05-0211 (PLBG)ole
LA UINA
�A
BUILDING & SAFETY DEPARTMENT
504 (760).777-7012
.LE TAMPICO FAX (760) 777-7011
;, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
Apy pLi-cation Number . . . . .
Property Address . . . . . .
APN: -
Application description
Property Zoning . . . . . . .
Application valuation . . .
05-00000211 Date 1/20/05
57550 BLACK DIAMOND
762-350-032- - -
PLUMBING
LOW DENSITY RESIDENTIAL
500
Owner Contractor
----=------------------- ------------------------
MCKAY MHAIRI MAPLE LEAF PLBG HEAT/AIR COND
57550 BLACK DRJKD P.O. BOX 3563
LA QUINTA CA 92253 PALM DESERT CA 92261
(760). 346-6758
WCC: STATE FUND
WC: 046001349204 11/06/05
CSLB: .481393 10/21/05
CCC: C20 -C36
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Permit PLUMBING
Additional desc
Permit Fee . . . . 18.00 Plan Check Fee .00
.Issue Date Valuation . . . . 0
Qty Unit Charge Per. Extension
BASE FEE 15.00
.1.00 3.0000 EA PLB GAS PIPE 1-4 OUTLETS 3.00
--------7-------------------------------------------------------------------
Special Notes and Comments
1/2 INCH AS LINE TO FUTPEhOV5D APPLIANCE
Fee summary Charged Paid Credited Due
------------------ ---------- ---------- ---------- ----------
Permit Fee Total 18.00 .00 .00 18.00
Plan Check Total .00 .00 .00 .00
Grand Total 18.00 .00 .00 18.00
P.O. BOX 1504�� VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 44INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: �J — c�Z (� ` Date: /-2-0�
Applicant:
Applicant's Mailing Address:
Architect or Engineer:
Architect or Engineer's Address:
Lic. No..
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S 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 ia fullore and effect. r— - - • t r G
License Class ` 4License No._ `3
Date `--ZU�[) j Contractor
OWNER -BUILDER DECLARATION
1 hereby affirm under penalty of perjury that 1 am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed
statement that he or she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business
and Professions Code) or that he or she is exempt therefrom and.the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects
the applicant to a civil penalty of not more than five hundred dollars ($500).):
U 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 and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work
himself or herself or through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is
sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.).
U 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors'
State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to
the Contractors' State License Law.).
U 1 am exempt under Sec. B.& P.C. for this reason
Date Owner
WORKERS' 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
�_— i ued. My worke mperksation insurance carrier and policy number are: (�
Cartier �i-r..} _ Policy Number D�•) Ce0 C7 2 (A1 `f 2 U�(
_ 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, l shall
forthwith comply with those provisions.
1 Cpl X
Date 1"�1 Applicant
-�
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($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.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name
Lender's Address
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this 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 application, the owner, and the applicant, each agrees to. and shall, defend, indemnity and hold harmless the City of La Quinta, its -
officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit.
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 county ordinances and state laws relating to building
construction, and hereby authorize representatives of this count to enter upon the above-mentioned property for inspection purposes.
(Date = '� Signature (Ap'plicarit or Agent):
Desert}`: X11 = . ��"'
ENERGY S�� f" CADEC n^No.
et~vtces — B �� D lYl
,,,t
S
P.O. Box 621 Ph/Fax (760) 564-2044
Rancho Mirage, CA 92270 Cell: (760) 835-7939
Email: RKrown6237@aol.com
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page 1 of 7) CF -4R
P,A'SAb-ri_5 m P�l 4/15 ►G�o3
Project Title Date
�6. QU1141A A5H5gooMC &mr utj1-TIES
ro'ect Address Builder Name
�vE VA LyE � (7Gr�1 dol-3°�gl P�A�I 3
Builder Contact —� Telephone Plan Number
m0 3 3 G IZoy P 1
HERS ater Telephone Sample Group Number
Certifying Signature Date Sample House Number
Firm: DESERT EI g;44-( .SE'RJI LES HERS Provider: • H • IF– • CE– •R.5 .
Street Address: Ra gox (�21 City/Stale/Zip: f Le-Hotl IKA4E. CIA. 11221
Copies to: Builder, HERS Provider
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 t e diagnostic tested compliance requirements as checked on this form.
The installer has provided a'copy of CF -6R (Installation Certificate.
Distribution 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 r 0 s
If fan now is calculated as 400cfm/ton x number of tons enter calculated
value here 2.000
If fan now is measured enter measured value here
Leakage Percentage (100 x Test Leakage/Fan Flow) _ x•25% ,�,/
Check Box for Pass or Fail (Pass=6% or less) L'J ❑
Pass Fail
THERMOSTATIC EXPANSION VALVE (TXV)
Yes ❑ No Thermostatic Expansion Valve is installed and Access is
provided for inspection ❑
Yes is a pass Pass Fail
�M
LST ��-
Desert 5 --E550
ENERGY
CAOE�
Services — 6L CK
P.O. Box 621 Ph/Fax (760) 564-2044
Rancho Mirage. CA 92270 Cell: (760) 835.7939
Email: RKrown6237@aol.com
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page 1 of 7) CF -4R
'A'SA
roject Title
.4. r-%.
ect Addres
FWiA M0 %90RIP0111111 F7M-' % •
HER
Certifying Signature
Firm: DESE.RT EIJP f-: t `(5E2y1 LE -5
Street Address: R 0- B ox � 21
Copies to: Builder, HERS Provider
Date
—T&--.5 am P 5 # 1Go3
Date
A5145(ZOOK nMr UKIllmes
Builder Name
18 P LA Q 3
Plan Number
'939 4!;2oLiP l
Sample Group Number
'3 l'c T J# S 7 1!' r
Sample House Number
HERS Provider: d- H •�•�.R.S .
City/State/Zip: �A-lde-HoLl IPAryE. A. °22270
HERS RATER COMPLIANCE STATEMENT
The house was: B 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.
tJ The installer has provided a -copy of CF -6R (Installation Certificate.
Distribution system is fully ducted (i.e., does not use building cavities as plenums or platform returns in lieu of ducts)
Z 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:
2 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 �Z
If fan now is calculated as 400cfm/ton x number of tons enter calculated
value here 00
If fan now is measured enter measured value here �—
Leakage Percentage (100 x Test Leakage/Fan Flow) = 5. o
Check Box for Pass or Fail (Pass=6% or less) L�" ❑
Pass Fail
,THERMOSTATIC EXPANSION VALVE (TXV)
C(Yes ❑ No Thermostatic Expansion Valve is installed and Access is
provided for inspection ❑
Yes is a pass Pass Fail