SFD (0201-132)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (co'mmencing 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
7
' '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).
( ) 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 PACIFIC EACILE INS, Policy No. 4 010
(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
Codex LShail forthwith comply with those,,PrAyisjgns. el, 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 ow: 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.
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
thelbove-mentioned property19r-insgection pu poses. x
Signature (Owner/Agent) —Date
BUILDING PERMIT PERMIT#
DATE I VALUATION LOT TRACT
C y,Jt, 4�2�3,C<µl` 4JOB
SITE
ADDRESS +.�70ItilY�dt3 +'1 e73 V.I., AJjT
APN
OWNER
CONTRACTOR / DESIGNER / EN (NEER
200
23 CU O'11AT1,; P? x§113. M;�.M, 24
:IR' INE CA 92606
NE�7 PORT i".At+ �'2O
(949;719.4973 CW 6364
USE OF PERMIT
0'1? �, 1=2 PLAN 9UR. P1KR.11+llT UM -P,';4 5 INC IXID1!, E 1,0CX 'WAG1.,S;
P004SpA. OR. DRTVr,, .AY &PPR.OAC"H, 75% PL&N 011FCK FEE
I±EDUC'3ICN FOR YdIUIXIPIX ISSUAAICZ OF SA.W PIAN TYPE
CIJVO.M CONSTRUCTION 313I6,00 SF
POR.;.:if/3,'.h VO 81.2.00 SF
0ib.1RACIr..XAM"01t7` 8%.00 Sr
F.9Ty,Kf;. 1a.% COW OF i.^?<?.i°iVnIti.Ia11;0. l
11,512 1126m)
PXHMrX.FRE SUMMARY
CONSTPIUCTION PEN", 101-000-418.000 $1,427000
PLAN CiIJWK 714D-91 101-000-439-318 UR810
MECKANICALFIW. 101-00 0-4,21-000 91.71410it
X..EZTRICrix, IIEZ' 101-000.42W= $20:,4.06
P1,liA �a NCI>sRrr 101.000-419-000 $199.'?5
TROW MOTION IEL" - Ri�-''10 10 1 W -000 $22./4'7
ORADINQ FEE 101-000-423-000. $20,00
DEVELOPER ]PAPA.ICT I''L:ZW fjll,h07.i10
-ART dAf PLiI3d.IC P1 fiCE,S - I3Mi3; 270-V09-44$-000
s
7r",
BSA-Te,VAL C 0X;WT.i: Cr101,i 3yy1)y�P��yy�.A14 fes:','}7.
1RCK1+
DUEVOW
11MI.S1.310
FEB 19 2002
CITYGF�$gBt��,
RECEIPT,
DATE
DATE F 'ALED
INSPECTO
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
QZ a_
Ducts
Slab Grade
13 IIW&I— /(,L
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap 06,
b
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 a a2
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
�—
Waste Lines w
Gas Test
Electric Final
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
_
(o D L
Encapsulation
Gas Piping
Gas Test
/%d2
Appliances
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
Temp. Use of Power
Final /
Utility Notice (Perm) J ,ice t/a�
COMMENTS:
57
-.. v I - -- -- w
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 93/PHASE 3A
LOT #: 2002
SITE ADDRESS: X56=370 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
BY:
, a,/pl
TITLE: PFS DU TION MANAGER
DATE:
MAY 9, 2002
r .-,;UL.11.20Q.2 13:41 17602334081 NAYER ROOFING
u
Corporate Office:
P.O. Box 462890
Escundido, CA 92046
Liccnvc 0 663581
WESTERN PACIFIC HOUSING`
LA QUINTA
760-564-7022 (FAX)
Attn: JOHN
;2918 P.004/005
Roofing on "LEGENDS (4) PGA WEST" Ph 3 LOT #02
Phonc: (760) 7.37-8888
FAX: (760) 737-0.350
06-17-02
Mayer Roofing has supplied and instalkd "15 " O'hagin cloakcd roof vents, on lot #02
at.56- 70 MUIRFIELD VILLAGE, Tile vents have been installed per manufacturers
specifications,
Note: Exact vent locations are determined by builder
RESPECTFULLY SUBMITTED
SCOTT BEECHA.M
OPERATIONS MANAGER
Mayer Roofing, Inc.
Pagc 1 of I
558 T. brary Slrcct . San Femmdo. CA 91340 193 Qrangc Strcct . Rivetsidu, CA 92.502
(K18) 83S- ? A . FAX (8 18) 838-449:1 (1109) 782-060I . FAX (909) 782-080 l
x .'• � ;. �'" ,`t � d"�� } a rr'+.xi4suo.Fc.a,o- � .�.___ �. ;`�'�#yr r�' + �' : � � e x �} � ��.
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Tight Ducts) CF4R
PROJECT INFORMATION
Protect Title.
La Cala ., .
Project Address:
La Quinta
Builder Name:
Western Pacific Homes, Michelle Lopez
Voice # :
949-442-6199x462
Builder Contact:
John Zieman
Voice #:
760-5647555
Project ID #:
28838-2
Sample Group #:
Phase 3a
Lot #:
2002
Plan #
9
Address:
56-370 Muirfield Village
HERS INFORMATION
HERS Rater.
Scott Johnson
Certification #:
CCCSJ614037
HERS Firm:
Action Now
Voice #:
949-631-2274
Address:
2575 Westminster Avenue, Costa Mesa, CA 92627
HERS Provider:
CHEERS
Voice #:
818-407-1500
HERS Address:
9400 Topanga Canyon Blvd, Chatsworth, CA 91311
HERS RATER COMPLIANCE STATEMENT
T-24 Compliance Credit was Taken for Tight Ducts
The house was:
Tested r x Approved as a part of sample, but was not tested
x The installer has p`ro—vied a copy of CF -6R
x Air Distribution System is Fully Ducted (sheetmetal, ductboard or flex duct)
Where cloth backed rubber adhesive duct tape is installed, mastic and drawbands are used in combination with
cloth backed, rubber adhesive duct tape to seal leaks at the connections.
MINIMUM REQUIREMENTS FOR DUCT LEAKAGE COMPLIANCE CREDIT
Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage)
CFA:CFA Leak Max Tested Leak
System o
Indicate the maximum a owa 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 1 through 7 & 16
400 x (Cooling Capacity in Nominal Tons) x (0.06)
21.7 x (Heating Capacity in Thousands of Output BTU per hour) x
Other
uct Pressurization Test Results (CFM @ 25 PA)
100 x Test Leakage / Fan Flow = % Leakage
Check Box for Pass or Fail (Pass = 6% or Less) Pass
System� of
Indicate the maximum a owa 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 1 through 7 & 16
400 x (Cooling Capacity in Nominal Tons) x (0.06)
21.7 x (Heating Capacity in Thousands of Output BTU per hour) x
Other
uct Pressurization Test Results (CFM @ 25 PA)
100 x Test Leakage / Fan Flow = % Leakage
Check Box for Pass or Fail (Pass = 6% or Less) Pass
System r---1 of
Indicate the maximum a owa 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 1 through 7 & 16
400 x (Cooling Capacity in Nominal Tons) x (0.06)
21.7 x (Heating Capacity in Thousands of Output BTU per hour) x (0.06)
Other
uct Pressurization Test Results (CFM @ 25 PA)
100 x Test Leakage / Fan Flow = % Leakage
Check Box for Pass or Fail (Pass =^ or.Less) P
C v
Raters Certifying Signature -Date 8/19/2002
.,.r
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Coachels, �lgly YjDlfi "'d
rS60,0j .pWrI
ex 847 Ther ct
(760 )39 ma4 CA .9227 Fa:�iao,ct ca: ra,t,
85909 =t3X (76Q) 398-124 'nv>rt.gPl-r7 n8s
pA
77
AGFA.
kc
' rAstt: i
4nka.
C-ERMCATE OF COMPLjANCE
(C=8forWa Education Code 1 f620)
t?tajeat Narw. La Cala
Owner'aNaftte: idestei»n Pae iC s7n �e Dotr:: August 7, 20W
Prnjret Adtfregs; tt X -� Y y --�_� Pbone Ko. 9 bi$8
Project Defertption, __
APN:
See Attachment rp
Type Of➢cvelopment:
r• 28838-1 and .„,t._
�8-2 Loc ix :: 75 and 77
ZCommereio! 1 t t7tJ9
_ Industrial
Tota! Square Feel of B oildiag Area: _q -p -
Y^
C'Y"'ca"On otApplicnat'(Z'wnerc: The pt rsAt� si xttiHes t *,rTcot and _
:utter pem:Iry piP�Juf3 and ttia reprrsen s that h_ sshc is eulho'-i rd toe gtl an be}�alf of the O�waerldevela rCS Thts statomer..
Onted:
signature:
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SCRDAS Sail_ J es IM ♦ 1. ► 0. 4 . i J. . ,. A . r : a' s o ? A t a w Q• r r. :, o r r
At.CORbANC>E ti/f7J3 t3lv)r p ETgE FOLi.4� qNTS MR
C) VE Ekd fECT HAVE BEEN OR WILL BE UnSyigLi
Education Cordo Gov. Cod,
A.-762065995 t Agreeaent E2dsdisg
65945 Appwa al N
Npt SUN"[ to Fee-
Priar to l/L/87 Requirotuaat
Number of S%pt. , ' 'Note;
AmountP+erSQ.Ft y' ties —EE: _U,.&A.�
Ari aunt Co)jftLtd y _A: oPr mite —
S4ldinl; Perndt AppJit sting CatnKt 6 { �� t-l/'t r� ii7ta11 v .
p cted: XCsRVa "�'�-�Y�htlis' _ 9119 By, Fora " t" -Tom..-_
— c nt t
Adaiutictraw trr Charge
Crrliftcatt iisl+cdby: _q0rcela Y�ldey �i
SzGntitz re: —122244
�at:ilit7es Clerkjj
1°11S°IOTICE OF 90 .A _ O PROTEST OF
Sscrnn solo or g AND
the Government Curt¢ Rawrted b). As,&mbty Pubt 3081, d active Ja
rtic p�1�'tappN lent. ar ehe FatC afp�} oiapt of ter3opt ril�r Rtltt ptian a ralaSy I. 1997,.pSairee t►ru: ribs lllstria Ltt
that Fl= aed (2) the amount arch* fees. 'm�ro S F Yin*nt er oittert litctioa rt P vide (1) a Yrrittes notice to
s> ne to advisa�u that the 91 -da • itr aeeasdtatca with scctlon 66820 orate Gave eFmeotr of tha 50 -1&1 periaQ iD protest 1114 Inpork'on of
any,other regWw4 Y i7rO cu teriod in t eCarO gs.�ei FM .,the
Yal1 wdc and mhrr kppi6rwbio tt» this
a'lOt�:or di9eribod isjah 66029 of d`t =� oo+da+ate� trtth tb,; a Notice shoal]
Pe3attl9 of la/i tltao`af in Wtrrltc or I:t part tio►aarontaxtt code AddtdoaaJlr, aft* arooaal nl clic fca imposed s tvr i,ertip net WL� yAkce of
CtniQCatear ui L Gtt thi s to � t'cra of n �rz;f este otQKu
U:atrfeR nad Ce U valid t�tlnh. N to rLe litter, tLa sa dryi ntrts an th"
(fD ttl:bFft (3) such -teask m�) � 1tY+Jti 1ilCtfats Af ittWp�. l:itet►ilio.wih tt� Site dit! �lreol, ?fir
that hi theaetpJtetalthis C•ertideact. lb" "nor w be r 4A such tuns art this Co Mies only fat ;;orad ca 0114 all dateriaimd by it*.
Sctr.�l
r ►ilBl:0 alt?ircR if, Slrildios p rthrit Fat Slot
M Y rvn _oC ldcc ,. tfip ancC, bursad esti fans that were Dill Cr a6bhL tAli f�titlwto of t=umFUan � isluad toe the pr.;wJ
Sa
oettifi'Mic a. ,.a U
e1U171C1
;THL?,03.29 FAZ:,714° 442818gy
. L•�., ;r}{ » OPS LA CALA:.. 1002
4 •• 4 *•'
CMC: E"A VALLEY UNIFIED,SCHOQt, DISTRICT 4 x
P. 3 -•
�e: eox 847
FW;.Caflfomla9=4 -
RA CEIVE .t`RCM
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DUI1tof
Account... S
Affount Nid ...
3- r�rvixtOON
Balance $ due ...,_.... es
Cash U Check)k M.O. U
Fvm No t>ia �f Wl
7foaS By a U
ackgua Vagey U-Irmd Sctool District PGA West 93
MCI dba WPH-Orange County (La Quibta •Cala) Caeck
*Q ?625
�.a� . :.. Stub i or � 13&64 _pt. 08/02/02
1`t!lmber bate D�aipfion Cis
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05,693.62 4S,b93b2
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ro rhe oriier of ..
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IFOOOO?6 2Se. 1: L 2200 3 396x: 301jaO76?O Ilia
Certificate of Occupancy
City of La Quinta
Building and Safety Department
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code,
certifying that, at the time of issuance, this structure was in compliance with the various ordinances
of the City regulating building construction or use. For the following:
BUILDING ADDRESS:
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of Construction: VN
56-370 MUIRFIELD VILLAGE
Owner of Building: SRHI, LLC
-a't-t
Building Official
Bldg. Permit No.: 0201-132
Land Use Zone: RL
Address: 16940 VON KARMAN AVE. STE 200
City: IRVINE, CA., 92606
By: DANIEL P. CRAWFORD JR.
Date: 8/30/02
POST IN A CONSPICUOUS PLACE
Certificate of Occupancy
City of. La Quinta
Building and Safety Department
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code,
certifying that, at the time of issuance, this structure was in compliance with the various ordinances
of the City regulating building construction or use. For the following:
BUILDING ADDRESS: 56-370 MUIRFIELD VILLAGE
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of Construction
Owner of Building: SRHI, LLC
Building Official
\/ N
Bldg. Permit No.: 0201-132
Land Use Zone: RL
Address: 16940 VON KARMAN AVE. STE 200
City: IRVINE, CA., 92606
By: DANIEL P. CRAWFORD JR.
Date: 8/30/02
POST IN A CONSPICUOUS PLACE