SFD (0203-032)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing with Sectio 7000) of Division 3 of the Business and
Professionals Code, and my Licensees in full force and effect.. '
License # Lic. Class. i Exp. Date ^ -
Date,'"'�"�"� "<-'' Signature of Contractor
w ...
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 1, 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 4 Professionals
Code). j /
( ) I am exempt under Section B&P,C. for this reason
Date +r'° to r Signature, of Owner,
WORKER'S COMPENSATION DECLARATION
u
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.
A(,) 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 AMERICAN PROTEC ' Policy No. 9BR0835470
(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 marine? 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 witl4those.p ovisions. /
Date -^*` ('Applicant-
Warning:
`Applicant 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, indemnity
& hold harmless the City of La Quinta, its officers, agents and employees. I
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 prope.'jrty f�: nspection,purposes. i
f Signature (Owner/Agent)),,k�'t__ 4fr Date �
' BUILDING PERMIT PERMIT0200-032
DATE VALUATION 0#1�,tY LOT ' TRACT
JOB SITE
ADDRESS ♦Ax��Iii4��.
APN��'r
,OWNER
CONTRACTOR / DESIGNER / EN (NEER
W14 LLC
UM:p: O a3OUf ;V9(l dba WF 'iUINT P VMW
16940 VOITM�. 4 AW, X317, 200
DMMON V171 ?♦fit T4QP..f01T
IRVUE CA, 92606
T1LV_fNF1 CA 92606
(9`49)442-6199 011114
USE OFFyy PERMIT
y� q r �► �p y�q +r p�py
tJJiV�]',. . ��.Mfv2.t.1.+X id 0+ . ,1110
SA* ,y 3 ZA < �' t" %d ]k° J iX"INCLULIX 3btwC k;r.
WAL ,1'tOLo VA, OR DRIVYWaAY AP'PROA.CH. 15% REDUCTION ION O
PLAN CHEEK iii? FOR MULTIPLE ISSUANCZ OF SANLS PI. A14 `rir .ft
CWTOM C[)1iOTRUC: ION 31309.00 F
PC3X1.C"I:l1P,;�`i IC?`�+§i'i.GO S%7
QA AG.E'1CAR.PORA 694♦00 SF
EGrWAUD CiI`rJ/MTW R 0101 tl ias'4wl.+ii/.4Y
2 •4q"1fY:2XD
CONSTRUCT 1014 101-€ W-4) 8.000 $1E276.50
Pb..A14 C142,CK F'V,E 101-010-x•39-83118 6
)70. h, 7
,1 {.+I
MW.II4A"Wl��CIi.XY..4 F'Sly. .000-4.21.1000 S12.4.00
ELECTRICA3,.F E 101-000-420-000 019.2.20
PLUMBING 3M -E. 101-000419-000
STf34)daC~f Jt40TIDN F'F% • RESID 101-0110-241-000
CTyyf°�.e�.''�!"p�j)���I��c}�:y1{�'T'�� 19 101.000-423.000 $220.try}0
p t� p� o-
0—ME6/�lPPIR ICYJ.:�AC. �1:'�f:� $1,9J7.60
.SRT rN PUBLIC PIACES - F OSM 270-000-445-000 (203.61
mm=,'our, t::o1+ erriuC`nom A1e1T9 P -Aa CF e -K
$4,2037
LE' d :3 F'TC1a'-I'AID 1-72 3
$0,00
XWTATFZ4%WFnS DUE, ?fOW
$4,207-17
01
CITYOFLAQUIRTA
FINANCEDE"..
RECEIPT
DATE R
BY.
DATE F ALE
3a 3
EC O IN P
�wf�l •
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms&Fobtings knjL_ S
Ducts
Slab Grade 012-
Return Air
Steel Z
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 L
Final
Final /
BLOCKWALL APPROV S
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 �p� .�
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
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 0
Final
Utility Notice (Perm)
COMMENTS:
( Ol� 1p
WES'T'ERN 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 #: _ 18
SITE ADDRESS: 481-095,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 COW ACTOR: WESTERN INSULATION, L.P.
LICENSE NUMBER: 7 448
BY: 11
TITLE: PRODUCTION M AG R
DATE: NOVEMBEl 1, 2002
Corporate Office:
P.O. Box 462890
Escondido, CA 920.46
WESTERN PACIFIC HOUSING
LA QUINTA
760-564-7022 (FAX)
Attn: JOHN,
e D
Phone: (760)737-8888
INCORPORATED FAX: (760) 737-0350
License # 663581
Roofine on "LEGENDS Cad P.G.A. WEST" Ph 4B
1-6-03
Mayer Roofing has supplied and installed " 14 O'hagin cloaked roof vents, on lot # 2018
at 81-095 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 FIELD VERIFICATION AND DIAGNOSTIC TESTING (Tight Ducts) CF -4R
PROJECT INFORMATION
Project Title:
La Cala
Project Address:
La Quints
Builder Name:
Western Pacific Homes, Michelle Lopez Voice 011: 949-442-61199 x 462
Builder Contac:
John Zleman Voice aM : 760-564-7555
Project IDS:
2883&1
Sample Group 8 :
Phase ab
Lot A:
2018
Plan #
8
Address:
81-095 MuKeld Village
HER$ INFORMATION
HERS Rater:
Scott Johnson Jayrne Carden
Certification S :
CCCSJ614037 CCNJC615157
HERS FimY
Action Now Voice #: 949-831-2271
Address:
2575 Westminster Avenue, Costa Mesa, CA 92827
HER$ Provider:
CHEERS Voice #: 818-407.1503
HERS Address:
9400 Topanga Canyon Blvd, Chatsworth, CA 91311
HERS RATER COMPLIANCE STATEMENT
Q 7-24 Compliance Crodlt was Taken for Tight Ducts
The house was:
Tested r77Approvad as a pert of sample, but was rot tested
x The installer has pr ed a oopy of CF -BR
Air Distribution System is Fully Ducted (shaetmetai, dvotboard or flex duct)
Where cloth packed rubber adhesive dud tape is installed, mastic and drawbands are used in combination with
cloth Wckad, rubber adhesive Gust tape to seal leaks at the connections.
MINIMUM REQUIREMENTS FOR DUCT LEAKAGE COMPLIANCE CREDIT
Duct Diagnostic LeakeTesting Results (tiAaximum 6°k Duct Laakag0)
CFA: CFA Leak Mex Tested Leak
System
Indicate them mum a owe Is Dura Leakage and oto calculation used:
0.7 x Fkxw Area x (0.06) for Climate Zone $ through 15
0.5 x Floor Area x (0.06) for Climate Zones 1 through 7 8.16
400 x (Cooling Capaoity kr Nominal Tons) x (0.o6)
21.7 N (Heating Cepeaty In Thousands of Output BTU per hour) x (0.06)
Other
U07 Pressurisation Teat Results (CFM (M 28 PA)
100 x Teat Leakage / Fen Flow ■ °% Leakage
Check Box for Pass or Fag (pass= 6% or Lass) Passar
System of
Indicate the max mum a ale Duet Leakage and the calculation used:
0.7 x Floor Area x (0.06) for Climate Zona 8 through 15
0.5 x Floor Area x (0.06) for Climate Zones t through 7 & 16
a00 x (Cooling Capadty in Nominal Tons) x (0.05)
21.7 x (HesRing Capacity in Thousands of Output BTU per hour) x (0.08)
Other
ZW Preasurizadon Test Results (CFM Q 25 PA)
100 x Test Leakage / Fen Flow - °A Leakage
Check Box for Paso or Fail (Pass = 6% or Less) Pass
System of
F4111 7-1
Indicate the maximum J71-ow—able 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 Zonae 1 through 7 8 16
400 x (Cooling Capacity in Nominal Tone) x (0.08)
21.7 x (Heating Capacity in Thousands of Output BTU per hour) x (0.06)
Other
D-va Presaunzatlon Test Results (CFM 4125 PA)
100 x Test Leakage 1 Fan Flow ■ % Leakage
Check Box for Peso or Fail (Pass_ 896 or Less) e j f
Raters; Certifying Signature
Date (- �.S1J
F20o1-02 (3-02) Action Now T-24CF4RTIDmar.ro.xl5
� I �
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: 81-095 MUIRFIELD VILLAGE
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of Construction
Owner of Building: SRHI, LLC
Building Official
Bldg. Permit No.:. 0203-032
VN 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