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0207-110 (SFD)�*N.W T .ti o W o Z r C 0 0 W W I— .a f � Z 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 mq.License;is in.full;force and effect. License # Lic. Class Exp. Date 1AC" �"v'S :F3 �J31la#3 �r Date�Signature of Contractor'YY�'- OWNER -BUILDER DECLARATION wl 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. 704 .4, 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 STATE d7'MI Policy No. 1ff3'14a1.412' (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 Codeg`lha I forthwith comply with those pro sl s. A Iicant ° 21 > Warning: Failure to secure Workers' Compensation ,'�--bverage 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 hisI- application. 1. Each person upon whose behalf this application is made & each person:at whose request and f& whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold .har`mless 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. - ` ,r ► Signature (Owner/Agent)�� " T'`' Date`s w V BUILDING -PERMIT PERMIT# DATE VALUATION LOTTRACT 2914-74 JOB SITE ADDRESS`,.57^USr°i��11���gw�.'�i�`e APN OWNER CONTRACTORENGINEER ' wFWE0T,.-3'. CR�V GOLF c. dSMiOV4ysF_WW✓PMt7 COMPANY 514 0 A 9.DA WdAN3 514 0 ANIENMAMM34 S CARL,S1%AT) CA 92008 CART 1BAD CA. 92008 USE OF PERMIT HINUME IIA 17,Y MM -MG SY0 - LOT 30 PLAN LAR.: PERMIT -00FS NOT IN.CI UDt BLOCK, ,.9.5 A" P001, SPA. OR TJAiVL�'.>�Si'.4>,&'PROACH. 715'/,, PLAW CHECK F99 . REIDU'L'9'ION POR MULTIPLE IF43U.ANCE 00 SAMY, P AH'TYPR CUOTOM. CONSTRUCTION 1611//09 SP ' le OPWI:LIR A.T1O 5n.,.00 SP £1ARAMCARP O Ri 39.Op ST"' 99DW&ITM, MOT OF C1011TSUMC170H 221,157.40 P"Wrr 11'x,', summAn'$1• CONSTRUCTION FEER 101.000-416.000 &1,1164.50 PLAN CH WX WE 101-000.4394,318 01742 MMHk,IWAI L•Y' 101-000421-000 1;i1.A ELECTRICAL ME 10111-000-420-000 1'l. 171. 1'4AN1 YNOVEY, 101.000.419.00t? 5191.73 STRCWC1MOTION MOP,- R ?I)3 101-0 00-241-000 0 ttet.12 0112, MNO FRE 101 -000.4.23 -ow "1 0f1 ART 11. PUBLIC PLACES - RMI.1r 270.0,00-40»000 j): `. 81.I:13 -TOTAL C0WIMUMt,IR AND MI MI C'HM $1,212,:39 1=3 PRE. PAM is -ri�� 13 yotwr M"S MY, NOW 50100 'M CITY®FLAQUTAlTA s 4 RNAPICE®EPT• RECEIPT DATE r By " DATE FI L INS EC -1h . 4� cV INSPECTION .RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Zd 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 Dryyall - Int Lath it Final 0 Final I BLOCKWALL APPROVALS Steel POOLS - SPAS Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS 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 Pool Cover Sewer Connection/ _ e , Encapsulation Gas Piping Gas Test Q Appliances Final Final Utility Notice (Gas) ELECTRICAL APPROVAL 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) / COMMENTS: LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of ,perl'ury that I am licensed under provisions of I— Chapter 9 (commencing with Section 7000) of Division 3 of the Business and C-4 W, Professionals Code, and my License.is in full force and effect. ; E; :). M . Viiense # Lica Class Exp. Date UJ O ?60335 B . 3/31103 Z 'Data_ Signature of Contractor rz OWNER -BUILDER. DECLARATION W W 1 hereby'affirm under penalty of perjury that I am exempt from the Contractor's ~ License Law for the following reason: Z_ (•j r f":14s owner of the property, or my employees with wages as their sole coniperpation, will do the work, and the structure is not intended or offered for salg.(3ec. 7044, Business & Professionals Code). owner of the property, am exclusively contracting with licensed I contractors to construct the project (Sec. 7044, Business & Professionals Code). O I am exempt under Section B&P.C. for this reason N E• Date ` Signature of Owner U WORKER'S COMPENSATION DECLARATION o 1 -hereby affirm under penalty of perjury one of the following declarations: U) f_; .O .. () 1 have and will maintain a certificate of consent to self -insure for workers' X Lu LL compensation,: as provided for .by Section 3700 Of the Labor Code, for the Om 'Q `performance of the work for which this permiYis issued. ` Q () () I..have and will maintain workers' compensation insurance, as required by _ O ,V Q Section 3700 of the Labor Code, 4or the performance of the work for ,which this d rn H permit is issued. My workers' to insurance carrier ,& policy no. are: v -Z Camer"_3TATEFUND.. _. Policy No. _ . - co Q =� :0 - _ - - . (This section need not be completed N 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 3 subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Dater Applicant Warning: Failure to secure Workers' Compensation coverage is unlawful and ,shall subject an employer to criminal penardes 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 whosebenefit work is performed under or pursuantto 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. 2. Any.permit issued.as a result of this application becomes null and void if work isnot commenced Within'180 days from date of issuance of such permit, or cessation of work for 1.8.0 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 - ___PERM1T1__ DATE VALUATION , LOT 0207-110TRACT S221157A0. 50 29147-1 JOB SITE ADDRESS 57 -?15 SEAM0 JX DRIVE APN 762-380-009 OWNER CONTRACTOR / DESIGNER / EN (NEER CRY 40LF WF3T,;L P: :- - A9MR00K DEVELOPMENT COMPANY 5140.AVEX[DAEN(3AM 5140AVE14IDAENCINAS ' CARLSBAD CA 92008. CARISBAD CA 92008 • ' (760)8044868. GBL# 3376 USE OF PERMIT PWGLE FAMMY DVJM.LWG SPD -'LOT 50 PLAN 2AR' . PERMIT DOES NOT INCLUDE BLOCK WALLS. P094. SFA OR DRIVEWAY APPROACH. 73% PLAN CHECK FEE REDUCTION -FOR MULTIPLE ISSUANCE OF SAME PLAN TYPE _• CUSTOM CONSTRUCTION ?,613:00 OF - PORCHIPATIO 325.00 SF GARAGEICARPORT SM.00 OF EST A?ATE'D COST OF CONSTRUCTION 221,157A0 ' P1 --IM 9UAAD?ARY-.-- CONSTRUCTION FEE. -101-01DO 418.000 $1:066.50 PLAN CHECK FEE . 101-000-439-318 $217.42 MECHANICAL PEE 101-000.421-000 $111.00 FJYMRICALFEE 101-000-420-000 $135.71 PLUMBING FEE 101-000.41.9-000 1181.73 STRONG MOTION FEE - RESID 101-000-241-000 GRADING FEE 101-000423-000 :$20.00 : r -DEVELOPER IMPACT PEE $3,405.00 _ ART IN PUBLIC PLACES - RESII 270000-445-000 452.89 SUB -TOTAL CONI3TgtUCTION AND PLAN CF>ECK $4;212.39 LE39. PRE -PAID FEES "$0.00 "- TOTAL PERMIT FEES DUE NOW. 54 212=39 RECEIPT DATE BY DATE FINALED INSPECTOR ___j ,I - LOT *50 Desert � iE5 1 ENERGY S �`�- �r A E-sF-KiM0t C ervices — 4 a7 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 I of 7) CF -4R A -SAM= ZA 0q: 4/is #►G�o3 roject Title -' Date 'r �'Sii (ZDOK j,omNItJKIimIrS ro'ect Address O(_ 3 Builder ,,Name Y E A Lj E_�%g I Bur Contact —� Telephone Plan Number fZoy P. l HER at Telephone Sample Group Number Certifyin Signature Date Sample House Number Firm:DES.ERT ElIF-C -G S5FPo/ILE5 HERS Provider: �'• tl •�•�-•R•5 Street Address: 20- E3 ox (,a 21 City/State/Zip: GI-Idtj IRASE, A. 012270 Copies to: Builder, HERS Provider HERS RATER COMPLIANCE STATEMENT The house was: ❑ Tested eApproved as part of sample testing, but was not tested As the HERS rater providing dia?nostic 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 duc"tapis installed, mastic and drawbands are used in combination with cloth backed, rubber adhesive duct tape to seal leak�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 now 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) Cl Yes ❑ No Thermostatic Expansion Valve is installed and Access is provided for inspection Yes is a pass ❑ ❑ Pass Fail � LIVIC -{M►\1� cu anc :, :Cera�ficate::ofOc i�' It 77 ISCaao11TFD ^� p-� �i ►" tr -a • \ f 1' i� _ f -1a r. 4 Yf'T . vti T F ; y SafetyDepartment' . • a�{ ; w -' '_� x. - i w i .i' F ?'•� �' .x 1. !' fY ! cy�6 - ±�'Slti 7... `�� 7 4[1(. ✓�. L:J _ .F'+ ' �' t. ` �. ♦ "' -Certificate �s. issued, to: tlie'requirements of, Section,109Y,of the Calif6mmBuilding This` pursuant Code,- `certifying that, at ,the rtune -of� 'issuance, • this ` structure -was in compliance t with "the. . provisions of the ,Building Code _anllal the' various 'ordinances of` the\City4 regulating`; building" :. vI s t i -' construction,and/or use:' r` -`�. ~ i. �� �.^ T ,\ �Yi l .. ��.a. 4 ,y..,- .� 4. �'. 5.+ 't$ +t r� f ,) ^l .lt �', , y: r.+ -i,; �_ - -,?�-• �a- tit .� ., ev'..+' -�. Lj, ' at �•, {1 - 'Ji4t ' L Y i)t:�-' Y� -' ' �`,y�•- F,.. f-' .. - BUILDING ADDRESS: 57=715 Seminole Driye i t � � ' � r ,fit tr :�`by�} '�.. , - _ 't: �` . � ?� - i� r, �' �, ,::y - ' �l ` a , y' '{ .•1. Y � ' + e, -1. ,,1s-.. ; 1,,1` ,x. "V5 l a ,' ' ti i' L r L = � . "•��J •1 ' . , - ( i ,a> - J • - �r�` �ti .T. . n � � ^4j' , Et'- +. � ': `f? e•t, -: r �•-. r, i e - - . , ,-. a � +l` r y'r+ ... � 7 .., � F;, +.. *++. - "'1140 Use�classification: Single. Family Dwellings �,� .. - Bullding..Permit`No:: 02 07-110 r + •f •4 `7 t , j ' Occlaparicy.Gr"oup: R'3 � z < .TypT.gf,Construdti0n: VN ,� "' s r' L-and'Use Zone:'R1!1(7 .� � \ .1' i. ..i .y �•.t.`{Lr. r i+ L,,r �. -•-- t' t � �� e��N � C31'?,. . .� HCl .. �.i � iL� -'� - S,a. L � ' 1'!, - �� - w.f-.rA" J = _ . 'Golf.West ryr, ~ ` ' :Address: 5140 Avenida'Encians ' r Owner_,of Build-ing: CRV L.P. _�� , , ; ZIP:;Carlsbad, Ck,92008 .Gity,rST, -By: Daniel P. Crawford.Jr. ,Date: -7/31/03` .., , • 'Building Official .,� tr �� ''art. . � _ '\ ' t-, `[ •R _ w• '-� -- - 'P.OST IN A CONSPICUOUS'PLACE } '