0307-375 (SFD)LICENSED CONTRACTOR DECLARATION
I h6reby 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
PrdlesconaN Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
` 760355 B l` 03/31/2(
f - OLI .�.
,,Date �(f` 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
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
Section 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 STAN FUND Policy No. 16013301-012
(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 shall forthwith comply with those FY9Ylsions.
Date: Applicant—
Warning:
pplicant 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
r 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
16 & 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.
/PSignature (Owner/Agent)+( 'Y. Date 1t
/��r��
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0307-375 TRACT
11 • l q-• C , 69 . 29147-2
JOB SITE
ADDRESS 7E2�.�3L°Yw i 1 MO!`
APN
7'62--370AXIS
OWNER
CONTRACTOR / DESIGNER / ENGINEER
CI~V GOLr- WWr
AMMROOX DiVV�DPMM4T C01APANT
5140 AVOW).A M4(M AM
5140 AVENIDAERCINA2
CiNUSBAD CA 92006
CARLSBAY) CA 92005
(760)804.65868 CBIA 3376
USE OF PERMIT
aftq LE FA1vS.i ,Y I WR1.I.WG
SFD - CAT 69, PLAN SBR, PM11,= DOES NOT INCLUDE BLOCK
WALLS, POOL, SPA OR LIRRIEWAY APPROACH, 75% R&DUCTION TO PLAN
CHECK FEE DUE TO MULTIPLE ISSUA14C1;; OF SAME PLAN TYPE
CUSTOM CONISTRUCTION 2619.00 SF
PORCHMA►T1i0 525.00 SIT
GARA.0 W,ARPORT 534.40 SF
EsTfl7,ATED COP1' OF CONUIR C`7 0M
221,15'iAO
FKlz r F".11.3f; $3ImP1uliy
CONSTRUCTION FEE 101.000-418-000 $1,065.50
PLAN CHECK FEE 101-000-439-318 $317.Q1
IAECHANICAL 1'72 101.OWC- 47.1.000 $111.00
ELii.CTRICAL FZZ 101-000-420-030 $135,71
PL,UMBINO 6-E 101-000.419.000 S1311A
STRONID MOTION ".Z - h ESID 101-000--241-000 S.3Z.13
ORA.D1190 FRE 101.000-423.000 $15.G0
DEVFA,OPPER.!MPAC;T FT's
ART IN PUBLIC PLA.Ck*.8 - RISIL 270-000445.000 lla2,il9
SUB-TOTALCOMr.TX1!'T10N AND III" t;FLL::C'IZ
$4,2065.34
LUSS P.R1-PAT165.F7
$0.00
nn
TOTAL PFUMIT ICFZS D" NOW
$4,207.39
JJ�e
NOV 14 26-103 1� j
CIT11 OF Cts, CpU66?sA I✓
FIIUAMrF ncp,
RECEIPT 1
BY
DATE/.7 ALE
INSPS
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING 'APPROVALS
MECHANICAL APPROVALS
Set -Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel ' }
Combustion Air
Roof Deck /
Exhaust Fans
O.K to Wrap 7
F.A.U.
Framing Q
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Wywall,;- I . Lath
Final
Final •
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
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 _ j�J =
Encapsulation
Gas Piping
Gas Test
Appliances
`
Final
COMMENTS:
i
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)
-w.�..i7.b•`.1.w.'o,.-t^fr.'.^+.wtrM�..d ...�"ii•� v.•.t-y_�`....,..!n,d''.c..N•....wY f_.•-+-.. r^y... •` "+'T'�
•f
SERVICE�SPECIAL INSPECTION
REGISTERED INSPECTOR'S WEEKLY REPORT
JON TANDY
78-194 Elenbrook Ct.
Palm Desert, CA 92211
Office 760 772-7192
Fax (760) 772-7193
Pager (760) 776-3338
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLY
O POST TENSIONED CONCRETE O ASPHALT
O REINFORCED -MASONRY ❑ FIRE PROOFING
O
O,OTHER
- (� / r k ,h t X C �i , ` �
JOB LOCATION n .� vA �j
t(q L.,
REPORT SEQUENCE N0.
TYPE OFvbSTRUCTURE 4 o 1 ����•GJ
1G�
rasA,�, ��
PERMIT N0.
DATE I �
3 / �i
DAV OF WEEK
MATERIAL DESCRIPTION v
ARCHITECT
INSPECTOR...,.
HRS. CHARGED
/��� D' �,/ ��'� �.• � � J � �,�,/'
I
ENGINEER
ASSISTANTS
HRS. CHARGED
INSPECTION
DATE
GENERAL SUB
CONTRACTOR CONTRACTOR
Q
�.
i I �iR
y
Pti Almav usiIA.SL ,p S.
1p V
I
COPY SENT TO CLIENT O
CONTINUED ON NEXT PAGE O
PAGE OF
I
CERTIFICATION OF COMPLIANCE
L HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MY
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE
NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED
PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS.
SIGNATURE OF REGISTERED 'INSPECTOR
DATE OF REPORT REGISTER NUMBER
I
REGISTERED INSPECTOR'S WEEKLY REPORT
JON TANDY
78-194 Elenbrook Ct.
Palm Desert, CA 92211
Office (760) 772-7192
Fax (760) 772-7193
Pager (760) 776-3338
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLY
❑ POST TENSIONED CONCRETE ❑ ASPHALT
❑ REINFORCED_ MASONRY ❑ FIRE PROOFING
❑
HER n p
V"
JOB LOCATION
REPORT SEQUENCE NO.
TYPETrio
L d \ aL D&OW
PERMIT N0.
DAA � DAV OF WEEK
MATERIAL DESCRIPTION-IY
ARCHITECT
IN!, T HRS. CHARGED
ENGINEER
ASSISTANTS HRS. CHARGED
INSPECTION
DATE
GENERAL�o p� D� COMRACT�
CONTRACTOR (b �
C_ +
V / T
ARA" k Foxs r R wo o,,, -
COPY SENT TO CLIENT O
COPY
CONTINUED ON NEXT PAGE O
PAGE OF
CERTIFICATION OF COMPLIANCE
1. HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MY
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE
NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED
PLANS, SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS.'
GNATUR OF REGISTERE NSPECTOR
3 (� & o
DATE OF REPORT REGISTER NUMBER
LOT * G9
- 4c� Desert -
Uctcx NERGY
o� EerC A O E C
S
P0. Box 621
Rancho Mirage, CA 92270
Email: DESNRG CDAOL.COM
Ph/Fax (760) 564-2044
Cell: (7601250-1852
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of. 7) CF -4R
PASADERA
Project Title
P.G.A. WEST LA QUINTA
PH -5 DATE TESTED 6-14-04
Date
ASHBROOK COMMUNITIES
Project Address
STEVE VAN LUE II 760-801-3981
Builder Contact Telephone
RICHARD KROWN 760-250-1852
HERS Rater Telephone
OV4—. #CCNRK613292 JUL 2 1 ZU04
Certifying Signature Date
Builder Name
PLAN 2 2 UNITS
Plan Number
GROUP 4
Sample Group Number
LOT 69
Sample Lot Number
Firm: DESERT ENERGY SERVICES HERS Provider CHEERS
Street Address: P.O. BOX 621
Copies to: Builder, HERS Provider
City/State/Zip: RANCHO MIRAGE, CA. 92270
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)
❑ THERMOSTATIC EXPANSION VALVE (TXV)
❑ Yes ❑ No Thermostatic Expansion Valve is installed and Access is
provided for inspection
❑ ❑
Pass Fail