SFD (0201-129)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
7V 11
Signature ofContractorT--,-�^"
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
ti
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
Stiction 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 Policy No.
PAC0,10 S�.C'1a«.9 IN9 41.640100274
(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 pro isioni
,Date: /j"
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.
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) �y'v f Date�2&�� .
BUILDING PERMIT PERMIT#
[
DATE J VALUATION ~ LOT (j���.` Sf TRACT
JOB SITE
APN
ADDRESS ����' �}�!p��1�9*�p �1^p ^(y '1� �j` p p.
,rroE', � _ ';J.�F.46.' A.K'n.Y,M ?d �A.E4A`.FA. .Go
"OWNER
CONTRACTOR / DESIGNER / EN INEER
16940 V6334 XiVVAA.H AVZ -12.200
23 COIRPDXWE 17WA W1111: 245
1WWR CA 9.2,606
'WW_P0Xr,11LW.W 'CA 92660
USE OF PERMIT
Sq' XG1 R `,Ek'.a4iib4`.iT. Y D In,§
SPD - LDT 76 PLAN 0. VIE' .MiT DOM NOT rNMIUDE, S, YA)CK TVA,fA
Pc' O , PPA OR DR1V•T'WAY APPROACH
P011C.'IO.d>!:T1(a 760.00 kre
(iASY!%C"rkACr'3RFty3YI 696,00 9F
ia'.• .i. .i..iLRt COST Wr fs'+i od:SSYR9JM'S.v'd•`1
281,,442.
Pi;+ RAWVI ' E SUA41WY
4' ONS'fR.t1Cr"1'ION ME '101.000-418.000 $1,276,50
}?IAN C-Hwrl FRY, 101440-439-318 $1,040.69
1t FPC AWICAL YBE 1014)00-411.000 9124.00
1;e'u' .0 tIVI :A Z F'151: 1101-000-420-0000 $18.-w.20
PLUMBINO rule 900-43 {
31'RONTMOT1OM 1183 • REISI i 102-000-1,41-000 US.
ORADMO re -c
OL'V1111OPPI x.1M:PACT Pte ' f�lFgn r. GA
ART IN PUBLIC PTAC - RI T 270-(XtO-44.5M000 5.�93;b4
� gxm7 -row. trC1M1T IUC"'TIOX.A 0 PLAX C"li3iII -!K
.443 -WE-PAID FEEZ
$0100
� te.
3�rrY1K.9S W , Now
&4X7.69
F t8 19 2002
CIjTY0FLAQUIRM .
FINANT71)�
RECEIPT
DATE ,,,��^^F'BY,
`:b�,
DATE FINALED
INSPECTOR
7
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms 8 Footings
2 Il.l.
Ducts
Slab Grade
3 0414n_
Return Air
Steel
Combustion Air
Roof Deck
D
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
7otpa%_
Compressor
Insulation
0
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wail Firewall
Exterior Lath
7 10-7—
0ZDrywall
Drywall- Int. Lath
S
Final
Final
�
POOLS -SPAS
BLOCKWALL
APPROVALS '
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
il
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
_
ALL
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
_
S�5 GZ l�G
Encapsulation
Gas Piping
Gas Test
6
Appliances
Final
COMMENTS: p�
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
kY%'`..y7tfr�� gr F
,�8iG3'ti2 THU 08:28 'FAX 71f `4' ddi4 u, !}
' ate{ 'apt �.•� catia � 001
t 7EQ 1991224
Caathet�s,aly. YIDIttCd'Schaalp , 2
D1strfci
• (76U '3� 1, CAS 9227$ ' '>�.�,�� Ut—�.;
8-5909 - J`8x (760) 398-1224 09VELoprft r..
AREA•.-`.--�.--L_�
C', is f '
CASH:
CPRTrnChTF,:OF COMPL ANCE
(C&Nforula Education Code 17620)
Project Natae: La Cala
Cwutr'a'Nlu[]e: (es et rn Pac tc sin le D.t,_: August T, 2p0
Pmlt ct Addre9s: Y �' _ Phono R�o:
U x �-
Project Daseriptiott:
APIN., See_� Attachmen r • tr 28838–j and
_.�A. : %Loc 7a; and 7T -
TYP� of Dt vctopnneltt: Rosidential 8–� 1 r'Otf9
Commertild Ynd%4strial
R7 J -
Total Square Feet OfBuildiug Area:
` -
• l
Cor r p,7tion of pc4uryegt!poyAerv: The pctson s; tli es that tht'above inform. *i on i ; �,rrcct and rna,ccs chi: s
uldcr pt�t,jty oiperJ�Y and fiaEh r reprttsen a tont h✓sbe is authn
d2,d to siP mt behalf of the owtterldevel Pe:, tett rrer.
t7AfE1d:
_ `Slt;B3ttUr�:
# r 4
N} ft k♦ r; i' �. O W i w„# r a: z W !r • r A A 4 r W �. •+ A r t z t' 4# O M t a a 0 r r dr r o. a
SCROOL
NOIR C")I''WITH
QtfiREl4IENT&
C.I
aRPY]R THE ABOVE irkOJECT HAVE BEEN OR WILL HE 1,
ONE OF TSE POLLOWING: (CJJC1X tjN1E) 8AT1SKFffp
Education Ctwe Gov. Code
1620 65995 Frnject Agreement Ezisdng Not Subject to Fee
Approval Poor to M/117 Not
Number of Shpt.
Araolttti per $Q.I*'ky--- _ -EEi�.a.�–
AtrbauntColletttd S AJ RzL_MJ S-
tlK fq{ 9
S%didlagrertWCApplle:;tino Carnpteted: XearNo dated-
- --- —d—
.
Ry: .t..^_ P_er.: ic, S C
`nt—tim—astrao
AFodc
(nc'harso
Cemliflcetc iost,cdby: —. Yalder
___Nrcela
Signatusre '
FacilitiesClerk —'
€ QUCCE OF 90 D F_ O PR EST OF g AND — _
repo ; �OnO of tDc (:ovcrnm¢ni C.udc aAsvrttA �• Aararrtbty sttl ?1181, dfsctlw la
ittc PftMtsnt, ar dre r e d> a ral&ry Ii 1997,
that h5w and (2) the a mount ymaat of tt�ont tray,,, mitigotloa Meant or othtxeailelioat
and aCt►e foci: Ft uires amu. rho hUt�n pn'ydc (1} a wriftt1, r� j.e to
save to i (
Ttitmefera, iy aceocda#W will, �ttoa 6d�7e0 o!tee"o s-('iF eot, of the 50 -fav period to rotas tat (� , r
++" fi"' tU 9tt-day JIM= teriod 6r wde anB otfur F Rz fhon o.
any oth[T regalNmap� rr dtstribod in - aro r4 Leh Fres or the rigtt4 NivoLWithYDplteahie 1> +a Ibis ?�otice atalll '
otltflah btifl20
V9Yiflt9 It INA (Ltn;j'ur in rrl+•+Ic or In
ottJ`ii (+pteramt�t wde. s tb.: peyotl nl of r5t fae� ar p.rforro.nce of
Centacitt,af0w, Partpror.tolnaaawata Addtlbaalir,ftbamanatofthcfct.impoaedis&,1"VinnotioWL,MAethtr
lti ate tt valid tar CEf- draft ol0exuli>inC)'•
thirty fig) 1 r s In the isttar, else 9a a �t►trtx un r
talaMt; ani Ub tb till"" such cx � daft of ;styaa� &thrmioD;wif1 bt � the Qatr hecto. Taos
that b2ft<3 �) 2sntiow. agcy tK Yraotad. U arastsll only for ::apd q��
t3?Jee�gftltis'Crriititatc. tlrer
wth as this C of taailrlaiaet! by :Lr Sctr.Bt
the truer wiz 6c r¢J °rti cmttfos�lrm if
Duitdeos p tratir[,ao.SOC !abanadatlfirstltstwtreyu0p,a6t•tth1hrSCarhny,trof �=�(slued[nrthepraiwx
►+y acilde.> /oertifi.Tteo'.p�pdar,GC�
�+tapUapr�..
- ... 6F QAf17JCl
-
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 #: 949442-6199 x 462
Builder Contact: John Zieman Voice #: 760-564-7555
Project ID # :
28838-1
Sample Group #:
Phase 3a
Lot #:
1076
Plan #
8
Address:
56-460 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:
x Tested Approved as a part of sample, but was not tested
x The installer has prow 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 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
x 400 x (Cooling Capacity in Nominal Tons) x (0.06)
21.7 x (Heating Capacity in Thousands of Output BTU per h(
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 = 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
x 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 M of
Indicate the maximus
0.7 x Floor Are
0.5 x Floor Are
x 400 x (Cooling
21.7 x (Heating
Other
uc Pressurization
100 x Test Leakage,
Check Box for Pass
Raters Certifying Sig
8/19/2002
macro.xls
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 #: 1076
(--SITE ADDRESS: 56-460 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 NUMBE . 794484
BY: ZOV
TITLE: PR DU TION MANAGER
DATE: MAY 9, 2002
JUL.11.2002 13:40 1760233408! MAYER ROOFING #2918 F.002/005
c
Corporate Office.
R0. Box 462840 , , Phone; (760) 737.HRRR
Fscoudido, UA 9204(; 7 D FAX: . (760) 737-0350
Licrnsr �? 66.3591
WESTERN PACIFIC HOUSING;
LA QUINTA
760-564-7022 (FAX)
Attn: JOHN
Roofing -on "LEGENDS Cq� P.G.A. WEST" Ph 3 LOT 476
06-17-02
Mayer Hoofing has supplied and installed "13 " O'hagin dwked roof vents , on lot #76
at 56-460 WIRFIELD VILLAGE, Tile vents have been installed per numufacturers
gPecifieatlotns.
Note: Exact vent locations are determined by builder
RESPECTFULLY SUBMITTED
SCOTT BEECHAM
OPERATIONS MANAGER
Mayer Roofing, Inc.
Page 1 of
5581,i 7rary Street . Sin Feraemdo, CA 91340 193 i)mngu Street . 12i.versidc, C,1 9250w
(8 181) 838-6064 . FAX (818) 834-449;1 (909) 7,52.0601 . LAX (909) 7R2-0804