Loading...
0401-235 (BLCK)LICENSED CONTRACTOR DECLARATION •1 ht*eby 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. picense # Lic. Class Exp. Date 1 Date- �` -xw +t 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 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 `�PATL vvNt). Policy No. ptiC83tj -300 (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 fh`ose provisions. D6te:,1 ­­,%NAggllCant ✓ 'I K� 1, , '. Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. Signature (Owner/Agent) 1. Date., BUILDING PERMIT PERMIT# `� DATE VALUATION LOT ��TRACT JOB SITE APN ADDRESS . X4.5 WOUNTAIN WIN ' OWNER CONTRACTOR / DESIGNER / EN (NEER 5340 t!V`.!LM1. Ai..MT '5140 AWAL`MAFXCN.A.1 C.AkLHUD ('.,A 92008. CAMLOAD CA 92008 (160)804-6866 CO.rif' 3376 USE OF PERMIT (31raTINA1:, Bumrma , , , '00 LF. 6' 1!fl.00K: •WAU,y CITY S'11NDAK-0 4 Ff. WALL 100. %70 I '�y 7S Yny�• ( �{y y��;5 �'yx$r "moi fl'�'ED CO.Sr Or �CCi.�'��=�'t'�'fCT�ON .l.-.hh fpp�F��r�jI�.'Rry'.'.i�. 1�11,W113�Y+,y7.yI�Y�S�.i'16.'V 301-000-418-000 1*00 W N W6I.Gr d.V 161,1.. i.V�tls;'J,.w3�N 1. Ai '. i.\JA'ro �al-Y.IJ P,l.IRi.P.Y CHEM RECEIPT DATE BY / DAT�,7F LED��� IINSP�OR 2r'S[1.0.� ) T54.00 T!3M Who �J t W6I.Gr d.V 161,1.. i.V�tls;'J,.w3�N 1. Ai '. i.\JA'ro �al-Y.IJ P,l.IRi.P.Y CHEM RECEIPT DATE BY / DAT�,7F LED��� IINSP�OR 2r'S[1.0.� ) T54.00 T!3M Who INSPECTION RECORD %OPERATION DATE I INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS "]Set Backs Underground Ducts IForms& 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 I I Final Final BLOCKWALL APPROVALS POOLS - SPAS steel Set Backs Electric Bond Footings Q Main Drain Bond Beam v Approval to Cover I Equipment Location I Underground Electric 1 Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines 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 I Final i I Final Ufility Notice (Gas) I 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 I I Final Utility Notice (Perm) COMMENTS: ©T_ 1 D"Ort , 56- 645 ENERGY CADEC coo MO(JkJTkli\JvIEW S - P0. Box 621 Ph/Fax (760) 564-2044 Rancho Mirage, CA 92270 Cell: (7601250-1852 Email DESNRG DAOL.CO CERTIFICATE OF FIELD VERIFICATION• AND DIAGNOSTIC TESTING (Page I of 7) CF -41R PASADERA PH -5 DATE TESTED 6-14-04 Project Title Date P.G.A. WEST LA QUINTA ASHBROOK COMMUNITIES Project Address Builder Name. STEVE VAN LUE II 760-801-3981 PLAN 1 2 UNITS Builder Contact Telephone Plan Number RICHARDXROWN 760-250-1852 GROUP 4 HERS Rater Telephone Sample Group Number . �G�' #CCNRK613292 JUL 2 24aj' LOT I Certifying Signature Date Sample Lot Number Firm: DESERT ENERGY SERVICES HERS Provider: CHEERS Street Address:" P.O. BOX 621 City/State/Zip: RANCHO MIRAGE, CA. 92270 Copies to: Builder, HERS Provider - HERS RATER COMPLIANCE STATEMENT The house was: ❑ Tested ® Approved as part of sample testing but was not tested As the HERS rater providing diagnostic testing and field verification, I certify that the houses identified on this form comply with the diagnostic tested compliance requirements as checked on this form. El The installer has provided a copy of CF -6R (Installation Certificate. ❑ Distribution system is fully ducted(i.e., does not use building cavities as plenums or platform returns in lieu of ducts) . ❑ Where cloth 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 duct connections. ❑ MINIMUM. REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage) ' Measured Duct Pressurization Test Results (CFM 25 Pa) values Test Leakage Flow in CFM If fan flow. is calculated as 400cfm/ton x number of tons enter calculated value here If fan flow is measured enter measured value here Leakage Percentage (100 x Test-Leakage/Fan Flow) Check Box for Pass or Fail'.(Pass=6% or less) ❑ ❑ Pass Fail ❑ THERMOSTATIC EXPANSION VALVE (TXV) ❑_ Yes . ❑ No Thermostatic Expansion' Valve is installed and Access is provided for inspection ❑ !]