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0207-112 (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,%nd my License is in.full orce and effect. License # Lic. Class Exp. Date Date °*'"` }Signature of Contractoc���i'`'�r "';�: w' ,.:, ••' .fit ....�.�` i s :.f,%92:r�� OWNER -BUILDER DECLARATION y 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 Sect)ion 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 STJT pU1-1w > Policy No. ION"W-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 .l -s all forthwith comply with-t�hasep ovisions. Applicant .rc r,�°t�►'[�_ �' Warning: Failure to secure Workers' Compensafn 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' k 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) r F••-•�' Date BUILDING PERMIT PERMIT# � �" DATE ^^VALUATION LOT TRACT Rr'� . 17tt t1yy two JOB SITE ADDRESSI-Y'1)`f�!� APN ` OWNER CONTRACTOR / DESIGNER / EN (NEER CRR GOU WtW, LP. V !a. t2>. 13 k . 3d�i i� COMPANY S 1.4 0 :ANMD A. r^WfJVh 5140 dBeVERMA EMCMAS A .SFA CA, 9.2008 CARI.a"�'�AtS CA Wi18 (M )SO4>> 8618 CBW 3370 USE OF PERMIT SM - LOT 5-2 PLAN 28 . PER1b IT .002S13'OT INCLUDE BLOCK c WALLS, P091.s LIRA, OR LaRPd'W,AYk'+MOACM, 11% PLAN C¢txC.'z free f REDUCTIO14 FOR MULTIPLE ISSLTAHCNC OF SAME PLAN MY. CUSTOM CONSTRUCTION "ZW," SF PORCHPATIO TIO 3.29,00 SF WA(WCARPORT 3:3!.99 SF NQSy"1,: tTED COST ©3! 'CC�,i'�S'Et?Cl '�CUON 221,1 7.40 '. �y �p �} FERb l.f r N it[a I V A AR 3 CONSTRUCTION 101.000418,IID01 1111168150 PLAN CHZCK 109P. 101-000.4.39-318 $2.17.43 fV..19CRAN ICAL F92 101-000.421.000 $10M ELECTRICAL FIZ 101-•00"20-000 PLUM -WING ME 101.0010.419-00i STRONG PAOT1014 FEE n RPSID )01-00.(!1-000 $22.12 C�3.d�T�WO FFY, 101.0900 -44423.000 $20,00 1rT'EV4iOPiM IMPACT Fw $%405.LIO .A11,'1' IN PUBLIC P"ON • a , IC 2.70-0 00-445-000 AND PLAR CHFArX, S4,21239 :3 l $0,00 T% -E "L°:MS DUL" NOW S4,2123A) -. CITYOFLA & . FINAIRWCEDEPT RECEIPT DATE =' BY DATE L IN CT �i G f .: 14 F • � mow. A INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings 6 Ducts Slab GradelVd/102— 4z ReturnAir YCombustion Steel Air Roof Deck Q Exhaust Fans OX to Wrap A F.A.U. Framing 42 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 4z 1 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 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 J Pool Cover Sewer Connection U/4z Encapsulation Gas Piping 5— Gas Test (S p 3 Appliances 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) COMMENTS: 4:LICENSED CONTRACTOR DECLARATION I.hereby �affirm under penalty of perjury that I am licensed under provisions of Ch ter 0 (commencing with -Section 7600) of Division 3 of the Business and Professlgnals,Code and' License is in full force and effect. License # Lic. Class Exp. Date 860335 B 3/31103,. t t'` a Date... 'Signature of Contractor `OWNER=BUILDER DECLARATION i herebyfaffirm under penalty.of perjury that I am exempt from the Contractor's ticet�TB�,I_aw for the following reason: I,tag 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). . (.) 1,' as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec, 7044, Business & Professionals C_ ode). r. ;' ( )A am exempt under Section , B&P.C: for this reason Date _- Signature -of Owner ' . T 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-insure4orworkers' 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 tiy_, Section 8700 of ttie Labor Code, for the performance of the -work for -which this . permit -is issued.,My workers'. compensation -insurance rn eaer &.policy.no._are:. Carrier' STATE FUND -' " "Policy No.' 160$301=01Z CI `(This section need not be completed rf the permit, valuation is, for $100.00 or less). j ( )- I certify that in the performance of the work for which this permit is issued, I shall noYemploy 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 3766 -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 r 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, A 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 is not commenced within 1$0 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 _..._.�PERMTN 0207-112 TRACT PATE - VALUATION $221,157.40 LOT, .' .. S2 .29147.1 ;'. , . JOB SITE ADDRESS . 57=735'�IMMOLEDRIVEOWNER �AP762-.380011 CONTRACTOR / DESIGNER INEER CRV_t30L1? VVES'P L P. �. �.. A9HBROOK DEVIIAFMENT COMPANY S 140 AVENIDAENCIANS 5140 AVEN]DAENC111A9 . . CARLSBAD ' " ' CA 92008 ,CARLSBAD CA 92008 ; ..'. _ (760*04.6868 CBL# 3376 USE OF PERMIT SIN= FAVLY DV701MG SPD • LOT 31 PLAN ZB . PERMIT DOES NOT.INCLUDE BLACK 'WALL% P0O1 'SPA -OR DRNEWAY APPROACH. 75% PLAN CHECK FEE , • •REDUCTION FOR Ir>1t1L.TIPLE:ISSUANCE OF SAME PLAN TYPE.. •� ' ' �CU$TOM'CON3TRUCTION ?,613.00 SF jPORCHIPATIO 5B.00 SF t -GARAGWCARPORT 534.00 SF ` '-- 2ATLD COST Ols' �CONSTRuenciN — 221.1:57AO.. CONSTRUCTION FEE 101-400-418-000 -61,066:50 PL'AN.CHECK PRE "'101-000-439-318 31742 , MECHANICAL FEE 101.000-421-000 6111.00 - ial:ECTRICAi: PEE 01-000-420-M $135.71 PLUMBING PRE .101-000-419-000 s1131.?5 STRONQ MOTION FEE • RESID 1101,-000-241-000-. 32212 GRADING FEE 101-000-423-000 62060 r DEVEWPER•IMPAf=T FPS -_ $2,405,40 ART IN PUBLIC PLACES - RESIE 270-000.445-000 552.89 ' . "SUB -TOTAL CONSTRUCTION AND PLAN CHECK . $4,212 3Q LE95 PRE -PAID FEES x.$0.00 TOTAL PERNQT FEES DUE NOW RECEIPT RECEIPT ==BY DATE FINALED INSPECTOR ti� .N. Desert ENERGY C A 0 E C services - P.O. Box 621 Rancho Mirage, CA 92270 Email: RKrown6237@aol.com Ph/Fax (760)564-2044 Cell: (760) 835.7939 �7 -7 CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7) CF -4R A'SAi7L (z Q�• -TE—til p 4115 �IG�o3 roject Title Date I A5H 5goo K LM h/1 V K, ITt E S ro'ect Address VA T- L i ( '7G0\ Builder Name ' got - 3 &90 1 PLA Q 2. v E tJ l- Bur Contact Telephone Plan Number m0 5 3 4;12odP l HE Rat r Telephone Sample Group Number Cc-l.1Rto�32�2 a �..-r# 52 �2uM�Ts,� Certifying Signature Date Sample House Number Firm: DESERT EI,1F_� `f SE -2\/i e -z5 HERS Provider: L° • H •�•�-•R•5 Street Address: RQ Box City/State/Zip:.�A IdGNoij IFZ& , °222"10 Copies to: Builder, HERS Provider HERS RATER COMPLIANCE STATEMENT The house was: 13 Tested LJ 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 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) Duct Pressurization Test Results (CFM @ 25 Pa) Test Leakage Flow in CFM If fan (low 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 ❑ THERMOSTATIC EXPANSION VALVE (TXV) ❑. Yes ❑ No Thermostatic Expansion Valve is installed and Access is provided for inspection ❑ ❑ Yes is a pass Pass Fail • tIInVV/JJr(L• ti + •VV/'WWL 's �.f P �•_.C.ert�T te�Ocqynanc, Sof r ',a-"_i j~y'�.-', .. ,.-• �r~ZF • ,T, • -'�+'. �'• � f ? t ' .� � '!. - j�CpIFD1i7ID �� �#' , w3 .' - _ �•'`� aT � �� t•�� �.� •4 ,� r ���. � yy ,3 4l ryr,s 1 �','�{ A , � }rL � •,Y,�j1�I 4. f � �ti fir" -'' � }y • 31. ,. i .r �,+„.,• � .j lr. '+ 1 iL � )S �.. ,. � �oF9 <<f: �Buld�ng :& Safety: Department . .:: �• 1 , R . �YThis. Certificate is issued -pursuant to_ -;the requirements of Section, `109 of the, California Building Code; , `certi_ fying the', difie of z issuance; this. structure Was,, in,:,, compliance 'with. IH6 ,:that; ;,at provisions of} the Building 4g.-.,'Code."` and the ,'various..ordinances!_ of -•the Pity, regulating buildingL ' .. Y ✓ `-> �+ ,' � °>�' " t f = construction and/or.use.wo �'rt ' ''} •, •\, \ r-• 1' zl Y R- ]�S� f�1'. �+( .3. •��. ��! '�^i% if'L'� �'f r4,V ,• - 'V.. f \ ,\U` �I f .r'K .r �` f1. �. i' is •`•r f �•,� i �. S .: -[�• r .,•.'BOILDING ADDRESS�57-755'SEMINOLE DRIVE '� ;' 41 3 �_ r' —_ `� r � ° ....�..• 1 , r } � '~c' �!, Use'classification:.SINGLE FAMILY �DWEL'LING : }: a ,' �' : `� rBuilding Permit,No.:.0207-1.12 . ; n _ u �, r`• ?;.. `• !' v•' `.{ s i{.; � .'�. t7.. ".. .Y' �•_ ,r.-. ' - � 'C1...' -d ., ,7 ,'y_ -r •,�, Occupancy Group: R-3 ' Type of Construction:' VN �' ; r ,� - `-Land UseZone: SRL' . �' SI r'Owh6r of Building:. CRV GOLF WEST, L.P. " `� ' 5 `Address:°5140'AVENIDA ENCIANS > ' , h' ,.- .... City, ST, ZIP: CARLSBAD,,CA 92008 w; _ DAniel P. Crawford Jr.,: ' ,By:' 'Date- 6/26/03 } ti Building Offi lal r ` POST IN A CONSPICUOUS PLACE _ NJ In ir