0207-111 (SFD)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
Ions .I3 3IR1103
Date Signature of Contractor,�,r�
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.
, QI 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. 0YfgI`I: 3�+JN0 Policy No.• I6t�31ft#�
BUILDING PERMIT PERMIT#
DATE VALUATION A y ¢ qq /�e� r�� LOT • TRACT y q
c�.J 14,10<30 � � �. d.934J-4
JOB SITE ADDRESS 50.17351 MINO t,a;. M
APN 7C'Ad�^c'MO-0�.0'
OWNER
CONTRAA�CpTORp//DESIGNER,ENOIINEEE�yR
jQ'x"�y/�} ►Y'� }+ y q
y��4y� �+�� �� y
Affi-M.L4..00K 1.J2es�G°.,Lhlt� �'r••tV .1 CIfJA7/Z!}!NYI
51.40 AVENWA 1+'�fY". AN5
5140 0 At�;L+NIDA ��::INAS
C.d RLSBAD CA. 920011
CAR.LSBAD CA 92,008
X1)8{j>1.>.fa868 C.pm€�� 3,.ums
N
USE OF PERMIT
SFD e LOT S1 PLAN 1AR . PEWIT DOES NOT I'NC8.UMil EILtJ�:;C
'V'�`AI,Lq, POOL, ;q1'A 0k l)'Rty P. WAY APPROACH, 761Ya PLAN C UMICK ME
REDUCTION FOR MUi.TIPtfe 1SaUAPtCCE OF SAbIE DLi-%14 "Ir`RE. .
CIUSTOM C 9S�STRUCBION 2,501,00 SF
1�ORC.1^I&A,1'.10 558.00 SP
0A,R.�s.01�'C.ARPORT 6f,5.00 VIP
M COSH' 01?' f`ONS'AIRIUCt'aiON
x•14,207 -V
q�•�yyp �y •� �y� y'yp ryy«,•p +�/�'� �.�.S.,Ml•
S. �+.Y�14�,A`.71.1CmR1+ CdiJ'dvA�tTrt�tA!1i'.�Ai.
C011�1'YRUCT).0;14It s; 101.00 -?44.15.00 $1,0)2,00
P�R.4:((.��ty�,tti��C,9qHE��;CK;�r Z 19M.89
y1 {01-000-�/fi�39-�3�/18
Lu 4�t il"4 CAL C M E '1014004 x 1-000 S111.00
ELM'RICp,.1, FEIZ 1.01-00042L-Qt?O
I1NC3ir� E ii93�t1*,K7�1.�Nt�41d �!!Xa.��
57'if ONO MOTION, SSE?, 4 R'SSID 1 m1,�ti00-;41-.OW $.71.41
GRi�L INO �'`I?I 10f-0041-423-000 'MOO
DEVEW R IMPACTFRE
ART 11Pt lPUBLIC PLAC 9 - HESI ; ,2 70-000.40-000 U. ,�
ar
t �1i13-•��"! AL C0,1J Fi11 ,ON ,�23"!',� 1�.LA)f t,M4Y,
$4,119.45
LESS 1:1RU-PAM � 110
$0100
�,'
B
-*- 4"�. --•�-y ' . At816t P.MOT _ Z'.�8�'✓E D 4d� �!'�'YC
$4,1 r9V45
ill,; `� V Lt �2�`•3 j f ;;.±� �davf .
C� OF IA
•FINANCEIDE1'�T�4
RECEIPT
DATE
By"
DATE N ED
IN
E T
(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 s�iall fforthwitti.comply with�,4hGSe,p ov Bions.
Date t' .',f "�J. +"'l. -,Applicant � � r
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. y"
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.
rf, a° " J
Signature (Owner/Agentj`I/� Daft, p
r
^fir "Y a
3M:
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Q j46
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
✓
4
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
d
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O. '
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
D II - In Lath
dZ
Final D
Final 3
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
Gas Piping
PLUMBING APPR VALS
Gas Test
Electric Final
Waste Lines
_2�j141
Heater Final
Water Piping
i
Plumbing Final
Plumbing.Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
_
'L
Encapsulation
Gas Piping
Gas Test
Appliances
j
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 d 3
Final '
Utility Notice (Perm)
COMMENTS:
LOT
Desert
ENERGY �EC
�M i�oL
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
Project Title Date
4 � s TTS .l I �1 Tom;
A514sRooK �olH'�uKllTlEs
ro'ect Address Builder Name
E I at -3 g Pt-A�l
Builder Contact ' Telephone Plan Number
q�RD F Qovj (76,o)835r�93� GIQ-0dP t
HER ater Telephone Sample Group Number
O 5 L u k TS)
Certifying Signature Date Sample House Number
Firm: DFSER-r-ElJg_: C '(SER\/I C..ES HERS Provider: d • H •IF- •R•S
Street Address: Ra E3 ex �p 21 City/State/Zip: (�A'l,f 4-140 IEAgE, A- 01221
Copies to: Builder, HERS Provider
HERS RATER COMPLIANCE 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, l 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.a.dhesive 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 Pressurisation Test Results (CFM @ 25 Pa) ; values
Test Leakage Flow in CFM
If fan (low 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 ❑ ❑
Yes is a pass Pass Fail
•
•
• r � L�,Ji� QAC .r � � i •�. ic rta�te Of
.� f� . . .CCl/ pansy
IscaVocnim
of BU/�C�/n
_ .. t g & Safet .De art/»ent
Y p
• '. - " - ,te i
s issued
This -.Certificapursuant to the'requirements of Section 109 of the'California Building
} ;Code, certifying. that, gat the, time of. issuance, this structure 'was in cora fiance wi ~
provisions sof the, Buildifi Code •and 'the various ,ordin"ances of the ,City `re Matin `b th :the
g g. g wilding
construction and/or use.
BUILDING ADDRES•S:.57-735 SEMINOLE DRIVE
' _ - .. - ? t7` �._!, t 'i .. tY' _ - - N ..r `� �• , ;, ` •ter 1..
b. Use;classification:'-SINGL•E FAMILY DWELLING
1 _Building Permit No
...q2_
Occupancy Group: R-3 .. ,. ` .` 4 i
'' Type of�Construction:'VN - > r Y ?
1 Land:Use Zone: RL '
... - - ... +ice •'i` ; } _'r 1• . �'r� �' � . , I;_ j r` 1• u - �. � `: V , .-:r
Owner of Building: CRV GOLF WEST.L.P. `� s ' : �' r • �� �� ;
.:. Address: 5140 AVENIDA ENCIANS
City, ST; ZIP: CARLSBAD 'CA 92008 -
f - 'By: Daniel P., `rawfor&Jr.-
Building � • ,. , . _. ` ' •,� y Date:.?/1/03
' g Official :
y POST IN A'CONSPICUOUS PLACE