0210-223 (SFD)LICENSED CONTRACTOR DECLARATION
I�erdby 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
760335 B
Date Signature of Contractor
OWNER -BUILDER DECLARATION
03/31/2(
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.
( ) 1 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 STATE FUND 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 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
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, indemnify
& 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.
Signature (Owner/Agent) Date
BUILDING PERMIT PERMIT#
0210-223DATE
VALUATION $214,107.30 LOT 49 TRACT 29147-1
JOB SITE
APN
ADDRESS 57-695 SEAUNOLE DRWE
762-380-008
OWNER
CONTRACTOR/DESIGNER/EN (NEER
CRV GOLF WEST; L.P.
ASHBROOK DEVELOPMENT COMPANY
5140 AVENIDA ENCINAS
5140 AVENIDA ENCINAS
CARL.SBAD CA 92008
CARLSBAD CA 92008
(760)804-6868 CBL# 3376
USE OF PERMIT
SINGLE FAMILY DWELUNG
SFD - LOT 49 PLAN IAR PERMIT DOES NOT INCLUDE BLOCK WALLS,
POOL, SPA OR DRIVEWAY APPROACH. 75% PLAN CHECK FEE
REDUCTION DUE TO MULTIPLE ISSUANCE OF SAME PLAN TYPE.
CUSTOM CONSTRUCTION 2,501.00 SF
PORCHIPATIO 558.00 SF
GARAGEICARPORT 605.00 SF
ESrHdATED COST OF CONSTRUCTION
214,107.30
PFI AM FEE SUMMARY
CONSTRUCTION FEE 101-000-418-000 $1,042.00
PLAN CHECK FEE 101-000-439-318 $213.88
MECHANICAL FEE 101.000-421.000 $111.00
ELECTRICAL FEE 101-000-420-000 $133.14
PLUMBING FEE 101.000-419-000 $197.75
STRONO MOTION FEE - RESID 101-000-241-000 $21.41
GRADING FEE 101-000.423-000 $15.00
DEVELOPER IMPACT FEE $2,405.00
ART IN PUBLIC PLACES - RESII 270-000-445-000 $35.27
SUB -TOTAL CONSTRUCTION AND PLAN CHECK
$4,174.45
LESS PRE -PAID FEES
$0.00
. TOTAL PERMIT FEES DUE NOW-
$4,174.45
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
Desert �r "�
ENERGY S�r C A D E C-
services —
P.O. Box 621
Rancho Mirage, CA 92270
Email: RKrown6237@aol.com
Ph/Fax (7601564-2044
Cell: (760) 835.7939
i57
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I d?) CF -4R
pA�ADI_ 2A Qt4.2. ��-T-E,P D►J:.4/�s �►�/03
Project Title Date
• Qx15145RoonMrAyKiI'TIEs
Pro .ect Address 10Builder Nam
E ( 1 di - 3'g I P LA 0
Builder Contact —� Telephone Plan Number
3 3 G 12oy P l
HER a Telephone Sample Group Number
*e- 132 e)Z �,o-T- 41= +�) (2
Certifying Signature Date Sample House Number
Firm: DESERT ElJF-4tA ( 5E7P, LE5 HERS Provider; L° . N •�•�-•R.S • . .
Street Address: R t7• B ox W 21 City/State/Zip: (1J GF4o 1- I I F,& E . eA- 0222 70
Copies to: Builder, HERS Provider
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 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)
Measured `
Duct Pressurization Test Results (CFM Ca 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%o or less) ❑ ❑
Pass Fail
❑ THERMOSTATIC EXPANSLON VALVE (TXV)
❑ Yes ❑ No Thermostatic Expansion Valve is installed and Access is
provided for inspection ❑ ❑
Yes is a pass Pass Fail
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This -Certificate is issued'pursuantto \the re Section 109 of the�California-Building
Code, certifying' that;, the `'time` rof .issuance;',this - structur.•e', Was in, :compliance withw, the
.r pro visions'- Building `Code an r� `
M ' p - y-, . z g d'.the,varrous''-ordinances of ;they City -regulating. building'
construction and/or use: .' F c
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�BUILDI DRESS:;57-695 SEMINOLE}DRIVE,
�a• r .a �S\ - •i _ �•�y -�. .'� :.y*tel 3.-- '`••�,•_ r�h.a. •� �'�� �`�.• r, "'f ♦r-. i.l -1; ��,,r;e 'c• `a ' `. . ,r.� '" c r•�fi
Use classification SINGLE FAMILY DWELLING ' d `s - s'. _-. ,3 . /Building Permit No:: 0210-223
Jr
Occupancy Group:'R 3 _ . ,, Type of Construction, VN - +� Land Use Zone�yRL
.�. ti• 0 4 _ .,;+T, � .. 4; rte. � .o, ,,. » 'v• ; •._ ra-. .. .r - �i ` •� -
...+" .;rn ' .;i,i:, ii � F� F : y=C^ y,. G. �'e�\�+.x r s � .I i � i,�' s ,3.' +F' �'� �. '�-17 _ �. Y "� - r - l� � ♦� `' - ^ - � %'i
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-,-Own'er' :of µ' � �' GOL' F WE T,� .;f, .._ �;. •� ` -� .f � . - ��� . �;� � },.�.. � -� ,♦ , ". , � ` .•�
rBuilding: CRVr 'S L 0. n: - i _ Address. 5140,AVENIDA'ENCINAS. ;
''�„ -f�.J ! �'� mss` -\.': - .. •. f '•" -cr 4-- wr + - d - �`� - •vti �` 5 i i • r
"City, ST ZIP:'CARLSBAD, CA'92008
' ✓ '� 7. a .*: ,•'�� �`' + - �, * C - g,. �'• lir - . i �; v - -
ry y �� s- } ,' �4•; ;,' :By: Daniel P: Crawford'Jr.`
':�+� ri �� ` 4ti; T. • ♦� �"' - , y. t f +�1 • •J ..y-� � _ ''j 4I'' �' t.. .� � `l.. ,.,��^.t\� �, � • jr
Date 6/20/03
Ea `' C. -Building Official _ QA
Y rtK. .- 4 4�'l•- ♦ ♦� - � �f . r . '4'rf t. ' ❑ i ♦ _•'{..• `. 4 .r� .
'1Y� tit M4� ^• r� ', <. "�� ' ' /_ + i:� ,... � y ^, �� M.. - � .�. �;
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POST -IN A CONSPICUOUSYPLACE
-,:
.10'"
.C' 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
160335 13 017/3 1 tz(
A
Date 3 �'" + (- �" ? 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 ' OTAAUFUND Policy No. 1608.301-0t2
(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:. 1 Applicant X Ufa.
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. w
1. Each person upon whose behalf this application is made & each person `
whose request and for.whose benefit work is performed under or`pursuant D
any permit issued as a result of this applicaton agrees to, & shall, inde`mni
& hold harmless the City of La Quinta, 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 su h
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 s
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
thl�e_ab6ei-mentioned property for inspection purposes. "
Signature (Owner/Agent) `•-'.t " `Da4e t0='- �'� "��
BUILDING PERMIT PERMIT#
DATE VALUATION LOT' TRACT
S2..14,10730 (49, 29147 -
JOB SITE
ADDRESS
APN
OWNER
CONTRACTOR / DESIGNER / EN INEER
CXV00tY WYMT, LP.
Affi:lPzROOK rJ0r T,-'YP?AENT C014P.t KY
JASEN�.P,,1A FNC71
5140 ANFF DA� M :A S
15140
C.'ARLeYJRAD !••`.A YW`a 08
y:
p ry p
Cr69J.C.i./��'.'eSAD CA :f Lr1.F4!!n
Q60)804, -M68 (4131.0 $376
USE OF PERMIT
7T�'C i J FIAM)L'§Y
;DIM 0 LDT 49 kI~.AN 1AR. PERMIT DOES NOT 01CI.,UDY. BLOCK WEt'I.I4
POOL, VIA OR. DRiVEWASt',dtPPWA&CH, 15% MAIN 00;C K YU
:4 PMUUriON D•LsX TO M11L.'3'"IP41.0 ISS LTA'NCE, OF W�_MZ PLAN TYPE
CgS'r'MA CONSTRUCTION 2,501.00 oy
PORCH/PATIO 551K90 ar
GARAORrCAIxPORT 60.5.00 SP
,TLD i.OhT OF CC:►��'N`MUC�.3. OIN
.214,T.0730
'y'`1';��,pyyag ry'( ,{+wp'y`g g� ���°rJUK
-i].rvdi it'Yd J' d? �A`.'i'-s iDl.iEiCS':0.1SLAR
CON RUCTION MR -1"4 101 -MO -418 -WO $'la a-00
PLAN CHIS K I;`19 101-00c"39-311 $W..3.89
MEC`.f11'iFdl(.AL, FRE 101.000421.000 SHIM
L,b:a,C7'$Ut:ALM?L�,' 103-000.420-000 Mi. 14
PLf.1f +'il3l'13£1 Fl�i� IOY-000-419.000 $1�.�
d✓
u'rRO}}��P�O, 9ll��t�r7,+l�pp'ION ..'i?� - RLIVID 14 01-f03�Qgf� 44)-//Uqq�00� VIA!
QW4DiLtlG T' F, 101-000^4!'3^{JOO $15.00
D]GM4'EILOP.E•R.IMPACT YZE 3;knsm
ART IN PUBLIC PI.� qa M MIC 2770.000.445.000 5,�€
tw
U 19, U$ -Ti . . ` Ln, C)MJTRLT MOIR AND PLAN CI iC,
$49174.41
PRE -FAM 0XV23
$0,00
OCT1YW
3 7002 TafAL PERMIT MS- DTYF NOW
MJ-T41AS
CITY OFLAQUINTA I
FINANCE DEPT.
.s
• if
RECEIPT!
DATE f .yam
BY,
DA
INSP CT R
X'. r / f
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
I
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Steel
�-
Return Air
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
Q
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
Drywall - Int. Lath
3
Final
Final
BLOCKWALL APPROVAL9
POOLS'- SPAS
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
Waste Lines _ �f �'�
Gas Test
Electric Final
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
ZZ
Appliances
Final
Finals
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 3
Final
Utility Notice (Perm)
�'OMMENTS:
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