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0304-323 (SFD)0 - U) O =) C) Q LLlLo o Z ZOO OO H to -UUP �a C0 Z co LO N ON U °) CL Q Z Qcr O LL X W — maU OU a�H 'CT Z C) J 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 76(.) 31 Fs � :bra t It t r J Date `� � � Signature of Contractor � 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 v ' 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. Sec;:) I have and will maintain workers' compensation .insurance, as required by 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 il'i=.` rE FUND Policy No. 16031 30l-p'f:4 (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 Rro�dsions of Section 3700 of the Labor Code, I,bshall forthwith comply with those�provlsions..i ,D'ate: c Applicant '-... •.a.'""",�� Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for insaction purposes. 4� Signature (Owner/Agent) "f f�'--�....." Date (`� BUILDING PERMIT PERMIT .03a-%-323+ DATE VALUATION t*,'kyyJTl LOT 89 TRACT I' JOB SITE :5742,9if,:' <n7r.)D �.utr nn APN ADDRESS OWNER CONTRACTOR / DESIGNER / EN (NEER W GOLF 'AM.; k`, UK. ��!,�'.I l onq E. IC r1),SdRofY :51pp4**�3tt�tt��; ir2?{"!?? :140AV��ENID.f31-NOIT'AU ��71'iI?f� �a`ilt+'..6Y.f1.�L.� o.,o'ai �l�;V\Dv SJt� �� 1'�ti. .1.7:Grd'Lr•.j C& a t?'i 18 (160)8,04-6866 rV,LN 331116 USE OF PERMIT >:#IN 11,217.1.,;' ••s,.J ,Y + .� ..d a^ a.^ 1'" C'.:Y .. a u at',' ra ivV A' JAc1d'rav� : a)i wrek o ;rn►dL4;, POOL. SP.A. Olt I73t1Kf:G' VY A.P11k0A.C-1i `13% R.F;DVC: 1014 TO PIi,AN' (`11W. * fll?ff, QUF Tt.3 �AUI:f'?1`I.r'�.:SSli�:AI(.:£ Cii� �A�1•: i'•L,AI�"�"r7�k: ''}}• 1 , STOM COIN:'=.�I�a�s ON w'+.r Pt�CCx fi.7a''(` C? Sri, SP 536,00 3F ;CN3�'1tU�IIA1:wtE? 10)-000-41$»01D() 19,12.(30 I•>I.AWC 1-MACKFI LE 101-100.439-�is $7.a.¢',73 MEC:I•IAATIC"A!, Fr'r , 101.000.421.000 $85.50 CLEC'3 E;IC;AL Mn 101-000.42E-1)030 $162,;6 PLUM.'6I*g0, 7?,E 101,000.419.000 STR(Y0'� 4t 101�CAt :Z_000?d 1 ilt.�ell3!'�IifFIi1; 1fSi-ft(%ti�4i:3^G(1© '�L:i:;:D ,AM DT PUBLIC ?`T.,=1.`TS'' - RE, 9% 270-000.4454*0 .�i %'�i• • A �,1 ��:. J am/ [iL.4v..P �A1.�i'' .7DI`_-a.lw.. PRB-TAW'ETEEV $0.00 PE .1G 10 .�:�.� :�3�saINNO � t�l�•r � CITY OF LA QUINTA FIN XE DEPT. RECEIPT DATE BY E FIN 'E&.&) INS TOR 2 - INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings a a 3 Ducts Slab Grade 0 Return Air Steel Combustion Air Roof Deck 8 -o Exhaust Fans O.K to Wrap F.A.U. Framing Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final BLOCKWALL APPROVALS Steel POOLS - SPAS Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Heater Final Water Piping Plumbing Final Plumbing Top Out • ' Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection l Encapsulation Gas Piping Gas Test Appliances Final Final Utility Notice (Gas) 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) CO MENTS: Dt - = ENERGY CA0EC P.O. Box 621 Rancho Mirage, CA 92270 Email: RKrown52370ao cam Ph/Fax (760) 564,2044 Call: 17t�18- - --- 250-ISSZ 57-62-0 BLACK D 1AMOOD CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7) CF -OR Pas n d f R* 19 Ph--; /125- 0-33 Firm: Pf SEQ'rY 6SIM M-3 Street Address: ),'0.801K 621 Copies to: Builder, HERS Provider thh e Goll o�rn�l'N4,�4 Budder N e Plan Number �A dial * ce"' Sam-pllee Group Number Nampfeiouse Numbe HERS Provider: &A -F -F-". City/State/Zip: HERS RATER COMPLUNCE STATEMENT The house was: ❑ Tested ("Approved as part of sample testing, but was not tested As the HERS rater provididiiid fild verification. 1 certify I. 2. ng anostc testng ane at the houses identified on this form com I -v with the diagnostic tested compliance requirements as checked on this form. p " ❑ The installer has provided a copy of CF -61Z (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 teaks 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 flow is calculated as 400cfm/ton x number of tons enter calculated 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) ❑ 0 Pass Fail ❑ THERMOSTATIC EXPANSION VALVE (TXV) ❑ Yes .❑ No Thermostatic Expansion Valve is installed and Access is 010 orovided for inspection Yes is a pass Pass Fail