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0307-368 (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 'V;rofessionals Code, and my License is in full force and effect. License # Lic. Class Exp. Date 750335 R 1 dot rDate r . , r_ 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 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 pfovisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. ate:) �` �-1 � Applicant Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section -3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify .& hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. g / ) Signature (Owner/Agent) Date I it fti' BUILDING PERMIT PERMIT# I( 7.%-8 DATE VALUATION LOT. TRACT j 3 S.�23,,i57,�0 30� 28147a2 • !� rl � �^ _�I JOB SITE ADDRESS 8.1--1.9 aSiRF3iWC OCK ay is�vr LS APN OWNER CONTRACTOR/DESIGNER/EN (NEER CIk.1A (IOLP WE, TT "11BROOK DF4=�`lu:CMT CC3WANT 5140 AMM11l7A1..NCI1 Mkl 51.40 AVEMDA LeNCINAB C.'ARLSBAI) CA, 92008 C.AR :ISBAD (A' 92008 (760)$(A-6368 3376 USE OF PERMIT SOLE 13AX.Y I3T:iN� SPO . I:af PLAN 25. PERMIT 00.9.3 NOT 11NCf.UDE BLOCK WALLS, P00I4 SPA OR t7Ri°dE1JPAY APPROACH. 75% REDUCTION TO PLAN CHkK ",F, DUE TO MUTAIPL,E INJUA►NCZ OF SAME PLAN '1 YPE CUSTOM CMISTRUCTION 2615.00 OF POR.CHIPATIO 325,00 SP QAiZAOFJCARPORT SN,00 SF F.SlIn"TE, D CONN OV C+C9.1 WJrRUCTION U.1,1:57AO PIWIVIff 1= 11917M11!1'f Ry CONSTRUCTION."M 101-000-418-000 $1,060.50 ' PLA14 CHECK IEEE 101-006,439-319 $217.42 . MECHANICAL IEEE 101.000-421.000 S111.00 r =CTRICA1. PER. 101-000-420-000 Sl35."11 PL►taiBINO nZ 101X000-419-000 $181,75 STRONG MOTION • RIUS D 101-000-24,1-000 $22.12 GR A©INO ME 101.000.423.000 S13100 DEVELCIPERIMPACT l $1,405.00 ART IN PUBLIC PLACES - REIM 270.000,445.000 S52450 SM -TOTAL CON T7EtLXTIt'1N A ND PX AN CBEM $4,207.39 r -- LESS PRE -PAM $0.00 j; r` j AXE FiE�I411'I'.1 ffIs �a� E �rca�ir li INOV $4,"07.39 14 2603 CB i`t OF LA f3,iF!O5TyA / FWAPICE DEPT L RECEIPT DATE BY DA ALE , ( C INSPE�Tp� k �d INSPECTION RECORD +r3 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 —fl F.A.U. Framing _ %� Compressor Insulation 3 2 Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath D ii - Int. Lath - Final Final BLOCKWALL APPROVALS 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 Jr 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 Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wring Low Voltage Wiring Fbdures . Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: 3 0 Desert 5 IN �I : COC �+ L �S ENERGY C A E C S PO. Box 62.1 Rancho Mirage, CA 92270 Email: DESNRG RAOL.COM Ph/Fax (760) 564-2044 Cell: (760) 250-1852 CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7) CF -4R PASADERA PH -5 DATE TESTED 6-14-04 Project Title Date P.G.A. WEST LA QUINTA ASHBROOK COMMUNITIES Project Address Builder Name STEVE VAN LUE II _ 760-801-3981 _ PLAN 2 2 UNITS Builder Contact Telephone Plan Number RICHARD KROWN 760-250-1862 GROUP 4 HERS Rat Telephone Sample Group Number #CCNRK613292 MIL 2 12004 LOT 30 Certifying ignature 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) Duct Pressurization Test Results (CFM (d) 25 Pa) 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 Measured values Leakage Percentage (100 x Test Leakage/Fan Flow) = Check Box for Pass or Fail (Pass=6% or less) ❑ ❑ Pass Fail ❑ THERMOSTATIC EXPANSION VALVE (TXV) r� Thermostatic Expansion Valve is installed and Access is El Yes ❑t f provided for inspection ❑ ❑