0206-181 (SFD)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 # ^4 Lic. Class Exp. Date
6�57� Eti131103
Date ; I h* r>Signature of Contractor
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 Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
( ) I have and will maintairi 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.
(q.) 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 AWRIC'AN PROTEC' Policy No. 5D.R0335 70,
(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: ^ 't E �< i t� Applicant ,, _ '�- A^ —
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, 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.
t
Signature (Owner/Agent) * ` . �JZI pDate `7.1 C i
BUILDING PERMIT PERMIT"
DATE VALUATION .1261,630.10 LOT 20 _ _ TRACT 2.8833-2
JOB SITE
ADDRESS S��{��a�.•L� �.gi�sA.�.� >f
APN
'761"390-CY81A.A�
OWNER
CONTRACTOR / DESIGNER / EN &NEER
SI*11, UIC
LAWCC31~ OUM'00 db2tWEIMIMM 1'. CSFIC k
3 6940 VON XARMAN ANS, I TCE 2N)
:0 :51'rON 01-M3a.-110.1tTON
URV`-Ila CA, 92606
1XVI IE CA; 9260,6
(9, 4 9)441.6 k 99 (Milo 6735
USE OF PERMIT
SWOL . FAtui LY' D'dU'.�,1 UNG
3P'IT) v WT 24 PLAN11CR. PEWIT D= 140T rHC+L'f3nR HLOCis"
WAL,IA P004 OPS Cly"3:.DRIVEWAY.Ai9PROACH, '73% i'3,,AH Of WK FI
REDUCTION Y01t lb U TIPIX iS`iUAI-ICC OF SAME L.f.14 TYPE
CUSTOM a OBSTRUCTION 3»115.>'Ils -3F''
PC)RCHMA'i'IO '7 IWI SY
C1ARACSM.Ai',.I O RT 7.9toD 3F
GS"MiliSlJGD COS SIJ: CONSm.1.F`5.UM' N
21#10Ti'YA39110
PILIMMN 3ilm MAMMARY
COh1STRUCT ION FEE 30149* 418.000 $I, sA00
K..A.11'g,HECK FEE 1011.000-$39.33'6 M8_111
MECHANICAL FRZ 10!�NXI-42'1.000 $136,30
EILWJTU AIS FF:L, 101.000-420-000 $1.66.13
Pl.-iIm13alo VISE 101.000-41 S --000 S101111S
S,TRONCJ NOTION .• IRS"l1: 101 -000 -MI -000 WoN6
41iUDING FEV 101 43Y0423-000 $XOD
J33� P_I..OP1P f. JIJIPAC T V310, $.. ,410.00
ART iia PUBLIC: PLACM - RM35M 270.000.445-000 5171.60
t{
r D a SUB -IAL Gplikup 1tMO1al AW 1:IDAN r, C;7�
d;?� 9.14
r.Illi_ 1 ZUUI , FMIMITIII YXu DUE PTOW
C17YOFLAQUINTA
FINANCEDEPT.
$15W&6
RECEIPT
DATE }
BY-
DATE FI /ALE /,
IN! C O
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap dL S,
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 _/�
BLOCKWALL APPROVAL6
Final
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 APPROVAL
Gas Test
Electric Final
Waste Lines g $ p
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
COMMENTS:
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
Final
Utility Notice (Perm)
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 #: 20
SITE ADDRESS: 81-115 MUIRFIELD VILLAGE-LAQUINTA_CA.- i
------------------
--------------
EXTERIOR WALLS: BATTS
MANUFACTURER: KNAUF THICKNESS: 63/4" 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 N RACTOR: WESTERN INSULATION, L.P.
LICENSE NUMBER: -6448
BY:
TITLE: PRODU I? MA A ER
DATE: NOVEMBER 1, 200 _
N
JAN.06.2003 12:23 _7602334081
Corporate Orrice:
Y.U. Box 462.390
Escondido, CA 92046
WESTERN PACIFIC HOUSING
LA QUINTA
760-564-7022 (FAX)
Attn: JOHN,
MAYER ROOFING
Frtj�Alop"
R,',,QG
en on "LEGENDS ) P.G A. WEST" P6 4B
#3980 F.002l007
Phonc: (760)737-99RA
EA X: (760) 737.03.)0
1-6-03
Mayer Roofing has supplied and installed " 14 " Mhiein cloaked roof vents, on lot # 2020
at 81-115 Muirfield Villiage, Tile vents have been installed per manufacturers
specifications.
Note: Exact vent locations are determined by builder
RESPECTFITL1jY SUBMirrED
rKJ�41/� t1
SCOT -I' uEEcRAM
OPERATIONS MANAGER
Mayer RooPing, Inc.
Page 1 or .t
558 Library Street . Saul Fernando, (--:A 91340 193 Orang*t� S(rcct - ttivcnidc., CA 92502
(Rt$) UN -6064 . 1;AX (818) 939-4493 (90')) 782-06(11 . FAX (909) 782-0804
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Tight Ducts) --F-4R.
PROJECT INFORMATION
Project Title:
Le Cala
Project Address:
La Clulnta
Builder Name:
Western PacMlc Homes, Miehella Lopez
Voice tis :
949-442-6199 x 462
Builder Contact:
John Ziaman
Voice 0:
760-664-7555
Projoct ID #:
28838.2
Sample Group 0;
Phase 4b
Lot #:
2020
Plan 0
7
Address;
81.115 Muirfrold Village
HERS INFORMATION
HERS Rater:
Scott Johnson Jayme Carden
Certification # :
CCOM14037 CCNJCBI8157
HERS Firm:
Action Now
Voice # :
949-631-2274
Address:
2575 Westminster Avenue, Costa Mesa, CA 92627
HERS Provider.
CHEERS
Voice # :
818-407-.150D
HERS Address:
9400 Topange Canyon Blvd, Chatsworth, CA 81311
HERS RATER COMPLIANCE STATEMENT
x T-24 Compliance Credit was Taken for Tight Ducts
ae was:
x Teased =Approved ae a Pell Of eamDle, but was not tested
x The installer has provided a copy of CF -6A
x Atr Distribution System is Fully Ducted (sheetmetal, ductboard or flex duct)
Where doth backed rubber adhesive duct tape is installed, mastic and drawbands are used in combination with
Goth backed. rubber adhesive duct tape to seal leaks at the connections.
MINIMUM REQUIREMENTS FOR DUCT LEAKAGE COMPLIANCE, CREDIT
Duct Diagnostic Lookaa Testing Result (Maximum 6% Duct Leakage)
CFA: CFA Lack Max r Tested Leak
System o
Indicate the maximum a owa le 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 & 16
X 400 x (Cooling Capacity in Nominal Toms) x (0.06) 72
21.7 x (Hooting Capacity in Thousands of Output BTU per holo) x (O.C6)
Other
u Pressurization Test Results (CFM C 25 PA)
100 x Test Leekwe / Fan Flow o % Leakage
Check Soon for Pass or Fail (Pass = 8% or Less)
system Pesa x al
Indicate the axrrnuma a b Dud Leakage and the ealp,latien used:
0.7 x Floor Ams x (0.06) for Climate Zone 8 through 15
—0. 5 x Floor Area x (008) for Climate Zones 1 through 7 6 16
x 400x (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 Teat Results (CFM Q 28 PA)
100 x Test Leakage / Fan Flow = % Leakage
Check Box for Paas or Fail (Pass = 6% or Leas) Passi xFail[
SystemF�'1 of Q
indicate the ma mum al wofa to Duct Leakage and th® calculation used;
0.7 x Floor Area x (0.06) for Climate Zone 8 through 15
0.5 x Moor Area x (0.08) for C6mete Zoites 1 through 7 6 16
400 x (Cooling Capacity In Nominal Tons) x (0.06) 60
21.7 x (Heating Capacity in Thousands of Output ell U per hour) x (0.06)
Other
U77 Proasurization Test Results (CFM a 25 PA)
100 x Teat Leakage / Fan Flow = % Leakage
Check sox for Paas or Fall (Pass% or Less) -I Pass x a. -1
Raters Cart" Signature Date 1-7 h
F2001-02 (3-02) Action Now T-24CF4RTDm0c-ro.xis
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:
81-115 MUIRFIELD VILLAGE
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of Construction
Owner of Building: SRHI, LLC
Building Official
,Bldg. Permit No.: 0206-181
VN Land Use Zone: RL
Address: 16940 VON KARMAN AVE, STE 200
City: IRVINE, CA 92606
By: DANIEL P. CRAWFORD JR.
Date: 2/13/03
POST IN A CONSPICUOUS PLACE