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0304-320 (SFD)CN C0 W O =) M I�� timet; oZt` �0 ,JUS WW I- a rn Z M N ON U °) Q_ Q Lo QO X W mUU O liLO < Z ob J ` 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 760335 B 3/31/05 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). () 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 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 PERM 0304-320 DATE VALUATION $236,37760 LOT 53 TRACT 29147-2 JOB SITE ADDRESS 57-765 SEMINOLE DRIVE APN 762 -*-012 OWNER CONTRACTOR / DESIGNER / EN (NEER CRV GOLF WEST, LP ASHBROOK DEVELOPMENT COMPANY 5141 AVENIDA ENCINAS 5140 AVENIDA ENCINAS CARLSBAD CA 92008 CARLSBAD CA 92008 (760)804.6868 CBL# .3376 USE OF PERMIT SINGLE FAMILY DWELUNG POOL, SPA OR DRIVEWAY APPROACH, 75% REDUCTION TO PLAN CHECK FEE DUE TO MULTIPLE ISSUANCE OF SAME PLAN TYPE -2col CeE3 CUSTOM CONSTRUCTION 2,801.00 SF PORCH/PATIO 571.00 SF (1ARAOE/CARPORT 536,00 SF ESTUWATED COST OF CONSTRUCTION 236,377.60 PERMIT FEE SUNIMARY CONSTRUCTION FEE 101-000-418-000 31,119.00 PLAN CHECK FEE 101-000-439-318 $226.73 MECHANICAL FEE 101-000-421-000 $85,50 ELECTRICAL FEE 101-000-420-000 $161.26 PLUMBING FEE 101-000-419.000 $180,50 STRONG MOTION FEE - RESID 101-000-241-000 $23.64 ORADINO FEE 101-000.423.000 $15,00 DEVELOPER IMPACT FEE $2,405.00 ART IN PUBLIC PLACES - RESIE 270.000-445-000 $90,94 SUB -TOTAL CONSTRUCTION AND PLAN CHECK $4,307.57 LESS PRE -PAID FEE3 $0.00 TOTAL PERMIT FEES DUE NOW $4,307.37 RECEIPT DATE BY DATE FINALED INSPECTOR • • nta� _ - ENERGY -- CADEC "r — P.O, Box 621 Ph/Fax f7E01564 2044 Rancho Mirage. CA 92270 CeB: [7601 8939 250^1&57. Email: RKrawn62370aol.com 1 CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page,l of 7) CF -311 Pas a df R8 Ph --3 Proiect Title Aft D e Address Contact k A LV u1'N f 14 . Ue_ -IL. l -TGQ) APO )- Firm: cSellyI etes 'T Street Address: I.0 . &;K 621 Copies to: Builder, HERS Provider �jsh� aoK a/»3AUA)h;eS Bu�ildef �Na/ne Plan Number 01.1 Safmple Group Number ��.53 of a2 Sample House Number HERS Provider: e-H-F•l-g s. City/State/Zip: 6 0- O'tj1 E q)2270 HERS RATER STATEMENT The house was: t.7 Tested ❑ Approved as part of sample testing; but was not tested As the HERS rater providing diagnostic testing and field verification. 1 certify that the houses identified on this form comply with the diagnostic tested compliance requirements as checked on this form. UlTlle installer has provided a copy of CF -611 (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 dtawbands are used in combination with cloth backed, rubber adhesive duct tape to seal leaks at duct connections. K MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage) DTHERMOSTATIC EXPANSION VALVE (TXV) E ry"cs ❑ No Thermostatic Expansion Valve is installed and Access is provided for inspection Yes is a pass Pass Fail 0-�- ❑ Pass Fail Measured Duct Pressurization Test Results (CFM Q 25 Pa) Test Leakage Flow in CFM /values ! 7 If fan flow is calculated as 400cfm/ton x number of tons enter calculated' value hereO (� If fan flow is measured enter measured value here Leakage Percentage (100 x Test Leakage/Fan Flow) Check Box for Pass or Fail (Pass=60/6 or less) 0— ❑ DTHERMOSTATIC EXPANSION VALVE (TXV) E ry"cs ❑ No Thermostatic Expansion Valve is installed and Access is provided for inspection Yes is a pass Pass Fail 0-�- ❑ Pass Fail • [i ENERGY - 2ABEt` ��"� - - P.U. Box 621 Ph/Fax (76Q 5642044 Rancho Mirage, CA 92271) cert: (760) ------- Email:RKrown62370aol.com CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7) CF -411 P-p5ndf Rig Ph --31 -'2 5- 0-3 Pect Title D e Vl'Pj 1 14VAJ irojec Address Builder N aj n c eUr-. 7Go) J - / Bul er Contact Telephone Ian Number r -5-0-106a GI-�f #y -- Hptr Telephone Sample Group Number Ceniff ing signature toSamp a House um eC- �— Firm:_pE.'.�E r 4Y Som e -Es Street Address: PO (� 1 Copies to: Builder, HERS Provider HERS Provider:e- A- �yI�. �.�.�. City/State/Zip: K g0-fi® KA E &.052270 HERS RATER PMPLI.ANCE STATEMENT The house was: IT Tested ❑ Approved as part of sample testing, but was not tested As the HERS rater providing diagnostic testing and field verification, 1 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) L7 Where cloth backed. rubber adhesive duct tape is installed, mastic and drawbands are used in combination with cloth OK backed, rubber adhesive duct tape to seal leaks at duct connections. lK 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 10 If fan flow is calculated as 400cfm/ton x number of tons enter calculated value here G Q V 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°Yo or less) [a-- ❑ Pass Fail ,,__,,// ('THERMOSTATIC EXPANSION VALVE (TXV) Ir�t:s ❑ No Thermostatic Expansion Valve is installed and Access is provided for inspection Gi-- ❑ Yes is a pass Pass Fail U) � ..: CV W O CY � ' w� oZt� CO o' % w W �a N 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 my License is in full force and effect. License # Lic. Class Exp. Date' . "in COJ r Date <� '�5ignature 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: ( ) 1, 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. K,) 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 �'t`+s TF MR) Policy No. ' 16.143W -W (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 shall forthwith comply with those, , ovisions. Date: t , V f; Applicant— Warning: pplicant 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 r ''BUILDING PERMIT PERMIT'S DATE VALUATION: LOT `�;j° TRACT JOB'SITE—iSJW�:ru�. �,, l ADDRESS APN—.w k±�� OWNER CONTRACTOR /�DESIGNER 4V V r} .7 s ,4p yy/�ENGINEER -5141 IAV, i :CO 1 C.c+ �?, . ,. 40 AWYMA, M.dt;IAS ";'A :92008 CARLSR G f �.�e'� �12k^�aS USE OF PERMIT ',t.taav �M.sr *-\, '~A.1411.Wli .7f �� ? i:�✓ d :.:i, a�1 r a r, %ns.=n..a a�kn !♦ AV L7 oi/ x'001,, H A O uris'X'A}`PROkAO.K i`5%F1,91 t.`k;..s'1010 TO 'PLAN C:MCK- EtUOTOM (.01fl4;TAUt.:'T?W Z8611K0 E? £°OfiC,lidPKI 10 5W.0 WNW RU('9`ONVimbZ,iJ9,t1� PY.,.P'�.?'4 CHYCK P'L�13", :s {� c -IJ '1'^ �;� °•,� 'i �[�;6.7� Ad�'���AAFL{:.Al,i�;li. G��-i7C�i-�•�•�I�fJt>C3 �,^�.�x0 . ; &I-ZC'Y1C4kL, I'yiti, 113116 ppluKFofn'4l Et��Lrvi�d J'^7JVgtY1' Cpp�'rH1JV , p v .HM, M, 0 i�'a�A- 11??"' ? l4LxlV. 7 1.1 ? �10r1)1 r_:•'P 1 -000 .as! �.1r• �., �. ... m h t:lR,'�J:3' 4 4,.u•i�t�t} VEV+ C1LC31f,--t.'6M?�?S,V,T 14"E 5,x;is? f. ,�► ARIF jN d'tYBW.C-' KA;,s KP?' - %034 'iem iFJnr,v i) s'+n9 a(.�-. nes VIM 11TC,.-11SJ1rXFR10, it �I A � �j�' � � • s.6:.►111•'ICGIA .aV .�Q.uL' :� i�.y,1.6i SY Iv; V'9 L"' !p #���.cJ� (I ,d JUIN U 1 0 t - CIT,' G,c LAS QUINTA FtR' w4dCE DEPT.. . RECEIPT. DATE BY —TD #E F LED INS R { ,..- a?� INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs zi Underground Ducts Forms & Footings Ducts Slab Grade li Return Air Steel Combustion Air Roof Deck .a 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 Drywall - Int. Lath Final Final BLOC KW LL 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 LinesA&&/Za 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 Appliances Final Final UtiI4 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: