0307-365 (SFD)x
.�s
Signature (Owner/Agent) LL ✓i Date O L + t ''-i,
LICENSED CONTRACTOR DECLARATION
1.hereby affirm under penalty of perjury that I am licensed under provisions of
IC - hapter 9 (commencing with Section 7000) of Division 3 of the Business and•
ofeAionals Code, and my License is in full force and effect.
License # t •r +' " "w Lic. Class Exp. Date
f 60335 F3
Date �It/, s,fl'u, 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
S ction 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: f /' / - 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 aresult 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. i
PERMIT PERMIT#
_BUILDING
DATE VALUATION LOT '� TRACT 400
ai /• $221a,57AO .27' 29147.2
JOB SITE
APN
ADDRESS 81-10 SW- N :COCX HMLS
.762-350L016
OWNER
CONTRACTOR /DESIGNER / EN INEER
CRS• WLF WF=
JWM1MK I71I1i> � OP2+rlk'Di CO trs�A13 ,
5140 AV.[ fDA M4CIK1 M -
5140 AVEMA,MINA,9
CARLSBAD CA 92008
Ca IAL .'D CA 9=8
(7160)804-6869 CZL0 336
;
USE OF PERMIT • •
SINGLE FAMMY DWELLING
SFD - LOT 27, PLAN 2,AR. PERMIT DOES 11OT INCLUDE 8I OCK,
WAALIA POOL, SPA OR IDRrVKWAY APPROACH
CUSTOM CONSTRUCTION 2,615.00 2F
PORCH/PANIO . $2.5.00 SP
GAR.AGE(CARPORT 534,00 SF
r
1
991D"TED ED COST OF CON UCITON'
�2Ik,157.4iA
PERMIT FEE- S[ib04ARY
CONSTRUCTION FEE 1131.000.418.000 $lnQ16S,3n
PLAN CHECK FEE � Q1-QOQ-439=31 E $Ld69.�aii
MiCHA;NKIAL VE& 1.01.000.421 -OW 1111100 .
En,ZCTR.fCAL FEE $135.71
P1,()MBINO FEE 101-000-41R-000 $181,75
STRONO MOTION 1E - RESID 101-000-241-000 $32.12
'
GRADINO17F,E 101.000-423.000 615,00 ,
DWELOPM IMPACT FEL: '. $2,405.00 '
ART 114 PUBLIC PLACES -- R183L 270.000.44.3494 ~ S52,89.
B - ON.UMUMIQIi++T.A AND PT AK Cki6.t:T=<
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FI 1t'AR10E DEPT. f,, •.. _
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✓/
A
RECEIPT
DATE 111BY
DAT ED
INSPECTOR
f
INSPECTION RECORD
' OPERATION
DATE
INSPECTOR
OPERATION
DATE
TINSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
_
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Q(ywall - Int. Lath
/ Q
Final
Final
POOLS - SPAS
BLOCKWALL
APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
-
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Sewer Connection
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
-
Final
COMMENTS:
Final
Utility Notice (Gas)
y ELECTRICAL' APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures'
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
S
gl -l�5 5d1,-JN&CcU< e$erc - -
ENERGY C A D E C
S
PO. Box 621
Rancho Mirage, CA 92270
Email: DESNRG OAOL.COM
Ph/Fax (760) 564-2044
Cell: (760] 250-1852
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7) CF -4R
PASADERA
Project Title
P.G.A. WEST LA QUINTA
Project Address
STEVE VAN LUE II
Builder Contact
RICHARD KROWN
HERS Raters ,
Certifying Signature
Firm: DESERT ENERGY SERVICES
Street Address: P.O. BOX 621
Copies to: Builder, HERS Provider
PH -5
760-801-3981
Telephone
760-250-1852
Telephone
3292 JUL 21 2004
Date
DATE TESTED 6-14-04
Date
ASHBROOK COMMUNITIES
Builder Name
PLAN 2 2 UNITS
Plan Number
GROUP 4
Sample Group Number
LOT 27 2 OF 2
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 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 Q 25 Pa)
values
Test Leakage Flow in CFM 63
If fan flow is calculated as 400cfm/ton x number of tons enter calcuated
value l here 1400
If fan flow is measured enter measured value here
Leakage Percentage (100 x Test Leakage/Fan Flow) = 4.5
El
Check Box for Pass or Fail (Pass -6% or less) ® -
Pass Fail
CO
® THERMOSTATIC EXPANSION VALVE (TXV)
• ® Yes ❑ No Thermostatic Expansion Valve is installed and Access is ® ❑
provided for inspection
k. W