SFD (0203-023)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chaoter 9 (commencing with Section 7000) of Division N3 of the Business and
Professionals Code, and my License is in full force and effect.,.
License # Lic. Classr ! Exp. Daat�tte��yj ff
Date -D "/0"0 ^ Signature of Contractor, �o^�✓"� t -%r' x L
n
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 '&F Professionals
Code).,�--
O I am exempt under Section B&P.G for this reason
t�
DateIt.) - 6-!%' Signature of Owner,/>"'1.-
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.
1�( J)...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:
Carter AMERICAN PROTEC' Policy No. V�R03315470
(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 toy become subject to the
workers' compensation laws of California„and agree Pat if I should -become
subject to the workers' compensation4provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
Date: r^! a.+�._Applicant dtt_.:f (..«.:.,4
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 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.
r
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,forfinspedon purposes.
r4''1 l- -. d ! Date
Signature (Owner/Agent) _
BUILDING” PERMIT PERMIT#ryry
yn3'L%``,,r�y
�
DATE VALUATION =4,7,4 LOT r TRACT ��4
JOB SITE ADDRESS : d,tl4„,JAf;(FULD V.E,l.il Ab,
APN li36^.+�Ci cJ iY
OWNER
CONTRACTOR / DESIGNER / EN &NEER
SIS►,. LWI
:► -6aldco ]KOUSIN4 oa WeW ERN 1?h,C'mc, z
1�AR AN ANS S'#�/'���4q.�� 2O��i�,i9,,,,�[[
Y�L�opivv'�gql����y�x�ON OF :D,:k�.lF�C33.c.'.tO3/A�1
pp1��6�94�0qq��yVyON'
SLg.1P,i.k` E CA 92606
dd'�valL E CA 92606
(949)442.6199 mm.
1
USE OF PERMIT
GLE1FANMY 1;WUXW0
CUSTOM CON—iTRUCTION ;#,gtdxo SF
PORCIVtoATTO 913.00 SP
k°kMW.f PRE 90MMARY
CO1dSTRU(:'I'16a13 FEE 101.000-418.000 $1,4V.,60
'_N.A'N Ci•If:rK PEE 101-000-439-318 sl,tn01
MECHANICAL FIM. 4101.000-4�1-000 $124100
E1.Zr.0 MCAL P09 .101-000-420-000 $703.06
PLUMBING FEE 101.1 o-419-000 Si9Q175
STP.0140 MOTIOPd ME • RESID 101-000-241-000
Itl+.l I1d(? fit? 1.01-000-423.000 020,00
OEVEW.PER IMAM YZ $1,50”!
AcRX IN PUELM PIFACIA - II.IS.II:.270,000-445-000 3311.32
Y"
{Y
UB-TOTIA . CW8'i'C XJf! z0W A-3 z[��yyIL�.A11T (.r1H
1
s5'.1 r$010D
�ryy.
��r.�K ((���,.��yy
ie00 i' �A�a.L�i�A-,L961F.0L7
(1
$0100
TOTAL PEWMT]PNES D(TE BONY
r.
HAY 08
` CITYU
REC PT F�AtA �� BY
DATE FIVA L
INS CTOR
'%X1
INSPECTION,. RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
'Set Backs
Underground Ducts
Forms & Footings
_
Ducts
v
Slab Grade
Z
Return Air
_
Steell7a-
Combustion Air
Roof Deck
_
Exhaust Fans
0. K. to Wrap
-
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
POOLS - SPAS
BLOCKWALL A PROV LS
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
Pool Cover
Sewer Connection
��?
Encapsulation
Gas Piping
Gas Test t___
Appliances
04 -Dv
Final
COMMENTS:
Final
Utility Notice o ce (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
2
Final
Utility Notice (Perm)
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Tight
Ducts) CFAR
PROJECT INFORMATION
Project Title:
La Cala
Project Addroas:
La Quints
Builder Name:
Builder Contact:
Western Pacific Homes, Michelle Lopez Vofra e :
John Zieman
949-442-6199 x 482
project ID 0:
Voice #
28838-2
760-564-7555
Sample Group # :
Phase 3b
Lot fit:
2C04
Plan #
9
Address:
`58.390 MtulrHeid Village
HERS INFORMATION - - -
HERS Rater:
Scott Johnson Jayme Carden
Certification fit :
CCCSJ614037 CCNJC615157
HERS Firm;
Address;
Action Now Voice # :
2575 Westminster Avenue, Costa Mesa, CA 92627
949.631-2271
HERS Provider
HERS Addregs'
CHEERS Voice 0:
8400 Topango Canyon Blvd, Chatsworth, CA 91311
818.407-1500
HERS RATER CO N STATEMENT
X T-24 Compllon Wag ken for Tight Ducts
e e was;
Tested x Appr as a part of sample, but was not tested
x The installer pr d py of CF -6R
x Air Distribution tem ' . ally Ducted (sheetmetai, duotboard or flex duct)
Where Cloth back rubber adhesive duct tape is installed, mastic and drawbands aro used in combination with
cloth backed, rubber adhesive duct tape to seal leaks at the conneotions.
MINIMUM REOUIREMENTS FOR DUCT LEAKAGE COMPLIANCE CREDIT
Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage)
CFA:[� �CFA Leak Max Tested Leak
System
Indicate the ms amum alroMv to Duct Leakage and the caiculation 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 a 16
x 40D x (Cooling Capacity in Nominal Tons) x (0.06)
all -
21.7 x (Heating CaoacRy in Thousands of Output BTU per hour) x (0.06)
Other
Presaurltation Test Results (CFM @ 25 PA)
100 x Teat Leakage / Fan Flow e % Leakage
Check Box for Pass or Fail Pass = 6% or Less) Pass
M�� q
System of
Indicate the M00mum alUMble Dud Leakage and the calculation used:
0.7 x Floor Area 9 (0.06) 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 Nomlra) Tons) x (0.06)
21.7 x (Heating Capacity in Thousands of Output BTU per hour) x (0 06)
Other
u Pressurization Test Results (CFM C 25 PA)
100 x Test Leakage r Fan Flow' %Leakage
Check Box for Pass or Fail (Hass a 6% or Lees) Pass
system � of —� ai
Indicate the maximum airr�� ^••a I - --- - •
0.7 x Floor Area x (I
0.5 x FioorAre* x (I
x 400 x (Cooling Cap,
21.7 x (Heating Cap
Otter
0-0 Pressurization Test I
IDD x Test Leakage / Fan
Check Box for Pass or Fa
Raters CaantHylng Signator,
F -1-ud ia•ir[) Action Now I.24CF4RTDma=.xls
atr
EEP.30.2002 11:40 '_76::`2+3 081 N 0 N .�
RYER R F=CC ;r 434 2.0011011
D
Corporate Office -
P.0, Bi.)x 462890 ® , Phone: (760) 737-8988
Fseondido, CA 92046 D. FAX, . (760) 737-0350
. Licrnse l) 663581
WESTERN PACIFIC HOUSING
LA Q UINTA
760-5644022 (FAX)
Attn: JOHN
Roofing on "LEGEND$ 6a P.G.A. WEST" Ph 3B LOT #2004
09-30-02
Mayer Roofing has supplied and installed "1.5" O'haai>a cloaked roof vents, on lot # 2404.
at 56-3101 UIRFIELn ViLLIAGL, Tile vents have been installed per manufacturers
specifications.
Note; Exact vent locations are determined by builder
RESPEC:'i'F[TL.LY SUBMITTED
SCOTT REECHA�M
OPKRATIONS MANAGER
Mayer Roofing, -Inc.
Page 1 of i
558 Library Slree; . San Fern ndo, CA 91:40 193 Orange Street o Riverside, CA 92502.
(s 18) 838-6064 . FAX (818) 838-4493 (101)) 782-060.1 . FAX (909) 782-0804
WES'T'ERN 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 313
LOT #: 4
SITE ADDRESS: 56-310 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
LICENSE NUMBER: 79
BY:
TITLE: PRODUCTION
DATE: SEPTEMBER:
RACTOR: WESTERN INSULATION, L.P.
ER