SFD (0201-130)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
79706 13
I idJS ftc
of Contractor W ^'
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 & 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.
Sec( I have and will maintain workers' compensation insurance, as required by
t on 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 pACIazcC FAOJ,)& INS. Policy No. 411010027:
(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: tq. / ;�_APPlicantn�
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 •,Is
application. t
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
the above-mentioned property for inspection purposes.
,-Signature (Owner/Agent. ->r'' �d�,_ ✓!1 _---..Dater
BUILDING PERMIT PERMIT#
DATE _/ / VALUATION LOT TRACT
JOB SITE i
APN
ADDRESS��?Y�aIctA'f�
i�f�YISt�
OWNER
CONTRACTOR/DESIGNER/EN 1NEER
92606
3d:L.IKPOWT' NLACH CA $ 60
(949)719497," C�.'i # 63611
USE OF PERMIT
•
SM, LOT 77 PLAN 900 I ERMIX C 0tg NOT 114CLUDi? &,C2C;k'b�f�ai,i;,
P00,14 VA OR DRMWAYAPPROACH
CUSTOM CONSTRUCTION U161001 S!?
PORCHIPATIO 812:00 SF
UTMATED ED 3.+� !rf OF C'0T lay Jlo-Tss E✓11..!f:4.'J.V
ra.N`P� I.FY OSJGY
�yrM �v �y y -p gyp !�
1y�.`IS.�03.�. TY..F,►`7Y3.`Y�7.7'.rdi.Gt
Q'010TRUC TION PU 101.000.418-000 SI,42'1.00
PLAN CHECK ME ICI»000.41. 9"31.8 $11,152.01
Iv11E. IMICAL, IMF, 101 -WO -421-000 $124.00
'e: IVIC'I'T2SCAL,; f; 101-000-420-000 $201 06
P1, MI117+1K1s?I� 101.000.41`9.000
NSTRO)T40 MOTION N "IF: - R ID 101-60-241-000 .1-000 $33,47
(Vii ADI140 FER '101-000-413-000 $20.09
OFVYLOPER IldlPil.CT IE',S $I,9t13.aG
epi{'1' IN KffitllC I?LAM " RUM 270-00044-5-000 '13I 1.82
a U, -1 f3" L 00, "X I' °Tl0.3+F.t AND PLA a ...CK
1 I
LEVIS PRE
FEB 19 2002
ii- CffYOFLAQUIi1?'A ;..
14
RECEIPT .
DATE ' :
B`,....--1
DATE
INAL
INS TOR
/
r 'w-
INSPECTION RECORD
OPERATION
DATE
I INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Z
Ducts
Slab Grade
3 1 aZ
Retum Air
Steel
Combustion Air
Roof Deck
09
Exhaust Fans
O.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
ZO
Drywall - Int. Lath
6 O
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 APPROVALS
Gas Test
Electric Final
Waste Lines
3 OZ IL(.Heater
Final
Water Piping
v
Plumbing Final
Plumbing Top Out
Equipmept Enclosure
Shower Pans
; `
O.K.Jor rinish'Plaster
Sewer Lateral
7 '
Pool'Cover
Sewer Connection
ncapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
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)
;1r�=t)8iG3:�rj;
a4s�� n
W 'Valk ihni> ed S
!ox'8 7 ThCrw-al,
g&4909'�x {761
. a +urs 1.� r;At.A IQ! flpi
JPl'ft PUBS PA)D
CERTMC,tTE 'UF CO11 PLLd NCE
(Callfbrala Education Code 1'/628)
! tlAre
Project Name: La Cala
E7wuer°s Nartle: Wes ern pa i e 1�I n ze y y _ Dst.: August 7, 2002
Project Address; -�__� Phone �;o. bl�
Project beserip�oer; - _
ANN-, $ee AttacPlDl nt rp —�-- -
_ 28838-1 and ; %Lot ;: 7h and 7T
rYPe of Dc+•elopntutt: Rosidential g��Z 1 rig -
--�. �Commeraiol
� _ Irtdul4trial
Tofa! Squara Feet of 114ildiug Arett:
Certtticatiott of Appliennt!Owuerc: The persot, s;8�►g ctirtifies the the above info
aider pelt jty of P�jttrl' and �'ther repreren;s tlwt h,Jshc is autho:izcd to sipb
cm t]zta.ion i:; ai'Jrrcet and mrakcs This 5tatt mer•.
ehalf of thL owner/developer.
f7Attti :
Sigltature:
♦- l 4 .t * a < � : r i' i R* w r a t o A' ♦ v tl' Y �' • .v �• ,► *.! i. s Vr tr k r i, *♦ w a« .► l a .a w'. r e a TIP** N t a w q.
SCfiOpi DxSTRIt' Y'S Ot1xREi�7ENT& FOR THE ABOVE YROJEt^_•F HAVE REE?�1 OR YgLL HE SATISN tEp i'4
Ac CORDANC>E AVITH UNIT pF TSE p4DX.LDNYM;: (q cr,>? o. )
Educlarion Cock Gov. Cod,
1-1621► 65995 Prnjt;ct Agreement ESisdag 1ti
Approval Prior to I/11R9 of Subject to Fee'
ReQuirotuout
Number of S% t•
Amauut per Sq.F't—
Arftuni Coiletttd �_
tC �4 K7
Byildirt Perrn)t A{�plfcatin11 Comqptt:tedt Yc caul
By, Fa'?.c" Pen�(x, S c mtertdct�t
Adarltssstratpr tr, Charge
Nett::
•-Od2@+d_�1,Lptn1+� r ] F 4 t14g� - — _.
C=1if1cetc isF1wdby: _. --ftrcela YaIder '
Foci l i ties Cj e k �"_' S::� netire: 122Z
!YUTICiE 0890 ABY pF RiOb FC)R R r of
StcCen "1320-f the G*�crnmc 5 AND �i1Z OF FJ+, �r J.
tt�c pm)ut appN rant et the ii taf +dc axsvrttfl bi Aaambty Bill VSj, off etiv" Jaenwty 1. 1497, raSul�o tfiut rho 111nrric� rn
that Am "d F�Ymaht of tetttsol fae�, ntltf�At)an paYmtnt er ot6exciac6oes !`Fearii D vldc (1) a rrritt¢K notice to
i2) the amount o[ Na feai. Tbcrrefor; iti actordattca with n of tltt. Sd dao periad [o pratat tha i n t
serve 11 r vequ rea sc ti the 9u daY mtru Ceriod in rr$atrt to a fon 6dat10 0. tbt' Gttvtreoxot nude and other po icon of
any.otlt2t t egeletitnap� as &-seribod to i..r od in estJtr tact► Fsea'ar the t>1H Y-0plit�bia !tom this hotlee'lietlt
trdAihle it t1:L thea ur in b1+.R1c ar In a Mereo% mdateaeas With
tbt pay aim of t5e lac or p.r fonosece of
p rt!N!oP��saacaafn Ad�ftn:ley,dtesmog atoftbefee, impaudFfas tf—net:tnWb,y1)e cr
Certtfleue nfCa4but e i1vII1;d'W.thi C�rtiRrato of Qecupraq, At fi tl,e iotlar, the 9a &).g,�hrts un
Utotrict and up to thr+aa (�) fuch ate diyii t1Y+ta t?teddii of aswticr. Etteailoa +r:ll tx dee ODIC beriaE T&is
that t,t zfte aubJta *obis Conti ' n+f°°` may be sratdod. At atteh tJmr to thka C aranted only for ::aod caa.,e as delenninlw by t* Setcol
eats, the iraer wt!16c role►tiBcmte t,t�t!cs ifa build P rrt.tit Fao oat beta 1Huad fnP the p:aiax
lh'� cin:y�cc�/dcc�epyo fimlco' pnrppinGC+ mt�stdaufiet thlttWtrepladto'obtalaAlitJ-,ti ;z-icutaFUanl .
' Qp/17101 _
WESTERN INSULATION, 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 93/PHASE 3A
LOT #: 1077
SITE ADDRESS: X56-430 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:
TITLE: P D CTION MANAGER
DATE: MAY 9, 2002
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Tight Ducts) CF -4R
PROJECT INFORMATION
Project Title: La Cala
Project Address: La Quinta
Builder Name: Western Pacific Homes, Michelle Lopez Voice #: 949-442-6199 x 462
Builder Contact:
John Zieman Voice #: 760-564-7555
Project ID # :
2883872
Sample Group #:
3aLot
#:
FP!—ase
Plan #
i7Address:
56430 Muirtield 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 #: 818407-1500
HERS Address:
9400 Topanga Canyon Blvd, Chatsworth, CA 91311
HERS RATER COMPLIANCE STATEMENT
Qx T-24 Compliance Credit was Taken for Tight Ducts
The house was:
Tested rx--]Approved as a part of sample, but was not tested
x The installer has prove ed 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 aTowa 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 L ---j of
Indicate the maximum allowable 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 he
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)
System L—J of Q
Indicate the maximun
0.7 x Floor Are;
0.5 x Floor Are.
400 x (Cooling
21.7 x (Heating
Other
uct Pressurization T
100 x Test Leakage /
Check Box for Pass c
Raters Certifying Sigr
8/19/2002
macro.xls
IUL.11.2002 13:39 1.7602334081 MAYER ROOFING #2918 P.001/005
Corporate Office: Phone: 060) 737-9888
P.O. Box 462890 a I a
L,sec)ndido, CA 92046 FAX: (7601737-03,50
WFSTERN PACIFIC HOUSING:.
LA QUINTA
760-564-7022 (FAX)
06-17-02
Attn: JOHN
Roofing on "LEGENDS (a� P.G.A. WEST" Ph 3 160-1,07
Mayer Roofing has supplied 4nd installed "15" O'bagin cloaked roof vents, on lot #77
at 56-4.10 MUIRFIELD VILLAGE, Tile vents have been installed per manufucturers
specifications.
Note: Exact: vent locations are determined by builder
RESPECTFULLY SUBMITTED
SCOTT BEECHAM
OPERATIONS -MANAGER
Mayer Roofing, Inc.
Page I of I
I
559 TAITUTY SLTCCI * San Fe, rniizido, CA 91340: 193 Orange Street • Riverside, CA 92502
(h 18) 838-6064 - FAX (818) 838-4493 (909) 782-0601 FAX (909) 782-0804
I
d
Certificate of Occupancy
�,� __ W • �1111r��1��� J
£
isawowrm
Mz
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.
BUILDING ADDRESS: 56-430 MUIRFIELD VILLAGE
Use classification:`SINGLE FAMILY DWELLING Building Permit No.: 0201-130
I
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RIL
Owner of Building: SRHI, LLC Address: 16940 VON KARMAN AVE STE 200
I
I City, ST, ZIP: IRVINE, CA 92606
z
n
By: DANIEL P. CRAWFORD JR.
Date: 8/19/02
Building Official
F -
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t
POST IN A CONSPICUOUS PLACE