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0306-458 (SFD)LICENSED CONTRACTOR DECLARATION ka eby affirm under penalty of perjury that I am licensed under provisions of pter 9 (comm enci ng with Section 7000) of Division 3 of the Business and dProfessionals Code, and my License is in full force and effect. License # r Lid! Class Exp. Date .,Date ' "�1 t' 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 e T.ATLY 1q;1ND Policy No. 16=1-012 (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 p?ovisions. ,Date:f3'>.A'plicant �� .. 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 I 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 upori the above-mentioned property for inspection purposes. Signature (Owner/Agent) . -' (� .-- Date PERMIT # BUILDING PERMIT DATE VALUATION:d,�-di . LOT 5 ' ` TRACT JOB SITE ADDRESS!% fi luiJ:r�Ii.11�N APN I�i✓�ioi OWNER CONTRACTOR / DESIGNER / EN &NEER CAV 1111011.; WE 9Tk lVit) ^s�C"FF�:P�.9• 5140.&M.Mf+ �Rs'`••!1`iM i I�iRI�YH�� CA 92008 ('MR1,0ZAD ' CA VM?0£; (760"'394.646S G d .1.476 USE OF PERMIT ssq-pp Wl�is:a i.!_ a�_.-.:.i..ri..:.�.��i�.,m. t7.�y+t��3U %Tiy.. r:..._..1i�igLgiril •,t1 tgr •�lq P001, �F,.vY•. dA4: N7l.fi%.i�ry7[�,t.Y AJ13P1.h6+&H i i CUSTOM C;tJld4UR."410,TSOH 21615.00 I POR.C'13.1r=A.VO' 525.0 sle GAR.,P,+.CI'Itdt^R RPORt:t ,EmA CCJd'O..i J'. 1.!ti�A�oE , r{•�j�l, .r�'.�.SR; f'r",�,y11�d uslY.S µ[.ii J's`iih PERAUT FEE SK1111 114LM'i' COteO'YLrAWT10A11'EE 101-000-448.OM $1,066.50 PLAN CHf~ "•IW MEC:HANICf.A]. FFM 161.00.4X1.000 �fI1.t6tJ P,1.WTRIQfKL. PVX- 201 -Ofd -4 0-060 P'Is1.1.C17MP`!:S D7t ' I01--%0. 19-000 tg11S1." STRO40 Xt7' 7014 IFE? - r 101 000-2-11 -0,M) , 41RAD04, RSYR10..000-4t3<d300 W,09.; �z���c�t� r�tt.t,a�k�a�,�:�;j' ��r •���it�s.ac� ART 4N Pft'BUC3 P.Af,`28 ... 4 i 4v'n � i. - , 4:4t !6Y3.[�l.J !!.A•��/JY AND PJJ49 v:1,c'.t.FJ...il� i x 'f'Fc�72} 2 52.003 CITY OF L.A QUINTA DEPT. ' F16dAIICE RECEIPT DATE BY D FINALED INSPEW0,22 INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings 9PL 1 WV72 Ducts Slab Grade r Return Air Steel Combustion Air Roof Deck v Exhaust Fans OX to Wrap F.A.U. Framing^- Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wail Insulation Condensate Lines Party Wall Firewall Exterior Lath D II V. Lath MID tn Final � � BLOCKWALL APPROVALS Final 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 Unes 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 1146 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 —d Utility Notice (Perm) COMMENTS: - _ 5�-795 Deaen- ' • SNPrERGYvices C A D E C. - PO. Box 621 Ph/Fax (760) 564-2044 Rancho Mirage, CA 92270 Cell: (7601250-1852 Email: DESNRG (MAOL.COM CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page Iof 7) CF -4R PASADERA PH -4 03-12-04 Project Title Date P.G.A. WEST LA QUINTA - ' ASHBROOK COMMUNITIES Protect Address. - Builder. Name .. STEVE VAN LUE II 760-801-3981 PLAN 2 2 UNITS Builder Contact TelephonerPlan Number GRANT RICH 760-250-20841 GROUP 3 HERater Telephone Sample Group Number #CCNGY207439 03-19-04 LOT 56 Certifying Signature Date Sample. Lot Number Firm:' "DESERT ENERGY SERVICES HERS Provider: CHEERS Street Address: P.O. BOX 621 City/State/Zip: RANCHO MIRAGE, CA. 92270 Copies to: Builder, HERS Provider HERS RATER COMPLIANCE STATEMENT The house was: ❑ 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 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) Measured Duct Pressurization Test Results (CFM @ 25 Pa) values Test Leakage Flow in CFM If fan flow is calculated as 400cfm/tori 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) i ❑ Yes ❑ No Thermostatic Expansion Valve is installed and Access is provided for inspection ❑ ❑ - N R;•ti LICENSED CONTRACTOR DECLARATION I hereby Orn 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 3131105 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 PERMIT # BUILDING PERMIT 0306458 DATE VALUATION $221,157.40 LOT 56 TRACT 29147-2 JOB SITE ADDRESS 57-795 SEAUNOLE DRIVE AP" 762-380-015 OWNER CONTRACTOR / DESIGNER / ENGINEER CRV GOLF WEST ASHBROOK DEVELOPMENT COMPANY 5140 ENCINAS 5140 AVENMAENCINAS CARLSBAD CA 92008 CARLSBAD CA 92008 (760)804.6868 CBL# 3376 USE OF PERMIT SINGLE FAMILY DWELLING N 4"L). L;U-1 3 0, FL. -LN 2B. F97MI"I L)UZZ� NL) I INIC. ELIDE BLOCK WALM POOL, SPA OR DRIVEWAY APPROACH CUSTOM CONSTRUCTION 1,615.00 SF PORCHIPATIO 525.00 SF GARAGEICARPORT 534,00 SF ESTIl"TED COST OF CONSTRUCTION 221,157.40 PERA41T FEE SUMMARY CONSTRUCTION FEE 101-000-418-000 $1,066,50 PLAN CHECK FEE 101-000-439-318 $869.66 MECHANICAL FEE 101-000.421-000 $111.00 ELECTRICAL FEE 101-000-420-000 $135.71 PLUMBING FEE 101-000.419-000 $181.75 STRONG MOTION FEE - RESID 101-000=241=000 $22.12 GRADING FEE I01-000-423-000 $15.00 DEVELOPER IMPACT FEE $2,405.00 ART IN PUBLIC PLACES - RESIE 270-000-445-000 $52.89 SUB -TOTAL CONSTRUCTION AND PLAN CHECK $4,859.63 LESS PRE -PAID FEES $0.00 TOTAL PERMPT FEES DUE NOW $4,859.63 RECEIPT DATE BY DATE FINALED INSPECTOR