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0304-322 (SFD)LICENSED CONTRACTOR DECLARATION I herebl 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 ,.,Date ��' t���NSignature of Contractor rA L -I 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. iA� 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 16TATLT FUND Policy No. 1603DI-01;1 (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 thoa proyisions. Dater FI Applicant �i 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 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) "' i `�. Date `� BUILDING PERMIT PERMIT , DATE VALUATION $2114,10 S.'g) LOT S.5 1 ' ( TRACTJOB SITE ` i7— Zig e?�+6fa�i+��a�': 1 APN�:kx-.a�i ADDRESS OWNER CONTRACTOR /DESIGNER CAV CY1eYWL.rT1.uP y/ENGINEER /eVMIROhC ,I.J�: `�'.Y:t1.J•:,�y�a�tiF9'aV'j' v�..i:!Ia.i�u: �[Y S. USE OF PERMIT ETAJ4 1,1P OR D?tAUNAY APPROACH 75% REDUCT:.1014 TO PLAN CH);:t K FEYE.0WP, Ti? X;•Pa`UAI CF:OF'SAa.M %LAI3'X'•f"IR " n f .$ •r Y. C ,5 CUSTOM' CONSTRVOTi IBJN 130,M) 8F 6 PfX0Z1Cf11TT A T10 5 'l,A10 3F OVID 3F (%�'YNO' RU<'! ION'' PUM ; i? 1 Qrjci41 S'. 000 o PL?I=I CH401. F51t 1(i; 101061�A301.318$AM3.,Re l� C: xANiC` i, tri "s l W.0004- 31:oaki S111,40 �'1. rRIC:AL P)M.. 101_41100 -.1620 -WD $137.!1 1Q1.Mk4,'19 000 M47 S'3t3.0NO MOTIGli 17.21:` R2SIX7 101-i.}�.?(—.7.},1,-000 Im ifi:'•'P Ji' °I' i }=1.F�SLitx L� ,,%''a��[?a" ^ ntt'`z1.E�, r�i?.tjleYl rF4� ()W 2 t 34 t SJ'r� .: t l ZJr :k:t31 t):t'7A � I`t i31a- Pk : $4,1`l445 DI YMMTFK � 1"AD..ar I+tO'4ler $4,1 74A5. TIN 10 7G 3 Cln1 OF LA QUIINTA FINI ANCE or RECEIPT DATE �f i i . BY �I i. f0ff FIND ��' . . IN TOR it ./. Y INSPECTION RECORD OPERATION DATE I INSPECTOR OPERATION DATE I INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs I Underground Ducts Forms & Footings �f3 Ducts Slab Grade Return Air Steel Combustion Air Roof Deck •B j T Exhaust Fans O.K to Wrap - F.A.U. Framing C VT j 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 r 7 BLOCKWALL APPROVAL,4 POOLS - SPAS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final I Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines jf Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans OX for Finish Plaster Sewer Lateral Pool Cover Sewer Connection' - D Encapsulation Gas Piping Gas Test 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 Sz Final - Utility Notice (Perm) COMMENTS: �/J� 7�3< _ .. -y r. ,y v Po J., y -u. F. 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: Camer 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 1 1116- 111 R H I N I U3U4=322 DATE VALUATION $214,107.30 LOT 55 TRACT 29147-2 JOB SITE ADDRESS 57-785 SEAUNOLE DRIVE APN 762'0-014 OWNER CONTRACTOR / DESIGNER / EN (NEER CRV GOLF WEST, LP ASHBROOK DEVELOPMENT COMPANY 5141 AVENIDAENCINAS .5140 AVENIDAENCINAS CARLSBAD CA 92008 CARLSBAD CA 92008 (760)804-6868 CB1,4 3376 USE OF PERMIT SINGLE FAMILY DWELLING I POOL, SPA OR DRIVEWAY APPROACH 75% REDUCTION TO PLAN CHECK FEE DUE TO MULTIPLE ISSUANCE OF SAME PLAN TYPE X001 CSS CUSTOM CONSTRUCTION $501.00 SF. PORCHIPATIO 558.00 SF GARAGEICARPORT 605.00 SF ESTIMATED COST OF CONSTRUCTION 214,107.30 PERNIlT FEE SUAI MARY 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 GRADI'NO FEE 101.000-423.000 $15.00 DEVELOPER IMPACT FEE $2,405.00 ART IN PUBLIC PLACES - RESIL 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 (. • i Desem= = ENERGY - CADEG S"� — P.O. Box 621 Ph/Fax (760),564`'044 Rancho Mirage. CA 92270 W: f76M 89 250- Email: Wrown62370aol.com CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7), CF -411 PAMqk Ph-. Builder Na e Ian Number 611 # Sample Group Number "S�- ampa il ouse um ei Firm: !��1 ��-���yl �-�� HERS Provider: •1�•IE��Q,.'S> Street Address: City/State/Zip: Id ft' $ Copies to: Builder, HERS Provider HERS RATER STATEMENT The house was: L7 Tested ❑ Approved as part of sample'testing, but was not tested As the HERS rater providing diagnostic testing and field verification..) certify that the houses identified on this -form complN with the diagnostic tested compliance requirements as checked on this form. ff"Tbe installer has provided a copy`ofCF-6R (installation Certificate. Distribution system is fully ducted (i.e.. does not use building cavities as plenums or platform returns in lieu of ducts) C�'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 @ 25 Pa) values Test Leakage Flow in CFM If fan flow is calculated as 400cfrtt/ton x number of tons enter calculated u value here ot?0o V if fan flow is measured enter measured value here Leakage Percentage i 10 x Test Leakage/Fan Flow) Check Box for Pass or Fail (Pass=6% or less) �- ❑ Pass Fail L'! THERMOSTATIC EXPANSION VALVE (TXV) Thumostatic Expansion Valve is installed and Access is LJYes ❑ No [� ❑ provided for inspection Yes is a pass Pass Fail 0- Dwm�t CADEC EfVERGY ' S " P0. Box 821 Ph/Fax (760) 564 - Rancho Mirage. CA 92270 Cell: (760) 9904MM 250- IapjSZ (:mail: Ri(rown82370aol.cam CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page 1 of 7) CF -4R Dr 0-nQ, D/1'h�iYlv�u 1!S_ BuildcrNarnc Ian Number 4 I11 � Sample Group Number amp a ouseurn er HERS Provider: G•I�°��-Q-S• City/State/Zip: ��►`l(9 TAj gid** Firm: PES�I� Street Address: Copies to: Builder, HERS Provider HERS RATER COMPLIANCE STATEMENT The house was: (9/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 complp 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) ff'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 @ 25 Pa) values Test Leakage Flow in CFM 7� If fan flow is calculated as 400cfm/ton x number of tons enter calculated value here 0 d 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 3 THERMOSTATIC EXPANSION VALVE (TXV) I J Yes ❑ No Thermostatic Expansion Valve is installed and Access is Q provided for inspection Yes is a pass Pass Fail