SFD (0203-024)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. ,__7
License # Lic. Class 9 Exp. Date
67570 / 1 rad.
Date /- "/C"' C%:"�% r 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:
( ) 1, as owner of the property, or my employees with wages as their sole f
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 °�—
O 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 3700.6f 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 fAMF?1133.(,%Q4 PROTRC' Policy No. 15DR035517
(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 mariner 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.
Date: 9—'i Applicant
Warning: Failure to secure Workers' Compensation, C/o, is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each: person at .
whose request and for whose benefit work is performed under or pursuant to x
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application -and state that the above information is
correct. I agree to comply with all City;' and State laws relating to the building
construction, and hereby authorize, representatives of this City to.enter upon
the above-mentioned property for inspection`purposes.
Signature (Owner/Agent) �{ i Date `
� k.I rr+.--�_ ; w
BUILDING PERMIT PERMIT0#2}3
4
DATE VALUATION ��� LOT "p TRACT 281338-2
ter: • �. 42JOB
s��
ADDRESS y W220 AV)UU - X N°�,eAUE, y
APN 762-3"-007
OWNER
CONTRACTOR / DESIGNER / ENGINEER
Y R`r 4QI VUitiT K f4R td P�Y1r+. q.F"j3 200
Dr0=11T OF DIRIHOPI C()N
IR 'E CA 92606
MWE �.,�`i{{92�'06
`
(94,9,744.2-6.199 4[p��Jl=a7 7,
USE OF PERMIT
1
i,iV�Qy *� .i.�q�'1y"kt�•�J„pE�. 41 i7it; Y/��.•K t'1r 1JIL t; t.• m Li �1i,�.,.�„
a�..';iy�1U3'
P004- SPA Q11 7J «i��l fS�i A APPROACH.
CUSTOM C OVIPTRUCTTON 3,302.00-.3p
PO.R.0 HA)IAITIO 760.00 SF
0A.RAWCA.RPOF�t A" . 06100 VF
�'$MWA lTClZ Cogr C.*Ir C'{1!.�ia� ��'f�l�Y1
.281,442.80
FEE SUMMARY r
CCMTRUCTION FRE 101 -000 -41S -k,000 51.111,.50
PL" CHECK FEE 101-000439-318 $1,040.69
ME(;Fi,€` IC AL FEE 101 •000^421.000 $3.14.00
EL.f.,.C:`f ;l ICAL, MEE S1183.20
WUIl+SBNO FEE 101-000419.000 S20171
STRO740 MOTION FFM - FF4,IrJ '101-000-241-000 $32.14
C1iYADINGAR V10100
DLA"JEi.,C7PENR 134B1P MCT 4 F%, $1,9Ca? o
ARUN PUBLIC PLltrol•.;u' - RE' WE 270-000-445i-000 �Bn3,6
z
:SUB -TOTAL. COMYR.UM'ICYN AND PLAINT CMCK
9
MUS :PRL? -PAID 17MS
p� TAL PMOM' YMR DIJE NO
4X7.8 .
CITYOFLAQUINTA
11— FIN C
RECEIPT -1
-DATE ;
e- C)
- o
BY
DATE FI LED
o
TOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms &Footings _
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap dO _
F.A.U.
Framing 'L(o Z
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath y _
Drywall - Int. Lath v
Final
Final
POOLS - SPAS
-
BLOCKWALL APPROVAL
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPRQ►VALS
Gas Test
Electric Final
'�v����/0�.�
Waste Lines �i��JIJ��
Heater Final
_ _
Water Piping /
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans _
O.K. for Finish Plaster
Sewer Lateral � (�j j0 s
Pool Cover
_
Sewer Connection -///�
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
��r/o��
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.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
CERTIFICATE OF FIEL.O VERIFICATION AND DIAGNOSTIC TESTING (Ti ht Ducts) CF4R
PROJECT INFORMATION
Project Title:
La Cate
Project Address:
I-8 Quints
Builder Name:
Western P8Cft Homey, Michelle Lopez Voice # ' 941-442-6199 x 482
Builder Contact
John Zismari Voica # : 760.564-7555
Project ID S :
28838-1
Sample Group 6:
Phase 3b
Lot #:
2007
Plan #
9
Address:
56-220 Muirfleld Village
HERS INFORMATION
HERS Rotor:
Scott Johnson Joyme Carden
Certification 0 :
CCCSJO14037 CCNJC615157
HERS Firm:
Action Now Voice 0: 949$31-2274'
Address:
2575 Westmlme.ter Avenue, Costa Mesa, CA 92627
HERS Provider.
CHEERS Voice # : $18.407.1500
HERS Address:
9400 Tcpanga Canyon Blvd, Chatsworth, CA 91'311
HERS RATER COMPLIANCE STATEMENT
T-24 Compliance Credit was Taken for Tight Duets
14;ousa was:
Testedx Approved as a part of sample, but was not tested
x The installer has prov a copy of CF -6k
x Air Distribution System is Fully Ducted (sheetmetal, ductboard or flex duel)
Where cloth tracked rubber adhesive duoi tape is installed, mastic and drewbands are used in combination with
cloth backed, rubber adhesive dud tape to seat leaks at the connections.
MINIMUM REQUIREMENTS FOR DUCT LEAKAGE COMPLIANCE CREDIT
Duct Diagnostlt Leakage Testing Results (Maximum $% Dud Leakage)
CFA: CFA Leak Max Tested Leak
System o
Indicate the maximum a we le Duct Leakage and the calculation, used:
C.7 x Floor Area x (0.08) for Climate Zone 6 through 15
0.6 x Floor Area x (0.06) for Climate Zones 1 through 7 & .16
x 400 x (Cooling Capacity In Nominal Tons) x (0.06) 40
2Othe1,7rx (Heating Capacity in Thousanos of Output STV per hour) x (0.08)
T0 Pressurization Test Results (CFM Q 25 PA)
100 x Test Leakap I Fan Flow = % Leakage
Check Box for Pass or Fail (Pass = 6% or Lela) Psae ai
System ® of
Indicate the max mums ala 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 (0.08) for Climate Zones 1 through 7 & 16
x 400 x (Cooling Capacity in Nominal Tons) x (0.06)
21.7 x (Nesting Capaelty In Thousands of Output BTU per hour) x (0.05)
Other
TrO Preaauriaalion Test Results (CFM Q 28 PA)
100 x Teat Leakage I Fan Flow = % Leakage
Check Box for Pass or Fell Pass = 6% or Less) Pass m
il
System IIme of
Indicate the me mtun a to Duct Leaka6e and the calculation used;
0.7 x Floor Area it (0.06) for Climate Zwm 8 through 15
0.5 x Floor Area x (0.06) for Climate Zones 1 through 7 & 16
X 400 x (Cooling Capacity in Nominal Tony) x (0.06)
21.7 x (Resting Capacity in Thousands of Output BTU per hour) x (0.06)
Other
uet Pressurization Test Results (CFM a 25 PA)
100 x Test Leakage / Fan Flow w % Leakage
Check Box for Pass or Fail (Pass = 8,*or less) --I Pon
Raters Certifying Signature([_ = e rZ / ��p�f'�` Date —0
F2001-02 (3-02) Action Now T-24CF4RTDmacro.xls
WES'T'ERN INSULA'T'ION, L.P.
4211 Latham Street, Riverside, Califomia 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 36
LOT #: 7
SITE ADDRESS: 56-220 MUIRFIELD VILLAGE - LA QUINTA CA.
----------------- -----------------------------------------------
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/794484
484
BY: (-
TITLE: PRODUCTIO ANAGER
DATE: SEPTEMBER 26, 2002
SEP.30.2002 11.42 !716023"L081 MAYER ROOFING ;13484 P.004J01i
u
C:urpurate Office:
P.O. Dox 462890® ® Phonc_: (760)7'-7-8688
Esmodido, CA 92046 FAX: (760)737-0350
License 0 663591
WESTER .PACTFIC HOUSING
LA QUI NTA
760-564-7022 (FAX)
Attn: JOHN
Roofine on "LEGENDS lad P.G.A. WEST" Ph 311 LOT #2007
09-30-02
Mayer Roofing 11;as supplied and installed "12 " O'6aaiin cloaked roof vents, on lot # 2007
at 56-220 IviUIIt MLD VILMAGE, 'file vents have been initalied per manufacturers
specification,;,
Note: Exact vent locations are determined by builder
RYSP:ECTFULLY SUBMITTED
SCOTT BEECHAM
OPERATIONS MANAG=ER
Mayer ]hoofing, Inc.
Page 1 of 1
558 Library STI-eet . San Funan do, CA 913:10 193 Orange Street . Riverside, C:A 92505-
1',.18) 538-6064 . lA\ (41 i;) 8;33-44?:3 (909)78Z-0601 FAX(909)782-08W
r
February 16: 2004
Andy FracPr 5z,
Toll Brother -
73 -121 Fred Waring Drive, Suite 100
Palm Desert, Ca 92260
Re: Mo irfield at PGA West
GE.LG Job#60368
Lo-. 10
Lo+. 8
Loi 7
Ph�-se l
Dear Andy F:.-aser,
This letter ar.'vises that we have observed the structural requirements that are visible during construction
at the time cf Our site visit.
Gouvis Engir.4eering believes .that the as -built construction at the time of our visit is in general
conformance with our swuctunl plans and rAL-va.nt correspondence issued by our office relating to the
above referenced dwelling.
We observe, the building in its framed condition prior to instailativn of drywall and stucco. We obrervad
the visual and accessible structural requirements. (Exclusions are items such as: size of footings,
reinforced steel in the foundations and roof sheathing.)
This report : s understood to be an expression of professional opinion by this engineer, which is based on
his best knowledge, information and beliefs. As such, it consists of a report for only structural ulements
(as above ovdined) and is neither a guarantee nor a warranty, expressed or implied for other trades or
r equirements of subject dwelling.
Respectfully Submitted:
GOUVIIS ENGINEERING CONSULTING GROUP, INC.
Cliff Hattar C Magdy Yacoub
Director, FiMd Operations
('A 111t'.t::.m1on.CA
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SIAf1S9
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Certificate of Occupancy
• TM
� w
OF 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.
r ,
BUILDING ADDRESS: 56-220 MUIRFIELD. VILLAGE
Use. classification: SINGLE FAMILY DWELLING Building Permit No.: 0203-024
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: SRM, LLC Address: 16940 VON KAIRMAN AVE STEM
Building Official
POST IN A CONSPICUOUS PLACE
City, ST, ZIP: IRVINE, CA 92606
By: DANIEL P. CRAWFORD JR.
Date: 11/1/02