SFD (0202-131)LICENSED CONTRACTOR DECLARATION
I t;ereby 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
5 B
c'"" A -Signature of Contractor
r
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). intended.
( ) I, as owner of the propgrty, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code). i
,
() 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
S ciion 3700 of the Labor Code, for the performance of the work for which this
ermit is issued. My workers' compensation insurance carrier & policy no. are:
Policy No.
Carrier Pyr,°T�.0 E�.�1.E: I1�T;3, 4s0100273
(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.
Date:.°') Applicant
[;n/
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code; interest and attorney's fees. g
i' t
IMPORTANT Application is hereby made to the Director of Building and Safety.
for a permit subject to the conditions and restrictions set forth on his, i
application.
1. Each person upon whose behalf this application is made & each person at s
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnity,
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation,
I certify that I have read this application and state that the above information is`:
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon .
the above-mentioned property for inspection ur • oses.
Si nature (Owner/A ent)' / 7 _Date ` +t L/r,
BUILDING PERMIT PERMIT#
�
0202-1 31
DATE VALUATION LOT TRACT
f
JOB SITE
ADDRESS _3y dgycy anv�7�"a
APN
76'2-1.0"005
OWNER
CONTRACTOR / DESIGNER / EN &NEER
.`3k yn"
MkZ OR COAL OP.1AdivC
1555ML1 VON XM.�M.AVZ :;�M. 2W
23 �.0 OP6VTxt.;E`L�1.,�t►�SWT 245
XR.MITE C -A 92606
3+1, VORT23BA.CM CA 92"o
(9•t9)'719»497 y CIBIN GIMA
USE OF PERMIT
P004 SPA OR L)RIiI'M1',Y APPROACH. 7516 PLAN t;:UEt, K FE 9
OVIC17 ION F0,X VIULNIPC.F TSVIU.ANCE OF SAME PLAN TYPE
CUSTOM CONSTRUCTION :X810.00$.V
OF
QFtvilRt471.W.R1..43:.r3J�'672�
�7��y JyriC lr($,•
�{; ,t�p.y�'p'v�,r�; t}.y•�y ��p�,�•��p�lYp.E.�,LED4.01V_,r
1�1f.I4YAr FEE, S1D.EY3iid&.a�1L'�A
COWSTSTlrGI''ION YM 101 _00"-M000 11,427.00
PLAN CHECK. 211-00"39-318 $294.0
F►+ 1ECHA.NICAwFUl 101-M-421.000 $124.00
XC:T)UC:.AL IF'9E' 101-000-420-tiW $A3.06
P'140IMRINM FFM 101-.000419-0C3C1
S'PTi.040 MOi ION PRO.9931D 101-000-241-.000 $32.4
01 DINO FU $20.00
LJEVELOPLFt IMP!iC;'}!' YU? z ;, $1,911'7 oo
ART IN PiJr`t. ?LIC: PLACES - RESM 2 a0.000444,d)(YJ 011.82
t•
D $ '1B.'I jf L Cd ? ETCd,10),,T AND PLM (M=�r�
$t's 13.10
MON�, %�
1 P1^�I.J.c MM
$0.00
I
FEB 19 2002 1 LPERNUTIVER'S.DI7ENOW
WYOFLA(lUIRTA
$4x51 :.3r'�0
FINAMCF07P3 ,
a.: 9
.
RECEIPT
DATE r' r
��
r Y
�k�w
DATE/ F AL 1) IN TOR
�I
�..
✓"
V Lr
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Farms &Footings
Ducts
_
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck d
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final 0
BLOCKWALL APPROVALS
POOLS - SPAS
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 Q�- _ _
Water Piping
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral _
Pool Cover
Sewer Connection �/ i
Encapsulation
Gas Pipingn—�
Gas Test
Appliances 11
Final
Final
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 j
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
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 #: 5
SITE ADDRESS: 56-280 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 CO TRACTOR: WESTERN INSULATION, L.P.
LICENSE NUMBER: 7.448
BY:
TITLE: PRODUCTION N ANAGItR
DATE: SEPTEMBER 2d2002
SEP.30.2002 11:=1 176023:;4081 11IRYER ROOFING #3484 P.002/011
A—i6
C'orperate Office:
Leon 46289U Phrne: (760) 1137-9R88Escondido, CA 92(.146 FAX: (760) 737-0353
Lim-& 9 h63581
WESTERN PACIFIC HOUSING
LA QIT INIA
760-:647022 (FAN)
Attn: JOHN
Roaring on "LEGENDS rad, Y.G.A. WEST" Ph 313 LUT #2005
09-30-02
Mayer Roofing has supplied and installed "2 " O'haain cloaked roof vents, on lot t>~ 2005
at 56-280 MUIRRELD V11,ILIAGE, Tile vents have been installed per manufacturers
specifications.
Note: lxact vent locations arc determined by builder
IlESPECTFY1L LY SUBMITTED
SCO'rr BEECHAM
OPERATIONS MANAGER
Mayer Rearing, Inc.
Page 1 of 1
558 1 Jbra,'y Street , San Funnndo. CA 41340 193 Or;inge StrCCI . Riverside, CA 92502
(A 1 8) 839-6964 . 1'A?: (s 11) S,R-449; (909) 792-0601 . i AX (909) 7$2-08U4
CERTIFICATE_ OF FIELD VERIFICATION AND DIAGNOSTIC TESTING Ti ht DuCt6) CF -4,R
PROJECT INFORMATION
Project Title:
La Cala
Project Address:
LA Quints
Builder Name:
Western Pacific Homes; Michelle Lopez
Voice r ;
949442-6188 x 452
Builder Contact:
John Z'ieman
Voice k :
760-564-7555
Project ID W,
26838-2
Sample Group 9:
Phase 3b
Lot s:
2005
Plan *
g
Address:
t— - 68-280 Muirfield village
HERS INFORMATION.
HERS Rater:
Scott Johnson Jayme Carden
Certftation e :
CCCSJ614037 CCNJC615157
HERS Firm:
Action Now
Voice 0:
949.631-2274
Address:
2575 Westminster Avenue. Costa Meea, CA 92627
HERS Provider.
CHEERS
Voice
818-407-1500
HERS Address:
9400 Topanga Canyon Blvd, Chatsworth, CA 91311
HERS RATER COMPLIANCE STATEMENT
11T-24 Complianoe Credit was Taken for Tight Ducts
The ouse was:
x Tested (-",Approved as a part of sample, but was not tested
x The installer hall p d a copy of CF-bR
x Air Distribution System is Fully Ducted (sheetmetal, ductboard or flex duct)
Where doth backed rubber adnaslve duct tape is installed, mastie and drawbsnds are used in combinaiion with
cloth oacked. rubber adhealve dud tape to seal leaks at the connectione.
MINIMUM REQUIREMENTS FOR DUCT LEAKAGE COMPLIANCE CREDIT
Duct Diagnostic Leak Testing Result$ (Maximum 6% Dunt Leakage)
CFA: CFA Leak MaxTested Leak
System
Indicate the max mum a 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 x (0.06) for Climate Zones t through 7 8 16
x 400 x (Cooling Capacity in Nominal Tons) x (0.06) 48
21.7 x (Heating Capacity in Thousands of Output BTU per hour) x (0.06)
Other
Pressurization Test Results (CFM 4125 PA)
100 x Teat Leakage / Fen Flow ■ % Leakage
Check Box for Pass or Fal! (Pass = 5% or Less) Pass
FailSystem
Indicate heT.mum O1 le
Duct Leakage and the cakutati0n used:
0.7 x Floor Area x (0:08) for Climate Zone 5 through 15
0.5 x Floor Area x(0.06) for Climate Zones 1 through 7 a to
x 400 x (Cooling CaPedty in Nominal Tons) x (0.05) 84
217 x (Heating Capacity it Thousands of Output STU per hour) x (0.06)
Other
ue PM$urizatior Test Results (CFM @ 25 PA)
100 x Teat Leakage i Fen Flow ■ % Leakage
Check Box for Pass or Fail (Pass = 5% or Less) Pagel x FOHL
System Iof
Indicate the maximum alf�ls Duct Leaka go and the calmlatlon used:
0.7 x Floor Area x (0 Oe) far Climate Zone 6 through 15
0.5 x Floor Area x (0.06) for Climate Zones 1 through 7 & 19
X 400 x (Cooling Capacity in Nominal Tons) x (0.06)
21.7 x (Healing Capacity in Thousands of Output BTU per hour) x (0.08)
Other
DZ7 PreesurliMion Test Results (CFM 6 25 PA)
as -
100 x Test Leakage ! Fan Flow = % Leakage
Check Box for Pass or Fail (Pass ■ W or Less) -An P806L x I Fa,�
Raters CartVng Signature Mr �/L Qr � Date ^(%
F2001-02 (3-02) Action Now 7-24CF4RTOmecra.xte
Certificate of Occupancy
q1CV
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: 56-280 MUIRFIELD VILLAGE
Use classification: SINGLE FAMILY DWELLING -Building Permit No.0202-131
Occupancy Group: RR=3 Type of Construction: VN Land Use Zone: RL
Owner of Building: SRHI, LLC Address: 16940 VON KARMAN AVE STE 200
City, ST, ZIP: IRVINE, CA 92606
By: DANIEL P. CRAWFORD JR.
Date: 11/1/02 .
Building Official
POST IN A CONSPICUOUS PLACE