0402-342 (SFD)f—
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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
r= PrdNssionals Code, and my License is in full force and effect.
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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.
1 /��.Signature (Owner/Agent) ��-<u�l�✓'"�-� Date «+"��3'
"'
License # Lic. Class Exp. Date
128102 13 ,,TAC, 9/30/04
Date �'•? &1 Signature of Contracto�r� -- 1,/,/",/"-�&-/
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.
(\ )` 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 OLID :It?1't3F3LiC' 3rJ3U Policy No. M'4ATC:IOff-MVID
(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 provisions:
Date: '5' Q s '?X Applicant- !A",141
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
7,addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application. ,
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
BUILDING PERMIT PERMIT#
0402•-3. 42
DATE VALUATIONLOT TRACT
:fii3$,'SfDSr`ii? 13 i9S7�
ADDRESS 79.4 0613 CKL.O.T�.�a?RIVE. JOB SITE
APN W,---024
OWNER
CONTRACTOR/DESIGNER/EN (NEER
LDWAR MAWS 3P CALIFORMi.
'�8•�':)? C %q�"*_TwAY 31 I
78.403 C IUMUTWAY 3 7 i
1..UI CA 92253
1A QlwfA. C A 92253
(760)777-0131 (MIA4 3434
USE OF PERMIT
M;fOLLRY, i7MMY 1?S�y.1: T:C.I 40
LOT. 13, PWN 3`A'Rr PERMIT DOES NOT INC:LIJDS BLOCK
WAl.,t,:k P0t0L, f11'A Oft L`12iN'EVAYAPPROA01
TRACT CONSTRUCTION .097,00 SI?
P042C;1rfir`°CiC] �13.i)1'i SP'
O,ARAOWA.RPORT 410.00 OF
1::gMdlfTED C057 OF CONS,rRUC'1"1:ON
138,4M.40
CON eTiiUCT A Fi'.R.', 101-000-4 18-000
PLAN C�itGl:: Wit? 1 Ca S ft�iG• 4.3186y, l K
MECHANICAL VEX 101-000-121-000 S47A
21%C`#'.R,ICAL FREF 1101-00(14.2004*0 $1"40.41
P'Li,narNCt I a 101-000-4 W-000 $964.75
" S' fTRO__NO MOT 1014,PRI! . REM) 101-•00.0-241-0
GRADING FEE 101-t- 00.123 U00 �1S.Od
JD'.EVZLf0PF,R IPZPAC T .F29 $d,A05.00
UR3 T UC"i 013" AM PL A14 CH1_C,;
S4,186.13
53 1p)M-1PJID VU&S
$0.00
DLI
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` 4 200�a �a311111., dw. MIS DIVE NOW
S4,1811S 1
MAR 2
C9T1 GF t 3+QUINaA
RECEIPT
DATE
BY
DATE D
INSPEC OR
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1: ,
INSPECTION RECORD
OPERATION
DATE
INSPECTOR OPERATION
DATE
INSPECTOR
BUILDING APPR V MECHANICAL APPROVALS
Set Backs _ Underground Ducts
Forms & Footings
/ 1 _ Ducts
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 Pibg. Test
Final
Gas Piping
PLUMBING A r2p0OVE 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
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
Utility Notice (Perm)
'
RUG-19-20U4'THU^ 6:47 AM TEAM HEATING & A/C FAX N0, 9096943803
P. 26
HVAC INSTALLATION CERTIFICATE for Page 1 oft CF -6R
Site Address: 79-806 Barcelona Drive Permit Number.
Tract Number. 29323
Plan * 3Yr Phase:
Lot Number. 13 Project Esplanade Builder. Cornerstone Dev.
An installation certiticate Is required to be posted at the building site or made avalible tot all appropriate inspections.
Atter completion of final inspection, a copy must be provided to the Bullding Department (upon request) and the building
owner at occupancy, per Section 10-103(b).
HVAC SYSTEMS:
l-Ic�iinn Frn ,ir.r»nni
_ 7..._.._ of Fliticiancy QeZ-)
"eating ea ng
Equip, Name Identicle (AFUE, etc.) Dud Load Capacity
Type and Model Name Systems (>= CF -1 R) ( R -value (BTU / Hr) (BTU / Hr)
Air
r'.nniinn Fniiinrnant
#Of lztticiency Duct Gooling Cooling
Equip. GEC-CertltiEd Mfr Name Identide (SE=ER, etc.) Location Dud Load Capacity
Type and Model Number Systems (—CF -JR) (attic, etc.) R -value (BTU / Hr) (BTU / Hf)
TIP— US Air attic 4.2
i, me uncersigneo, vemy mat equipment ustec aoove is: i) is cite atzum equipmnm ulawlicu, c/ nquivaio,u LU U1 ,,,WIo
efficient than that specified lqlfh certificat compliance (Form CFAR) submitted for compliance with the Energy
Efficiency Standards for res' en a 'Idin s, nda uipment that meets or exceeds the appropriate requirements for
manufactured devices fm the Ii nce E cy a lations or Part 6), where applicable.
Team Mechanical
gna ure, Date installing u con re or(Co. Name
i 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 of r7-1
Indicate the maximum aIl owab 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
DUE Pressurization Test Results
100 x Test Leakage/ Fan Flow= % Leakage -
Check Box for Pass or Fail (Pass = 6% or Less)
QT -24 Compliance Credit was Taken for TXV
QT -24
m 77 of
Indicate the maximum 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 & 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 FIOw
u Pressurization Test Resu
100 x Test Leakage / Fan Flow = % Leakage
Check Box for Pass or Fail (Pass = 6% or Less)
0T-24 Compliance Credit was Taken for TXV
x.06
X.05
TXV wai
TXV wa:
PAGE 1
F2001-01 (4-02) Action Now T-24CF6-RTD&TXV macro
RUG-19-20,04�THU'06:47 AM TEAM HEATING & A/C FAX N0, 9096943803
P. 27
HVAC INSTALLATION CERTIFICATE for Tested Duct Leakage & TXV Page 2 of 2 CF -6R
Site Address: 79-806 Barcelona Drive Permit Number. 0
Tract Number: 29323
Lot Number: 13
Plan #: 3Yr Phase:
Project: Esplanade Builder Comerstone Dev.
System � of
Indicate the maximum a awl 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
M-6[ Pressurization Test Resu
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
y em of
Indicate the FOmum a7rowable 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
F---
D-ud Pressurization Test Results
100 x Test Leakage / Fan Flow = % Leakage
Check Box for Pass or Fail (Pass = 6% or Less)
PT -24 Compliance Credit was Taken for TXV
ys em 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 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 par hour) x (0.06)
Measured Fan Flow
Vu—a Pressurization Test Results
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
ys em � of
Indicate Che maximum 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 & 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 Pressuraation 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.06
X.015
TXV was
TXV war
TXV wai
TXV wa:
I, the undersigned, verify that thea a diagnostic test results and the work I performed associated with the test(s) is
in conformance with the requireme is r mpliance credi a builder shall provide the HERS provider a copy of the
CF -6R signed by the builder empl r u racto ng that diagnostic testing and installation meet the
requirements for compliance crad, )
r.OTeam Mechanical
ei gna ur Date' 1� InstallingSubcontractor 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 that wil l likely lose their effectiveness over time. It has not been treated
with chemicals that can corrode wiring or metal. Fiberglass will not absorb moisture MrWill 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 #.: 13 Plan: 3YR Address: 79-866 Barcelona Dr., La Quints, CA
Ceiling Area: R-38 Blown Garage Ceiling:
Overhangs:
NN nth Living Above
Ceiling:
Inaccessible to Blow
Signed
Interior Walls:
Exterior Wails: R-13 Unfaced Batts
Garage Wall:
.. OJ I
Ca 91701
Cantilevered :
Floors W/Living Above
Co., Inc.
License #465709
Conchita Ortiz, Secretary/Treasurer --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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