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Home My WebLink About0207-105 (SFD)LICENSED CONTRACTOR DECLARATION I I hereby affirm under penalty of perjury.that I am licensed under provisions c `Chapter,9'(commencing with Section 7000) of Division 3 of the Business an Pro%s§(pnals Code, and my license is in full force and effect. ' Li¢erise # Lic. Glass Exp. Date I Oa r;' 60335 B 3/31/03 Date` Signature of Contractor n. OWNER -BUILDER DECLARATION I hei`ebyfaffirm under penalty of perjury that I am exempt from the Contractor' Uc j!} O 4 aw for the following reason: ( );,: I, • owner of the property, or my employees with wages as their sol comp'en , tion, will do the work, and the structure is not intended or offered fc said (Sec. 7044, Business & Professionals Code). (.) 1; as owner of the property, am exclusively contracting with license contractors to construct the project (Sec. 7044, Business & Professional Code). , O I amrexempt 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 declaration; :) I have and Will maintain'a certificate of consent to self -insure for worker, compensation, as provided .for, by Section 3700 of the Labor 'Code,'for th performance of the work for which this permit is issued. ( ) I have and Will maintain workers' compensation insurance, as required b Section 3700'6f the• Labor"Code, for the performorice of the -work for, which thi permit:is -issued. Nly workers' .compensation insurance carrier .& policy. no..an Carrie 'STATEFUND • Policy No. -1608301-012 (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 issue( I shall not employ any person in any manner so as to become subject to,th workers' compensation laws of Caldomia, and agree •that ff t should becom •subject to the workers' compensation provisions of.Section 3700 of the Labc Code, I shall forthwith comply with those provisions. Date: Applicant Warning: Failure to secure Workers' Compensation.coverage:is unlawful an shall subject an employer to criminal penalties and civil fines tip to $100,000, i addition to the cost of compensation, damages as provided for in Section 370 of -the Labor Code, interest and attorney's fees. . IMPORTANT Application is hereby made to the Director of•Building and Safel for a permit subject to the .conditions and restrictions "set forth on hi application. 1. Each.person upon whose behalf this application is made .& each person r whose request and for whose benefit work is performed under or pursuant t any permit issued as a result of this applicaton agrees to, & shall, indemnil & hold harmless the City of La Ouinta, its officers, agents and employee., 2. Any permit Issued as a result of this application becomes null and void work is not commenced within 180 days from date of issuance of suc :permit, or cessation of work for 180 days will subject permit to canceliatior 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 heregy authorize representatives of this City to enter upo the above-mentioned property for Inspection purposes. Signature (Owner/Agent) Date of BUILDING PERMIT - - ----FERMITk.•_ —.� _ _�_ :. ,�.._.;.__ d0207-105 . DATE VALUATION LOT TRACT 523677.60 45 ' 29147-1 JOB ADDRESS S 57-MSEllMOLEDRIVE ;' APN 762-3$0-W4 1 OWNER CONTRACTOR/DESIGNER/EN INEER CRV t�OLF WE;3T;-L.P — - -ASHBROOK DEVEL.OP),QIT CO1"PNY 5.140 AVENIDA ENC•IANS 5140 AVENIDA ENCWM k , s CARL3BAD CA 92008 CARLSBAD CA 92008 ' s _ (760)804-68¢8 CSL# 3", 6 USE OF PERMIT . d 8W0'LE FAIMLY DWEtUNG ` s _ SFD - LOT43 PLAN 3B . PERMIT DOESNOT INCLUDE BLOCK - WAP004 SPA OR DRIVEWAY APPROACH. 75%PLAN CHECK FEE LLS,OR-DRIVEWAY - REDUCTION -FOR MULTIPLE ISSUANCE OF SAME PLAN TYPE , 'CUSTOM CONSTRUCTION iZ801.00 SF _ + ' PORCHIPAT•IO 577.00 SF e QARAGEICA "RT 536.00 SF - S p ESM" COST OF CONFMUCTION _.,235,377 .x PERMIT FEE: 9UAQ4ARY _ I• CONSTRUCTION FEE 10.1-400.418=000 $1,119.00 1, PLAN CHECK FEE ` 101-000-439-318 3226.'73 e MECHANICAL FEE 101 -000 -421 -ON ELECTRICAL FEE 101-000-420-000 =161.26 PLUMBING FEE 101-000-419-000 5180:30 " STRONO MOTION FEE - RESID I Of -WO -441 -ON $23.64 GRADING FEE 101-000-423-000 $20.00 d DWEL`DPER IMPACT FEE n ART IN PUBLIC PLACES- RESIE 270-000=445-0.00 590.94 v S I It SUB -TOTAL CONMULMON AND PLAN CHECK $4,312,57 , Y IYM PRE -PAID FEES - - 00 f if TOTAL PERAW FEES DUE NOW $4;.312 57 h r; i S nt RECEIPT DATE BY DATE.FINALED INSPECTOR { LOT 5, Desert: ENERGY s,��r�AOI:�- �5�=�3�s Services — SIM I NOLE OR1 VE . P.O. Box 621 Rancho Mirage, CA 92270 Email: RKrown6237@aol.com Ph/Fax (760) 564-2044 Cell: (760) 835-7939 CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page 1 of 7) CF -4R A�A�t:. 2A QFC• 2 S�-iED DLJ: 4/►s � 03 Project Title Date P•4 • A• EST _ T'L�. A 5 P)Roo l< ,oM r�ItJ h� l'Tt E s ro'ect Address Builder Name 9YE VALyE 17Gr�� gdI'3°figI PLAQ 2 Buil er Contact Telephone Plan Number Ktj akRg D K�$oW1J 62oLiP 1 Telephone Sample Group Number SCC-).1R1o132�j2. v3 4:5- (I u�y/TS� ertifyi g Signature Date Sample House Number Firm: DESERT �NF�—IW �( ,SERVICES HERS Provider: L° • N •�•E •fZ.S Street Address: Ra Box X21 City/State/Zip: -06140 11PAgE. CSA. �I22i0 Copies to: Builder, HERS Provider HERS RATER COMPLIANCE STATEMENT The house was: El Tested i�J' Approved as part of sample testing, but was not tested As the HERS rater providing diagnostic testing and field verification, I cenify 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 now 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) ❑ Yes ❑ No Thermostatic Expansion Valve is installed and Access is provided for inspection ❑ ❑ i Yes is a pass Pass Fail