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0207-103 (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 fiU aS 13 .1131102 DateV� Signature of Contractor' -''f 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 6tion 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 STATE FUND Policy No. 108301.012 (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 'hall��orthwith comply with trr. ose,provisi9ns.. Dater W'°ti/r'r� Applicant ,"'+sofI ;�`111'di.,��4��[[. 0 Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. . IMPORTANT Application is hereby made to the Director of Building and Safety for a permit --subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at,'' whose request and for whose benefit work is.performed under or pursuant to; any permit issued as a result of this applicaton agrees to, & shall, indemnify; & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit*issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. � w Signature (Owner/Agerif) "t `i ';~� f`� Date/"""`- �i µs�TY �f:• BUILDING PERMIT PERMIT# r 024 i 10 DATE VALUATION LOT 85 TRACT 29147-1 JOB SITE ADDRESST—.J��wa)AA�:T�SSSR� APN OWNER CONTRACTOR / DESIGNER /EN (NEER 1V GOLF trg, P. `Ecr74VOK dLtlSL0Pb&_'nFUPAVm S 140 AMMAMCWTS ,S 140 A,'�.WfDAitJRTCWx9 C„ATi1..&` KO C::1 92..003 %>9 RL..,MAD CA, 920(1'5 t;"d�0a��i�!•.�$�+i� T.,�f337«5 USE OF PERMIT W3'LY?.E'RAWLY DiAtrLLIgG LWD , 1.03' 85 MAN XA.. PERMIT DOES 140'1 INC1.UDK R1.00 K i1V:aa 5, POOL, 5PA OR iJRkVE AY APP4t,U,W14, 15% TaJA (.`I-'!k�,`°1ti FEE IIEDUCTION'.K)k A3CIg..? PLE iSR1.T.AIACE OP M.ME TYPE C LIOTOM f:.'C?L3STRUCTION 216IS.00 SP Pi' RCHM&T-10 525.00 :gip a �A1`uAOFMMhRPORY M4.00 F 10,5 kdCd.CDiTF-T) can, a 4-L.r'di.4auTJCA' dr'o ) 22M57A) - C(kT3`3'x3.1JCT101.IFEE 101.000.4418-000 fil,aaso VJ.K1MiIIK.FEZ 101-000.433)-3'18 x317.92 MZC;HA1 ICAL IF�'1"; 101-00 0.421-0010 $111,110 s.�a 1sCY°�:fc:P.f, tFT11011.000-420-000 'tim.`F1 PL:l1MF31NC1,1:' X 101.10001.1119>000 $18135 YEE - F,.ESID U1 -f/3�f(�1C�1�2{41-�0{i'j0 $22..{12 ,**3yq'l`qR.g.(')Ny��C9qi`^-1{t�$:fv�J.2p'�d�7Ti g3 C7ld�ei-7-� N0 A'3:,K 101 iY"5J4iS�`�•Y23-000 MATO F . V'1;LOPElt, IMPAOT VEF 03.fsD ART IN L'eiIC1,1t'I MOM, HZIS1.0 2701-M1T3-445-0«)«1 -'1`MAT, Cf511TS'1'R�.darfCM AND P140 fat; C. $4,212-39 SCP 0 4 2002 CITY OF LA WNTA Y' FINANCE DEPT.14 RECEIPT DATE BY DAT NALINS% CT R INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs I A Underground Ducts Forms & FootingsOd Q— f �L Ducts_Jp ✓d Slab Grade V. 0 Return Air Steel Combustion Air Roof Deck✓� Exhaust Fans O.K. to Wrap _ RA F.A.U. Framing M Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath 1A Z4 4.4 Drywall - Int. Lath Final Final _ POOLS - sPAs BLOCKWALL APPROVA S Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPR VALS Gas Test Electric Final Waste Lines Heater Final Water Piping _ _ _ , numbing Final - Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection n A��-� "�— -!17 - Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring7�/ a Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) CZ DoT * 85 e�- 57-590 Desert �r' �� ENERGY �} CADEC Services — 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.'SAflt= 2A ?A -I -TE-51 .D 04: 4 s �►G�o*s Project Title Date } 1: Quiwr& �SFi (ZDO K ("�M NI 11 h� IT1 E S ro•ect Address P Builder Name YE VA LdI- Z (7Gv1 901-3&,)01 • rL,".Q 2. Bui�er CContact Telephone Plan Number G2oyP t HERater Telephone Sample Group Number l4_T_# Certifying Signature Date Sample House Number Firm: DESERT Eda� C. -r Se7P, i LES HERS Provider: d - M •� •E.R.S . Street Address: .2 a BOX tPZ 1 Ciry/State/Zip: (�Alde-140tl IRASE. CA• L Copies to: Builder, HERS Provider HERS RATER COMPLIANCE STATEMENT The house was: ri 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. Q"'The installer has provided a'copy of CF -6R (Installation Certificate. Q2" 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. 2MINIMUM 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 �3 If fan flow is calculated as 400cfm/ton x number of tons enter calculated value here j 40v If fan now is measured enter measured value here Leakage Percentage (100 x Test Leakage/Fan Flow) = 3.1 0,/, Check Box for Pass or Fail (Pass=6% or less) �u ❑ ,.,/ Pass Fail LL'TH ERMOSTATIC EXPANSION VALVE (TXV) Yes ❑ No Thermostatic Expansion Valve is installed and Access is ,_2,/ provided for inspection 0 ❑ Yes is a pass Pass Fail Desert ! CAD ENERGY Services P.O. Box 621 Rancho Mirage. CA 92270 Email: RKrown6237@aol.com Ph/Fax (760) 564-2044 Cell: (760) 835.7939 53-5790 CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7) Project Title .. . Es -r., ro'ec� t Address VE VA 11E (76X01-3&N5I Builder Contact — ' Telephone Telephone Certifying Signature . DatE Firm: DESERT E�] fa C `(SEg\/I C. -E5 Street Address: R t% BOX W 21 Copies to: Builder, HERS Provider 8cw plgM CF -4R TESIE P O0: 415 ►G�o3 Date j A5?4 5 ROO I< ("� It/1 m u h1(TI E S Builder Name P t_I,,, N 2 Plan Number G20LiP l Sample Group Number l 4-,- # 0.5- Z - Z Sample House Number HERS Provider: C° . h •�•�..R.S . Ciry/State/Zip:�1CNol`� IRASE. LFII• °12270 HERS RATEOMPLIANCE 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) U 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. dMINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage) Measured Duct Pressurization Test Results (CFM rci 25 Pa) values Test Leakage Flow in CFM O If fan flow is calculated as 400cfm/ton x number of tons enter calculated value here 1&00 If fan now is measured enter measured value here Leakage Percentage (100 x Test Leakage/Fan Flow) = 4•'�° Check Box for Pass or Fail (Pass=6% or less) ❑ Pass Fail THERMOSTATIC EXPANSION VALVE (TXV) Yes ❑ No Thermostatic Expansion Valve is installed and Access is provided for inspection g, ❑ 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 57-590 BLACK DIAMOND Occupancy Group: R-3 Type of Construction: Owner of Building: CRV GOLF WEST, L.P. Building Official Bldg. Permit No.: 0207-103 VN Land Use Zone: RL Address: 5140 AVENIDA ENCIANS City: CARLSBAD, CA 92008 By: DANIEL P. CRAWFORD JR. Date: 5/21/03 POST IN A CONSPICUOUS PLACE 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 57-590 BLACK DIAMOND R-3 Type of Construction: Owner of Building: CRV GOLF WEST, L.P. Building Official VH Bldg. Permit No.: Land Use Zone 0207-103 RL Address: 5140 AVENIDA ENCIANS City: CARLSBAD, CA 92008 By: DANIEL P. CRAWFORD JR. Date: 5/21/03 POST IN A CONSPICUOUS PLACE