SFD (0203-029)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chap�er 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
Date - i 2- 62 1 Signature of Contractor
OWNER -BUILDER• DECLARATION/
I hereby affirm under penalty of perjury th t 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).
O I am exempt under Section , B&P.Cs 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.
IV+ 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 ,AM. RIC AN I'rR THC' Policy No. $B? 03354` 0
(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' thaC`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: -1 ` � �. -P• "Applicant � �l � ,.-.- �-
It — .. .
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,060, in
addition to the cost of comperisation, 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 ujion
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) L 1� Date
BUILDING PERMITPERMIT #
DATE VALUATION8�.So LOT '14 TRACT 2RS38-2
rvc� •- . • I' Cry
JOB SITE
ADDRESS �8 .0 v�sTai,� .
APN 762-31
OWNER
CONTRACTOR / DESIGNER / EN (NEER
ali E,, I I +u
I_kMCO 1-T0` 8M'0 dba VW3: ".� PACOC I
16,940 jJON Y.ARMAK AWK, UYE, 200
I)lYi.WX OF%,R.11Y01troN
MV= CA 92606
IRVINE CA 92606
(949)442.61.99 CBd O
USE OF PERMIT
�i" - T 4 �N IlCl s' 1KM11' U r, U T / LY1r ia-lt �L
WALLS,1}OOY SPA, OR DRIVRWASi .A,PPROACH, 75% REDUCTION TO
PL A14 CIKWK FEE FOR MULTIP1,E IauUANCE OIr SAIVEIC PLA -M 1'i PF_
CUSTOM CONSTRUCTION %308.09 SF
POACHIPATIO 190.00 SIP
l3ARAaloYC.AR€ ORT 606.00 Sr
ESITIM&TRID+ c0slf GF COI?i'IMUC110,14 W9,442.80
PUR?'40.ZXS`l P, OfrWhAla?
C 014S`t'RUCYJC+? IMF, 101-000.418.000 61,27&50
PLAN MIFZK FEE '101-000-439-318 $360.17
MECHANICAL FRE 101.000.421.000 $124,06
X'L EC f'I1'IC.AL, FEIZ 101-000-4210-000 $192.20
PLIUMiii'NG FEE 101-000.419-000 $403,75
STIZ0140 MOTION FEE -'R:IESID 10+1-000-2441-000 $28.14
(IRADING Pte: 520100
I)WE.WPER IMPACT FF.Z;? �ty,9li?.00
ART IN PUBLIC PLACER • I&W1: 270.000-445.OWI
.0397
S)A-TCYfAL CON.11"RLTC�",�fOW AWL) 9LkXClTCC 71
I2113 ::c"F.A SS gf�0
r�
7P1RMf FtEES DVE f(OW $4,2017,x'7
J
CITYOF,LAQUINTA
FINANCEDEPT, -
RECEIPT
DATE `'
BY
:KN SPEC
INSPECTION RECORD
y OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
A
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
p, I t (p 1 92
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
its
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final - --
Final
- —
POO S - 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
PLUMBING APP VAL
Gas Test
Electric Final
Waste Lines
/
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
_
%..Z oQ (� _
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
-
COMMENTS:
sT� Ale,
Utility Notice (Gas)
_ _
ELECTRICA` APPRO"'-L
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels /__
Exterior Receptacles
G.F.I.
Smoke Detectors 10
Temp. Use of Power
-
Final
oe_
Utility Notice (Perm)
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Tight Ducts) CF -4R
PROJECT INFORMATION
Project Title:
La Cela
Project Address:
Lo Quints
Builder Name:
Wastam Pacific Homes, Michelle Lopez Voice 0 : 94%442-6199 x 462
Builder Contact;
John Veman Voice 0: 760 -564 -755, -
Project ID F :
29838-1
Semple Group ! :
Phase 48
Lot 0:
2014
Plan 0
6
Address:
804)W Illiulrfiald Villsge
HERS INFORMATION
HERS Ratner.
Scott Johnson Jayme Carden
Certification is:
CCCSA14037 CCNJC815157
HERS Firm:
Address:
Action Now Voice a 949.637-2274
2575 Westminster Avenue, Costs Mesa, CA 92927
HERS Prower:
HERS Address:
CHEERS Voice 0: 818-407-1500
9400 Topanga Canyon Blvd, Chatsworth. CA 91311
NERS RATER COMPLIANCE STATEMENT
rx 1 T•24 Compliance Credit was Taken for Tight Ducts
house was:
Tested MApOMY19d as a part of sample; but was not tested
x The installer has provided a Copy of CF -6R
x Air Distribution System is Fully Ducted (sheetmetol, dudboard or flex duet)
Where doth backed rubber adhesive duct tape is installed, maotio end drawbands are used in combination with
doth backed, ribber adhesive duct tape to seal looks at the connections.
MINIMUM REQUIREMENT$ FOR DUCT LEAKAGE, COMPLIANCE CREDIT
Dud Dlagnostic Lesk�eTestinq Results (Maximum 6% Dud Leakag2)
CFA: eak Max ��'�Tested Leal.System 0 Indicate them ule Dud Leakage and the cakaxlation used:
07
. x Floor Ares x (0.06) for Climate Zone 8 through 15
0.5x Floor Area x (0.0e) for Climates Zones 1 through 7& 16
x 400 x (Cooling Capacity in Nominal Tons).Y. (0,06)
21.7 x (Heating Capacity In Thousands o` Output STU per hour) x (0.06)
Other
u ,Pressurization Test Resuhs (CFM ® 25 PA)
100 x Test LeakeW / Fan Flow = % Lea"
Check Box for Pass or Fail (Paas = 8% or Less) Paas
System ® Of fr s-1 Fell
Indicate the maximum eticwable 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 (Cooing Capacity in Nominal Tons) x (0.06)
21.7 x (Heating Cepadty.in Thdusands of Output BTU per hour) x (0.08)
Other
DW Pressurization Test Results (CFM ® 25 FIA)
100 x Test Leakage / Fan Flow = % Leakage
Check Box for Pass or Fail Pass = 6% or Less) Pass a
System rs-1 of
0.7 x Floor Are:
0.5 x Floor Are?
x 400 x (Cooling i
21.7 x (Heating
Other
U-0 Pressuflzaticn T
100 x Test Leakage !
Check Box for Pass o
Raters Certifying Sign
(/-/Z-U Z
• - ,, -. wn nuw i-,&Yt.r'4K a umacr0.48
C
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 - LA CALA / PHASE 4A
LOT #: 14
SITE ADDRESS: 81-055 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 QQNTRACTOR: WESTERN INSULATION, L.P.
LICENSE NUMBERS 79 484
BY: /
TITLE: PRODUCTION VANAC
DATE: SEPTEMBER 26.2002
SE?.20.2002 11:45 171502334081 DLkYER A ^.FINE
. o
Corporate Office2
T',-'). Box 462890
L'scuudidu, CA 92046
Licrnse k ti635R I
WESTERN PAGE!( HOUSING
LA QUINTA .
760564-7022 (FAX)
Attn: JOHN
#3484 2.011/011
Phone: (760) 737-8899
FF_X: (760) 737-0350
09-30-02
R.00fmc on "LLGENDS n.P.G.A. WEST' Ph..4A. LOT. #2014.
Mayer Roofing has supplied and installed " 14 " 01hagin cloaked roof vents , on lot # 2014
at 81-055 MI,JiftFTELD VI TA JAGS, Tile vents have been installed per manufacturers
specifications.
Note: Exact vent locations are determined by builder
RESPE( TULLY SUDY[ITTED
SCOTT BEECHAM
OPERATIONS MANALGER —
-M.ayer'Rooting,- nc.
Page 1 of 1
5S8 T.ib�ary Street . 5an Fernando, (.'A 91:S$(i 14; Orange ,trees . Riversi.de, CA 92'102
(8 18) M8.6064 . FAX (418) M8-4493 (901) 782-0601 . FAX (909)782-0804
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