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05-4151 (BLCK)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 05-00004151 Property Address: 81897 COUPLES CT APN: 764-060-040- _ Application description: WALL/FENCE Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 3250 Applicant: Architect or Engineer: 0 /1Q+ LLCENSED CONTRACTOR'S DECLARATION BUILDING & SAFETY DEPARTMENT /BUILDING PERMIT 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 lass: B Li No:: 760044 ate nd t�tor: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that 1 am exempt from the Contractor's State License Law for the following reason (Sec. 7031.5, Business and.Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or. repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or sheds licensed pursuant to the provisions of the Contractor's State License Law' (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis;forthe alleged exemption. Any violatiorrof Section 7031.6 by any applicant for a permit subjects the applicant to a civil penalty ofnot more than five hundred dollars:(4600).: (_ 1 1, as owner of the property, or my employees with wages as -their soie,compensation, will do the work,. and 100 the structure is not intended or offered for'sele (Sec. 7044, Business'and Professions Code: The Contractors' State License Law does not'apply to an owner of property who builds or improves thereon, and who does the work himself or hereelf:through his or her own employees, provided that the improvements are not intended or offered for sale. If, however„the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.); 1 1 I, as+owner of the property, am exclusively contracting with licensed contractors to construct -the project (Sec. 7044, Business and. Professions Code: The Contractors' State License Law does not apply to an owner of property who Wilds or improves thereon, and who contracts for the projects with a contractors) licensed pursuant to the Contractors' State License L:awJ. 1 _) I am exempt underSec. B.BP.C. for this reason Date: Owner: CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is:issued (Sec. 3097; Civ. C.). Lender's Name: - I- Lender's Address: Owner: BIRDIE HOMES III, LLC 300 E. STATE ST. STE. 100 LA QUINTA, CA 92253 > Contractor: D FIRST PACIFICA DEV CORP 300 EAST STATE ST, SUITE #100 REDLANDS, CA 92373 (909)798-3688 LiC. No.: 760044 VOICE (760) 777-7012 FAX (760) 777-70.11 INSPECTIONS (760) 777-7153 Date: 9/19/05 ------------------------------------------------ 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 Cade, for the performance of the work for which this permit is issued. My workers' compensation, insurance carrier and policy number are:' Carrier STATE FUND Policy Number _ I certify that, in the performanceW 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 Laoor.Code; I shall forthwith.opmply with those provisions. WARNING: FAILURE TO SECUREWORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS 0100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED, FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT Application Is hereby made to the Director of'Suilding and. Safety fora permit subjectto the conditions and restrictions set forth on this 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 application, the owner; and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quints, its officers,, agents and employees for any act or omission related to the work being performed under ;or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and voidif 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 thwabove information Is correct. I agree to comply with all city and county ordinances and state laws relating to building construction,=and hereby authorize representatives of this county toenter upon the above-mentioned property'farinspection pur ossa. �fe! Sign pllcam a All i„ Application Number . . . . . 05-00004151 Permit: . . . WALL/FENCE PERMIT Additional desc . Permit Fee . . . . 63.00 Plan Check Fee .00 Issue Date . . . Valuation 3250 Expiration Date 3/18/06 Qty Unit Charge Per Extension BASE FEE 45..00 2.00 9.0000 THOU BLDG 2,001-25,000 18.00 ------------------------ ---- Special Notes and Comments -- 130 L.F. 6' GARDEN WALL, CITY STANDARD Fee summary. Charged Paid Credited Due. Permit Fee Total 63.00 .00 .00 63.00 'Plan Check Total .00 .0.0 .00 .00 Grand Total 63.00 .00 .00 63.00 LQPEk nr CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING I The P Ims Project Title 81-897 Couples Ct. La Quints. CA Project Address Herb Herman (909) 322-7140 Builder Contact Telephone T �) S �� (951)780-7265 HERS Rater Telephone 1�amry�zl -Va—Z(K Certifying Signature Date First Pacifica Dev. Coro. Builder -Name 1-S Plan Number 6 Sample Group, Number 6' Svs. 1 Sample House Number Firm: Energy Calc Services. Inc HERS Provider: CHEERS Street Address: 16551 Mockingbird Cyn. Rd. City/StateRip: Riverside, CA 92504-9638 CF -4R 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 aoTply 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, ribber adhesive duct tape is installed, mastic,and draw bands are used in combination with cloth backed, rubber adhesive duct tape to seal leaks at duct connections. M 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 400-.&n/ton x number of tons enter calculated value here 800 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 0 THERMOSTATIC EXPANSION VALVE (T)M or Commission approved equivalent ❑ Yes ❑ No Thennestatic Expansion Valve (or Commission approved equivalent) is installed and Access is provided for inspection ❑ ❑ Yes is a pass Pass Fail January 5, 2001 TE OF FIELD The Palms Project Title AND DIAGNOSTIC TESTING 81-897 Couples Ct. La Quinta, CA Project Address Herb Herman (909) 322-7140 Builder Contact J Telephone Tiem 951 780-7265 HERS Rater Telephone V)i_ - 't6 Certifving Signature Date 2000 First Pacifica Dev. Co Builder Name 1-S Plan Number 6 Sample Group Number 6 Svs: 2 Sample House Number Firm: Energy Calc Services, Inc HERS Provider: CHEERS Street Address: 16551 Mockinabird Cyn. Rd. City/State/Zip: Riverside, CA 92504-9638 The house was: U Tested 1A Approved as part of sample testing, but was not tested CF. As the HERS rater providing diagnostic testing and field verification, I certify that the houses identified on this, form ply with the diagnostic tested compliance requirements as,checked on this form. The installer has provided a copy of CF -6R ( Installation Certificate) 13 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 draw bands 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 1200 If fan flew 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 0 THERMOSTATIC EXPANSION VALVE (TXV) or Commission aooroved equivalent ❑ Yes ❑ No Thermostatic Expansion Valve (or Commission approved equivalent) is installed and Access is provided for inspection ❑ Yes is a pass Pass Fail January 5, 2001 CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING I The Palms Project Title Date 81497 Couples Ct. La Ouinta, CA Project Address Herb Herman (909) 322-7140 Builder ContactTelephone Ti Y� Y\ I ��,t 4 r 11 951 780-7265 RS Rater Tele hon am _� /C Certifying Signature Date % First Pacifica Dev. Cor Builder Name 1-S Plan Number 6 Sample Group Number 6 Svs. 3. Sample House Number Firm: Enersw Calc Services, Inc HERS Provider: CHEERS Street Address: 16551 Mockinabird Cyn. Rd. City/State/Zip: Riverside, CA 92504-9638 CF -4R 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 ply 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 draw bands 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 400cfin/ton x number of tons enter calculated value here 44o(r/6'W 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 ❑X THERMOSTATIC EXPANSION VALVE (TXV) or Commission approved equivalent. ❑ Yes ❑ No Thermostatic Expansion Valve (or Commission approved equivalent) is installed and Access is provided for inspection ❑ ❑ Yes is a pass Pass Fail January 5, 2001