0207-102 (SFD)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
760335 13 31.31103
"`°'!�/�
r 7 --Signature of ContracPo
'
Date 4f ry„
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
S ce tion 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 STAT), Ir--fTAD Policy No. 1608,3111-011
(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 Tall forthwith comply with th,osINprqvisions.
Dace? Applicant � r RF:',/✓"✓
�'
Warning: Failure to secure Workers' Compensatio0oyerage 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. c
Y
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 top�
any permit issued as a result of this applicaton agrees to, & shall; indemnify U
& 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 iif
work is not commenced within 180 days from date of issuance of sue 11
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 informationtis
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. t
Signature (Owner/Agent)f Tif '�;I it. t + Datd .
BUILDING PERMIT PERMIT#
0207-102
DATE VALUATION V14,1()7.s,() LOT 86 TRACT 29147-1
JOB SITE
ADDRESS $7� i�7(1'M .6 Cy DMTdo�a
APN I62-n(WIM
OWNER
CONTRACTOR / DESIGNER / EN (NEER
cmv GC)u? WM,.P,
ASHB +°7t7KM;11�;,&...UP'tv1�`.'W 00mPfia `Si'
5140 NM1DA.Es" 4aMNS
5140 AVS A.T"A4CW
CARLSBAD C'}4 92008
C..AR OAD CA V4008
('7 frfl;1�3G I s i (T-1,4 337 6
USE OF PERMIT
�1 p
CM 4X.i.c J.'AM9,71J
VD v LOT 96 PLik'N blit. ,1•'µbt7t5I .Ii•LDKS NOT INCLUDE 13LOC 6V.aziUA
11004 SPS, OR f5.t i'AYAPF'EYCiACH
CUSTOM GON11TRUCT10H U01.00 SF
PO4t#:FtPPATIO 1558.00 SV
0APA(MICARPORT wF
1?:9L%ftTA t 10•08r or, CO S-C':F�'1T(.:TY01Y
214,107.30
Ct1A1 '1°1EliTCi3C'-�]'F1�; 101-000.418.000 S150+2.00
PLAN CliECIC .FRE 101 _000-14139-31 8 $855.50
i111WHAAiiS'•AL M 101.000-421- 000 S111160
Fi..&P.C:TR1CA , ";E 101-ODO-420-000 �I:sj.34
1y1,i M131W) PER 101-000-419.000
Syy°�yyk�A/st�••tNyyg�s,,:�����g*1�C�'1CgION I � g7„MtD 101-1tyfi�3hyC1-2411 -p0000
p$21.41
00 20.00
iCDEVZ1 C1'ER,1'[N1PACT PEE-
PEE
ART IN ljliBi'..zC F"A.:11,GN.,R931C 0770.000.445-000 S.;ISsd�
ART
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CITypF
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FIIV,gjII
iEDEPr
RECEIPT
DATEEat
%. '
BY
��
DATE F NA D
S 3
INSP CTOR
• 4, f F r�
-
� �d • � � t off:
r�-
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Z.
Underground Ducts
Forms & Footings
p
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
_
F.A.U.
Framing
_
_
Compressor
Insulation
I
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
D vall - Int. Lath
_
Final
Final
/ a31WPOOLS
- SPAS
BLOCKWALL
APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground PIN. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
9(�
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
_ _
1
Final
COMMENTS:
7D / cads 42 996"_�d02
ZVY,, A
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power 3
Final / D3
Utility Notice (Perm)
�a
Desert ��
ENERGY ��� -- j" � A l) I: C
Services — 5�-5�-0 8l�c�K D1ftMON�•
P.O. Box 621 Ph/Fax (760) 564.2044
Rancho Mirage, CA 92270 Cell: (760) 635.7939
Email: RKrown6237@aol.com
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page 1 of 7) CF -4R
PA-5A2A TE-5JED Off, 4/- 15 #►GL°3
Project Title Date ll
,ASN s goo IC &m NIu llj ITI E S
ro.ect Address Builder Name
�VE VALIE IL (7tio1 901-3& Pl-AQ 1
Builder Contact Telephone Plan Number
GK0yP 1
HER R Telephone Sample Group Number
T 4#
Certifying Si nature Date Sample House Number
Firm: DESERT i LE5 HERS Provider: L° • H •�•�•R•S .
Street Address: Ra BOX � 21 City/State/Zip: f�AI.IGNotl IRA<E. CA• °12270
Copies to: Builder, HERS Provider
HERS RATER COMPLIANCE STATEMENT
The house was: Tested ❑ Approved as pan 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.
B"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 retums in lieu of ducts)
Where cloth backed, rubber adhesive duct tape is installed, mastic and drawbands are used in combination with cloth
backed,-rubbe� 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 �-
If fan now is calculated as 400cfm/ton x number of tons enter calculated
value here )Soo
I f fan now is measured enter measured value here
Leakage Percentage (100 x Test Leakage/Fan Flow) = 4-0,01.
Check Box for Pass or Fail (Pass=6% or less) ❑
Pass Fail
THERMOSTATIC EXPANSION VALVE (TXV)
ZYes ❑ No Thermostatic Expansion Valve is installed and Access is
provided for inspection Z ❑
Yes is a pass Pass Fail
Desert
ENERGY s/ IrC A 0 E C 5� -- 5�-0 61QcK d;ama
Services —
P.O. Box 621 .
Rancho Mirage, CA 92270
Email: RKrown6237@aol.com
Ph/Fax (760) 564-2044
Cell: (760) 835.7939
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page 1 of 7) CF -4R
A15A 0I
Project Title
9 ro'ect Address
E
Builder Contact
HERS `erg
�'c�.1R1o�32�j2.
gol-3
Telephone
Telephone
Cerfffying Signature ' Date
Firm: DESERT EIJ fz� `(SERJi G_.E5
Street Address: RQ Box �21
Copies to: Builder, HERS Provider
HERS RATER/COMPLIANCE. STATEMENT
The house was: CJ Tested ❑ Approved as part of sample testing, but was not tested
As the HERS rater providing dia,gnostic 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 retums 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 a 25 Pa) values
Test Leakage Flow in CFM 118
If fan flow is calculated as 400cfm/ton x number of tons enter calculated
value here ZQpD
If fan flow is measured enter measured value here
Leakage Percentage (100 x Test Leakage/Fan Flow) _ ,�/
Check Box for Pass or Fail (Pass=6% or less) L'� ❑
Pass Fail
WTHERMOSTATIC EXPANSION VALVE (TXV)
Yes ❑ No Thermostatic Expansion Valve is installed and Access is
provided for inspection ❑
Yes is a pass Pass Fail
TE.s-� P 00:,hS J I kL
Date
j
A5HsgooK ,aMrAt.14iT1ES
Builder Na
M51
PI.A 0me'
Plan Number
GK0LiP l
Sample Group Number
�T 4# SG _
Sample House Number
HERS Provider
L° . H •�•�.R.S
City/State/Zip: �A ld e- {o tl I A<E , 6L. 0/2210
HERS RATER/COMPLIANCE. STATEMENT
The house was: CJ Tested ❑ Approved as part of sample testing, but was not tested
As the HERS rater providing dia,gnostic 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 retums 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 a 25 Pa) values
Test Leakage Flow in CFM 118
If fan flow is calculated as 400cfm/ton x number of tons enter calculated
value here ZQpD
If fan flow is measured enter measured value here
Leakage Percentage (100 x Test Leakage/Fan Flow) _ ,�/
Check Box for Pass or Fail (Pass=6% or less) L'� ❑
Pass Fail
WTHERMOSTATIC EXPANSION VALVE (TXV)
Yes ❑ No Thermostatic Expansion Valve is installed and Access is
provided for inspection ❑
Yes is a pass Pass Fail
Certificate of Occupancy
City of La Quinta
Building and Safety Department
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code,
certifying that, at the time of issuance, this structure was in compliance with the various ordinances
of the City regulating building construction or use. For the following:
BUILDING ADDRESS:
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of Construction
57-570 BLACK DIAMOND
Owner of Building: CRV GOLF WEST, L.P.
Building Official
VN
Bldg. Permit No.: 0207-102
Land Use Zone: RL
Address:
5140 AVENIDA ENCIANS
City:
CARLSBAD, CA 92008
By:
DANIEL P. CRAWFORD JR.
Date:
5/14/03
POST IN A CONSPICUOUS PLACE