0402-340 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
HCha'ter 9 (commencing with Section 7000) of Division 3 of the Business and
N W Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
zR t 0a D rye ,� 9/30/04
Z Date'-'n� Signature of Contractor ��,
J U C) OWNER -BUILDER DECLARATION
W WW I hereby affirm under penalty of perjury that I am exempt from the Contractor's
U) License Law for the following reason:
Z_ ( ) 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).
Cl) () I am exempt under Section B&P.C. for this reason
LO
N Date Signature of Owner
O N _
0)
d Q WORKER'S COMPENSATION DECLARATION
o cr I hereby affirm under penalty of perjury one of the following declarations:
Lo � O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W �= compensation, as provided for by Section 37.00 of the Labor Code, for the
O � Q performance of the work for which this permit is•issued.
CD Q V (` /) I have and will maintain workers' compensation insurance, as required by
O U Q Section 3700 of the Labor Code, for the performance of the work for which this
d I— permit is issued. My workers' compensation insurance carrier & policy no. are:
? Z Carrier 01.1, REPl7MAC INSU Policy No. (tNYCaflM601)
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(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
Date: %/ 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.
1
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. r—�
1. Each person upon whose behalf this application is made & each per`!soh at
whose request and for whose benefit work is performed under or pt irs l alnttto
11./�
any permit issued as a result of this applicaton agrees to, & shall, Indg�nnlffy
& hold harmless the City of La Quinta, its officers, agents and empla, yees. P
2. Any permit issued as a result of this application becomes null and Noidlif
work is not commenced within 180 days from date of issuance osucFi—C
permit, or cessation of work for 180 days will subject permit to cancel ation.
I certify that I have read this application and state that the above informa Ion 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.
Signature (Owner/Agent)- rice Date
BUILDING PERMIT PERMIT# .,
0402340
DATE VALUATION LOT TRACT
�A�t'7,7.E?31.'PTP 11 2y3�i
JOB SITE
ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
LOWAR HOWS OF CiUMORNIA
I a4NAR ROWB r.�r CAL r0:��A.
76.401 C I-RIGHWAY i 1 i
78.461 C HSMH- AY )I!
LA QlaII}i:t` k CA 92253
LA. QrtJ!' . TA GA 99,253S
(760)777-0131 CBLA 3434
USE OF PERMIT
19WO E F'111SI.LLY DVVHf t iG
SPO . IJ.)r 11, PLAN ID, PERMIT ;JOSS NU- INCLUDE BLOCK 'WALLS„
C'004 SPA O i; RIV1y'VV'.AAt'APPPOACH. 75 % E 13DUCTION TO PLkH C-11RCK
FEE IDUE TG MULTIPLE E;1SUANCE Of SA AE PLAN TYPE
TRACT COMMUC:TION l,1sG6.:1fl ��
1 OP,CHIPATIO ' S_00 SP'
0AR.A01+ CAPUPOWr 425,40 Sly
CONSTRUCTION FEE 1 t11..n�IO �1143�i101; S� J. ,fl
PLAN C HILCY: I atE, 1�i1 �UCiG-d��-31L� X157.6?
MECk1KIACALMR 101.000-421-000 $47,00
ELF,C t RIC:AL PEr. 101-4000,420-000 91Q5. a I
P UMB1140 FEV, 101-000.4.19.000 5140.73
STRONO AADTION "SE . RI<.RID 101-000-24,11-000 X10.71
0P.ADING FEE 101-000.423.000 W106
0LrAr .WP`EPt IMPACT PACT HELI $2,105.00
%
3, 28.80LWS
z RU -PA ii 73�'f;;S
2 4 tOOF
:AHCE
LA OUiNTA
DEPT. —_
'.t
RECEIPT
DATEBY
DAT FI ALE/
INSP R
:4 _ ,-) ^3 -r11. l
�(, r ,i
INSPECTION RECORD
OPERATION j
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
Set Backs
APPROV/AL S �-
MECHANICAL APPROVALS
Underground Ducts
Forms & Footings
Ducts
Slab Grade
J
Retum Air
Steel
Combustion Air
Roof Deck
_ _
Exhaust Fans
O.K. to Wrap
_ _ _ _ _
O
F.A.U.
Framing
Insulation
_ _
_ _
Compressor
Vents
Fireplace P.L.
Is
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
_
Aq
Drywall - Int. Lath
15
Final
O-SP�AS//
Final
POOLS
BLOCKWAL
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
Waste Lines
Gas Test
Electric Final
Heater Final
Water Piping
_
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Sewer Connection
��
Pool Cover
Encapsulation
_
Gas Piping
Gas Test
Appliances
Final
19A if
COMMENTS:
i
If
Final 4141 Alt
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
_
Low Voltage Wiring
FbQures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
- v
AUG -19-20C}+ THU`--006;47 AM TEAM HEATING & A/C FAX N0, 9096943803
P. 22
HVAC INSTALI.ATIQN Tested Duct Leakage & TXV Page 1 oft C17 -6R
Site Address: -774 Barcelona Orive Permit Number:
Tract Number. 29323 Plan #: 1 Phase: 4
Lot Number. Project: Esplanade Builder: Cornerstone Dev,
An installation certificate Is required to be posted at the building site or made avalible for all appropriate Inspections.
Atter completion of final 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:
Un�+in.. Cn„iwrMnn4
1 X1-1 ----ff of Efficiency Duct Heating I Heating
Equip. CF=C Certifiedr Name ldenticle (AFUE, etc.) Location Duct Load Capacity
Type and Model Name Systems (>= CFAR) (attic, etc.) R -value (BTU / Hr) (BTU / Hr)
FC US -AW- arc 4.2
r r%nlinn {=ni iinmant
oFfficiency u Cooling Cooling
ulp- CEC-Urtified Ufr Name Identicle (SEER, Ott) Location Duct Load Capacity
Type and Model Number Systems (>�CFAR) (attic, etc.) R -value (BTU / Mr) (BTU / Hr)
Us Air 993CNX060 SEER 12 —atUc
1, U10 unaeraignea, venry mar equlpmenr Ilsreo aevva Ib: 'r Is uie acwaI 04UIIJIIICIIL 11.4,V1110 , �i-4-91vm w " ,,,•+,�
efficient than that specified in thifWrtificate,of compliance (Form CF -1 R) submitted for compliance with the Energy
Efficiency Standards for reside 'al u s, 3) 94AUpment that meets or exceeds the appropriate requirements for
manufactured devices (from th Ap li oe E Ioi no nqlation5 or Part 6), where applicable_
•-p� Team Mechanical
Signature, 15ate Installing SubcontractorName
OR General Contractor (Co. Name) OR Owner
MINIMUM REQUIREMENTS F DUCT LEAKAGE COMPLIANCE CREDIT
Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage)
CFA:
System of 17-71
Indicate the maximum alrowwa 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
Mu Pressurization Test Results
100 x Test Leakage / Fan Flow = % Leakage
Check Box for Pass or Fail (Pass = 6% or Less)
T-ompliance Credit was Taken for TXV
ys 24 C= of
Indicate the maximum a owe 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
D-u-ff Pressurization Test Results
100 x Test Leakage / Fan Flow;-- % Leakage
Check Dox for Pass or Fail (Pass = 6% or Less)
OT -24 Compliance Credit was Taken for TXV
x .06
X M5
TXV was
PAGE 1
F2001-01 (4702) Action Now T 24CF6-RTDBTXV macro
AUG -19-2004 THU'-66:47 AM TEAM HEATING & A/C FAX N0, 9096943803 P. 23
jr
HVAC INSTALLATION CERTIFICATE for Tested Duct Leakig;4 & TXV, Page 2 of 2 CF -&R
Site Address: 79774 Barcelona Drive Permit Number. 0
Tract Number. 29323 Plan #: 1 Phase: 4
I-ot Number 11 Project. Esplanade Builder: Cornerstone Dev.
System [71 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 Capacit in Thousands of Output BTU per hour) x (0.06)
Measured Fan Flow _
IM Pressurization Test Results (QFM a 25 PA)
100 x Test Leakage / Fan Flow = % Leakage
Check Box for Pass or Fall (Pass = 6% or Less)
nT-24 Compliance Credit was Taken for TXV
` ysS fem E= of
Indicate the maximum a owa le Duct leakage and the Calculation used:
0.7 x Floor Area x (0,08) for Climate Zone 8 through 15
0.5 x FloorArea 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 Resu s
100 x Test leakage / Fan Flow = % leakage
Check Sox for Pass or Fall (Pass = 6% or Less)
T 24 Compliance Credit was Taken for TXV
;y:RM-
of
Indicate the maximum allowdbl9 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 Resu
too x -rest Leakage / Fan Flow � % leakage
Check Box for Pass of Fall (Pass = 6% or Less)
T•24 Com liance Credit was Taken for TXV
em of
Indicate the mawmum aowaa 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 Pressurization Test Resu s
100 x Test Leakage / Fan Flow � % Leakage
Check Box for Pass or Fall (Pass o 6% or Less)
OT -24 Compliance Credit was Taken for TXV
x `O6
TXV wa:
x'.08
XV we!
x :wn
TXV war
X.06
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 wkh the requirements f r ompllance credit builder shall provide the HERS provider a copy of the
CF -SR signed by the builder employe ors n ors ng that diagnostic testing and installation meet the
aedik
requirements for compliance '
�• l�v�� Team Mechanical
assts rgna ure, a V Installing u con rac orame
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-240F6-RTA&TXV macro
4
Certificate of Insulation
Your Home has been insulated with CertainTeed Fiberglass Insulation products, which are designed
for today's safety standards and tomorrows 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 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 insulal ion 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 Trac(: 29323-2 Phase: 4
Lot N.: 11 PIan: 1 Address: 79-744 BarcelonaDri., La Quirta, CA
Ceiling Area: R-38 Blown Garage Ceiling:
Overhangs:
With Living Above
Ceiling:
Inaccessible to Blow
Signed
Interior Walls:
Exterior Walls: R-13 Unfaced Batts
Garage Wail:
Cantilevered :
Floors W/Living Above
. OJlnsulation Co., Inc.
/�
!Ca 9170A {676)81-6(170 License #465709
Conchita Ortiz, Secretary/Treasurer --or-9 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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