0307-370 (SFD)LICENSED CONTRACTOR DECLARATION
1 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
N LV Professionals Code, and my License is in full force and effect.
O ch License # Lic. Class Exp. Date
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w yG33;c B t)3J31a2C
Z r- Date �1%r�l���a Signature of Contractor
ZD 0
J U CD OWNER -BUILDER DECLARATION
W LU I hereby affirm under penalty of perjury that I am exempt from the Contractor's
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).
C'`) () I am exempt under Section B&P.C. for this reason
110
N Date Signature of Owner
ON
am
Q WORKER'S COMPENSATION DECLARATION
OL
C:) Z I hereby affirm under penalty of perjury one of the following declarations:
LO - 0 () 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
00 J Q performance of the work for which this permit is issued.
Q U (;) I have and will maintain workers' compensation insurance, as required by
0 0 QSection 3700 of the Labor Code, for the performance of the work for which this
I:L U Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier S`1'ATF.' FUND Policy No. 1608,101-412
cb5
r O
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
Code, I shall forthwith comply with those provisions.
+ +�Date:—Applicant.-A"77
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, indemni
& hold harmless the City of La Quinta, its officers, agents and employee,,. i�
2. Any permit issued as a result of this application becomes null and void D +
work is not commenced within 180 days from date of issuance of suc t
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 i
• correct. I agree to comply with all City, and State laws relating to the buildin
construction, and hereby authorize representatives of this City to enter upo
the above-mentioned property for inspection purposes. {� p
Signature (Owner/Agent) F"" - Date (J r �;
BUILDING PERMIT PERMIT#
0307-370
DATE VALUATIONLOT TRACT
.3 S2211,157-40 054 29147.2
JOB SITE
ADDRESS 1-140 C1&NTJCT,,FX1Z DR'r
APN
752-3110-020
OWNER
CONTRACTOR / DESIGNER / EN (NEER
CRV GOLF'VIM
A13ROOX DE'J1,2-0F.>1ut. NT COWANY
5140AMIDAENCWA S
5 140 AMMAENCUMS
CAMBAD CA 92008
CMUMAD CA 92008
(76O)8(M-6868 CBCT 3376
USE OF PERMIT
GLE TAMIL' 'Y' MM ING
SFD » LOT 64i PLAN 2AR. PERMIT DOM NUT FNIC.LUDErBLOC'K
1,'YALLS, P0014 SPA OR DPJVEWAY APPROACH, ?:f°lo REDUCTION TO PLAN
Cii�f:Y� d�,� 'L1i1L? TO MULTY€�Y.L{', fuMtY�,PiC� OF `.ti!•.loN,1i'. P1.�1� Tl°Y'�E ,
CUSTOM CONSTRUCTION �,61S,00 S
PORCHIPATIO 523,00 Sy
t' t.ARAGWCA'RFORT $34.00 S1;
ESMdAIX1D COST OF C01V'9%'k V M— 011
221,157A-), .
1( LEWA'd Pi .I+'.n gt331&W.11,RY
CONOTRUCTION FEE 1U1KOU-9.41t:C-000 s1,o6b.g0
YUAN CHECK" FSF 1O1.,000-439-318 $217.42
MECHANIC -AL L FEE 101.O00 -421 -MO $1 i 1.0
91,F, T PJCA.L FEE 101-00"25-000 $135.71
PL17MBINO FEE 101a=-419-000 $18t.73
STRONG MOTION Y ZE • REBID 1.01.000-241. -000 $27.12
O RAT ING FEE 101.000.423.000 91510
1iYWEL VER IMPACT 172, $.8,6435.00
ART IN PUBLIC PLACES • 1 ERIE 270otltJO-44.3.000 SSB,SS�
U10- r0l AL C,ONgrRUC flONAND1:'LA1a CMCTC
$4,207,39
MIS PRE-1;�.�ii FEES
$0,00
p
. TOTAL,
N10V 14 2003.
��,��i.����aT1���
CITY OF LA C9U1NTA
FINANCE DEPT.
RECEIPT
DATE ;
BY
Aim
DAT FI ALE
INSPEC ,
�.
;:r
/E -
INSPECTION RECORD
L 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 — '
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
- Int. Lath G
v
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines jz,
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)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
MainService
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
LOT 4 67 � Dewrt
91-14-0 ENERGY C A 0 E C
PO. Box 621
Rancho Mirage, CA 92270
Email: DESNRG RAOL.COM
Ph/Fax (760) 564-2044
Cell: (760) 250-1852
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7) CF -4R
PASADERA PH -5 DATE TESTED 6-14-04
Project .Title
P.G.A. WEST LA QUINTA
Project Address
STEVE VAN LUE II
Builder Contact
RICHARD KROWN
HERS Rater
#CCNRK61;
Certifying Signature
Firm: DESERT ENERGY SERVICES
Street Address: P.O. BOX 621
Copies to: Builder, HERS Provider
Date
ASHBROOK COMMUNITIES
Builder Name
760-801-3981 PLAN 2 2 UNITS
Telephone Plan Number
760-250-1852 GROUP 4
Telephone Sample Group Number
JUL 2 12004 LOT 64
Date Sample Lot Number
HERS Provider: CHEERS
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
1 N