SFD (0206-179)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 # )t! Lic. Class Exp. Date
y /v1
Ry 1 ELI
rte...
'Date �I E I Signature of ContYactbr^ a
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 I. 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.
() 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 .p,MERICAN PROM,*' Policy No. ABR0935170
(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: . '1 i ;P 1r:v. Applicanf <I" , ;,,`,
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,5;
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, indemnity
& 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. I
j ,-
Signature (Owner/Agent) Date~'! 61
BUILDING PERMIT PERMI(
DATE VALUATION S268,639.lu LOT ' TRACT 28838.2
'�- Ipl •c'�
JOB SITE
ADDRESS -�•,3�1e r�t.•.t.IM.e,L1L'G�+
APN 762-390-01.15
OWNER
CONTRACTOR DESIGNER ENdIINEER
10940WXYT =4 HANANS, STXX00
rommC'm01TPl, ,k:IC)R .3N
izi" lk� CA 9260 �
'IRM -C, CA 92606
(99)442.16199 C ui,
USE OF PERMIT
" Gyg1Yfiiff DApALryG
SM - WT $3, PLAN ?C. FITMAMT Z70M -NOT YN f..11I7.FL BUOC K W.A,LL.%
,0001,, MAPA OR. L7R1V. WAY APPROAC-H
0387'OM CO'N�'zPWCTION 19.00 SI?
POKC'HIPATIO 154,00 $'F
GARAWCV0-z> ORT 708,00 SIF
ESMUEEM C`0ST O1.+ COMMUcTION
268,09.10
COA1'�'z'R:EfC�'lr,�i1T 101�Ca0(Y«4i�«C�tlt� �1,31,9a
PLAN C:Hbf:':CFft? 1(31^(3Q�D-di35�^�15 iS1,�iGl.titr
b'iEC'• ANICAL ME' 101.000-21.000 $.136,50
Z1.1✓c,'I RWAL s:'• E , 01-000-420-000 $166.13
Pl.C1M)3 O M 1(;�1.000.413Rt 0.1 S1811173
; T110NO MOTION FEB • R -SI 101-000-241-000 $26.S6
GUAM() FFIF 1011-•00-42:1.000 920.00
DFIVE1101-Itp, tlutPACT $trefG.5.0(f
Alk'F IN PUBLIC! I'L ACji 5 -.Ata'93.1; 2'70-f3W-445,0100
60-It"1<iAl., C 0 U� 101-T AMD PIAN C;HMt
$5,' 40.10
7 ,g FIM-£'. ME.')
$0.00
'I` TA!.► YUM Y9 VESI)t;:rt?'..1'�'t. W
0
,�*4i9et19
[UR
rJ111C17Y0FLAQI111MkrTrA-
RECEIPTFINANCED t/,E:BY
DAT INA D
INS E R
CA
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings D— A1.61
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
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
Drywall - Int. Lath
Final
Final d
BLOCKWALL APPROVALS
POOLS - SPAS
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
Waste Lines 02
Gas Test
Electric Final
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection d 2 J
Encapsulation
Gas Piping .
Gas Test
Appliances
Final
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 y
Final
Utility Notice (Perm)
COMMENTS:
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Tight Ducts) CF -4R
PROJECT INFOF#MATION
Project Title:
La Cala
Project Address:
la Quints
Builder Name:
Western Pacific Homes, Michelle Lopez
Voice * ;
949-4a2-8199 x 462
Builder Contact:
John Zieman
Voice # :
780.564-7555
Project ID 0;
28838-2
Sample Group #:
Phase 4b
Let 0:
2015
Plan *
7
'AKAddress: ,:
815 MulrfW41 Village
FRS�IN,FORMATION
HERS Rater:
Scott Johnson Jayme Carden
Certification!! :
CCCSJSW37 OCNJC615157
HERS Firm;
Action Now
Voice 0:
949.631.2274
Adersss;
2675 Westminster Avenue, Costa Mesa, CA 82e27
HERS Provider:
CHEERS
Voice 0:
818.407-1500
HERS Address:
9400 Topenga Canyon Blvd, Chatsvrorth, CA 9131 1
HERS RATER COMPLIANCE STATEMENT
r� T-24 Compliance Credit was Taken for Tight Duds
TF�house was:
Tested MApproved as a part of sample, but was not tested
x The installer has p—rovicFed a copy of CF -8R
Air Distribution System 16 Fully Ducted (sheetmatel, duotboard or tax duct)
Where cloth backed rubber adhesive duct tape is installed, mastic 9nd drawbands aro used in combination with
cloth backed, rubber adhesive duet lope to seal leake at the connections.
MINIMUM REQUIREMENTS FOR DUCT LEAKAGE COMPLIANCE CREDIT
Duct Diagnoff;CFA"Leak
Tting Results (Maximum 6% Duct Leakage)
CFA: Max r --Nested Leak
SystemIndicate themaxime Duct Leakage and the calculation used:
0.7 x Floor Area x (0.06) for Climate Tone 8 through 15
0.5 x Floor Aree x (0.08) for Climate Zones 1 through 7 g 16
400 x (Cooling Capacity In Nominal Tons) x (0.06) .
21.7 x (Heating Capacity In Thousands of Output BTU per hour) x (0.06)
Other
c Pressurization Teat Results (CFM @ 25 PA)
100 x Test Leakage r Fan Flaw = % Leakage
Check Box for Pass or Fait (Pass = 6% Or Lass) PaOe a,
System ® of
Indicate the maximum o oI m Dud Leakage and the calculation used:
0.7 x Floor Area x (D.06) for Climate Zone 8 through 15
0.6 x Floor Area x (0.06) for Climate Zones 1 through 7 $ 18
.400 x (Cooling Capacity in Nominal Tons) x (0.06)
21.7 x (Heating Capacity In Thousands of Output BTU per hour) x (0"06)
Other
u Pressurization Test Results (CFM C 25 PA)
100 x Test Leakage / Fan Flaw c % Leakage
Check Box for Pau or Fall ass o 6% or Less) Paso a
mit-
System of
Indicate the max um a
0.7 x Floor Area x
0.5 x Floor Area x
400 x (Cooling Ce
21.7 x (Heating Ci
Other
u Pressurization Test
100 x Teat Leakage / Fa
Check Box for Pass or F
Raters Certifying Signstk
`ZO_03
macre ria
,i
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: LA CALA
LOT #: 15
SITE ADDRESS: 81-065 MUIRFIELD VILLAGE - LA QUINTA CA.
-------------------------------------- --------
EXTERIOR WALLS: BATTS
MANUFACTURER: KNAUF 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 C TRACTOR: WESTERN INSULATION, L.P.
LICENSE NUMBER: 9448
BY:
TITLE: PRODUC IO M ' GER
DATE: NOVEMBER t, 20
e p
Corporate Office:
P.O. Box 462890 , , Phone:, (760) 737-8888
Escondido, CA 92046 INCORPORATED FAX: (760) 737-0350
License # 663581
WESTERN PACIFIC HOUSING
LA QUINTA
760-564-7022 (FAX) ,
1-6-03
Attn: JOHN,
Roofing on "LEGENDS (a), P.G.A. WEST" Ph 4B
Mayer Roofing has supplied and installed " 14 " O'hagin cloaked roof vents, on lot'# 2015
at 81-065 Muirfield Villiage, Tile vents have been installed per manufacturers
specifications:
Note: Exact vent locations are determined by builder
RESPECTFULLY SUBMITTED
SCOTT BEECHAM
OPERATIONS MANAGER
Mayer Roofing, Inc.. ;
Page 1 of 1
558 Library Street . San Fernando, CA 91340 193 Orange Street . Riverside, CA 92502
(818) 838-6064 . FAX (818).838-4493 (909) 782-0601 . FAX (909) 782-0804
HVAC INSTALLATION CERTIFICATE for Tested Duct Leakage & TXV Page 1 of 2 CF -6R
Site Address- B(CN75 l)IRF IE -Lb U)Lt_ACI- E Permit Number:
Tract Numtxtr, 2,83 _2 Plan #: I
Lot Number: )'5
An installation car1rhtate is required to be posted at the building site or made evallble tar all appropriate inspections.
After completion of tmal inspection, a copy must be provided to the Building Depaltnuil (upun ieyuesl) and Via building
owner at occupancy, per Section 10103(b).
HVAC SYSTEMS:
Heating Equipment
Equip. CEC Certified Mfr Name
Tvoe and MOCO Name
Cooling Equipment
Equip. CE -1 Certified Wfe Name
I ype and Model Number
# of Efficiency Duct
Identicla (AFUE, etc,) Location
Svstems i}= CI' -1 R) (sitic, etc.
# of Efficiency Duct
Identlele (SEER, etc.) Location
syshwigs (;-CF -1R) (attic, etc.)
Ali !1•�I.���►�i��'��■�L�i�
� l��i>•�E� � r 1�T�1
I, me undersigned, %nmy that egtupment ustm aoow is: 1) i5 the actual equipment mstallec. G) equivalent to or more
efticienk than that specified in the cedifioate of compliance (Forth (:1--114) submitted for wriplianco with the Energy
Efficiency Suv%dards for residential buildinos, and 1) agi,ipment that Meeks or exceeds the appropriate requirements for
manufactured devices (frog the Appliance: Efficiency Regulations or Part 6), where applicable. Libeliy Hea trig and Air Concliboning, Inc-
�nalure. Date 'e- Installing u con ra or o. ame
OR General Conlredor (Co. Name) OR Owner
MINIMUM REQUIREMENTS FOR DUCT LEAKAGE COMPLIANCE CREDIT
Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage)
CFA:
System . Q of �,
Indicate the maximum sl owe Duct Leakage and the calculation used:
0.7 x Floor Area x(0.06) for Climate Zone 8 through 15
0.5.y Floor Area x (0-06) far Climate Zones 1 through 7 8. 16
400 x (Cooling CapacAy in Nominal Tons) x (0.06)
21.7 x (Heating Capacity in Thousands of Output BTU per hour) x 0.06
Measured Far: Flow (–" x .06
ilei Pressurization Test Results (CrM U 7-5 PAT
t 00,x Test Leakage ) Fan Flow = % LeakaW
ChErt:A Box for Pass or Fad (Pass = 6% or Less) Pass . ail
T-24 Compliance CreQIowabldit was Taken for TXV TXV was insta i
of
Indicate the mm aximual a Duct Leakage and the calculation used:
07 x Floor Area x (0.06) for Climate Zone 8 through 15
0.3 x Floor Area x (0.06) for Climate Zones 1 through % & 16
400 x (Cooling Capacily In Nominal Tors) x (0.06)
21.7 x (Heating Capacity in Thousands of Output BTU per hour) x (0.06)
Measured Fan Flow X.06
ZO Pressurization Test ResultsCFVr@ 25P-
100 x Test Leakage / Fan Flow = % Leakage
Check Box for Pass or Fall (Pass = 6% or Less) Pass i_ a
511
=T-7..4 Cc4T#iance Credit was Taken for TXV TXV was insta I --
PAGE 1
F2001.01 (4-02) Action Now T-24CFS-RTD&TXV macro
Z00 'd -deT ISO Z0/e_TiZT T9Z4ZeSt;T/_ -i!v S 1—i -i "'IdziE11
Heabng
Heating
Duct
Load
Capacity
fl -value
BTU I Hr)(
BTU I Hr)
J IIVi(.l'i
7 0C
`4
4
00
Cooling
Cooling
Duct
Load
Capacity
R -value
(OTU / Hr)
(BTU / Hr)
Ali !1•�I.���►�i��'��■�L�i�
� l��i>•�E� � r 1�T�1
I, me undersigned, %nmy that egtupment ustm aoow is: 1) i5 the actual equipment mstallec. G) equivalent to or more
efticienk than that specified in the cedifioate of compliance (Forth (:1--114) submitted for wriplianco with the Energy
Efficiency Suv%dards for residential buildinos, and 1) agi,ipment that Meeks or exceeds the appropriate requirements for
manufactured devices (frog the Appliance: Efficiency Regulations or Part 6), where applicable. Libeliy Hea trig and Air Concliboning, Inc-
�nalure. Date 'e- Installing u con ra or o. ame
OR General Conlredor (Co. Name) OR Owner
MINIMUM REQUIREMENTS FOR DUCT LEAKAGE COMPLIANCE CREDIT
Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage)
CFA:
System . Q of �,
Indicate the maximum sl owe Duct Leakage and the calculation used:
0.7 x Floor Area x(0.06) for Climate Zone 8 through 15
0.5.y Floor Area x (0-06) far Climate Zones 1 through 7 8. 16
400 x (Cooling CapacAy in Nominal Tons) x (0.06)
21.7 x (Heating Capacity in Thousands of Output BTU per hour) x 0.06
Measured Far: Flow (–" x .06
ilei Pressurization Test Results (CrM U 7-5 PAT
t 00,x Test Leakage ) Fan Flow = % LeakaW
ChErt:A Box for Pass or Fad (Pass = 6% or Less) Pass . ail
T-24 Compliance CreQIowabldit was Taken for TXV TXV was insta i
of
Indicate the mm aximual a Duct Leakage and the calculation used:
07 x Floor Area x (0.06) for Climate Zone 8 through 15
0.3 x Floor Area x (0.06) for Climate Zones 1 through % & 16
400 x (Cooling Capacily In Nominal Tors) x (0.06)
21.7 x (Heating Capacity in Thousands of Output BTU per hour) x (0.06)
Measured Fan Flow X.06
ZO Pressurization Test ResultsCFVr@ 25P-
100 x Test Leakage / Fan Flow = % Leakage
Check Box for Pass or Fall (Pass = 6% or Less) Pass i_ a
511
=T-7..4 Cc4T#iance Credit was Taken for TXV TXV was insta I --
PAGE 1
F2001.01 (4-02) Action Now T-24CFS-RTD&TXV macro
Z00 'd -deT ISO Z0/e_TiZT T9Z4ZeSt;T/_ -i!v S 1—i -i "'IdziE11
HVAC INSTALLATION CERTIFICATE_ for Tested Duct Leakage & TXV Page 2 of 2 CF -13R
Site Address:0& 4Z:, I F10; D UILLA611F Permit Number:
Tract Number 2i�6—
Lot Number: 15
system Q (allov�f
Indicate the mammum a Duct LeakGW and the calculation used:
0.7 x Floor Area x (0,06) for Climate Zone 8 through 16
0.6 x Floor Area x (0.06) for Climate Zones 1 through 7 8 16
400 x (Cooling Capacity in Nonan Torts) x (0,06)
21.T x (Heathtg Capacity In Thousands of Output BTU per hour) x (0.08)
Measured Fart Flax
Pressurization Test ROSUIM`(CF1Q! ?
100 x Test Leakage I Fan Flow = % Leakage
Check Boot for Pass or Fail (Pass = 6% or Less)
r,T 24 Compliance Credit was Txken tui TXV
ysof
Indicate the mQ at Duct Leakage and the tabulation used;
0.7 x Floor Area x(0.06) for Climate Zone 8 through 15
0_5 x Floor Area x (0.06) for Gli nate Zones 1 through 7 8 16
400 x (Cooling Capacity in Nominal Torts) x (0.08)
21.7 x (Heating Capacity in Thumantits of Output BTU per hour) x (0.00)
Measured Fan Flow --,
u Pressurization Test Results
100 x Test Leakage! Fan Flow = % Leakage
Check Bm( for Pass or Fail (Pass = 6% or Less)
;R ]T,24 Corn liamv Credit was Taken fix TXV
I I Of 1.
Irtdleste the mi-m—um Duct Leakage and the calculation used:
0.7 x Floor Area x (0.06) for Climate Zone 8 through 15
-" 0.6 x Floor Area x (0.06) for Climate Zones 1 through 7 8 16
400 x (Cooling Capacity in Nominal Tons) x (0.06)
21.7 x (Heating CalxlacO in Thousands of Output BTU per hour) x (0.06)
Mwsured Fan Flow
C Pressurization Test ResultsCFM @ 25A)
100 x Test Leakage / Fan Flow = % Leakage
Check Box for Pass or Fall (Pass = 6% or Less)
7-24 Compliance Credit was Taken for TXV
em
Qof
Indicate the maxm�+um a162e Duct Leakage and the calculation used:
0.1 x Floor Arise x (0.06) for Climate Zone 8 through 15
0.5 x Floor Arty x (0.06) for Climate Zones 1 through 7 816
400 x (Gaoling Capacity in Nominal Tons) x (0.08)
21.7 x (Heating Capacity In Thousands of Output BTU per hour) x (0.06)
Measured Fan Flow r
DEE Preasurizatign Tort Rasult$ (CFU (a 26 FA)
100 x Test Leakage / Fan Flow = % Leakage
Check Box for Pass or Fad (Pass - 6% or Less)
QT -24 Compliance Credit was Taken for TXV
X.015
X.06
X.015
x .06
TXV wM
Plan #;
TXV wax
TxV wat
TXV ww
1, the undersigned, verify that the above diagnOStie test results and the work I performed associated with the test(s) Is
in conformance with the requirdrnents for compliance credit. (The builder shall provide the HERS provider a copy of the
CF -6R signed by the buiki&, employees or sub -contractors certifying that diagnostic testing and installation meet the
requirements for compliance credit.)
Te—fs — Signature,. Uad ��rr � 0� oz
Performed
COPY TO: Building Department
HERS Provider (if applicable)
Building Owner at Occupancy
Sensible Load 1.
Coding: .2.
L DOq Heating and Air Conditioning,
ns ing 9ubruntractor (QQ. e
General Contractor (Co. Name)
PAGE 2
600 'd "'dGT i20 Z0,'LS/7Z T9Z4Z89bSL a!V e leaH 112i3IF11
11.1.8/0Y 1tl;ll 1533 FA,i 7:t4 4l4Z0144
;*Ov Of 2002 1.2;G?prl CVUSO FNCII-ITIES " d
Cgacheiia daUey Unified School District
P.O. Box 847, Thermal, CA 92274
(760) 398-5909 - Fax (760) 398-1224
?6039E1224 P • ? -
Tbiz sox Fur nisuiat Us: Only
I)V,N ER GFRR FEES PAID ARCA.' _
tFvEL a"ewOWr� �fiVOL 1N'D A✓tti; M)'nC1,1'Na4 AMOUNT: CGUN'n4%'MMINT•
OA91& . MSCF,1Pr CMncr:r iNr14L1 ^
CERTIp1.cA,r9 OF cOMPUA> NCE
(Calltornist Edtecadeln Code 11620)
ProjaetNatnpc _ Ltl Calm `_ Date. _„•P
Owner's Naar_:gGt Pe o -1_n�_ Phone No.
Project Address: Mu�f'i el d V i 11 aq% ( Seen ' ttac hrnent �" � PGA -West, 111 Ot
Project Descriptintt:._ 12 Si Ilgl a Fa(ri 1.Y+ Home
APN:
us,u
Got WS: 10-21
Type at DevelopmentXX Co moreiltl ^_. Indueltrw _
(- + 1�0 l�>sitding Axen: �c
Cartification of Appt eant/0winers: Tiro pczmn siguing certi>hea that the above intattrsation i.: cottaet and ruaktes this statement
tutder penalty of perjury aAd tiut)W rupresents that he/she is avEbwrized to sign t332 behalf of ti c owaerldervelapl r.
Dated, Signsiturv; -_ _.
♦wa It •,s lrwwww.av s �•ar tw sreoo Pw+*t rwrxwatrw r%.wrrt.a w.ew. •erre y.twwr«err o-rr♦
SCHOOL DISTRI(CT'S REQUTR$NIENTS FOR THE ABOVE 1"ROJEC T HAVC BEEPr'Uft WILL BE SATISFIED IN
ACCoRDANCti; WITH ONE OF THE FOL LOWINGI (CIRCLE ONS)
Edocslion Code Gov. Code project Agreemntat 9xiatiaq Nat Subject to Fee
17620 6,99E Approval Prior to 1111187 Rmgttirellywat
Note.
Number of Sq.it
1- (� ':2-— ITI =d1Tjj t _ZEE_48,85 58.8§a . ®8 far home As nor
Armotutt per Sq.Ft. �___ M1 ti_911t i On AUreetnen t
Amount Collected S 1Qa Ng Y�£1L�.1
Building Permit Application CompilvIlesl- Yr1fND
eY clux M. Carts yn.
Amt. Sup%.. Rudilvas Seri.
erliitt ata issued by: Marcela Va 1 dei —1 Sigti�twr.;�n
1=ac
.' �� o�� F 3 �R rau�'�sl o� FUS an RAI' I' UY Ft$E9
Svcdon 6607a of the Government Code assartwl by .&sswWy Aul 34111! ef(taltre January 1. 194', ragYlroa uiat• t 4 bi,trkt previus Il) i Ren a0GC0 xn .
it u prciect appelts= at dw. lute of paympat o4 sehoot fen mitlpsion poymont or other mrsctwas, CilFgloe), of the Y(klay period to pro"tthe Irapoattlue of
these Ft" rati (2) the atanunt of the tuts, Thererara to accw/dance wtth satiion 66WA of the t3ev rntnem Godo olid ealtw eppUastttte law, trete Notice shall
serve to advU@ you that the fall -day prttluat period iA rtgord t4 such Fees or the validity dweeif, easntruh949 Wi0l the psymoat at thm flee or par fnrgpaee of
any other rrquir¢menW OA dtecsabod in bectim 66020 of ler C.overnmavl cads hAditioually, tate atrwuot afths fen tmpas94 i■ as bereln set forthwhethrr
payable of this flaw Orin N hots ar lE part prior to Isatsatlea of* C—li6eata of Oeeupanv7- Aa an the latter, the days stnrtf on the date beruuf. This
Ccriilleattof COM01urtee ie Valid forrhlrty (30) days fNt.1 Clow dote of is;soatnte< Rsoenslon %jilt be drgs*donly for good cauta, as detrmtesd by the School
rAstrict and Up wthree (3) such oateasloos rear he Rrootcd. At sur9 lane as thb Certiticsioe:panu,:f abuilding
per Mea not batA !sued for tfic project
;bet & the wbieet of this C lslitfcata, the owner will bs rdatisurnad all fees that were quid to abIIHn asst <;wt'fle lee of Ct mplle'sm
4tv.vlrtydeel✓dev!'ues/satifi, atu of complinct; 09/90/04
Certificate of Occupancy
City of La Quintal
Building and Safety Department
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code,
certifying that, at the time of issuance, this structure was in compliance with the various ordinances
of the City regulating building construction or use. For the following.
BUILDING ADDRESS:
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of Construction
81-065 MUIRFIELD VILLAGE
Owner of Building: SRHI, LLC
Ile
.Building Official
vni
Bldg. Permit No.: 0206-179
Land Use.Zone: RL
Address: 16940 VON KARMAN AVE, STE 200
City: IRVINE, CA 92606
By: DANIEL P. CRAWFORD JR.
Date: 2/5/03
POST IN A CONSPICUOUS PLACE