWO
POOL, SPA: OR DIUrT.EWAY APPROACIL 73`No REDUCE`€OR TO PLAN
C:HWK IY^ FOR .MU TIPIA iSSUA34C Z OF SAME PLA14 TYPE
CUSTOM M CONSTRUC'MM V16'100 ISI
P'O.rR6' WPATIO 812.010 1;P'
CIARA IsrCARPOWt � IMI Sri
FSMIATM COST OF OO.i'�W�'�'.�VC".T101f
324,7 6.00
C014,53TRUC:TJON FEE 1011 00.418-000 t$1,4MO
PLAN CHECK rLD $218.00
3�EC��IICAI.,'(�'r�; ...10iA000�421.O�JCD '�124.�0
EI.1f.C;TRICAL, P&C, V03-06
PLIUMBIM ME 101-000-419-000 $199.75
5TRDNO:(ulOTION FE -,,RE ID ?oi -000-,2AI-Q-00 $32.47
CRADINO WS, 9101.1000.42.3-000 520100
SXi'2 WP2.R IMPACT 11141; $10907.00
ART 114 PUBLIC PIACE3 - R-88iC 270.000.445.000 M I X
D -Tt3 'AT. CONSTRI-'.ITC' 9 AND PUN t"HWX
S4,513.10
TZ,03PRE-PAID F 3
$01:00
YIERNEIP FEES WE N(YW
N�Fd��AF1q
RECEIPT
DATE BY
DA ALED
Cjl
IN ECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Retum Air
Steel
Combustion Air
Roof Deck
S
Exhaust Fans
O.K. to Wrap
pZ
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 _ f
POOLS -SPAS; "
BLOCKWAL
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 APPROVALS
Gas Test
Electric Final
Waste Lines
Z
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
_
������-
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
--
COMMENTS:
Final
�1//�(/G
- T a
Utility Notice (Gas)
— _ _ -
ELECTRICAL APP OVkLS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
_
FbQures -
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors o _
Temp. Use of Power
Final
—
Utility Notice (Perm)r'l/
! EP.30.2GQ2 1:i.43 "`r`233,C51 MAYER n0017I iG
#3%,34 P.007/01!
Corptira(e Office;R-0, Roc 4(2S9 , ® ® I'lime: (760) 737-8588
Escondido, CA 92046 FAQ: (760) 727-0350
License N 661591
WESTERN PACIFIC HOUSING
LA QUINTA
760-564-7022 (FAX)
09-30-02
Attw JOHN
KWfing on "LU&NAS (#I P.G.A. WEST" Ph 4A LOT 42010
Mayer Ropfing ha.5 supplied and installed " 19 " O'hagin cloakcd r02f I U, on lot .2010
t 56-130 NILTIRFIELD VIUTAGE, Tile vents have been installed per manufacturers
specificatic>'ns. w � .
Note: Exact vent locations are determined by builder
RESPECTFULLY SUBMITTED
SCOrt' BEECHAM
OPERATIONS MANAGER
Mayer Roofing, Inc.
Page I of 1
X38 f'ibi-my Suce( • Sall Fcrntuido, CA 91340 193 Orank Strcet . Riverside, CA 92502
(Kiss) 535-0064 . FAX (8!.!s) 8:39-4493 (909) 7fi'?-8601 • l'AX (90y) 782-•OK44
t
0
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 #: 10
SITE ADDRESS: 56-130 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:
INSULATION CONTRACTOR; WESTERN INSULATION, L.P.
LICENSE NUMBER: 944
BY:
TITLE: PRODUCTI?MANAGER
DATE: SEPTEMBER, 26,2%2
M
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING Ti ht Ducts CF -4R
PROJECT INFORMATION
Project Title:
La Cala
Project Addretis:
La Quinta
Builder Naim:
Western Padfic Homes, Michelle Lopez
Voice a ;
94"42-6199 x 452
Buikfer Contod;
Project tD e :
John Zieman
28838-2
Voice 0:
760.564-7555
Sample Group 0 :
Phase 4a
Lot N:
2010
Plan *
8
Address:
56.130 Mui field Village
HERS INFORMATION
HERS Rater:
S= Johnson Jaym® Carden
Certification M :
CCCSJ514037 CCNJC615167
HERS Finn:
Addros%
Action Now
2575 Westminster Avenue, Costa Mese, CA 92627
Voice # :
848.831-2274
HERS Provider.
HER$ Address:
CHEERS
9400 Topengs Canyon Blvd. Chatsworth, CA 91311
Voice a :
818-407-1500
HERS RATER COMPLIANCE STATEMENT
M T-24 Compliance Credit was Taken for Tight Ducts
The house was:
x Tested Approved so apart of sample, but was not tested
x The installer has prove ed a copy of CF -6R
x Air Distribution System is Fully Ductad (aheetmetal, ductboard or flex dud)
Where cloth backed rubber adhesive duct tape is installed, mastic and drawbands are used in combination with
doth backed, rubber adhesive dud tape to seal leaks at the connections.
MINIMUM REQUIREMENTS FOR DUCT LEAKAGE COMPLIANCE CREDIT
Duct Diagnostic Leaks a Tet Resufts (Maximum 5% Duct Leakage)
CFA CFA LeaK Max ®Tested Leak
System o
Indicate the max um a owa is Duct Leakage and the calculation used:
0.7 x Floor area x (0.08) for Climata Zone 8 through 15
0.5 x Fkmr arca x (0.08) for Climate Zones 1 through 7 d 16
X 400 x (Cooling CaporAy in Nominal Tone)i x (0.06)
21.7 x (Heating Capacity In Thousands of Output BTU per hour) x (0.06)
Other
U0 Prrsysurization Test Results (CFM 0 25 PA)
100 x Test Leakage / Fan Flow a % Leakage
Check Box for Pass or Fall P 6•h or Lou), Paas x al
System M of r 3
Indicate the maximum a owaI le Duct leakage and the calculation used;
0.7 x Floor Area x (0,06) for Climate Zone 8 through 15
0.5 x Floor Area r (0.06) for Climate Zoned 1 through 7 16
x 400 x (Cooling Capacity in Nominal Tons) x (0.06)
21.7 x (Heating Capacity in Thousarids of Output BTU per hour) x (0.06)
Other
DUE Pressurization Tost Results (CFM @ 25 PA)
100 x Test leakage I Fan Flow = % Leake
Check Box for Pass or Fail (Pass w 6% or Less) Pis Y a
Systsxn of
IndiCat® the max mun'-
0.7 x Floor Ares
0.5 x Floor Arai
X 400 x (Cooling t
21.7 x (Heating
Other
Tu7 Pressurization T4
100 x Test Leakage I I
Check Box for Pass of
Raters Ca". Ing Sign+
r///- rz -6 -�--
7lacro.xis
Certificate of Occupancy
I'm MTM
ext
OF9w Building & 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 56-130 MUIRFIELD VILLAGE
Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0203-025
Occupancy Group: R-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 Offi al
POST IN A CONSPICUOUS PLACE