0306-461 (SFD)LICENSED CONTRACTOR DECLARATION
I herby 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
P.rofe,sionals Code, and my License is in full force and effect.
Llaense # Lic. Class Exp. Date
'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.
(0 1 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 ca rier & policy no. are:
Carrier i�T.t�TE, �`e3ND PolicySNo. �Mt�s�Jf'Jz;s
�t
(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:
pplicantWarning: 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 inspfction purposes.
Signature (Owner/Agent) -L " Date 1- • C�?
,s
11.:1�1'L'"�'rr'C�Y
BUILDING P1g,yE�JRytM��p.IT PERM'T0/9��y{gy�pJp g�pp
�
DATE VALUATION $211,137ACI LOT. _ q TRACT
,7 r r
JOB SITE 44.`7-8,i �! a�S.O %y�%I�TCi�a . ai Edi
APN
ADDRESS
OWNER
CONTRACTOR/DESIGNER/EN INEER
5140IN(MvA�
�; cr CA MOOR
G���Q;a��;.'� � � _9,20axf
60)3 A-1:,43035 C8L4 3376
.aava aor•.n. ,vr •�•�r Yuas raa
USE OF PERMIT
SINGLC
.,.a..
tr/J
VA Rf N./J d.•� AM-W.Y •. Vlai ,.�Ya.y a, .,'a YAav u4n n.r aF :v M1v.
120041 OPA Olt &PPRJP► .11 ': rA. RY- 1J(7f.R.A. ro PIA)4 C;far.-4
FLLo:3 T)UZ .VSO MUt:.l IP.L.S OF SAMP, PL,kll ', klf,
T:+"1114A T f3 w°°0T fir' CaOC;
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
v
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
W v.Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
DrIwall - I Lath
Final
Final
!v a
POOLS - SPAS
BLOCKWALL
A PROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
'Underground Electric
Underground Pibg. 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
_ 'Age
Pool Cover
Sewer Connection
-'G
Encapsulation
Gas Piping
Gas Test
„Q y
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 JA
Temp. Use of Power
Final d u -
Utility Notice (Perm)
LICENSED CONTRACTOR DECLARATION
I hereby affirril under penalty of perjury that 1 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:
( ) 1 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
��yyLabor Code, for the performance of the work for which this
permit is issued.
F y workers' compensation insurance carrier & policy no. are:
Carrier 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 3106
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. PER0306-461
DATE VALUATION $221,157.40 LOT 56 TRACT 29147-2
JOB SITE 57-825 SEAHNOLE DRIVE
APN 762-380-018
ADDRES
OWNER CONTRACTOR/DESIGNER/EN (NEER
CRV GOLF WEST ASHBROOK DEVELOPMENT COMPANY
5140 ENCINA9 5140 AVENIDAENCINAS
CARLSBAD CA 92008 CARLSBAD CA 92008
(760)804.6868 CBL# 3376
USE OF PERMIT
SWGLE FAMILY DWELLING
SFD - LOT 59, Pt" 2A. PERMIT DOES 116T 11 St;QCK WAtt;3;
POOL, SPA OR DRIVEWAY APPROACH. 75% REDUCTION TO PLAN CHECK
FEES DUE TO MULTIPLE ISSUANCE OF SAME PLAN TYPE
CUSTOM CONSTRUCTION 2,615.00 SF
PORCH/PATIO 525.00 SF
GARAGE/CARPORT 534.00 SF
ESIMATED COST OF CONSTRUCTION
221,157.40
PERMIT FEE S TMMARY
CONSTRUCTION FEE 101-000-418-000 $1,066,50
PLAN CHECK FEE 101-000-439-318 $217.42
MECHANICAL FEE 101-000.421-000 $111.00
ELECTRICAL FEE 101-000-420-000 $135.71
PLUMBINGYEE 101.000-419.000 $181.75
STRONG MOTION FEE - RESID 101-000-241-000 $22.12
GRADING FEE 101-000.423-000 $15.00.
DEVELOPER IMPACT FEE $2,405.00
ART IN PUBLIC PLACES - RESIL 270.000-445.000 $52.89
SUB -TOTAL CONSTRUCTION AND PLAN CHECK
$4,207.39
- -3 PF.E-PPS? FEEQ
$0.00
TOTAL PERMIT FEES DUE NOW
$4,207.39
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
LOT'
50-5 �,�- .r cn5ec
5EM i NoL'E NZII/G . ENERGYAces_
S
I.
PO. 66x.621
Rancho Mirage, CA 92270
Email: DESNRG AAOL.COM
Ph/Fax (760) 664-2044
Cell: (760] 250-1852
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (PageI of 7)
PASADERA PH -4 _ 03-12-04
Project Title I Date
P.G.A. WEST LA QUINTA ASHBROOK COMMUNITIES
Protect Address
STEVE VAN LUE 11
Builder'Contact
GRANT RICH
HERS,Rater _ „
Certifying Signature
Firm: DESERT ENERGY SERVICES
Street Address: P.O. BOX 621
Copies to: Builder, HERS Provider
Builder Name
760-801-3981 PLAN 2 2 UNITS
Telephone Plan Number
760-250-20841 GROUP 3
Telephone Sample Group Number
03-19-04 LOT 59
Date
CF -4R
. Sample Lot Number,,
HERS Provider: CHEERS
City/State/Zip: RANCHO MIRAGE, CA. 92270
HERS RATER COMPLIANCE STATEMENT
The house was: ❑ Tested ® Approved as part of sample testing but was not tested
As the HERS rater providing d'laghostic 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/ton 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)
❑ Yes El No Thermostatic Expansion Valve is installed and Access is
provided for inspection
FEINN-01