0207-106 (SFD)r�. N LU -
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LICENSED'CONTRACTOR DECLARATION
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 # Lic. Class Exp. Date
331 B 3/13VOI
Signature of Contra t9.
.rf
OWNER -BUILDER DECLARATIO' Nr
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.
e,) 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 5,1A:rg 1 U7dO Policy No. 1608301-612
(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, Ihalforthwith comply with. hi ions.
Date: � O
Applicant
° `� r fig ' XI A
F.- v
Warning: Failure to secure Workers' Compensatijcoverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the. Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety,
for a permit subject to the conditions and restrictions set forth on hiss.
application.
1. Each person upon whose behalf this application is made & each person,at`:
whose request and for whose benefit work is performed under or pursuan6o' W
any permit issued as a result of this'applicaton agrees to, & shall, indemnify .
& hold harmless the City of La Ouinta, its officers; agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation..
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building r.,
construction, and hereby authorize representatives of this City to enter, upon :
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) •`"'{ Dat$'_:! '
BUILDING PERMIT PERMIT#
tl
DATE VALUATION LOT __— TRACT
cf 1,1i�idl 46" LOT
JOB SITE
ADDRESS `i�i S'Oi,M ��{JAS .✓
APN
OWNER
CONTRACTOR / DESIGNER / EN (NEER•
CRV t our WEVI, Z.P.
ASHBROOK 1'3IEV1,%4PIVIENT t,"OMPAITY
5140 AVEfi11:DA MCIMS
5 14 0 AV72, -EN
C.r";RUM6 D C "A, 9'20431
CAP.1:.9BAD CA 92001.;
(IC0)804^fi.86e� 5376
USE OF PERMIT
3OLEX LY
5FD - IDT46 PLM 2.A.. PURMT DOES NOT INC>`I..Y E79 BLOCK;
WALIA POOL, SPA OR DM A' YAPPROACH, ?M PIAN CHECK 1
ia.I1.,DUCTX0*H FOR MUL,T1PLZ RA'StYAXC°E OF !ME 1?l..AWrYPE.
CUTY0M C0141RUCTION ?,615,008F
j! O RC:HMA.`.I'10 526100 SF
GARIs►CiMARPORT 5 7,00 SFS
ESTMA11D CWT W CONSTRUG" ION
22.1,157.40
PERMIT NIX MADJARY
C-`ONOTR'UCl'S.C3NFRE, 10l-000.41.8—om S1;4t66,5D
PLAN CHWK 81-W 101-000.4394,319 0117.42
MECHANICAL FTi:t 101.000.421.000 $11110
ELECTRICAL W, 101-00"20-000 $11531
M.4.TMFi-Nor:'; , 101-000-439.000 1111.0,73
""RO'NO MO9'.iS:` N 1'"iPt . RRSID I il .WLD-241-000
ORADE90 ? 101400-423-000 G�ES,OlD
0ZV 1.,0PEdR. 3M1'ACT ME 82005m
iRT 04 P[ BUC s1,,%C E9 ' M131t 170.000-4415-000
,
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4T1-T0`1,'Aa. C:<)j4t. 1`kUCPt.1CaX AND PL AN M
-.9
7 P 0MIT TWINS D1: E NOW
S, 4,212_V
ic
CITY OF LAQUI A
FINANCE
DEPT r�
RECEIPT
DATE
� .2
BY
i
DATE F ALED
103
INSPECTOR
01
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backsf
I
Underground Ducts
Forms & Footings
D
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
O.K. to Wrap
/ Q$A
Exhaust Fans
F.A.U.
Framing / s
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
DVwall - Int. Lath
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
Gas Piping
PLUMBING APP OVALS
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
Sewer Connection
Gas Piping
11 _
Pool Cover
Encapsulation
Gas Test
3
Appliances
1
Final
Final
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) Q
COMMENTS:
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•
SMINaf DRIVE,
Desert �y' ��
ENERGYS�r�ADI:C
Services —
P.O. Box 621 Ph/Fax (760) 564 -2044 -
Rancho Mirage, CA 92270 Cell: (760) 835.7939
Email: RKrown6237@aol.com
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page 1 of 7) CF -4R
A, ILS Imo 0g: 4/�S #►kms0_3
Project Title Date
'rQUIWIA A!514 sgooK 1�n m rA iKI1-riF.
ro'ect Address T Builder Name
V E VA lo L Li E: -1i176 -CA 601-30 st3 l P SA IJ 2.
Builder Contact —� Telephone Plan Number
760 3 3 G fZoy P l'
H Er at r Telephone • Sample Group Number
C�)JR�O132�I�.. a3 �.o-1 474 (2kwIT 1
enifying Signature - Date Sample House Number
Firm: DESERT �IJ�fCCi'(.SE2�/) C_ES HERS Provider: d • H •.�•�.R.S .
Street Address: Ra BOX (pZ I Ciry/State/Zip: GhlotjI�IyE. �,�• 022270
Copies to: Builder, HERS Provider
HERS RA.TER,.COMPLIPA CE STATEMENT
The house was: El -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 retums 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)
Duct Pressurization Test Results (CFM a 25 Pa)
Test Leakage Flow in CFM
If fan now is calculated as 400cfm/ton x number of tons• enter calculated
value here
Measured
values
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
❑ TH ERMOSTATIC EXPANSION VALVE (TXV)
❑ Yes ❑ No - Thermostatic Expansion Valve is installed and Access is
provided for inspection ❑ ❑
Yes is a pass Pass Fail
/(n1-IMl� ,
�-a-V► �� 4 Certificate of Occupan�cy
Qum&
r.?. LycoroMTM
,YC,, ixa
G� 0F9�� Building Y p & Safety Department
This Certificate is issued pursuant to the requirements of Section 109 of the California Building
Code, certifying: that,, at the time of issuance, this structure was in compliance with the
provisions of the Building.t Code. and the various ordinances of the City regulating building
construction and/or use. '
r BUILDING ADDRESS: 57-655 SEMINOLE DRIVE
Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0207-106
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Special Conditions: NONE
Owner of Building: CRV GOLF WEST, L.P. Address: 5140 AVENIDA ENCIANS
City, ST, ZIP: CARLSBAD, CA 92008
.rte a By: STEVE TRAXEL
Date: 06-09-2003
Building Official
POST IN A CONSPICUOUS PLACE
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LICENSED CONTRACTOR DECLARATION
I hereby :affirm under penalty of perjury that I am licensed under, provisions of
'Chapter 8 (commencing with Section 7000).of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
License #. Lic. Class Exp. Date
760335' B 3/31/03
Date 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). '
), 1 am exempt under Section B&RC. for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION .
hereby affirm under penalty of perjury, one of the following, declarations:
O 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. t1Ay workers'compensation insurance carrier & policy no. are:
= =-STATE FUNAT - - _ .Policy -No:- No;- =.:
(This section need not be completed. if the permit valuation is for $100.00 or less).
'1 cern that in the erformance of the work for which'this , rmiTis issued;
%) fY P - _ pe
1shall not employ any person in any manner. so as to become subject to the
workers. compensation laws of Cal'rfomia,,and agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
—Code, l shall forthwith comply with those.l rovisions.
. Date: Applicant -
_ 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.7equest and for Whose benerif work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnity
& hold harmless the .City of La Quinta, its officers, agents and employees.
I 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) Date
BUILDING PERMIT=PERMrr#
0207-106
DATE VALUATION $221.157AO LOT 46 TRACT 2914?!1
JADDDRESS $7-655 M01MOLE DRIVE
APN . 762-3804=
OWNER'
CONTRACTOR/DESIGNER/ENGINEER
CRV GOLF WE8'P, L P:. '
AMROgK DEVEIAPMENT COMPANY
5140:AVENWAENClAN9
5140AVENIDAENCINAS ..
CARmAD . _ CA 92wo
CARI.ZBAI? .. CA 920M
. ,
(76U)804?6868 CBL# 3376
USE OF, PERMIT
SINGLE FA)M Y DV1ELLINE3
SFD - LOT46 °PLAN 2A . PERMIT DOES NGT INCLUDE BLACK
WALLS. P0014: SPA OR DRIVEWAY. APPROACH. 75% PLAN CHECK FEE
-REDUCTION. FOR MULTIPLE .ISSUANCE OF SAME PLAN TYPE.
CUSTOM CONSTRUCTION' 2.615.00 SF
PORCHIPATIO 525.00 SF
OARAGEI<CARPORT 5344.00 SF
ESTIlI+ ATED COST OF CONS"Tl IICTTON
221,151.40
PEFaD.TFEE SUBdM1IRY.
CONSTRUCTION FEE:,, 101 -M -418 -ON 51AE" . -
--PLAN CHECK FEE-�. - - 141tw i 39-319`-: X22?42 .
MEL'HANICAL PEE 101-000-421!-000;l1 t:00
ELECTRICAL FEE, 101-000-420-=. .$135.71-
=135.71•PLUMBING
PLUMBINGFEE :: 101.-000-419-(= 5181.75
'
STRONG MOTION FEE- RESID 101-000-241-000 432.13
GRADING FEE _ 101"000-423-000
_ _..... $20.00
_
_ DEVEIAPER-IMPACT PEF.' 1{"1,405.00
I
ART IN PUBLIC PLACES - RESK 270-000-445-000
SUB -TOTAL CONSTRUCTION AND PLAN CHE(.'ZG
21 2.39
I= PRE PAID FEES
e .
; ;..$0.00
TOTAL PERMIT FEES DUE NOW
.44,212.39
RECEIPT
DATE
9Y
DATE FINALED
INSPECTOR
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3Th s Ce'dtificate is ;issued pursuant to ;theYrequi ements of Section;109; of'. the California Building�U
�'Code,`� certifying that,i of„the time,' of issuance, ,this structure Ywas in, corripliance °with the -
r; :provisions' -of, the '.Building,,,Code• and _ the-�various ;ordinances of the City"regulating building',,,
a
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.."constriction and/or
,'use.
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'•BUILDING7ADDRESS: 57=655 SEMINOLE�DRIVE • .
F R`+.. Gln, l• T � .y: � - � � r -- .., - - .. ., ./'c'd-. ` .%. c, .� Cf �
�� � .3 ;. •ty ``a'
Use classlfication:.SINGLE:FAMILY DWELLING ` r ra'-_ � t �� �[ � ,r{ B.uilding Permit Noi 0207-106
max;_ ti
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Occupancy Group: R 3. ._ �'` Type of Construction:'VN ` '� 'f land,Use Zone: RL '
;,.3 � 3 _ -_Y •Fy .:{ .. vi •5'4 V � t - � ^,CT+•” � '' �Y . �. ..
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..-Special Condition's:•NONE
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- 'Owner -of Building: CRV GOLF WEST;,L.P: . '�• �,cAddress,°5140�AVENIDA'ENCIANS'
;t' ANT � - .. ! 54 .- .� I S•
' j' [: -a + J - A� �
City, S,T; ZIP: CARLSBAD, .CA `92008,
�4 B 'STEVE TRAXEL
Date:•06-09-2003. z '
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Building:Official
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POST.INA'CONSPICUOUS PLACE'