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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.
License # Lic. Class Exp. Date
728102 B lac d 9/30/04
Date r' `I r 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:
( ) 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. 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.•e. 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'
5. 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:
Carder OL -3 RLl'U81.IC 114.QU Policy No. WC1 M690
(This section need1not 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,
1`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 withthose provisions.
o ns
s' P
Date: - r9 � •� 7Applicant %y d�
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 pursuan ra,—
any
any permit issued as a result of this applicaton agrees to, & shall, indemnl
& hold harmless the City of La Quinta, its officers, agents and employe
2. Any permit issued as a result of this application becomes null and voi
work is not commenced within 180 days from date of issuance of su
i
permit, or cessation of work for 180 days will subject permit to cancellatiot .
I certify that I have read this application and state that the above information s
° correct. I agree to'comply with all City, and State laws relating to the buildinL_
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent)�Date
---•-!rte-- - � Y F '' /
BUILDING PERMIT PERMIT#
�Zf'l02-�.�li
DATE VALUATION S-122 '466.60LOT TRACT
.r; . _) e f , .-
JOB SITE
ADDRESS r -c8. 9 .e3" C111014A r)Rn?wL
}"
APN
OWNER
CONTRACTOR / DESIGNER / EN (NEER
L N-1_+1A7_Z 1111',I OF CAL.*'O lIA
Z� L M HOMO Or CM-:il•O3`c1TIA.
78.401 C-1EGHWAY I 13
78.401 C 1901WAY 1 11
LA QUINTA CA 92253
LA r,--)Tf TA CA 92233 "
C760)777-0131 CBIA 3434
USE OF PERMIT
MX01 • FAMILY D'U4sMlE,iNO
:11i'i3 � L0► 7,1�I.nA1+1 217.A: ��1V11�' �I�1f�S� PdOT 1idC:L11f:�E F;L�'31',�:'LYALt.;, ,
P004 SPA OR DRIVEWAY APPRO&C H
TRACE' CUNSTRUCTIC'N Z03.00 5r
pow-pipm,10 45.00 ST'
QAR_A0E/CAPPC3WF 44100 5F
ESTBLAIED COST OF C't NSMIUM70111
122t466.60
M..RMIT YME, MIM.�i0:� AIM
CONSTRUCTION ION IEE 101-000-41V,000 $720.09
PLAN C1ifaCK FEE 101 ••000-43`x-318 $5.88.95
11 ZCHAN ICA L FEE 101.000.421-000 1456
ELECTRICAL ME _ 101-00041.20••000 $115.3
PLU1v1131HO F`RE. 101.000.419.000 $141},`1
STRONG MOT] Cn@ .fYl~N • P.E;;101 101. -000-24 1-000 $12.25
0R.&DING FES $0,00
13E`ifZLOPrR IMPACT Phi
C:C7NUALrCwJI OM AND � LAN CIMC �
T4,03'7.s�0
M LUSS rJRR-Ff�.1.FUMS''
2 4 2004 �cax/, r�� ava� �ac�w---
-
:MAR
F t.A Q1Ui1i 9A�bCE
DEPT.
RECEIPT
DATE
BY
DATF-FPQALE D
INSPE T R
ell,. /)� t < j
j! 11
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS,
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
_
Slab Grade
Retum Air
_ _
Steel
Combustion Air
Roof Deck
Exhaust Fans
_
0. K. to Wrap_
.A.U.
_
Framing '
Compressor
_�_ _ _ _
Insulation ✓� _,'Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
_ /I
Exterior Lath 11i
Drywall - Int. Lath c�
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING AP VAI
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_
Sewer Connection 6 -' /—c�i _ _
Pcv Cover
Encapsulation
Gas Piping
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
Utility Notice (Perm) I /
P, - i %-.o
AUG -19-2004 TJ 06:46 AM TEAM HEATING & A/C FAX N0, 9096943803
P. 14 1
HVAC INSTALLATION CERTIFICATE for Tested Duct Leakage & TXV Page 1 oft . CF -6R
Site Address: 79-849 Barcelona Drive � Permit Number.
Tract Number: 29323
Plan * 2r Phase:
Lot Number. 7 Project. Esplanade Builder Cornerstone Dev,
An Installation certificate is required to be posted at the building site or made avalible tar all appropriate Inspections.
After completion of Thal inspection, a copy must be provided to the Building Department (upon request) and the building
owner at occupancy, per Section 10-103(b).
HVAC SYSTEMS:
Winf; f. t=ell ii►.mnnt
#of Efficiency Duct Keating Heating
Equip. Clied Mfr Name ktenticle (AFUE, etc.) Location Duct Load Capacity
Te and Model Name Systems (>= CF -1R) (attic, etc.) R -value (BTU / Hr) (BTU / Hr)
I-RUS Ir attic
r _nnlinn Fni Ilhmant
o aency Duct Gooling Cooling
quip. a ama Identicle (SEER, eta) Location Duct Load Capacity
Type and Model Number Systems (>=CF -1R) (attic, etc.) R -value (BTU / Hr) (BTU / Hr)
FF- US it is
I, me unoemignea, venry mai equlpmemi 115EUU auUVU W: 1) 1, UW CwUgl 04WNIII6„t 1110WII w, y �4-01WFIa w v nw—
efflclent than that specified in VreVertificate of compliance (form CF -1 R) submitted for compliance with the Energy
Efficiency Standards foA�sid I u In s, nd uipment that meets or exceeds the appropriate requirements for
manufactured devices ( p a E e cy liens or Part 6), where applicable,
Team Mechanical
-Signature, Date Installing Subcontractor(UT.-Name
OR General Contractor (Co. Name) OR Owner
MINIMUM REQUIREMENTS FOR DUCT LEAKAGE COMPLIANCE CREDIT
Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage)
CFA:
System EQ of
Indicate the maximum aowe 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 1400 x (Cooling Capacity in Nominal Tons) x (0.06)
21.7 x (Heating Capacity In Thousands of Output 13TU per hour) x (0.06)
Measured Fan Flow
Mu Pressurization Test Results
100 x Test Leakage / Fan Flow = % Leakage
Check Box for Pass or Fail (Pass o 6% or Less)
T-24 Com fiance Credit was Taken for TXV
m of
Indicate Nle mawmum 1lle 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 Flout
D-U—d Pressurization Test Renu
100 x Test Leakage / Fan Flow = % Leakage
Check Box for Pass or Fail (Pass = 6% or Less)
=T-24 Compliance Credit was Taken for TXV
TXV was
TXV was
PAGE 1
F2001-01 (4-02) Action Now T-24CF6-RTD&TXV macro
AUG -19-2004 THU 06;46 AM TEAM HEATING & A/C
FAX N0. 9096943803
P. 15
HVAC INSTALLATION CERTIFICATE for Tested Duct Leakage & TXV Page 2 of 2 CF -6R
Site Address: 79-849 Barcelona Drive y Permit Number. 0
Tract Number. 29323
Lot Number. 7
Plan * 2r Phase:
Project Esplanade Builder Cornerstone Dev.
System [= of
Indicate the maximum a6 --wile Duct Leakage and the calculation used:
0.7 x Floor Area x (0.06) for Climate Zone B 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 BTUer hour) x (0.06)
Measured Fan Flow
u Pressurization Test Results
100 x Test Leakage I Fan Flow = % Leakage
Check Box for Pass or Fail (Pass = 6% or less)
T-ompliance Credit was Taken for TXV
ys 24 C
m I—I of I—I
Indicate them—a'x7mum a'j owba to 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
I—__—
b—Lia Pressurization Test Results
100 x Test Leakage I Fan Flow = % Leakage
Check Sox for Pass. or Fail (Pass = 6% or Less)
T-24 Compliance Credit was Taken for TXV
y:12I-
� of
Indicate the mawmum aowa le Duct Leakage and the calculation used:
0.7 x Floor Area x (0,05) 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
u Pressurization Test Results
100 x Test Leakage I Fan Flow = % Leakage
Check Box for Pass or Fail (Pass = 6% or Less) .
�T-24 Compliance Credit was Taken for TXV
ys em �mof
Indicate the aximum a 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 8,16
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
DO Pressurization Test Results
100 x Test Leakage / Fan Flow = % Leakage
Check Box for Pass or Fail (Pass = 6% or Less)
OT -24 Compliance Credit was Taken for TXV
x .06
X.05
TXV was
TXV was
TXV we!
TXV wa:
I, the undersigned, verify that the above diagnostic test results and the work I performed associated with, the test(s) is
in conformance with the requirementAr compliance credit. (The builder shall provide the HERS provider a copy of the
CF -6R signed by the builder employ ors rtifying that diagnostic besting and installation meet the
requirements for compliance credit, r
7 .9• ,04-- Team Mechanical
're— gna ure, a I Insralling Subcontractor o.ame
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-RTDBTXV macro '
Certificate of Insulation
Your Home has been insulated with CerlainTeed 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 that will likely lose their effectiveness over time. 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 CertainTeed 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 #.: 7 Plan: 2R Address: 79-849 Barcelona Dr., La Quints, CA
Ceiling Area: R-38 Blown Garage Ceiling:
Overhangs: Exterior Walls:
With Living Above
Ceiling:
Inaccessible to Blow
Signed
Garage Wall:
6,
Interior Wats:
R-13 Unfaced Batts
Cantilevered :
Floors WlLiving Above
. OJ Insulatn Co., Inc.
Ca 917021 (626) 8 S 6070 Ucense (1465709
Conchita Ortiz, SecretarylTreasurer--or--"R. Scott Jenkins, President--or--
Lou Merola, Director of Operations Officer
R- means resistance to heat flow. 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 home, this certificate should be passed on to the buyer.
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