SFD (0203-028)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,' Ezp. Date�,�,,
-N
6757,09
Date w "!, t "•• Signature of Contractor 1Y
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 &, P,rofessionals
Code).. - i I i // d!
() I am exempt. under Section B&P.C. ,for this1reason
Date mer x- rs Signature of Owner V!,X
s �
WORKER'S COMPENSATION ,DECLARAT ON
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.
SecI have and will maintain workers' compensation insurance, as required by
tion 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 AMERICAN PROTL, 0' Policy No. 38I;i033,*;470
(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 thaVif I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those=provisions.
Date:'"''- , ..�-.. " Applicant : t Al.
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 employee
2. Any permit issued as a result of this application becomes null and void
work is not commenced within 180 days from date of issuance of suc
permit, or cessation of work for 180 days will subject permit to cancellatio .
I certify that I have read this application and state that the above information i
correct. I agree to comply with all City, and State laws relating to the buildin
construction, and hereby authorize ire presentatives of this City to enter upo
the above-mentioned property for i spection,purposes.
Signature (Owner/Agent) `s,.%+ . -.__,. ' `{�'.,a •• Date`r�"'
'E t
BUILDING PERMIT PERMIT
��'
DATE VALUATION S-32-1,726.00 LOT 13 TRACT "UK;8„2
JOB SITE ADDRESS 81445MJ LI.Ml� �a�rbl��
APN 761, 1 DI.,
OWNER
CONTRACTOR / DESIGNER / ENGINEER
16940 VQX KART'i M AVE. STE 2 V0
DI4'1t11014 OF D,F.J1TW ' )YT
CA 92606
inV20:1 CA 92606
(94S 1442.65199 MW
USE OF PERMIT
MCIt1✓FAftF1T 1h13T
.rlrL) r 3.,L7T I ' N &N 9'.�t FLRMAT [JOE'S f3T INCt.t OY, iid..LWKWALL:;
P004 SPA OR DRNLWAl" APPROACH. 1% REDUCT(ON TO laf JAN
CH CKt' a FOR MFJUTIPLE I`.;SEJA14CE OF SAME i>i.KH TYPE
t.WTOM CONSTRUCTICYN 1%316.00 SF
POR.C111P.010 812100810
OASfi,i�.�iT:�W'.Y'.b.SIP'iM'dhluJtl
p
Ef'MAMW COST 00 C J.T+iUNUC`110.
n4,726m)
,PkvmlTI lb's`% "AMMWY
CONSaTtTiCT104 T,l..B 101-000.418.000 S1;471,00
PLAN CHECK ME 101-000.439-x318 $299,00
NT1±vFI. YNCAL FEE 101.000.421.000 SIX00
I?'.UXTI21CAL IPUR '101-0001420-000 $203.06
PLUMD1140"M 101-000-119.000 '$199,75
STRO140 MOTION PEI: - ROMID 101--000-241-000 $31e)
GIZADD1 ME 101 -WO -A23-000 $2(}u1f3
DEVEWPKIt.IMPACT FRX $1,411';,ou
ART 131-1 PUBLIC PLACF..9 - REESTE M-000=4454100 $3131.132
-'i°OTA.d. WAITMIfC:"I109 A14 -D PUS CTMCX-
T 4,513.10
' .TAM11VI Pra-PAID 1?E` 923
ZOO
�y U 1.0
CITYOF LAQUIRTA
FINANCEDEPT.
RECEIPT
DATE,
BY
FINA D✓0
I ECTOR
<A
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
'JA
Ducts
Slab Grade
42 LL-=
Return Air
Steel
Combustion Air
Roof Deck
(p OZ
Exhaust Fans
J i
O.K. to Wrap
a
F.A.U.
tp
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
°L
POOL - SPAS
BLOCKWALL
APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
_ _ _
i y I
2
nderground Electric
Underground Plbg. Test
Final
��
Gas Piping
a
PLUMBING APP OVALS
Waste Lines
Gas Test
Electric Final
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
Gas Piping
Gas Test
;7 is a trL
�Z
Pool Cover
Encapsulation
Appliances
Final
COMMENTS':/
D
—
Final
Utility Notice (Gas)
i-�
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)
f
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 - LA CALA / PHASE 4A
LOT #: 13
SITE ADDRESS: 814045 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 OONTRACTOR: WESTERN INSULATION, L.P.
LICENSE NUMBER: 79 484
BY: A ry I
TITLE: PRODUCTIO` .ANA(
DATE: SEPTEMBER 6, 2002
SEP-30.2CO2 11:45 1715023-14061 111AYER RCOFING
D
V Corporate Office,
T1.0. 13ox 462,490
I COR
CA 92040 Al
Licenxe # 66358
WESTERN PACIFIC HOUSING
LA QUINTA,
760-564-7022 (FAX)
Attn: JOHN
#3484 P.010/011 -
Roofing on '11-9L—hM (a-), P.G.A. WEST" Ph 4A LOT #2013
Phone: (760) 737-8888,
FAX: (7 6 0) 7.37 -(..;?50
09-30-02
Mayer Roofing has supplied and installed " 4 " Q'hagin Cloaked roof vents , on lot -# 2013
at 81-045 MUIRFMLD YlLLIAGE,Tfle vents have been installed per manufacturers
specifications.
Note: Exact vent locaLions are determined by builder
RESPECTFULLY SUBMITTED
SCO'T'T BEECHAM
OPERATIONS MANAGER
Mayer Roofing, Ine-
Page 1 of I
S58 Library Sti-ect . 'Sajj Fe. - 7
filkindo, CA 91340 193 Orajige Sheet . Rkc, 7 -de, CA 92502
(8 18) 83X-6064 . FAX (K1 R1 838-4493
(9.09) 782-0601 - FAX (909) 792-0804
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Tight Ducts) CF' -4R
PROJECT INFORMATION
-
--Project Title:
La Cate
Project Address:
La Duinta
Builder Name:
Western PaCft dames, AAC11e1le Lopez
Voice 0:
949-442-6199 x 462
Builder Contact:
John Zleman
Voice 0:
750-564-7555
Prcgoct ID 0:
28838-2
Sample Group $ :
Phage 4o
Lot sl':
2013
Plan N
9
Addnew
91-045 MuirWd Village
HERS INFORMATION
HERS Rater.
Seo* Johnson Jayme Garden
Certification 0 :
CCCSA14037 CCNJC515157
HERS Firm:
Action Now
Voice # :
949.631-2274
Address,
2575 Westminster Avenue, Costa Mesa, CA 92627
HERS Provider.
HERS Address:
CHEERS
9400 Topanga Canyon 91vd, Chataworm, CA 91311
Voice R :
818-407.1500
HERS RATER COMPLIANCE STATEMENT
= T-24 Compliance Credit was Taken for Tight Duds
The house was:
Tested =x 1Apgroved as apart of sar.+plo, but was not tested
x The Installer has pro'R deo a copy of CF -8R
x Air Distribution SW*m is Fuliy Ducted (sh"Imetal, duCtboard or ftex duct;
Where doth backed rubber adhesive dud tape is installed, mastic and drawbands are used in Combination with
doth backed, rubber adhesive duct tape to seal leaks at the connections.
PANIMUM REQUIREMENTS FOR DUCT LEAKAGE COMPLIANCE CREDIT
Duct DiagnoVGFA
Testing Results (Maxirrwrn 6% Duct Leakage)
CFA: Leak Max Tested Leak "
SystemIndicate the le Duct Leakage and the oakwiat Ork used;
0.7 x Floor Area x (0.178) for Climate Zone A through 15
0.5 x Floor Area x (0.06) for Climate Zones 1 through 7 & 15
X 400 x (Ceoting Capacity in Nominal Toros) x (0.06)
21.7 x (Heating Capacity in Thousands of Output BTU per hour) z (0.06)
Other
uo Praasurization Test Results (CFM ® 25 PA)
100 x Test Leakage / Fan Flow a % Leakage
Check Box for Pass or Fail (Pass = 6% r'or less) Paas a,
System Y j of
In41t:Ate the max mum a le Duct Leakage sind thio calculaRipn used:
0.7 x Floor Area x (0.06) for Climate Zone 8 through 15
3.5 x Floor Area x (0.08) for Climate Zones 1 through 7 & 18
x 400 x (Cooing Capacity in Nominal Tons) x (0.06) 84
21.7 x (Heating Capacity In Thousands of Output BTU per hour) x (0.06)
Other
Pressurization Test Rosulia (CFM @ 25 PA)
100 x Test Leakage / Fan Flow = % Leakage
Check Box for Pass or Fati Pass = 6% or Less)pis ai
System I--��t--"I of
Indicate the meAmum a e Duct Leakage and the Calculation used:
0.7 x Floor Area x (0,08) for Climate Zone 8 through 15
0.5 x Floor Area x (0.06) for Climate Zonas 1 through 7 8, 16
x 400x (Cooling Capacity in Nominal Tons) x (0.08)
21.7 x (Heating Capacity in Thousands of Output BTU per F:owi x (0.08)
Other
Duff PressurizaNOn Test Results (CFM (M 25 PA)
100 x Test Leakage ! Fan Flow - % Leakage �
Check Sok for pass or Fail pass or Less) ,t pg�r-
Rates Certifying Signature Date
F2001-02 (3.02) Action Now T-24CF4RTDmacro.xla