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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.
❑dense # Lic. Class Exp. Date
?2€1 OM B 1RC 9/30104
Date ?'�" I/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.
(fir) 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 C)LL, I k'fJXf1,1i; ji-ISU Policy No. MWCI0077690
(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 provisionse
f
Date: R! c� _ Applicant -: �%�/ W Ax. `
- — 17e
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.
4.
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 forinspectionpurposes.
Signature (Owner/Agent) ✓/�' 1��'7"� Date 2 10/
BUILDING PERMIT PERMIT#
M2 -MA
DATE. VALUATION $12,2466e60 LOT TRACT 2932$
JOB SITE
ADDRESSi- 11F%a��L�e3siRi�.
APN
OWNER
CONTRACTOR / DESIGNER / EN (NEER
^ RNIA
UNYTfia I10tW8 OF CALIFORNIA
L��I3 Pit ���v�!tZr9'3 t41i C'��i1�C)l�f��
7IS_101 C; InGHWAY 211
78-401 C &310 THWAY 111
i,E1.Q)TNT'fi. C,ek 192.2.53
I.AQLMI A CA 92253
(7 f-0)`%'37.01.1 CDS€ 3434
USE OF PERMIT „
sS1 oLL rmu-y mwmuga
SF17 . LOT 15, P1.,AN 7C. P?R8/t T DOMS 140T INCLUDE 811JCK WALI-% -
P0014 SPA. 011. CDRfVZWA` _4-PPf�!1A.CH,'75'15 REDUCTION TO PG,04 1:iI>wL'•fi
FEF DUF 'fQ- 4U1, T1lP1Z ISSUANCE OF SKME PLAN 'H t PE,
TRACT, CONSOT RUCTION 210 100 SP
PORCHO)KNO 45,00 SV
0A1 AGUCARPC)U 447,00 SF
iM A -M-1) COS'I' 0sr co.N."I";1ZC.YL'` 0.1111
E22,406.60
,P)MMIT IIOR SI1J i1�'J1�4 Z
CONSTRUCTION FEE 101 -000-418-00 MUD
:. AN C H IDCK FEE 101-0400-4391-31 E; $147. ag
MECHANICAL ME 101-000-421-000 $40.50
ELECTRICAL FEE 101-000-420-000
'(ak;il@, 8N0i FFI " ' 101.,-000-.419.000 5140,15
STRONO rvlcs'r1ON FEVE • XTSID 101-000-241-000 $12.25
GRADING FEE . 101.000-423.000 $15100
DEVELOPER, IMPACT PRE $x,405.00
,,jam;-TOT.A61,C--nA4'SIi?if€rri-O i'AtJDPLAk4(:k1(F:,CK
$%,596.09
1.M.0 :PRE PALL FCi I
$0.00
�TA:id 1 .-!:V.LiCIff .r r]iM.15 DVIiJ NO
MAR 2 4 20041
J
CI u Y OF !.A QU 'TA
F6►:lb',NCE. DEPT.
RECEIPT
DATE /
BY `t
DATE IN LED
7 90
INSPEJsT�.
"%'r f
fid hd
((C/C/JJ
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVAI
MECHANICAL APPROVALS
Set Backs r_ f!
Underground Ducts
Forms & FootingsDucts
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
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 �'''l�
eater Final
_
Water Piping I V�
Plumbing Final
_
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Cover
_
Sewer Connection �,(7
Enca cation
Gas Piping (f!
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 I 11A
Utility Notice (Perm)
z
AUG -19-2004 THU 06:48 AM TEAM HEATING & A/C FAX N0. 9096943803
P. 30
A)
MVAC INSTALLATION CERTIFICATE for Tested Duct Leakage $ TXV Page 1 oft CF -613
Site Address: 79-838 Barcelona Drive Permit Number.
Tract Number. 29323
Plan #: 2r phase:
Lot Number: 15 Project Esplanade Builder. Cornerstone Dev.
An installation certificate is required to be posted at the building site or mane avalible for all appropriate inspections.
After completion of final inspection, a copy must be provided to the suilding Department (upon request) and the building
owner at occupancy, per Section 10-103(b).
HVAC SYSTEMS:
W- Mfinn Mn"inmon4
of Efftoeii-dy Duct Hea"Heating
Equip. CEC Certifiedame Idenficle (AFLIE, etc.)A(atflc,etc-)
Duct Load Capacity
Type and Model Name Systems (-CF -1111R) R -value (BTU I Hr) (BTU / Hr)
r
r'nnlinn i—rmi rrrlpnt
o ciency Duct Cooling Cooling
Equip. CEC CertMedName Identlde (SEER, etc.) I-ocation Duct Load Capacity
Type and Model Number Systems (>--CF-1R) (attic, etc.) R-iralue (BTU / Hr) (BTU / Hr)
Ir 563CNXDBD4-2
I, me unoersignea, veiny mar equipmunr liw= auuvn Va. 1) w pw auum oyuianicrn inawllau, &) "y iiv w w u... w.�
efficient than that speci0:esid
he certificate comp is ce (Form CF -1 R) submitted for compliance with the Energy
Efficiency Standards fonti ildln s,a d eq ipment that meets or exceeds the appropriate requirements for
manufactured devices (e Ap I n Efti a cY lotions or Part 6), where applicable.
Team Mechanical
Igna ure,a ns IngSubcontractor(Co. Name
OR General Contractor (Co. Name) OR Owner
MINIMUM REQUIREMENTS DUCT LEAKAGE COMPLIANCE CREDIT
Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage)
CFA
System M of ri71
Indicate the maximum a'f(owa le Duct 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 Tons) x (0.06)
21.7 x (Heating Capacity in Thousands of Output BTU per hour) x (0.06)
Measured Fan Flow
710 Pressurization Test Resu
100 x Test Leakage / Fan Flow � % Leakage
Check Box for Pass or Fall (Pass = 6% or Less)
T-24 Com llance Credit was Taken for TXV
y5 m [ of
Indicate the maximum allowable 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
400 x (Cooling Capacity In Nominal Tons) x (0.06)
21.7 x (Heating Capacity in Thousands of Output BTU per hour) x (0.06)
Measured Fan Flow
Vu_a Pressurization Test Results Q 25 PA)
100 x Test Leakage / Fan Flow = % Leakage
Check Box for Pass or Fail (Pass = 6% or Less)
[71T-24 Compliance Credit was Taken for TXV
x .06
TXV was
TXV was
F2001-01 (4-02) Action Now T-24CF6-RTD&TXV macro
AUG -19-2004 THU 06:48 AM TEAM HEATING & A/C ' FAX N0. 9096943803
P. 31
HVAC INSTALLATION CERTIFICATE for Tested Duct Leakage & TXV - Page 2 of 2 CF -6R
Site Address: 79-838 Barcelona Drive Permit Number. 0
Tract Number. 29323 Plan #: 2r phase: 4
Lot Number: 15 Project Esplanade Builder: Cornerstone Dev.
System Q of
Indicate the maximum a owa le Duct Leakage and the calculation used:
0.7 x Floor Area x (0.06) for Climate Zone a through 15
0.5 x Floor Area x (0.06) for Climate Zones 1 through 7 & 16
400 x (Cooling Capacity in Nominal Tons) x (0.06)
21.7 x (Heating Capacity in Thousands of Output BTU er hour) x (0.06)
Measured Fan Flow
VuZf Pressurization Test Resi7ts (L;t-M 9 z
100 x Test Leakage I Fan Flow = % Leakage
Check Box for Pass or Fail (Pass = 6`ya or Less)
�T-24 Compliance Credit was Taken for TXV
� Indicate
I—I of rj
Indicate the max mum cillo—wa'ble Duct 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
400 x (Cooling Capacity in Nominal Tons) x (0.06)
21.7 x (Heating Capacity In Thousands of Output BTU per hour) x (0.06)
Measured Fan Flow
Mu Pressurization Test Results
100 x Test Leakage / Fan Flow = % Leakage .
Check Sox for Pass or Fall (Pass = 6% or Less)
I—�T-24 Compliance Credit was Taken for TXV
yRm = of
Indicate the maximum a owe le Duct Leakage and the calculation used:
0.7 x Floor Area,x (0.06) for Climate Zone 6 through 15
0.5 x Floor Area x (0.06) for Climate Zones 1 through 7 & 16
400 x (Cooling Capacity in Nominal Tons) x (0.06)
21.7 x (Heating Capacity in Thousands of Output BTU per hour) x (0.06)
Measured Fan Flow
uct Pressurization Test Results
100 x Test Leakage / Fan Flow = % Leakage
Check Box for Pass or Fail (Pass = 6% or Less)
I—IT24 Com Man-ce Credit was Taken for TXV_
ys m of
Indicate the maramum allOwab19 Duct 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
400 x (Cooling Capacity in Nominal Tons) x (0.06)
21.7 x (Heating Capacity in Thousands of Output BTU per hour) x (0.06)
Measured Fan Flow
TIM Pressurization Test Resu
100 x Test Leakage I Fan Flow = % Leakage
Check Box for Pass or Fail (Pass = 6% or Less)
OT -24 Compliance Credit was Taken for TXV
X.06
x.06
X.06
X.06
r�
TXV was
TXV war.
TXV wall
I, the undersigned, verify that the ab ve diagnostlo test results and the work I performed associated with the test(s) is
In conformance with the requirerne is or mpliance credit. (rhe builder shall provide the HERS provider a copy of the
CF -6R signed by the builder empl Yee
r s - n ctors ing that diagnostic testing and installation meet the
requirements for compliance credi )
Team Mechanical
7e -5E— Igna r, aInstalling u con or o. Name
Performed OR General Contractor (Co. Name) OR Owner
COPY TO: Building Department
HERS Provider (if applicable)
Building Owner at Occupancy
PAGE 2
F2001-01 (4-02) Action Now T-24CF6-RTD&TXV macro
Certificate of Insulation
Your Home has been insulated with CertainTeed Fiberglass Insulation products, which are designed
for today's safety standards and tomorrow's energy requirements.
Fiberglass is inorganic and therefore permanently noncombustible, so it does not have to be treated
with fire -retardant chemicals thatNvill likely lose their effectiveness overtime, It has not been treated
with chemicals that can corrode wiring or metal. Fiberglass will not absorb moisture nor will it
settle over time as may other insulation materials.
This also certifies that GrrlainTeed Fiber Glass Insulation has been professionally installed in this home
to provide the following thermal performance:
Job Name: Tapestry at Esplanade Tract: 29323-2 Phase: 4
Lot #.: i5 Plan: 2R Address: 79-838 Barcelona Dr., La Quinta, CA
Ceiling Area:
R-38 Blown Garage Ceiling:
Overhangs:
With Living Above
Interior Walls:
Exterior Walls: R-13 Unfaced Batts
Ceiling: Garage Wall:
Inaccessible to Blow
Signed
Cantilevered :
Floors WJLiving Above
OJ IIISUI rtion Co., Inc.
917102 j42X 2-6070 Mcense #465709
Conchita Ortiz, SecretarylTreasurer --old-- A Scott Jenkins, President--or--
Lou Merola, Director of Operations Officer
R- means resistance to beat Dow. The higher the R- value, the greater the insulating power.
Ask your builder for the fact sheet on R- values. Keep this certificate with your other
valued papers. if you ever sell this Dome, this certificate should be passed on to the buyer.
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