0306-469 (SFD)LICENSED CONTRACTOR DECLARATION
Cl) I hereby affirm under penalty of perjury that I am licensed under provisions of
H Chapter 9 (commencing with Section 7000) of Division 3 of the Busines's and
Cl) «; Professionals Code, and my License is in full force and effect.
O ���11tt M = License # LLiic. Class Exp. Daterr gg��
5 Ji/05
LLJ
oZO ,Date `-/" tir Signature of Contractor
C- OWNER -BUILDER DECLARATION
UJ UJ I hereby affirm under penalty of perjury that I am exempt from the Contractor's
J
~ U) License Law for the following reason:
Z_ ( ) 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).
co () I am exempt under Secfion
LO B&P.C. for this reason
O N Date Signatures of Owner
U rn f
D_ Q WORKER'S COMPENSATION DECLARATION
C) 2 z I hereby affirm under penalty of perjury one of the following declarations:
Lo � O () 1 have and will -maintain a certificate of consent to self -insure for workers'
X W �= compensation, as provided for by Section 3700 of the Labor Code, for the
O J Q performance of the work for which this permit is issued.
m Q C) I have and will maintain workers' compensation insurance, as required by
O U Q ' Suction 3700 of the Labor Code, for the performance of the work for which this
dLOH permit is issued. My- workers' compensation insurance carrier &. olicy no. are:
? .z Carrier r' J `-` E_I'U D Policy No. l0 ii313i ui.2
cb ry5
V
J (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
`3A Code, I shall forthwith comply with those,"provisions.
,Date: Applicant --A--
4b Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
1 of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application:
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void If
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) Dated
BUILDING PERMIT PERMIT#
DATE VALUATION<,d••Q���•� LOT r?;:$� TRACT%+�'m
JOB SITE v�` l¢ NY t%+�F.�t�. ; . l c r� i
APN wtw-j"dC;-taq
ADDRESS
I
y
OWNER (
CONTRACTOR / DESIGNER / EN (NEER
CR V %101* ' W-tj `
minp.cjoy. 3� iyaa.i'Jnani r mAirmw
,140 WKWA10
C".A.1�'n.:�4;P.�AD �° i _ 92 009
Cr R.j..� .Bta) C.P.
94,008
,
t
USE OF PERMIT
1,WCrX : FAh&11111 D i.}?°.$ 3' L110
14 '6t
W-ALL., Pool, llv%:;*t t"a1Ypam?wf! t"PPR AC HI REC?1: O 0. TO PLAN
01.11 " D' id UL-TFPLE 1k',3VX,.,4C? OF aP3W ti'i...*21 7%,'M,
CUSTOM CQ,-VF3.fiIMI(M �,613.Ce N. RIA
It�yPaJRCpY-O3�PA�',�.i'1�{p::ftt�r�n 5t':S5t,;Ci.L^i'�
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i C?k iiT l~ t 1 IG37 '.tY?s`**'.• 10.1 -000.41 R-000 $I,OU $1.
F'l&wd CHOCK, PL11111 11217.42
l'alECI-WICAL JOKIZ 101-000-421-000 SH ILMI
t IIZC `Cu;iC.°,A,'f,. 101
101-000.419a000
3TRf'R-0MC'T10'i FIE F.rRIESI£a 1.01-ib10-2eE:-WO $2R.1I
C11iADIN,1 M 1.01 -00' -WO $15.00
DE:'li`X1-:G1[�?f9Rt xttt.r,^ PA -C li '�Ti+u' ge113 .CAit-
��ff �e��y Yy ��l� f t?�t11 Aqnq yy�r. t(�}
ART IN I'V71�).1C .P11,A0R`,' * [1f.�n:A.t A- ,.b l ���'?��7�i-446'*000 SJ1A*
• t7/rY,Gi`Tf}.!:1l'1.4r ca'P1J%R.1,7i.nod'7 T.4.1' ,),.,,1��,7L.�Abrryy
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. 13 3�.6i♦i.i'"S,R'"wYD :,t!',L>bi2:�
��f.���:;;71'SyyZ��F��fy,,,.f.�Ahyy. fi+�r'$0.00
. {7*
$0.00
�JJ JUL 2 5 2003
��:,'.;;� •.:.CITY OE LADUINTA., .. ,:.. • .� -
'
�/%'r° "FINANCE DEPT:' ��'•
Me
RECEIPT
DATEBY
DAT LEDINS
T
•�� f
INSPECTION RECORD
a OPERATION DATE INSPECTOR
BUILDING APPROVALS
Set Backs
Forms & Footings
fic-
Slab Grade
Steel
Roof Deck
O.K. to Wrap
Framing —
Insulation
Fireplace P.L.
Fireplace T.O.
Party Wall Insulation
Party Wall Firewall
Exterior Lath
r)nAmnll _ Int I ath n
Final
BLOCKWALL
Set Backs
ALS
PLUMBING APPROVALS
Waste LinesJj
Water Piping
Plumbing Top Out
Shower Pans
Sewer Lateral ,
Sewer Connection
Gas Piping
Gas Test
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)
OPERATION , DATE I INSPECTOR
MECHANICAL APPROVALS
Underground Ducts
Ducts
Retum Air
Combustion Air
Exhaust Fans
F.A.U.
Compressor
Vents
Grills
Fans & Controls
Condensate Lines
Steel
Electric Bond
Main Drain
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Te
Gas Piping _
Gas Test
Electric Final
Heater Final
Plumbing Final
Equipment Enclosure
O.K. for Finish Plaster
Pool Cover
Encapsulation
Final,
COMMENTS:
POOLS - SPAS
sweat ,
ENERGY, A E�
semces
P0. Box 621 Ph/Fax (760) 564-2044
Rancho Mirage, CA 92270 Cell: (760] 250-1852
Email: DESNRG (MAOL.COM
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7) CF -4R
PASADERA PH -4
Project Title
P.G.A. WEST LA QUINTA
Pro't Address
NEVE VAN LUE II 760-801-3981
Builder Contact Telephone
GRANT RICH 760-250-20841
H=
,/I
Telephone
"SFU #CCNGY207439
03-19-04
Certifying Signature
Date
Firm: DESERT ENERGY SERVICES
03-12-04
Date
ASHBROOK COMMUNITIES
Builder Name
PLAN 2 2 UNITS
Plan Number
GROUP 3
Sample Group Number
LOT 73
Sample Lot Number
HERS Provider: CHEERS
Street Address: P.O. BOX 621 City/State/Zip: RANCHO MIRAGE, CA. 92270
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 the 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
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) ❑ ❑
Pass Fail
❑ THERMOSTATIC EXPANSION VALVE (TXV) 0
❑ Yes ❑ No Thermostatic Expansion Valve is installed and Access is 11 ❑
provided for inspection