SFD (0203-027)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. .11
License # Lic. Class r f Exp. Date
675709
Date..- Ir-- /2 Signature of Contractor
OWN ER-BLII LDER,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). t
( ) I, as owner of the property, am exclusively contracting with, licensed
contractors to construct the project (Sec. 7044, Business &-'Orofessionals
Code).
O I am exempt under Section B&P.Ctfor�this re �oW
f at
Date r" Signature, of Owner �d . R.. ; ... __ - ff.-� �.•-,...
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 JAMERICAP1 PF3.r,7°1'Ft:' Policy No. SRR0181,'1401CJ
(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 tfiat if h should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions:
Date: i' �e - *'' Applicant4' ` 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. w
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 I,nspectionf;purposes c
Signature (Owner/Agent) �tvi - Fl�� _- *-,Date �` II °' r r
•��ff
' BUILDING PERMIT PERAMM!7
DATE VALUATION S2S M2,$0 LOT `� . 2' TRACT 28838-1
S ��i-��la. T " +ZI' n
ADDRESS
APN
76?,..WG-0012
,OWNER
CONTRACTOR / DESIGNER / ENGINEER
R u„ •r ,c
1JWC0 .H0UM G dba'W-EZ . TI • 1IC E
16940 ifON NC; \PIAA'tIAVV,!'>'TLE 200
DIM91014T OF AR.1S4JI�.� Y14
IR VI'N'E CA V2606
MW E awl,•!,. 92606
(949)44.2-6199 (.�"iR
USE OF PERMIT
SMILL? RAMlIX DW.K.0 G
SYD • WT 13 PLAN Yui. P.KRM11' 0(NOT INC:L► Drt. Y'#WCK 'Vd•14LU,
P004 SPA, OR DPIV"f3WA•YAPPROACH, '75% REDUCTION TO KAli
CHECX FEE IK)It MVL,TIPL,E 182 UANCE OF SA.UE PLQ4 TYPt
CUSTOM COT'43TRUCTION 3.42101) VF
PORCI37PATIO 160.1!() S=~
.�.c�.�,�.�:�OI�T • t:��,�a �a�
g�RZ1lMA",i'.1+ 3� C•°OMI OF COWS,WT!G'`'"Ca A.ON
281,4420)
Pli RM ° I= S'1:%M3V'CAW
CURSTRUCIT1014 RE $4,2W. 'so
PLAN CHECK FEE $260.117
tJiL?CHAWIt AI, FEE 101-000421-000 $124.00
9L ECTR ICA,L Li%L' $1+9120
PL:UTt BINO FRE M.'n
STRONO MOTION FES o WMD 101.0004AI-000 1,fa 14
GRAL-11140 FEE, 1.01-OW4 l-000 $20,00
C3EVZLO.PER iMF>A+`'!' Avn $V0a.00
ART IK I11JBSIAC PLACNI; - R 311270 00-445.000 $20161
Wt --'r V fA L 710_W �dCiiTCd:J0 A A) X'.LA@7:I1\7 'vi1.WX
V.,%01,37
i U S PFX, -PAID FEE
$$100
� !p TO,¢ � y,F�,�py�v r�+1� q��f�-�7 i(�/�g�y
�i�-� .[ .6 W Td-. L .�' KEM4;M I TEEN DID, NOW V f
____
t9*7
sm j7e0 I --i S
MAY 0 8 2
CITYOFIAQUIp�A
FWANCEortex -
RECEIPT
BY
D Irk _
IN ECTOR
'01
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
S c'L
Exhaust Fans
O.K. to Wrap
it, Z
F.A.U.
Framing
I
Compressor
Insulation
i
Vents
Fireplace P.L.
_ _
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
02
Drywall - Int. Lath
Final
Final
_
_
PO LS - 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 APP_ OVALS
Gas Test
Electric Final
Waste Lines
j��fi
Heater Final
Water Piping
_ �`
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
//d�
Pool Cover
Encapsulation
Gas Piping
Gas Test
y 7
��/` fi •S
Appliances
Final
_
COMMENTS:
Final
_ —
�p`
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)
— —�
SF_ .30.2002 _1.44 !76n-2334061 11IR ER ROOFING
#34884 P.009/oii
0
Corporate Office.
P.O. Box 462890
Escondido, CA Q2f�=1fi Phune: (760) 737-3888
_ ED FAX (760)737-0350
I icemr.aGG3iKl
WESTERN PACIFIC HOUSING
I,A QULN'lA
760-564-7022 (FAX)
Attn; .IOYiN
09-30-02
l
Rgo ang on "LEGENDS (di), P.G.A. NEST" Ph 4A LOT #2012
Rayer Roofing has supplied and installed " 14 " ijimin cloaked roof vents ,cin lot # 2012
di $1--035 MU)RFIELI? ViLLIAGE, Tile vents have been installed per manufacturers
specifica ions.
Note -Exact vent locations are determined by builder
RESPECTFULLY SUBNHTTEID
SCOTT BEECFIAM
OPERATIONS MANAGER
Mayer Roofing, Inc.
(Page I of 1
5:18 Library Strer.l . Sero Ferrand.7, CAf;1S4o 193 Orange Street . Riverside, CA, 92502
(i,l,N) 838 -6064 . FAX l818% 838-449.? (909') 782-0601 - FA -Y, ('909) 782-0804
WES'T'ERN INSULATION, L.P.
4211 Latham Street, Riverside, California 92501
Tel. (909) 686-8760 Fax (909) 686-8786
INSULATION CERTIFICATE
THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH
THE CURRENT ENERGY REGULATION, CALIFORNIA ADMINISTRATIVE CODE, TITLE 24,
STATE OF CALIFORNIA, IN THE BUILDING LOCATED AT:
TRACT/PHASE: PGA WEST - LA CALA / PHASE 4A
LOT #: 12
SITE ADDRESS: 81-035 MUIRFIELD VILLAGE - LA QUINTA CA.
------------------------------------------------------------------
EXTERIOR WALLS: BATTS
MANUFACTURER: JOHNS MANVILLE THICKNESS: 5.5' R- VALUE: R-21
CEILINGS: BATTS
MANUFACTURER: JOHNS MANVILLE THICKNESS: 13" R- VALUE: R-38
GENERAL CONTRACTOR: WESTERN PACIFIC HOUSING
BY:
TITLE:
DATE:
INSULATION 6NTRACTOR: WESTERN INSULATION, L.P.
LICENSE NUMB E . 79r,
.
BY:
TITLE: PRODUCTI N M NAG R
DATE: SEPTEMBER 26. 2002
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Tight Ducts) CF -4R
PROJECT INFORMATION
Project Tkb: La Cala
Project Address: Lo Oulnta
Builder Name: We9tem Pacific HOMO$, Michelle Lopez Voice # ; 949-442-6199 x 462
Builder Contact: John Ziemart Voce 8 : 760-564-755E
Project 10 #: 28838-1
Sample Group A: Phas* 4a
Lot #: 2012
Plan e 8
Address: 81-035 WOW* Vil!age
HERS INFORMATION
HERS Rater
Scott John3on Jayme Carden
Certification 0:
CCCSJ614037 CCNJC615157
HERS Firm:
Action Now - Voice #: 349-831-2274
Address:
2975 Westminster Avenue, Costa Mese. CA 82627
HERS Provider:
HER$ Address:
CHEERS Voice q : 616-407-1500
9400 Topanga Canyon Blvd, Chatsworth, CA 91,311
HERS RATER COMPLIANCE STATEMENT
M T•24 Compliance Credit was Takan for Tight Ducts
The house was;
MWhsrs
Tested Approved as 2 part of sample, but was not tested
The kWaller has pro ed a copy of CF -6R
Air Distribution System Ig Fuily Ducted (3heetmetal, ductboard o -'Rex duct)
doth backed rubber adhesive duct tape is installed, mastic and drawbsnds are used in combination with
doth backed, rubber adhesive duct tape to sea! leaks at the connections.
MINIMUM REQUIREMENTS FOR DUCT LEAKAGE COMPLIANCE CREDIT
Dud Diagnostic Leakaa Testing Results (Maximum 60% Duct Leakage)
CFA; CFA Leek Max ®Tested Leak
System 0
Indicate the max mum a owe le Duct Leakage and the calculation used.
0.7 x Floor Area x (0.06) for Climate Zone 6 through 15
0.5 x Floor Anaa x (0.0$) for Climate Zones 1 through 7 & 16
x 400 x (Cooling Capacity in Nominal Tone) x (0.06)
221.7 x (Heating Capaclty in Thoussnde Of Output BTU per hour) x (0.06)
Other
Uv—a Presswization Test Resub (CFM a 25 PA)
100 x Test leakage / Fan Flow • % Leakage
Check Box for Pees or Fail (Pas6 = 6% or Less) Paso x e,
SystemOf
Indicate the max mum allawabls Duct Leakage and the calculation used:
0.7 x Floor Area x (0.06) for Climate Zone 6 through 15
0.5 x Floor Area x (0.06) for Climate Zones 1 through 7 d 16
x 400 x (Cooling Capacity in Nominal Tons) x (0.06)
21.7 x (HoatbV Capacity In Thousands of Output BTU per hour) x (0.08)
Other
PrMurizatbr Test Ra9UR9 (CFM @ 455 PA)
1 DO x Test Leakage / Fan Flow o Vo Leakage 72
Check Box for Pae* or Fail Pass m 6% or Less) P096 Faill
System M of
Indicate the maximum a owe a Duct Leakage and the calculation used:
0.7 x Floor Are* 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 400 x (Cooling Capecity in Nominal Tons) x (0.06)
21.7 x (Heating Capacity In Tilouaands of Output STU per hour) x (0.08)
Other
u Pressurization Teal Results (CFM @ 25 PA)
100 x Test Leakage / Fan Flow a 95 Leakage
Check Box for Pass or Fail (Pa3aM6% or Less) f i Pas Y
Raters Certifying Signature
Date / /Z -0
F2001-02 (302) Action Now T-24CF4RTpm"acro.xls