SFD (0307-378)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
Prof ,*onals Code', and my License is in full force and effect.
License # Lic. Class Exp. Date
't ?60335 1`3 03131/2(
� •
Date 11/66 1� Scsignature 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:
( ) 1, as owner -of the property, or my employees with wages as their sole
compensation, will do fhe-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•urider 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.
(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 SrATF. j`IJND Policy No. 00830-61,
(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 $700 of the Labor
Code, I shall forthwith comply with those p(oviisions. .
Dated � t' ,f lF! . ",',)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, 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)! w, Date
r C.✓
BUILDING PERMIT PERMIT"
DATE VALUATION.
41
;SX16, 7i .LOT '�. TRACT 29147-2,''JOB
SITE
ADDRESS 5�.N�10tfNN'rA1ly
APN 762-32CL4XM
OWNER
CONTRACTOR/DESIGNER/EN (NEER
CRV• WLF VIE£
` l t>C9 AS G 01PMENT CO�dlk'ANY
3140A'ONI►?AENCINAS
5140AVI N1v,14.MCIRM
C,AllUMAD �. M 92008
CARIMA 3 C� ��a(113
Ct 60)804G6868 CSIX .3376
USE OF PERMIT
ID - WY % PLAN 3k PMMIT i'JDL?i:3 NO3' INCLTJDE BLACIC'WA=
P0014 SP,A,'OR DRIVENA'Y APr't?aK3AC ,15'Jo'k EDUCTION TO PLANT 61.1WK
FES DUZ TO 1AilLTIPIX .ISw5T3,e NCE OF SAMY, P) ,AN °rYPZ
CUSTOM CONa3TRUOrlow 3,01',00 O
POTCMP.ATtO M.00 SF
0A PL iWCAitt ORT sp
Jw1mXmi) Con or! CONSTRucrion
MMId'Ii MMMMARY
CONSTRUCTION IO FRE . 101'-OQO-418.000 $1,119.00
PLAN CHECX IEE 101,E 200-439. 1-9 t�an�7s
MECHANICALF3s`F. 101 -000-421 -000 185. so
ELECr'i'ifICAL'1EF 101_000-420.600 $161,26
,
PLi MBANO RE . 101-;000,419-000 31oU,'SC
Y'�FtQTiC! AIlQIIDT3 ME - WIPSTEf 101:-01DO-248-000
CHADI O FEW. 101.O{ —423.004 SIS Oq
I�£s.'VLTLOt�1v.R:I1f[PPC'3' PFS` $,ai0S.Q0
ART IN PUBLIC p ,ACES -.11E911270.000-9.45-000 $90,94
0UR-1�i�.00>�i l it 'i ON'•l� f PI.A� CREC
-3 FIRF
1MAt PEIMUIFERS DDR NOW
$4.307.57
NOV 1.4 2 03
CITY OF
RECEI DIfINANlCE DE qJ TE
B.
DAT FI ALED
INSPECT L
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
- —oc
Exhaust Fans
O.K. to Wrap
3a
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
6
D II - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL
APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALGas
Test
Electric Final
Waste Lines
L,7
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Z y
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL :APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low VoKage Wiring
Fixtures'
Main Service
Sub Panels.
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
1 (,/
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`�'6�� ► - C'A0EC
M0016(n
El1RGY
�IevjS
PO. Box 621 Ph/Fax (760) 564-2044
Rancho Mirage, CA 92270. Cell: (7601250-1852
Email: DESNRG MAOL.COM
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC -TESTING (Page I of 7) CF -4R
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 3 2 UNITS
Builder Contact Telephone Plan.Number
RICHARD KROWN 760-250-1862,, GROUP 4
HERS Telephone Sample Group Number
#CCNRK613292 1111 Z LOT 3
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.
❑ The installer has provideda 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 now 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.