0201-021 (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 # Lic. Class Exp. Date
53 3 67 0 B bic 6/ tYo2
a
/Date. - = 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.
'e 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 €T'YAT.'E FtTND Policy No. 071$2
(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%prow dons.
,,. Date: itr 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 l 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
tl <>.above-mentioned property for inspection purposes.
Signature (Owner/Agent),-'"=--t=-- Dated•• ?
• BUILDING PERMIT PERMIT#
•'C3�i.
DATE %r VALUATION 4 [1U+ 4; LOT 40210102101TRACT �n i
JOB SITE '
ADDRESS ^F 1� ti «� Lr% Ci . �I�
APN
773".'0224A i
OWNER
CONTRACTOR / DESIGNER / EN (NEER
3M)C)HARC MES
S1.NTkI0 SE CC_OR.NCjWIn0l
77»564 CCali'rRY (rS.MB DRUNMA 137
77 -645A CGUNTIRY C:LM, DRRIV =79,'] 50
'i` g': t' C'A. 9271-1.
P.P IU 3:YF..WkT e 'rk 92260
t`!
(760)772-8224, C8I.01 11:7
x
USE OF PERMIT � I
77AA,� spv�� ry1 !ty ��-qq����}y Cc77Pr iy `44 7q�f
gW.K'.`.:'�..aGr
VO 1, OT 6 PLAN IR. PERMIT I)ORS'€dOT INCY UDL,1 H DC K'W.A1A4. ,
POO V., SPA OR, D1i.IVEWAYAPPROACH
CUSTOM C01QP8,U&i0N % H.00 �N?
FOR.Ci-3,IVATIO 186.0 1W
0.0,40it7C ARPO T 325,00 8F
,iq�pC�h.f.7—MAXED COe7.i RI.IC' CONSd..A.i.VJ`ls.►J:RIA,fi.srl.�i�.'•a8.2.
+i
f,3 �.JkVR.�RWG1Z::
,F-.irli+tviASi.Y7+ray
CONSTRUCTION FEE 1011«00041,8.00o 5+J4d:itt�
tb1 AIS CHWk FZZ 101-000.439.316, V68.W
MECHM1CA L 101-000-421-000 VIA
F -LE .'Y`It,iULL FEE 102.40.420-000 3P d:.etcti
PWIMBINO PKIE 101.000.419.000 $I$2110
STRDINIQ MOT1WN- FSE e, ' OID. 1011, -000-241 d000 418.69
1.01��Cl00-423.000 :r€seMfl�A
K�fT�+,e��,t�yfteriC#x.�:i�Fa�,gi�
Min
0JKV X1- A3PC"A I�114f'.7&C PVNIT,
M -TOTAL tats$Yt.';'Y�iON ,I WD PLAW CM0_'1,
S4,034.35
JAN u 8 2002 �: � P W FETM
Bi V 6F_CAQ_L,1__* ... .. I4'R:1P.0.i. tRlJA ,NEX11311 W'A:+A'r-o
FKM
J+41M_"T,3
n,
' • `F
RECEIPT
DATE /�
f •iF /<.t..,�
BY y✓•
DAT FI LED
INSPECTOR
�G(l •tel i
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
-DATE
INSPECTOR.,
BUILDING
APPROVALS
MECHANICAL' APPROVALS
Set Backs
pZ
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
_
Exhaust Fans
O.K. to Wrap——
�'
F.A.U.
Framing
.L --�/
Compressor
Insulation
Vents -
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
��T!
Drywall - 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 APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
Sewer Lateral
Z _ /_. a2—
O.K. for Finish Plaster
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
-�3— 62- d
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas) <
- ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final -X:v
Utility Notice (Perm)
FROM :HACIENDAS AT LR QUINTA
FAX NO. :760 7771643 Sep. 05 2002 03:26PM P1
.tu
�s' Sti Cf �t.)F LA OUINTA
OF' ll
'T% :• BUIL¢tNdt 'SAFETY DEPARTMENT
N t _ � 777-7012
INSW7ION REQUEST LINE
k1�' t. 777-7153
Ownet' ..,5�� r� �rA HOMES
Contractor SUNROSE CORPORATION
Permit Number 0201-021
POST ON JO.B IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
J08 ADDRESS 77-865 LAREDO COURT'
SFb - LOT 6 PLAN IR. PERMIT DOES N01'
INCLUDE BLOCK WALLS, POOL, SPA OR
DRIVEWAY APPROACH
TYPE OF INSPECTION
FOUNDATION & SETBACK
FOOTING STEEL
MAIN GROUND -SYSTEM
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB -
JOISTS & GIRDERS
ELECTRICAL. GROUND WORK
DO NOT POUR CONCRETE UNTI _ ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC y
ROUGH PLUMBING
ROUGH GAS $ GAS TEST
HEATING & VENT -A/C
FIREPLACE
ROOF _ .
BOND SEAM ^
O.K. TO wnAP
GROUT 3 4' 08'
FRAMING
1 INSULATION
PRE -ROOF
COVER NO WORK UNTIL A30VE HAS BEEN SIr,N&—
DRYWALL INTERIOR
EXTERIOR LATH
1
POOL PRE PLASTER
POOL FENCE & GATE
1
SEWER
FINA;S
ELECTRICAL
PLUMBING
FINAL GAS TEST
HEATING • A/C
HOUSE NUMBERS
JOBCOMPLETED
TEMP POWER
ABOVE APPROVALS DO NOT iNCLUOE RIGHT TO
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING SCF=4R-
Project Title Date
rU 7= 765 ��re� G��' ref !, Seyv'04 �ayy
Project -Ad ress Builder Name,
Builder Contact Telephone _ Plan Number
Telephone Sample Group Number
�rtifying Signature •I' Date
Firm: fr✓ �' �SSd-G is��45
Street Address:
Copies to: Builder, HERS Provider
Sample House Number
HERS Provider: /,
City/State/Zip: Ge 4Larz
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.
7-.-D istribution 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 b 7
If fan flow is calculated as 400cfm/ton x number of tons enter / Z
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
L UrTHERMOSTATIC EXPANSION VALVE (TXV) or Commission approved equivalent
&Yes ❑ No Thermostatic Expansion Valve (or Commission approved
equivalent) is installed and Access is provided for inspection
Z Yes is a pass
❑ MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT
1. ❑ Yes ❑ No ACCA Manual D Design requirements have been met
(rater has verified that actual installation matches values in
CF -1 R and design on plan.
2. ❑ Yes ❑ No
TXV is installed or Fan flow has been verified
verified fan flow matches design from CF -1 R.
Measured Fan Flow =
5
Yes for both 1 and 2 is a Pass` Pass'-
.
If no TXV,
0`'' ❑
Pass Fail
Fail