SFD (0203-031)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
C6ter 9 (commencing with Section 7000) of Division'3 of the Business and
Professionals Code, and my License is in full force anis effect.
License # Lic. Class ' f f Exp. Date
e
675709
&InDate'' `Signature of Contractor � -_-�•-°• • ,
A-°•5'`"'"�-`
t
OWNER -BUILDER DECLARATION.`
I hereby affirm under penalty of perjury that I am exemo 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).
( ) 1, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044,�eB6siness,& Professionals
Code). _ 1 I ;
( ) I am exempt under Section B&P.C. for this reason "
Date I r 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.
d 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 AM1321W 1PROTU " Policy No. MOM"
(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: 'r' _.... .• t^ Applicant-
-Warning:
pplicant 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 pursuanYto
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 represntatives of this City to enter upon
the above-mentioned property for inspection purposes_.
r f t r.
Signature (Owner/Agent) Date`"
PERMIT #
BUILDING PERMIT
(Y
DATE VALUATIONs•4 LOT.` TRACTJOB
ADDRESS r �I a".Kd,v MUMaa.1) M. 4.40
APN
OWNER
CONTRACTOR / DESIGNER / EN 1NEER
y'* ,�9
.ORM, Lai:.ar
p�,qC� r�
LAMCO 2'�OT7,91NO &P V1fi�'riI TMN Y 1, F
16.940 VO, 14 KAR. N AVE& M 200
DMI01014 OF DKI-10100191
TRME CA 92606
IRVINE CnA. 9260£
(949)44Z-6199 (IDLIll
USE OF PERMIT
SINGLE PALMY DMMUNG
. FL)T1.AY / Y r'3,@ YC FiSit : IT UUr.S , UT INCL . 1:1 d " WCK WALLi
POOY4 81PA 011 PRIMIAV APMO.ACt'c, 75% REDUCTION TO PLAN
C::i'I:1fd".K FE 10 FORMULTIPLE 1SWANCE OF SAME PLAN TYPE
CUSTOMI CONSTi1.3301 N 31816.00 SF
POIZCH43ATIO &1160 ,SY
OA Ct}i4f° OEtT.' MICA Sp
EfY71MMM CCAS' OF COAV'SIRIUMOR
329,726.70
PX ,T'..M ihit:WARY
CONSTRUCTION ! i, ?01.000.4781-GC0 $1,42710
PLAN C;iiECK FRE 101-000-439-318 M8.00
i.��,yy(FEq12, 101-000'x2'1�'000 e 124��.0/0��
•M�XCII/�,'H[A�+g��I/`1C((��kppi
$130.06
'Si1hVA/�1'RG.i1..AL CFi 9 101-0100-4,20-000 $130.06
1$LUMD110 T"'We 101.000.419.000 $19+9,173
S'z:014IMCTION iER.RISID 101-000•241-#0 $32.47
4R)N"i101-000423-000 WWII)
DZ5iE-'ODER IMPACT FEB si"w 00
ART IN Pi,7T1UC T'IAMS - W11210.000.446.000
SUB -TOTAL CCAWIMUE"`i't.014 AND P.U41 IMMM..
$4,113.10
_ LUS PRiC-PAIDFRM,
DrzaawIrEnru-
$0,00
Now
CITY0F,LAQ1J1fJ
FINANCED
RECEIPT
DAT } B.Y f
DATE INAL
1 SPE R
IA
INSPECTION RECORD
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
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 _
BLOCKWALL APPROVAL
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
Gas Test
Electric Final
_
Waste Lines a2
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection( p
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low VoRage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors 0.1 4Z
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
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 #: 17
SITE ADDRESS: �1-085 MUIRFIELD_ VILLAGE = LA QUINTA CA.
----- --------------------
EXTERIOR WALLS: BATTS
MANUFACTURER: KNAUF THICKNESS: 6 3/4" R- VALUE: R-19
CEILINGS: BA TTS
MANUFACTURER: JOHNS MANVILLE THICKNESS: 11" R- VALUE: R-30
GENERAL CONTRACTOR: WESTERN PACIFIC HOUSING
BY:
TITLE:
DATE:
INSULATION C RACTOR: WESTERN INSULATION, L.P.
LICENSE NUMBER: 94484
BY:
TITLE: PRODUC I p M 4G R
DATE: NOVEMBEq 1, 200
D
Corporate Office:
P.O. Box 462890
Escondido, CA 92046 INCORPORATED
License # 663581
HOUSING
Roofing on "LEGENDS na, P.G.A. WEST" Ph 4B .
WESTERN PACIFIC
LA QUINTA
760-564-7022 (FAX)
Attn: JOHN,
Phone: (760)737-8888
FAX: (760)737-0350
1-6-03
Mayer Roofing has supplied and installed " 19 " O'hagin cloaked roof vents , on lot # 2017
at 81-085 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)1838-4493 (909) 782-0601 . FAX (909) 782-0804
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Tight Ducts OF-4Rr
PROJECT INFORMATION
Project Title:
La Cala
Project Address:
La Qulnta
Builder name:
Western Pacific Homes. M iicholie Lopez
Voice
949.442-6199 x 462
Builder Contact:
John Zleman
Voice sti :
760.564-7555
Project ID 0:
28838-2
Semple Group k :
Phase 4b
Lot 0:
2017
Plan X
9
Address:
61 -055 Muirfietd Village
HERS INFORMATION
HERS Rater.
Scott Johnson Jayme Carden
Certification # :
CCCSJ614097 CCNJC615157
HERS Firm:
Action Now
Voice 0:
949-631-2274
Address: .
2575 Westminster Avenue, Costa Mesa, CA 82627
HERS Provider:
CHEERS
Voice r# :
818.407-1500
MER$ Address:
8100 Topenge Canyon Blvd, Chatsworth, CA 91311
HERS RATER COMPLIANCE STATEMENT
T-24 Compliance Credit was Taken for Tight Ducts
Ouse was:
Tested ( x 1Approved as a parr of sample, but was not tested
x The installer has piro—yWed a copy of CF -6R
Air Distribution System is FURY Ducted (511901met0l. ductboard or flex duct)
Where doth backed rubber adhesive duct tape is installed, mastic and drawbands are used in combination with
cloth backed, rubber adhesive duct tape to seal leaks at the connections.
MINIMUM REQUIREMENTS FOR DUCT LEAKAGE COMPLIANCE CREDIT
Dud Diagnostic Leakage Testing Reaulta (Maxirnvm 6% Duct Leakage)
CFA: CFA Leak Max Tested Look
System o
Indicate the ma a w 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 Area x (0.06) for Climate Zones 1 through 7 8 16
400 x (Cooling Capooity in Nominal Tons) x (0.06)
21.7 x (Heating Capacity in Thousands of Output BTU per hour) x (0.06)
Other
TW Pressurization Test Results (CFM Q 25 PA)
100 x Test Leakage / Fan Flaw = % Leakage
Check Box for Palla or Fail (Pass = 6% or Less) Paere a
System of [�
Indicate d+e mum alfow�le Duct Leakage and the calculation used:
0.7 x Floor Area x (0.06) for Climate tone 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)
21.7rx (Heating Capacity in Thousands of Output BTU per hour) x (0.06)
u Pressurization Test Results (CFM ® 25 PA)
100 x Test Leakage r Fan Ftow = `/o Leakage
Check Box for Pass or Fall Pass = 6% or Less) Faill
System 4 of
Indicate the max mum F
0.7 x Floor Area )
0.5 x Floor Area x
400 x (Cooling Cc
21.7 x. (Meeting C
Other
D"u—a Pressurization Tea
100 x Tact Leakage f Fr
Check Box for Pase or I
Raters Certifying Signat
I::w
03
rrlacrc. x is
Certificate of Occupancy
City of La Quinta
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: 81-085 MUIRFIELD VILLAGE
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of Construction
Owner of Building: SRHI, LLC
Building Official
vni
Bldg. Permit No.: 0203-031
Land Use Zone: RL
Address: 16940 VON KARMAN AVE STE 200
City: IRVINE, CA 92606
By: DANIEL P. CRAWFORD JR.
Date: 1/30/03
POST IN A CONSPICUOUS PLACE
.K