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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
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
760335 B 3131103,
1.Date Signature of Contractor ^` �,
e -AA- '" tt=
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`ction 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 g ,0j,T9; U14D Policy No. j00301--1:21
(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,tq se, p ovisions;
Dater %� Applicant ' �-
��-Ar
Warning: Failure to secure Workers' Compensati0 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 c
for a permit subject to the conditions and restrictions set forth on his '
application. I
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 toq
any permit issued as a result of this applicaton agrees to, & shall, indemniij,
& 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 su I
permit, or cessation of work for -180 days will subject permit to cancellatio .
I certify that I have read this application and state that the above information s
correct. I agree to comply with all City, and State laws relating to the buildi
construction, and hereby authorize representatives of this City to enter updn;•-
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) A'A' Datet)`
T'��', `�
,
BUILDING PERMIT PERMIT/t
LOT 84 TRACT 297
DATE VALUATION *214,107.3011717-1
JOB SIT_
ADDRESS s7 -'I 5L,__A1 �.DTAh {� .a0RD+
APN
OWN
CONTRACTOR
CONTpRAgC�TOR / DE{SI'GpNERR / ENGINEER
y yp y ��qe �i
�y ams
MErr y/ Y y / y pY
5140
51,10A.Y:�:��'.t'�JA 44C7[NA.
LMLSM'AD CA 92009
'`'.e�/`.�tt.o°�"((:��€ AD rte. 9.1201(lrl
�(pp c
C]60)8(M,6$64 IQVJW 3376
USE OF PERMIT
SWM.17
$1?13 • #.ZT.54 P4AN LAR . PERMIT DORS NOT INCILUDt RWCK
WALLS, POOL. RIA OR D.R.FVEWAY APPROACH. '8`,11ro PLAN CHWK ME,
R4DUC, IO14 FOR MULTIPIA LaSUANt:E' OF SAME K.A14 TY1't
CUSTOM CW3`i`RUCTION X501:Q0 SFS
PORt;,` PATIO 552.00 a:N'
� 4i.I? t�}13'Jf�.AFdF'Cr.i 60131” ill -IF
A'yia TKNIXI) 009f OF
C0NOTRUCT1014 ITRE, 101.000-418-000 $1,041N
PLAN C"t WIX FE9 103.-000-E139-'31? 121k.a
:lvkl7E:k MITIQW,1 101.000-421.OUO $11i.00
tRAXW TRIC;.AL. nL 101-000-420-000 $133-1.4
P1aUMBR40 F&F 101.000-119.000 SI0714
STRCJJQ ,JOTION 119 - R. r"1D 101-000-2AI -000 $21.41
ORAI;,I'AG Ml 101.000-423-000 $20,00
`MFY1?�..OVZR, IMPACT ISI; $.9,405.00
.ART ,'rN P U£1UC F°11.ACE8 - RESIr :00-00U-44-:5,400 00 W.27
L,zi c t.XM P,kh•T'AIDM3
$0,00
'10���
3:1't�9<�I�.s
� � ��,l�l.11L1"`�'.1�1�J�.'fi;l�.�.�'o�?(A1J%.�A�t3W
CITY OF LA QUINTA
FINANCE DEPT.
_
RECEIPT
DATE
By
DATE FI ALE
� 03
INSP R
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
QZ
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
_ _
I—
Compressor
Insulation
Vents
Fireplace P.L.
7
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
�
6y
Final
Final s
BLOCKWALL APPROVA S
POOLS -SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APP OVALS
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
Pool Cover
Sewer Connection
_ _
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas) %1r�
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)
COMMENTS:
Desert
C A D E C -
ENERGY
services —
P.O. Box 621 . Ph/Fax (760) 564-2044
Rancho Mirage, CA 92270 Cell: (760) 835-7939
Email: RKrown6237@aol.com
7(,Oo ��0.>�u
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page 1 of 7) CF -4R
pA-5Aflt_ 2A
?A -I
"Ti -'5=P OQ: 4AS 4m&5
roject Title
"Date T—
•
�
��
h5mOOt< &mmuklrnES
FSR
Project Address
Builder Name
YE V/4{.I
Ll1E- ff�
901'3°�*j ' PLA 0
Builder Contact
Telephone Plan Number
X100
3 Gt KO d P l
HE at
Telephone Sample Group Number
ccs.! R to 32 °I2
s- v 3 l,y-r # M- ( 2
ertifying Signature
Date Sample House Number
'
Firm: DESERT Eldg-fr-i
SE-RyieE5
HERS Provider: • N •�•�.R.S
Street Address: R0•
BOX (PZ1
City/State/Zip: �AI 4-140M IRA -415— 6-'A- CV270
Copies to: Builder, HERS Provider
HERS RATER COMPLIANCE STATEMENT
The house was: - 0 Tested ❑ Approved as part of sample testing, but was not tested
As the HERS rater providing diagnostic testing and Feld verification, I certify that the houses identified on this form comply
h t
wite diagnostic tested compliance requirements as checked on this form.
The installer has provided a'copy of CF -6R (Installation Certificate.
istribution system is fully ducted (i.e., does not use building cavities as plenums or platform retums in lieu of ducts)
LJ 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.
52�M 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 (d
If fan flow is calculated as 400cfm/ton x number of tons enter calculated
value here 1000
If fan flow is measured enter measured value here
Leakage Percentage (100 x Test Leakage/Fan Flow) = 15 -'9$ ��
Check Box for Pass or Fail (Pass=6% or less)
1!9,THERMOSTATIC EXPANSION VALVE (TXV)
LTJ Yes ❑ No Thermostatic Expansion Valve is installed and Access is
provided for inspection
Yes is a pass
Pass Fail 1
• �E
s
Pass Fail
Desert
ENERGY ��� �- i 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
A-5A0I_ 2A ?A liLs=P OIJ: *As
roject Title Date
LA QUIWT&• TA51i�IZDOK (ZMN111I,ITIEs
pAddress • Builder Name
ct
YE Vi LIJE 901-3°9131 PLA -,0 1
Builder Contact Telephone Plan Number
G KOLJ P 1
HER ter Telephone Sample Group Number
s 4- (-
Certifying Signature Dale Sample House Number
Firm: DESERT E0 g� SE(Z\/ILES HERS Provider: • H •�•�.R.S
Street Address: 20-50)( W21 City/State/Zip: �I.�CNo[� I�rtE. CSA. °12270
Copies to: Builder, HERS Provider
HERS RATER STATEMENT
The house was: 'U' 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.
Z'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.
:)
CREDIT
MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE
Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage)
Measured
Duct Pressurization Test Results (CFM to 25 Pa)
values
Test Leakage Flow in CFM
��
y
If fan now is calculated as 400cfm/ton x number of tons enter calculated
y
value here
'
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)
❑
Pass
Fail
,�,/
C THERMOSTATIC EXPANSION VALVE
a�
(TXV)
Yes ❑ No Thermostatic Expansion Valve is installed and Access is
r
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
57-600 BLACK DIAMOND
Owner of Building: CRV GOLFWEST, L.P.
...r&4 -L
Building Official
VM
Bldg. Permit No.: 0207-104
Land Use Zone: RL
Address:
5140 AVENIDA ENCIANS
City:
CARLSBAD, CA 92008
By:
DANIEL P. CRAWFORD JR.
Date:
5/12/03
POST IN A CONSPICUOUS PLACE