SFD (0203-030)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 forceland effect. '�
License # Lic. Class' f Expo)
675709 { � � /� 813,V03
Date r Signature of Contractorf
OWNER -BUILDER
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). ; %
O I am exempt under Section , B&P.C,s firthisreasons
Date ,* /(!;' - 0 0 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.
k4l 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. Myy workers' compensation insurance carrier & policy no. are:.
Carrier ,AP�lI?RIC N PROTEV Policy No. SDR0833470
(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 wit�' those provisions.
Date: P`f It— 2Applicant
;
'Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer topiminal 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) ti--��-`1`'!"f''w •Date,���'
BUILDING PERMIT PERMIT�O
DATE VALUATIONLOT l(y TRACTJOB
APN 75��-521
ADDRESS
OWNER
CONTRACTOR / DESIGNER / EN (NEER
VIA ILC
ISA C0 TIOTISNO dba WWM�T 1)Af` LY,IC I-
16"0 V ON } MNW. 1 AVE M? 200
DriTiuloil7 O,ie DATIOrTf32q
011 92606
IRVWE CA 92606
f 949)442-6199 C'BW
USE OF PERMIT
. sI - IA. Q- 10 V4 60 VIU0W1T4JUQi HUT I V0 6 ULfic
S OOY,, 9PA OR DRIVEWAY A.PPROAi:K 75% 121'.Di£l",'i`.ION TO PLAN
CHECK I?'i"E POR Ik4iJUr1P1Z LSSUAIXXOF'F,,�;.F�I'? K.A.14 TYPH,
CUSTOM CONVR'UCTION -4308.00 V)
3;ORCHIP:A:TIO 761.cN Sir
f�A1ZA.t!413%Cds�tf'�I�T b�.ttti Si?
IT.'SI"aCr ATED WOW CONS'C1 ILIC-rIO `1•
201,442RO
FrIdAIT 1MV KUKWky
CONSTRUCTION FEIa 101.001.418.000 $I,Arx3D
PLAN CHtfF" K FEE. 101-000-4394418 $260.17
MEC"NiCAL FEE 101-000-421-000 $124.00
1CLWrPJCAL fvEr, 101-000-•420-000
PL IUMD)NOY F-% 101.000.4.19.000
ST:RONO M T IOIN FEE - .RES10 101-000-241-000 $28.14
G AI*40 [11. 101.000.423.000 $10.00
1]:VE-LOPE•f'F IMPACT FtZ $1,40.00
ART IN PUBLIC PLACES - RESIT' 270-000.445.000
SUP, -TOTAL C' ONWAWC:l:01v AND PLgA1�j�4 G"l—rRCK��''ff��,��
t ,2(��i/7.:3'7
[[,aa��' ((++
.00
� h4 W1�I.1'Ad�{ l:`7�Y.t..6V.f�F:E'.4' �:.p+A' �a"4i� HOW
$4,207,37
D�A
U 8 2102
CITYOFLAQUINTA
BY DATE F)fNAL90 INSP
OR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
p
Ducts
Slab Grade
o7—
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
17
Compressor
Insulation
Z
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
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 I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
8 aZ
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
UU14 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 / d ,
I 4Z
Final
Utility Notice (Perm)
COMMENTS:
IL
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 #:-' 16
CSCE ADDRESS: 81-075"MUIRFIEL"D'VIL'LAGE -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 C09-tRACTOR: WESTERN INSULATION, L.P.
LICENSE NUMBER: 7 4484
_V,
BY:
TITLE: PRODUCT y
MAN GER\
DATE: NOVEMBER/l, 2002
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Tight Ducts) CF -4R
PROJECT INFORMATION
Project Title:
La COO '
Projed address:
La Quinta
Builder Name:
Western Pacific Homes, Michelle Lopez Voice # : 949-442-8199 x 462
Builder Contact:
John Ziemen Voice 8: 780-564-7555
Project Ib 0:
28838.1
Sample Group 0 :
Phase 4b
Lot N:
2016
Plan 0
6
Address;
81.075 Muirfield Village
HERS INFORMATION
HERS Rater.
Sow Johnson Jayme Carden
Cer0catlon 0:
CCCSJ614037 CCNJC815157
HERS Firm:
Action Now Voice N: 949-831-2274
Address:
2575 Westminster Avenue, Costa Masa, CA 92627
HERS Provider.
CHEERS Voice 0: 618407-1500
HERS Address:
8400 Topengs Canyon Blvd, Chatsworth, CA 81311
HERS RATER COMPLIANCE STATEMENT
j� T-24 Compliance Credit was Taken for Tight Ducts
he 'house was:
Tested [ x ]Approved as a pan of sample, but was not tested
x . The installer has provided a copy of CF -6R
Air Distribution System Is Fully Ducted (sheetmetal, ducttmard or flex duct)
Where doth backed rubber adhesive dud tape is installed, mastic and drawbands are used in Combination wlth
cloth backed, rubber adhesive duct tape to seal leaks at the connections.
MINIMUM REQUIREMENTS FOR DUCT LEAKAGE COMPLIANCE CREDIT
Duct Diagnostic Leeks a Testing Results (Maximum 6% Duct Leakage)
CFA: CFA Leak Max Tested Leak
System Of
Indicate the maximum s o Dud 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 & 18
400 x (Cooling Capacity In Nominal Tons) x (0.08)
21.7 x (Heating Capacity In Thousands of Output BTU per hour) x (0.08)
Other
u Pressurization Test Rew tB (CFM ® 25 PA)
100 x Test Leakage / Fen Flaw u % Leakage
Check Box for Pass or Fall (Pass = 6% or Less) Pose ai
SystemO of
Indicate the memmum a o Duct Leakage and the Oalouletion 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 Zones 1 through 7 8 16
400 x (Cooling Capsolty In Nominal Tons)'x (0.06)
21.7 x (Hosting Capacity in Thousands of Output BTU per hour) x (0.08)
Other
Mu Pressurization Test Results (CFM (M 25 PA)
100 x Test Leakage I Fan Flow e % Leakage
Check Box for Pass Or Fail Pass = 6% or Less) Paas a
Systarn
Indicate them mof
ndicum aY.—L Dud leakage and the calculation used:
0.7 x Floor Area x (0.06) for Climate Lone 6 through 15
0,5 x Floor Area x (0.06) for Climate Zones 1 through 7 & 16
400 x (Coaling Capacity In Nominal Tons) x (0,06)
211 x (Heating Capacity in Thousands of Output BTU per hour) x (0.06)
Other
u Pressurization Test Results (CFM Q 25 PA)
100 x Test Leakage I Fan FlOw = % Leakage
Check Box for Pass or Fall (Pan Mit Or Less) �} Bnes gi
Raters Certifying Signature
dL— Date -d 3
F2001-02 (302) Action Now T-24CF4RTDmacdo.xl8
D
Corporate Office:
P.O. Box 462890
Escondido, CA 92046 INCORPORATED
License # 663581
WESTERN PACIFIC HOUSING
LA QUINTA
760-564-7022 (FAX)
Attn: JOHN,
Roofing on "LEGENDS Cad P.G.A. WEST" Ph 4B
Phone: (760)737-8888
FAX: (760) 737-0350
1-6-03
Mayer Roofing has supplied and installed " 15 O'hagin cloaked roof vents, on lot # 2016 .
at 81-075 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
Certificate of Occupancy,
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OF Building & Safety Department
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This Certificate is issued pursuant to the requirements of Section 109 of the California Building
Code, certifying that, at the time of issuance, this structure was in compliance with the
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provisions of the Building Code and the various ordinances of the City regulating building
F � '
construction and/or use.
A
P
.. BUILDING ADDRESS: 81-075 MUIRFIELD VILLAGE
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Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0203-030
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Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
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Owner of Building: SRHI, LLC Address: 16940 VON KARMAN AVE STE 200
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City, ST, ZIP: IRVINE, CA 92606
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By: DANIEL P. CRAWFORD JR.
Date: 2/20/03
x
Building Official
1
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POST IN A CONSPICUOUS PLACE