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SFD (0310-050)LICENSED CONTRACTOR DECLARATION I hereby affir.m'under penalty of perjury that I am licensed under provisions of. Chapter 9 (cominencirig with Section 7000) of Division 3 of the BusinesS'. and Professionals Code, and my License is in full for6e arid effect. ti L i Ase # Lic. Class Exp. Dat m4w J Signature of Contractor OWNER -BUILDER DECLARATION I'hereby affirm under penalty of perjury that I am exempt from the Contractor's Lice'ns6 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. 70441"Business & Professionals Code). 1, 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: ( ) 1. 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 S,6&ion 3700 of the Labor Code, for the performance of the work -for which this permit is issued. My workers' compensation insurance carrier & p6licVno. are: Carder Policy No. '(This section need not be completed if the permit valuation' is for $100.06 or less). O I certify that in the performance of the work for which this permit is issued, shall not employ any person in any manner so as to become subject to the ;j.Workers'.c6mpensation laws of California, and agree that if I should become subject to the workers'- compensationrov�l ions of Section -3700 of the.Labor Code, I shall forthwith comply with evisions, Applicant ✓ Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties an. civil fines up to'$1 00,000, in addition to the cost of compensation, damages as provided for in Section 370.6 of the Labor Code, interest and attorney's fees. -IMPORTANT Application is hereby I made to the Directiir OBuilding and Safety for a permit subject to the conditions and restricti6ns')Set forth on his application. 1 'N. 1. Each person upon whose behalf this application is made &%ach person at whose request and for whose benefit work is performed and any permit issued as a result of this applicaton agrees to -"i dem� .d and if n e 0 t C nce atio F L & hold harmless the City of La Quinta, its officers, agents 2. Any permit issued as a result of this application becomes and Void if work is not commenced within 180 days from date of is n e OP eftpermit, or cessation of work for 180 days will subject permit c n.ce to I certify that I have read this application and state that the abov inf to t F L correct. I agree to comply with all City; and State laws relating to the bANC WNC construction, and hereby authorize representatives of this Ci upul I the above-mentioned property for inspection purposes. - iv I. I wner/Agent) D ._,.,,�ignature (0' ate BUILDING PERMIT PERMIT# DATE VALUATION LOT TRACT Z, 29147'a JOB SITEAPN ADDRESS weS7445 1TWQTJTTT.4L"WV&'01 OWNER 6- ........... CONTRACTOR DESIGNER ENGINEER V GOU WRE11f, U-0. 1 -10 AVENIDA. HH0,-, NIAO 51 ffi. ]WITMA 2NWAU CAKAMIAD _2008 2,1 8 CrEZIAL. �1376.- USE OF PERMIT WX G-13, FAMU.M DMOEM140 Tva SF0 - L0T 26, PI., N 381t DOZ,'NOT 1NC"LIJIM, B1,,0,ZX WAL4.8. POOL4 SPA QTt '111,1RDUCT10-t4 w PLAN CH M -K ME DUP,' TO M.TJL:r13y'LE ISSRJANICIE QW SAYAR, PLAN'TYPT,?, c6s-rom Cfx4s-",FRUCT10)4 ZKIt'1019 SF s,- i. ew 'L A .5 'wa,1) - C 0v )y Inumlon =4 17.c CONSTRUCTION FEE- -361,.{;00.4l'4101JI; - $I, PLANK CHECKFEE. 101 -439 ? l S W&CHANIACAL R'S 1.01 10 1 20-006 116 c16, A,1 ST110NO MOTION ?BW R Z XD (amr).wo 101-0001,-423-001,5 DEVE1,0M IMPACT FEE',.' $2,o&w ART IN PUBLIC PLACEZ, IMUTI'70 00044 00"o' S 1% -703AL: 420148TRI. '14 ANT) X�'LWRZM W.0Q noCFTAID. 11IMS ]47JPM3bTr.TK1 NCAV 4 2004 SA)XI 1157 ---------------- A QUINTA E DEPT. CEIPT f ., DATE J BY * !,/ , I Al PATF E . J INSPEP790 XJ - f 7 f ,4 INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR -� BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Forms & Footings Underground Ducts Ducts Slab Grade Return Air Steel Combustion Air Roof Deck / Exhaust Fans OX to Wrap v 6e 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 APPROVALS 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 Yj 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 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 Final Utility Notice (Perm) COMMENTS: LOT 4V �2 6 6� — 4-'5 De"- N�©vn,-{�� ENERGY C A a E Gee PO.- Box 621 Ph/Fax (760) 564-2044 Rancho Mirage, CA 92270 Cell: (7601250-1852 Email: DESNRG IMAOL.COM CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I.of 7) CF -4R PASADERA 'PH -6 DATE TESTED 9-29-04 Project Title Date X57=1 55' MOUNTAIN_VIEW is OUINTA;~CA 92253 ASHBROOK COMMUNITIES t ro� Le.ct Address Builder Name' STEVE VAN LUE 11 760-801-3989 _ PLAN 3 2 UNITS Builder Contact Telephone Plan Number ALAN WEAVER 760-880-5504 GROUP 5 HER Telephone Sample Group Number #CCNAW183226 10-1-04 , LOT 26 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 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. 4 `. ❑ 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 1f fan flow is calculated as 400cfm/ton x number of tons enter calculated value here r 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 ❑ 0