SFD (0202-135)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
..Signature of Contracto�r%�f,/,/Jm ,'t`�� f�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).
( ) 1, 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
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.
( 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 PACt%f:CPAOLE Z0D. Policy No. 430.10'3`.d"d"«3
(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
Warning: Failure to secure Wofkers' Compensation coverage is unlawftlt'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 Y
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 upgn
the above-mentioned property for inspection purposes �V
Signature (Owner/Agent' +e'jc�`�?---�. - Date`
BUILDING PERMIT PERMIT #
DATE /�� VALUATION LOT{� 3•+ TRACT
JOB SITE
ADDRESS 56-190 .' 1TRr.€F'L,T) VE LA GE
APN
762-390-008
OWNER
CONTRACTOR / DESIGNER /EN61NEER
(({{RM LLCIIi
ppETIR Or, CAppyJLNIA WC
16940 V0 9,ARMZ M AVE M 200
23
CA 92606
1`&EWPClXi'MAM CA Sr2660
6364
USE OF PERMIT
SY0.1XITE 1 IA14 O.A k. PERMIT DOES NCJ+'t YNCLUDISt tILOCK UAi'.JI %,
PC3O4 SPAS, Ok D[ F.;WAYA-PPROACH. M MAN CHECK PRE
RZ113ZJG"P1014 4t'OR MUL TIPLS ISSU,F LICE OF SAME P:i,NN 1'YPF
CUSTOM C014 RUCTIUN �%O!coq 3?
PORC;1-bTIATIO fiLZOO sr
CLARAOFI(ARPORT Do P
D COV. Or C0N8VRTX,d.7•0X
31-4,72C,00
ry.,ePyt7i��'.G�.L.Mi'1A.L
T „a.,�L�J•':6f Y7ub7+ 1ridAYA�8,�6.8 d.
COXISUR11C`3011 FEE 101t000-418-000 $1,427.00
PLAIN CHECK dry, 101-00".39-318 $2311.0
MECHANICAL FEE, 101.000.421.000 $124.00
Y,,Lfxd TPUCnAL", Z 101-000-4261000 $20.06
PLUMMO FEE 101m000 -419.0(X) W910.7„;
STitC NCI NOTION FSE - RRSID 101-000-241-000 $3141
(l, DMO RE 101.-000-423m000 09.00
i?EVELOPI�I•i�• JMPACT PIaE l,r1c'+1 f!P
ART tFi PUBUC P1.AC.I s • i2" rsJr 2`70 -OW -9.4S,000
c"1m"`lyVA1.,C(➢NUIkT."i""nol.V howin ajuv('n..A"dl;1o:
i,XISS 1'II I>'AW FEW,
$0.00
tFEB19 2001
COlY®FLAQLINI?A
E A D� INSPECTOR
:BY4 C,,
rv.....�.
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
71
Return Air 14
Steel
Combustion Air
Roof Deck
Exhaust Fans
_
0. K. to Wrap
F.A.U. /
_ _
Framing 2_
Insulation
Compressor
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath V
Final
J
Final
_
POOL - S AS
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
/ —
Waste Lines
Water Piping
Gas Test
Electric Final
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral_q�� _
Sewer Connection �'�y(
Pool Cover
Encapsulation
_ -
Gas Piping
Gas Test _i,YL
/� -
Appliances l
Final
COMMENTS:
�Ixw
- —�i�sTGtGi'lJrl�
Final ,/ (_
_
Utility Notice (Gas)
ELECTRICAL APPROVAL
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 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:
L
TRACT/PHASE: PGA WEST - LA CALA / PHASE 3B
LOT #: - 8
SITE ADDRESS:56-190 MUIRFIELD VILLAGE - LA QUINTA CA.
t
EXTERIOR WALLS: BATTS
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 CONTRACTOR:. WESTERN INSULATION, L.P.
LICENSE NUMBER . 944V4
BY: A M
TITLE: PRODUCTION tNAGER
DATE: SEPTEMBER126.2002 '
a' 5 3 G . 2 0 0 2 11:x:2 176023",4.061 "IAYSR ROOiIN:J
Corporate Office:Mw P.O. Box 462$0(1Lscondidn, CA 92046
License # 663581
WESTERN PACIFIC HOUSING
LA Q[JTNTA
760-5647022 (PAX)
Attn: JOHN
#3424 P.005/011
Roofn>e on "LFGF ) .A. WEST" Ph 3B LOT 42008
Phono: (760) 737-XX88
FA X: (760) 737-035u
09-34-02
Mayer Roofing has supplied and installed " 2 " O'haain cloaked roof vents, on lot # 2008
at 56-190 MUWIELD VJLL.IAGL-, Tile vents have been in,§ta]led per manufacturers
specifications.
Note; Exact vent locations are determined by builder
RESPECTFULLY SUsHrrTED
SCOTT BEECHAM
OPERATIONS MANAGER
!Mayer Re' offing, Inc.
,Page 1 of I
558 Library Strect . S2J1Feriiando, CA 9 13 0
193Y)ra11ge Silt?,l .Riverside. C'A ►J35O2
(818)83&'-6664 . FAX(919)83S-4493
(909)78-1-0601 . 1'AX (y09)7R2-0804
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TEST!NC, Tight Ducts) CF -4R
PROJECT INFORMATION
Project Title:
La Cala
Project Address:
La quints
Builder Name:
Western Pacific Homes, Michelle Lopez Voice P: 949-442-6199 x 462
Builder Contact
John Zloman Voice #: 760-564.7555
Project ID 0 :
29838-2
Sample Group 4:
Phase 31)
Lot *
2008
Plan a
9
Addr+ssg
66-100 Muirfleld Village
HERS INFORMATION
HERS Rater:
Scott Johnson Jayme Carden
Certification e :
CCCSJ514037 CCNJO615157
HERS Firm:
Action Now Voice d ; 949-631-2274
Address:
2575 Westminster Avenue, Costa Mesa, CA 92627
HER$ Provider:
CHEERS Voice 0: 818.407.1500
HERS Address:
9400 Topangs Canyon Blvd, Chatsworth, CA 9131 1
HERS RATER COMPLIANCE STATEMENT
rx� T-24 Compliance Credit was Taken for Tight Duds
he house was:
Tested =x Approved as a part of sample, but was not tested
x The installer hasp ed a copy of CF -OR
x Air 019 tbution System Is Fully Ducted (sheotmetal, ductboarJ or ilex duct)
tfdhere cloth backed rubber adhesive duct tape is installed, mastic and drawbands aro usod in combination with
doth backed, rubber adhesive dura tape to seal leaks at the connei:tons.
MINIMUM REQUIREMENTS FOR DUCT LEAKAGE COMPLIANCE CREDIT
Duct Diagnostic Leakage Testing Results (Maximum 6% Dud Leakage)
CFA: CFA Leak Max wrested Leak
System
Indicate the maximum a ale Duct Leakage and the Calculation used:
0.7 x Floor Area x (0.08) for Climate Zone 5 through 15
0.5 x Floor Aro* x (0.06) for Climate Zones 1 through 7 & 16
x 400 x (Cooling Capacity In Nominal Tons) x (0.08)
21.7 x (Heating Capacity In Thousands of Output STU per hour) x (0.06)
Other
Pressurisation Test Results (CFM ® 29 PAI
100 x Test Leakage /Fan Flow a Leakage
Check Box for Pass or Fall (Pass o 6% or Less) Pass a,
System ® of
Indicate the mmannunl atlwaabte Duct Leakage and the calculation used;
0,7 x Floor Aroe x (0.06) for Climate Zone 8 through 15
0.6 x Floor Area x (0.08) for Climate Zones 1 through 7 & 18
--57 400 x (Coaling Capacity in Nominal Tons) x (0.06)
21.7 x (Heating Capacity in Thousands Of Output BTU per hour) x (0.06)
Other
uo Pressurization Tact Results (CFM ® 25 PAI
100 x Teat Leakage f Fan Flow = % Leakage
Check box for Pass or Fail (Pass z 6% or Less) Pass s,
System 17-T-11 of
Indicate Life mazemum'-
0.7 x Floor Area x
0.5 x Floor Area x
x 400 x (Cooiing Cal
21.7 x (Heating Ca
Other
37a Preeeuriiation Test
100 x Test Leakage / Pei
Check Box for Pass or R
Raters Certifying Sidnatu
00-9-0 2--
macro.xls
Certificate of Occupancy
44
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: 56-190 MUIRFIELD VILLAGE
Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0202-135
3
i Occupancy Group.- R-3 Type of Construction: VN Land Use Zone: RL
r
Owner of Building: SRHI, LLC Address: 16940 VON KARMAN AVE, STE200
City, ST; ZIP: IRVINE, CA 92606
�_ By: BILL GORDON
! dot Date: 11/12/02
3uildingOffici
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