SFD (0202-137)LICENSED CONTRACTOR DECLARATION
I hOeby 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
Date �A=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 am exempt under Section B&P.C. for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
f ;
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'
(x) 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 PACIFIC FA0L1311.4 Policy No. X801000
(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 sh II fort kith comply with those provisions.
Dater ~��r Applicant��rN��
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 is6bed 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 abo've-mentioned property for inspection purposes.
Signature (Owner/Agent)D_ate.�r'
BUILDING PERMIT PERMIT#
DATE VALUATION LOT P 0202-1311 TRACT .
JOB SITE
ADDRESS 1161) b� rXI Y i. D Vn XAG9
APN
762-390-00S)
OWNER
CONTRACTOR / DESIGNER / ENGINEER
rOF'CAJURIURWA
NYC
16940 WN141:CMMIT f=VR— ::100
23 CaRPORNIT; IAZA S'LCD2, 245
:iRVINE CA 92606
NIEWPORT'b1t AMM' Gds. 92660
(949)-1194975 117-5 f 6564
USE OF PERMIT
SPO .LOT 9 PLAN 98, PERIvIII.' DOES NOT !'PAGi..i. DE f;i..00K `WAIAX,
P004 SPA 0.1#.DRIVEWAY APPi:OAMI 75%PLAW Cf1,?ZK ME
1119DUC a 3013 FOR MULTAPLE .k;;u1.4ANC1? OF SAME P A14 'F' PI4
CUS 1 OTA WNSTRUCTION 963080 OF
..
PONCHMATIO 760.00 Sir
C' 1,ARAG;EbG`A2s•1 ORT 690,00 OF
VLF.if7�~A }•'a�6l C11ai"., or, 'Ms Od'7 SIXIMMIAl.Ci•
201,442W
y.�5 (pS•
�.NF.IVlr�+qy .Q'�� 7 C11E;►Si16?LLi..].
i Lti�aM''l ltti "i'lt?Pl FEE 101-000-418-000 '$1'rr`6.510
1%d,<AN CHECK P101F 101-X100-4: 9-318 $260.17
101.000.421.000 $04100
EL d"1'C.tI atl..1101^00"20.000 $182.41
PLUMN14 MF 101-000419-000 5205.135
31TWH 3 &aO'I'1OIN FFY, - RESID 101-000-241-000 $28.14
i'1{$iT311• O R17 101-000 423-000 100.011)
DEV21LOPEP.1ANgPACT PEE _ $1,90Y 00
ART DR 1 USUC:.IY.LACES'- �is+�Wr 270-000-445-000 $/.03166
i
•a
4 ,
SUB -InTAL PUA114 CHM LI
jy 5,373 r ,AID)' W
$0.00
P-W.MT P111.1 -EN DIN now
FEB 19 2002
WYOFLAQUIRTA
RECEIPT
DATE,/rte'. it
BY
DATE F ASD ^.
SPECTO
p
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ll 2
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
Framing
iffF.A.U.
Compressor /
Insulation
/ ?j
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
rywall - Int.lath
Final
Final
_
/ _
_
POOL . S $
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 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
Sewer Lateral
Sewer Connection
a^
Pool Cover
Encapsulation
Gas Piping
Gas Test
_
Appliances
Final
COMMENTS:
Final
Utility Notice
(Gas)
�l
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
000" A
Main Service
Sub Panels
M Alt --
Exterior Receptacles
7
G. F.I.
Smoke Detectors
_
Temp. Use of Power
Final
Utility Notice (Perm)
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 3B
LOT #:
SITE ADDRESS: 1567160 MUIRFIELD VILLAGE - LA QUINTA CA.'
----------------------------------------------------:-: -------------
EXTERIOR WALLS: BAITS
MANUFACTURER: JOHNS MANVILLE THICKNESS: 6 3/4" R- VALUE: R-19
CEILINGS: BATTS
MANUFACTURER: JOHNS MANVILLE THICKNESS: 11" R- VALUE: R-30
GENERAL CONTRACTOR: WESTERN PACIFIC HOUSING
BY:
TITLE:
DATE:
INSULATION NTRACTOR: WESTERN INSULATION, L.P.
LICENSE NUMBr: 79 484
BY: AM
TITLE: PRODUCTION ANAGER
DATE: SEPTEMBER 2q, 2002
SEP. 3 0 2 CY I1 4'3 1"'502334ROOFING
D
Corporate Off i cc:
RO. Rox 452890
NC D
E'-.-,00ridi&,CA92046-
.Licewell 663581
#3484 P.0061011
Phoue: (760)737-8888
)737-8888
FAX: (700) 737-0350
F-74
WESTERN PACMC HOUSING
LA QUrfTA
760-564-7022 (FAX) -
09-30-02
Attn: JOHN
Roofing on "LEGENDS. (@ P.G.A.-MIST! Ph,31B 1,0Z 4. ZW�_
Mayer RooEng has supplied and installed " 13 " 01haffin cloaked Mf vents , on lot # 2009,
at 56-160 MUIRFIELD VILLI AGE, Tile vents have been installed per manufacturers
specifications.
Note, Exact vent locations are determined by budder
RESPE&FULLV SUBMITTED
SCOTT - BEECHAM.
OPERA -!-BONS MANAGEW--
Mayer Roofing, Ik.
Page I of I
5511 Library Sircct, . San Fernando, CA 91340 193 Orange Street . Riverside, (:A 92IO2
(8;: ') 1, 8) 8.-, K-6064 , IAX f8 S 838 -449, f909)792-0601 a FAX (909)782-0804
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Tight Ducts) CF -4R
PROJECT INFORMATION
Project Titte:
La Cale
Proiect Addross:
La Quints
Builder Name:
Well' em Pacific Homes. Michelle Loper -
Voice
949.442-6199 x 462
Builder Contact:
John Leman
Voice
760-564-7556
Project ID #:
28838A
Sample Group a:
Phase 3b
Lot e:
2009
Plan 0
8 �^
Addre69:
—WIW lAuirWd Village
HERS INFORMATION I&V -+
HERS Rater.
Scats Johnson Jayme Carden
Certification 0:
CCCSJ614037 OCNJC815157
HERS Firm:
Action Now
Voice 8:
949 91-2274
Address:
2575 Westminster Avenue, Costa Mesa, CA 92627
HER$ Provider.
CHEERS
Voice #:
818-407-1500
HERB Address:
9400 Topanga Canyon Blvd, Chatsworth, CA 91311
HERS RATER COMPUANCE STATEMENT
®x T-24 Compliance Credit was Taken for Tight Ducts
The house was:
Tested F77Approved as a part of sample, but was not tested
x The installer has provided a copy of CF -6R
x Air Distribution System is Fully Ducted (shestmetal, ductboard or flex duct)
Where doth backed rubber adhesive duct tape is installed, mastic and drawbinds are -used in Combination with
doth backed, ntbbar adhesive duct tape to seal teaks at the Connections.
MINIMUM REQUIREMENTS FOR DUCT LEAKAGE COMPLIANCE CREDIT
Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage)
CFA: L CFA Leak Max Tested Leak
Systemc
Indicate the ma murn e e Duet Leakage and the calculation used:
0.7 x Floor Area x (0.06) for Climate Zone 8 through 15
0.5 x Floor Area x (0.06) for Climate Zones i through 7 8 16
X 400 x (Cooling Capacity in Nominal Tone) x (0.08)
21.7 x (Heating Capacity in Thousands of Output BTU per hour) x (0.06)
Other
D0 Pressurization Test Results (CFM lo 25 PA)
100 x Test Leakage f Fan Flow = % Leakage
Check Rox for Pass or Fail Pass = 6% or Less) Passa
SystemlmU of -
Indicate the ma um a owa le Duct Leakage and the calculation used:
0.7 x Floor Area x (0.08) for Climate Zone 8 through 15
0.5 x Floor Area x (0.06) for Climate Zones 1 through 7 d 16
x 400 x (Cooling Capacity in Nominal Tons) x (0.06) 84
i1.7 x (Heating Copecity in Thousands of Output BTU per hour) x (0.06)
Other
D-0 Preasurization Test RestA6 (CFM & 25 PA)
100 x Teat Leakage / Fan Flow = % leakage
Check Box for Pass or Fail Pass = 6% or Less) pass a
System of
ll
Indicate the maximum a ,ours Is 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 x (0.06) for Climate Zones 1 through 7 6 16
X 400 x (Cooling Capacity in Nominal Tons) x (0.06) 95
21.7 x (Heating Capacity in Thousands of Output BTU per hour) x (0.08)
Other
Uu-a Pressurization Test Results (CFM 1025 PA)
100 x Test Leakage / Fan Flow = % Leakage
Check Box for Faso or Fail (Pae$ = 0W Less) /a pug a,
Raters Certifying Signature
Date ID Z
i
F2001-02 (3-02) Acton Now T-24CF4RTDmacrp.xl6