0306-464 (SFD)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
:'P-rofessionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
r �S
,"Date o `''� —)Sign' ature of Contractor ✓�If
- 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)A '
( ) I, as of 6er of the property, am exclusively contracting with licensed
contractors to -construct the project (Sec. 7044, Business & Professionals
Code).. r ,
() I am exempt under"Section B&P.C. for this reason
Date 4/ "" Signature of Owner
r WORKER'S COMPENSATION DECLARATION
I hereby affirw'brider 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
peormance of the work for which this permit is issued.
(S 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. Myr workers' compensation insurance carrier & policy no. are:
Carrier �`{'riTF F?t1Ac1D Policy No. lbD�;B61-a�?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, Isal forthwith comply with those provisions ,
Dale:'a r3• c�
Applicant -
Warning:
�•
Warning: Failure to secure Workers' Compensation coverage. is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit. subject to the conditions and restrictions set •forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, .& shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permiY issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
('certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property fo'r inspection purposes.
�Bignature (Owner/Agent) fl Date__*,,�" �;T1
BUILDING PERMIT PERMIT#
DATE VALUATION �,I7JJY� LOT' (�� ,' TRACTJOB
SITE
ADDRESS ...y5 43$��xn bMTVX
APN
OWNER5
CONTRACTORDtEaS�IIG�NrE•tRq/ENGINEER
Sy //{�//t�eqq� L����yy;; R�v4
(MV 6:lt,Jl.�, VV,Cs - - -- -- �-
7/
yYp
F7.�7.�1..�3.`�.S.�Vlri..!✓'J:+Ft3.?a(✓e.I:c'J.�E:•�'gr CL�i�cvLf�a"1,�,1:
5140 ;(r.�iCNAS "
5 i 40.fiVaMIDA RN CXXHXX<
ClYM. 7C�,, 9'20'09
CAR i. BAD (o � srx.0 8
G)8E'.K-ci86's cmvi, 3376
USE OF PERMIT
•L
-..lei 4..AT!•1
�.p
n Ib 4.6� J.'.I. Y; 1'+3WVL-�A'4:'6 •l:e.11Y'VA lti �r,feb4LdW W'lJnAWI\ tlOr N!) _ "'„N.
po" SPS: OR DIXTR WA, APPR ACS'. 75% RFP1 ;'N* 017MCK
rXES .DUE TO UZAMPL-F.1821!;A.NOW, OF SAM2 !%L&II TYPE,
CUSTt. 14 CCINSTRUC 710N `3; NA, O
J
PoRclifoA1p • .,�> JU 25 2003
�,o 7p .Mq.u0
�:�.RA<1t`�.f'i.l'MSY�C4R.1
'LA QUINT
1,L_�HYNAA
ICE DEPT
CONSTRUCTION FEZ 101 -1)(0-41 B-000 SI'llip-60
PLAt4 CHECK PIR 1E71,.006439-3IR
Iv ecliA;1 Icw, ;Z.F .)ta�tz(Y�• °,�C �7 � ;': � .
}:i,WHUChAL FEE ii i-Q(;rJ, 4 P-fii 0
STY�4f�d0,'Yiit'1C3':+:r�t?;� I�.�ils! 'i4i9-1J'3iF4Y�C?;�tt inn4
C3ft.Ai)Ei O F',V-.2 ' 101,,000-423-000 0;1.0 '
lD I.': ,Ad;T MIVY,
S TB-CAA1, r'0148YICTIc3KAW �PP���(;f���JreM X} X$0.00
RECEIPT
RECEIPT
DATE„
BY
I DAT LED
I INSP�
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
OX 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
tz
DrWall - I t. Lath
Final
Final
POOLS - SPAS
BLOCKWAL
APPROVALS
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
OX 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)
U)
H
V C/)
W
r
M
' W�
Z
D 0-
C:)
_J
11 LU
—a
to
Z
co
ul
N
ON
U °'
Z
la— O
W LL
J J
J Q
ULIDU
� Z
cb5
�p
J
noiavy 01111111 u11uai Na"auy vi Naijuiy uiat 1 0111 uwilovu uiiuoi Nivvwwns V1
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: ADDlicant
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
fora 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
' �.. vvilL.lv11vb3 rGnlvlil1 0306-464
DATE VALUATIONau.o�77.60 LOT 62 TRACT 29147.2
�..._. Vrr..r.;,. .
JOB SITE
ADDRESS 57-925 SEAQ VOLE DRIVE
AP" 762-380-021
OWNER CONTRACTOR/DESIGNER/ENGINEER
CRV GOLF WEST ASHBROOK DEVELOPMENT COMPANY
5140 ENCINAS 5140 AVENIDA ENCINAS
CARLSBAD CA 92008 CARLSBAD CA 92008
(760)804-6868 CBL4. 3376
USE OF PERMIT
SINGLE FAMILY DWELLING
Sru 'N 3B. PERMIT DOES NOT INCLUDE BLOCK WAttt,
POOL, SPA OR DRIVEWAY APPROACH. 75% REDUCTION TO PLAN CHECK
FEES DUE TO MULTIPLE ISSUANCE OF SAME PLAN TYPE
CUSTOM CONSTRUCTION 2,801.00 SF
PORCH/PATIO 577.00 SF
GARAGE/CARPORT 536.00 SF
ESTEWATED COST OF CONSTRUCTION
236,377.60
PPRAM FEE SUhD&ARY
CONSTRUCTION FEE 101-000-418.000 $1,119,00
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
GRADING FEE 101-000-423.000 $15.00
DEVELOPER IMPACT FEE $2,405.00
ART IN PUBLIC PLACES - RESIL 270-000-445.000 $90.94
SUB -TOTAL CONSTRUCTION AND PLAN CHECK
$4,307.57
LESS PRE -PAID FEES
$0.00
TOTAL PERMU FEES DUE NOW
$4,30757
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
Loo 6a.
5• D"O,t -
SEN� •ENERGY Set � C �A 0 E C
a • S
PO. Box 621 Ph/Fax (760) 564-2044
Rancho Mirage, CA 92270 Cell: (760] 250-1852
Email: DESNRG O)AOL.COM
CERTIFICATE OF FIELD 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
Pr2jject Address - Builder Name.
STEVE VAN LUE II 760-801-3981 PLAN 3 2 UNITS
Builder Contact Telephone Plan Number
GRANT RICH 760-250-20841. " GRO 3
HES Rater Telephone= S le Gro Nu ber
s, #CCNGY207439 - 03-19-04 OLOT 62.
Certifying Signature Date Sample Lot NAAber
Firm: DESERT ENERGY SERVICES HERS Provider: ERS
Street Address: P.O. BOX 621 City/State/Zip: RANCHO MIRAGE, CA. 92270
Copies,to: Builder, HERS Provider r
i
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
e
e
Test Leakage Flow in CFM
If fan flow is calculated as 4006fm/ton x number of tons enter calculated
value here
J 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) ❑ t ❑
Pass Fail
❑ THERMOSTATIC EXPANSION VALVE (TXV) -
❑ Yes ❑ No Thermostatic Expansion Valve is installed and Access is
provided for inspection ❑ ❑