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0306-460 (SFD)LICENSED CONTRACTOR DECLARATION r'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 ,Date �' r6y , gignature 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 exclusvely contracting with licensed contractors to construct the project (Sec. 7044, Business & ,Professionals Code). I , () I am exempt under Section , B&P.C. for this reason Date ` Signature of Owner WORKER'S COMPENSATION DECLARATION I hereby affirm I nder`penalty of perjury ortVpf 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. ( r) 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: Cartier STATE UND Policy No.,; 1610330.1-01,1 (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 th&e provisions. ,D'ate: 1 )Applicant- Warning: Applicant Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as.a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. Signature (Owner/Agent) -'_ -�" - �---- Date BUILDING PERMIT PERMT# DATE VALUATION LOT TRACT JOB SITE ADDRESS °'015 1.�.Z•„ IM01n�a ixV>. art' APN �� :? s� •�'/�. �% OWNER / CONTRACTOR/DESIGNER/ENGINEER CRVI40CrU?, g i'�•(i :t��:��-:sem : :. � �4a f���r�C►.e�:r��i�r��� . CA 92008 C"Al2LITE A D CA 92008 ('6 0)604-6868 C1,141# # 3376 USE OF PERMIT 1 SW -bOTl'N V1.4JtAM", : eD J gmtt• d:: YllAl�.r». jljl�j C.'DIM'1 RUCTIUN ZMA BF 1L 2 5 1003 U . A.:�F�` ` t< °t< 6ti5.4t11 ",�'}� C f f' �IN --�. Jn °1wI.AJisn) vowi'or cC?wmucrriot �a�a��ri�.v�•:r�a�x�)a�:: �(:�4aaa.4ls�a©t� �i,4d�.u� PL01 C ECK FLA% I+%iWHANK.", FEE 9LECTR1C,;L FES -000-4.20-000 PIAIMBING FF$. :i rRO1,11tJ p� 1 i.C;A; ., • .[ `If C? t,;j1 <.()L3i7-2A°I -O�Q x:11 •<#i RY���/[3]1�C'Cpl E 01-COO.423wq(1a �rt,S tl i g s V"i)Z-,*WT L COIRMUC,1'C09 MD:i'Lt I (ti10 MK $4,8 1 ti.Cr? LOU FTIV,10 T4LY .U,*,1 .YR, 'fiQT Yt'=S 7tZ�IE . ,,IOW RECEIPT DATEl BY I DA E LEDINS R INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck 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 D%wll:l Int. Lath 7 Final Final POOLS - SPAS BLOCKWAI A PROVALS 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 Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: 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) LICENSED CONTRACTOR DECLARATION I herebraffirm 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 ontractor_ 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). ( ) 1, 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: Carder 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 1 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 0306460 DATE VALUATION $214,107.30 LOT 58 TRACT 29147-2 JOB SITE ADDRESS 57-815 SEMINOLE DRIVE AP" 762-380'017 OWNER CONTRACTOR/DESIGNER/EN (NEER CRV. GOLF WEST ASHBROOK DEVELOPMENT COMPANY 5140 ENCINAS 5140 AVENIDAENCINAS CARLSBAD . CA 92008 CARLSBAD CA 92008 (760)804.6868 CBL9 3376 USE OF PERMIT SINGLE FAMILY DWEIJ+TCI S170 - LD 7 51� PtIM 1AR. PEIMI I DOES NOT INCLUDE BLOCK WALLS, POOL, SPA OR DRIVEWAY APPROACH CUSTOM CONSTRUCTION 2,501.00 SF PORCH/PATIO 558.00 SF GARAGEICARPORT 605.00 SF ES TMATED COST OF CONSTRUCTION 214,107.30 PERMIT FEE SU3AA& RY CONSTRUCTION FEE 101-000.418.000 $1,042.00 PLAN CHECK FEE 101-000-439-318 $855.50 MECHANICAL FEE 101-000-421-000 $111.00 ELECTRICAL FEE 101-000-420-000 $133.14 PLUMBING FEE 101.000.419.000 $197.75 STRONG MOTION FEE - RESID 101-000-241-000 $21.41 GRADING FEE 101-000.423.000 $15.00 DEVELOPER IMPACT FEE $2,405.00 ART IN PUBLIC PLACES - RESII 270.000-445-000 $35.27 SUB -TOTAL CONSTRUCTION AND PLAN CHECK $4,816.07 LESS PRE -PAID FEES $0.00 TOTAL PERMIT FEES DUE NOW $4,816.07 RECEIPT DATE BY DATE FINALED INSPECTOR Demrt ENERGY, CAD ECemces P0: Box 621 Ph/Fax (760) 564-2044 h DESNRG CaAAOL.COM Cell: (760] 250-1852 Email: CERTIFICATE OF TIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 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 1 2 UNITS. Builder Contact Telephone Plan Number GRANT RICH .760-250-20841 GROUP 3 HE t r Telephone Sample Group Number #CCNGY207439 03-19=04 LOT 58 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 housewas: ❑ 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). , ElWhere 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 REDUCTIOWCOMPLIANCE CREDIT Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage) Measured Duct Pressurization Test Results (CFM @ 25 Pa) Test Leakage Flow in CFM If fan flow is calculated as•400cfm/ton x number of tons enter calculated cuhere 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) values ❑ ❑ Pass Fail �❑ THERMOSTATIC EXPANSION VALVE (TKV) �t ❑ Yes ❑ No Thermostatic Expansion Valve is installed'and Access is ❑ ❑ provided for inspection