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0403-262 (SFD)LICENSED CONTRACTOR DECLARATION 1 I hereby affirm under penalty of perjury that I•ttm, licensed under provisions of Chapter §,(commencing with Section 7000) of Divisio i 3 of the Business and Professionals Code, and my License is in full force and effect. License # Lic. Class Exp. Date Daie, k f Signature of Contr tort , , ✓� »� 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 1aRhfPT Policy No (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 Califorhia, and agree that. if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Cede, I shall forthwith comply with those,provisions�+/ Date" y/Applicant Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose -behalf this application is made & each person at T whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned prope�rty`for,inspection purposes. 1 ignature (Owner/Agent)'''/, j�� Date// • 7 Cr CfF/ BUILDING PERMIT PERMIT# 04W-26-2 DATE 7 VALUATION LOT TRACT 12 JOB SITE ADDRESS 'Y,/- 0CATrp Ir ,A APN 77����J-024 OWNERv CONTRACTOR / DESIGNER / EN 1NEER AT 221.4 N :R2IDGEWOOD ... R0, i.UX 696 2AN�`,�! AMAOA 9270$ _ : Q%).31,1TA CA 92253 CiI150)464-7820 C Uf 0206: USE OF PERMIT I546 S.F. St{IO PgRMIT I3t3ES 7.401 'INCLUDE BLOCK W&1.1, PCIO dSPA OR DIR 'WAY APPROACH, 7S% PXI DUCET) KAN CFiE_ K Fr -,E FOR PAULfillat>,� PT�AB�iSOl�SAME 1'�'P11a TRACT CONSTRUCTION 1,540 Sr 1''ORC!•1/pATIO 130.40 SP' GAP AGWARPORT 52L06 3F 1T.S11MA COST OF COMMUC-MON py-pl?ft, P501'SIU CONSTRUCTION ME 101.000.418-000 $621.:$9 PLAN CHECKFEE 101-000.439-318. $124.60 1%E !DEPOSIT 1011.000.439.313 4250.00 NIFCHANIGRL t IZE' ' 101-000-•421-000 ELECT1UCAL FET: 101AOM420.000 3113.0 PLLI:' BI NO FEE 101-0004119-000 $115.04 STRONG .MOTION FEE - PAID 101.000-241-000 $934 GRADING P7_L 1 01 -CIOO-423-000 $15.00 DWELOPER, IMPACT. F919 !$2,.445.00 PR FXIISZ PLAN 1101-000-441'345 V10i1.00 B,_.r6NZM,' VL.,LJ.0 All-.y18`.S..a'LL'7 LnS-7AL+=, - $3. 578,3 TOTAL P3a.�1R`` ITY' MS DUE NOW $3.328-31 AJACE DEPT. RECEIPT DATE - BY �' DATE FINALED INSPECTOR i' 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 : 0 — 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 Drywall - Int. Lath 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 I 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) t444"* P.O. BOX 1504 APPLICATION ONLY /'lfejn66��,8-4CALLETAMPICOBuilding (P (� 4 Address A, CALIFORNIA 92253 Owner Mailing F BUILDING: TYPE'CONST. OCC. GRP. Address f A.P. Number (f t t. / Zi � T I,,j % �(/ /dam /1 Q%] —�a ,(L/ ,� 1 n� � Legal Description 4o ip StateLjc. 171 1&® ILi & Classif. ic. # Designer Address Te City Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5.Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to 'its Issuance also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). L: 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, Buisness and Professions Code: The Contractor's License Caw does not apply to an owner of property who builds or improves thereon and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale.) 1'1 I, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) 1-1 1 am exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company rl Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed it the permit is for one hundred dollars ($100) valuation 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. Date Owner NOTICE To APPLICANT: If, after making this Certificate of Exemption you should become Subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Lender's Name Lender's Address 1 This is a building permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. 1 certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives -of this city to enter the above- mentioned property for inspection purposes. Signature of a0plicant Date Mailing Address City, State, Zip Sq. Ft. No. Size Stories New Add ❑ Alter ❑ n No. Dw. Units �l Repair ❑ Demolition ❑ PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL ZONE: BY Minimum Setback Distance : Front etb 'e❑tP_.�r Line- Rear tback rI ; AQJJIN Side Street Se � FINAL DATE Side Setback from Property Line INSPECTOR Issued by: Date Permit Validated by: Validation: WHITE = BUILDING DEPARTMENT YELLOW = APPLICANT PINK = FINANCE Comments'Credit of $73.20 to be used in future certificates. At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions under 500 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile homes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason: EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Education Code Section 17620 and Government Code 65995 Et Seq. in the amount of $2.24 X 1,546 S.F. or $3,463.04 have been paid for the property listed above and that building . permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued. Fees Paid By . C/C-1st Bank, Sharon Bills Check No. 71008 Name on the check Telephone 880-3446 Funding Residential By Dr. Doris Wilson Superintendent Fee collected /exempted by Patricia Barbuzza Payment Recd $73.20 $3,536.24 Over/Under Signature NOTICE: Pursuant to Government Code Section 6020(d)(1), this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified above will begin to run from the date on which the building or installation permit for this project is issued, or from the date on which those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier. NOTICE::This Document NOT VALID if Duplicated Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting 4: CERTIFICATE OF COMPLIANCE Desert Sands Unified School District - 47950 Dune Palms Road �o Q BERMUDA DUNES r Date' 3/17/04 La Quinta, CA 92253 RANCHO MIRAGE (7 No. No. 26707 (760) 771-8515 fA �i� WELLS ESERT PALM DESERT ,y LA QUINTA ,.�. 4 INDIO O Owner Pat Doherty APN # 774-245-024 Address 2214 N. Ridgewood Jurisdiction La Quinta City Santa Ana Zip 92705 ' Permit # 0403-262 , Tract # Study Area Type Single Family Residence No. of Units 1 Lot # No. Street ' S.F. Lot # No. Street S.F. Unit 1 12 77660 Calle Temecula 1546 Unit 6 Unit 2 Unit 7 Unit 3 Unit 8 Unit 4 Unit 9 Unit 5 Unit 10 Comments'Credit of $73.20 to be used in future certificates. At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions under 500 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile homes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason: EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Education Code Section 17620 and Government Code 65995 Et Seq. in the amount of $2.24 X 1,546 S.F. or $3,463.04 have been paid for the property listed above and that building . permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued. Fees Paid By . C/C-1st Bank, Sharon Bills Check No. 71008 Name on the check Telephone 880-3446 Funding Residential By Dr. Doris Wilson Superintendent Fee collected /exempted by Patricia Barbuzza Payment Recd $73.20 $3,536.24 Over/Under Signature NOTICE: Pursuant to Government Code Section 6020(d)(1), this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified above will begin to run from the date on which the building or installation permit for this project is issued, or from the date on which those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier. NOTICE::This Document NOT VALID if Duplicated Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting MH -1672003 09:02P FROM: Fab -18-03 42:53pm Fran-0LD REPUBLIC TITLE RECORDING M- UESTMaV . OLD UPbBJC TULZ ca WHEN RECORDED MAL. TO AND MAIL TAX STAT@MENTS To Cove Deveiopaleal, LIC 2310 N. lUdtewood slat, Aus, Cs 9/arya(�s Tide Order No. Escrow No. (-u-Oks ilt•>�p3 �� TO:5648601 P:3/6 780'1172111 r T461 P.04100 F-667 �Ol280;R-724341L2✓ iMx Jf Papa I of g Raearid in 0/ficial ttaeorda C—Ay of Rival -side copy L. OMa Alsraaar, CDNMV Clarlt A R�ardar u s i „md tu OA .3 r A R L Nary WMA M%AQ 1KlIa GRANT DEED ME Ulr nsr 'M CR (s1 OPS A MM WCUMBMM OLYTRAi18M TAX h am CITY TAIL la Sego 13"0 (e a3St �xvs kT. 0J `3 o =ww on dw Adf vnlna ortw,waw oma.RrAir, aft lad 9E1nW-pwsMg= or �+P�ad as 15Ii raAm kai value of r6au ar auampeaaau r<unaiataa nt tial ofrak FOR A VALUABLE SIDERATION, rlaaeipr ofwbich.is hereby aakwwlei%A PltticJf T. onbany and Sh ty A?. Dobttrty, 649band and Wife as X)bt Tbaants hereby GRANT($) to Cove Developmelat. LLC , a California LIMLted Liabll ty COMMw do fbIbMng desq'o" raa! Prtrpeny In t:hc city *FLA Wata, ColmW of Riymtde, Star of Caiifamis: As sb*wn in Qftit °A" 40achtd held* and made a part hcmf A.P.N. Ba wnacbed Dated: N©vaMber 12, 2102 STATE OP CALIFORNIA cotlrm► � E' ,} ss. uaaangtned, Nc=q PUND In and for wild sm, panwally appea 1 AtKsmapy known to ata (or pmwed to on on the basis 61 N arldum) io be an tronsaf S) Whose nwjW4I Wsra uftgobvd to go "w" IrmownM aAd Ackwwadlpd to Rte that o+P»ubl1wb a by hW_ DIgow1l, 8 ftnMw and n UM (M&MUM VM P V'W M(Sh at the tatty upon bdW offVMlct+ ttii paraan(A1 aaead, axaaucad ea. dK6'ilnaM rNTtl e� atf4enlClallaal. (bw v Notary fa0tnm or Solt DAWIt ►ANQ '—rt C6afm./1209311 1 G�MAY NWo-eu alu (N `r ow f! Caw. a# C.4 w,a.4841 *sit Tax Staten as as Directed Above Doe w lnat•.m provided by OLD REPUBLIC TITL11 f, aMIPANY DesWpdon: Riverside, CA Document- Year. DOOM 2002.724341 Page. 1 of .3 Order. AE -02-13-2003 0241-48 PM Comment: ,• y� Feb -13-03 02:54pm Frm-oto NEPO IC MLE T0: 5648601 160,782111 t-683 P.08/08 F -86T ?73.215-004 LOT 4 BLOM I OF SANTq � MAP ON FILE DJ BOOR 1 B, P OF MAPS. LA A9 3Hp WN By � ���QI � � UNIT NO. 1, 774475-p07 VEPSMS C0 SH LOT ? SOCK 187 OF SgNpA CA�LITA AT VALE LA MAP ON F 1N BQpg it, PAGES 30 AND 310.- Q181r'1: A 1QYP1' NO.18, AS SHOWN By a', 774.973,406 RRC10F pg OF RiVER81p£LOT COUNTY !ON� 1 SANTA 9, Pq MAPBLOCK �A AT VALE LA QLW fA OE8 30 A11fD 31 of MAPS, RE UNrr UN &lvMO. 18. AS SXoWX By Z��'S'OF SANTA BWK 19, PA 34 ANDD 31 OF MAPS 1 Qt S O rrNo' ! 6, AS SHOWN BY 794-09$-0OS vMMIDE C'Oulay. LOT 20 NW= 215 OF SANTA L1'1,A AT VALE � MAP ON FIlrS 1N BOc?IC 1 S, PACE 39 OF UAM RIMORDS OF TW 177 Ip CO 20. AS S1i+OWNBy 77449S-OOb UKI'y. LOT l9 BLOC7C 215 OP SANTA CARMMITA AT Vgt,R MAP ON FILE 181,BOOK 19, PAQE 36 OF M O,,,jVp� UNIT NO.24. AS SHOWN BY 774.111-003 . REODR� Ole RIVEpt=g cOtrNTy. LOT 22 BLOCK• 192 OF BANTA CAR�►'1FL> . AT MAP ON PB,$ IN BOOR I9, PA(M 33 ANN 34 VALE LA OF QUINTA UMT NO. 19, AS SHOWN BY 776-112-004 MS' RECORDS OF RIVFR$Mg COUNTY. LOT 21 BLOCK 191 OP SANTA CLT1'A AT VALE A MA P OA1 PILE IIY 800K 19, PAGES 33 AND 34 OF QUiNTA'11NITN0,19. AS SHOWN BY 774-173-023 RECORDS OF RIVO SIDE COUNTY. i L09' ! ! SLOX 249 OF SANTA C MAP ON MX !N ARMBUTA AT VAL9 LA QtM4TA IIMT NO. 23, AS SHOWN BY 8008 20, PAGE 2S Of MAPS. RECORDS OF RIVMjjoE COUNTY, �) 774.173-024 LOT 12 bLOMV(j3 o SANTA l Z5 01; AAT VALE LA QUMrA UNIT NO.23, AS SHOWN $Y MAP ON 2 IN BOOK 20, $ABB 2S OF MAPS, RFMRDS OF RJVMUbE COUNrV. 774.245-009 ' ..� LOT 16 BLACK 7190 OF SANTAY'A AT VALE LA QLIIAffA UNIT N0.26, AS SHOWN BY MAP ON p" IN I3007 C 24, PAGE SO 4F MAPS, MORDS OF kY5 MpjDE CotM Y,. 4.245-010 LOT 15 ux*K 290 OF S A cA1IMELt7 A AT VALE LA Q111NTA U4T1' N0.26, AS 3tiOWtd BY MAP aN Ti PADS SO OF MAPS, ASWAM Of RIVERSIDE GbUNTY. IAT 14 BLOCK 290 OF SAMA CARMEUTAAT YALE LA QUIN rA*tnCr NQ, 26, AS SHOWN BY I�fA P ON FTLS IN BOOK 20, PAGE SO OF MAPS. R&CORAS Op hIV>:RSIDB COUNTY. �- I IQ IR�II�f�I�� lMill 902-,1434t IM D"cotfon. Riv&wda,CA Document-YeW:DoolD 2002.724341 P"s.' 2 of 3 Order. A!~02-13-2003 02-41.48 PM Comment: 4 11% A JL -era,) YJ7 : UttF 1 1 \lJl �: x T0:5648601 P:516 Feb -18-03 OVUM Frmn-OLD REPUBLIC TITLE 780;782111 r-se6 P.Os�QG F-967 774.24"12 LOT 13 BLOCK 290.OF SANTAA A YA Q MAP ON FU W BOOK 20, PAOR Og LH Lq' uprA Z I�J<TNO. 26. A8 SHOq►N BX MABS. RROORDS OF EWMDg COUNTY. 774.24M2Q _ LOT 9 BLOCX 290 OF SANTA CAIRWA AT VALE LA QM:lA tM No. 26, AS SHOWN BY ' MAP ON FHLB IN BOOR 20, PAOR $0 OF MAPS% R80GRDS OF JRTNI;RSIDE COUNTY. 774-245-022 LOT 10 BLOCK 240 OF SANTA CARMPA AT VALE LA QuMA UNr.Np. 26, AS SHONYN BY MAP ON FILE 1N BOOK 20, PAGE $O OF MAPS. RECORDS OF RMI RME Count. 774424S-023 tAT 1 I BLOCK 290 OF SANTA CARMMnA AT VALE LAQU A Lrt4T N0. UAF 'ON FLW 1N BO26. AS SHOWN 8Y . (vGWt" OK 20, PAGE SO OF MAPS, UCOM)S OF BiVER$IDB COUKiY, ` i I� 774-245.OU LOT 12 BLOCK 240 OF'gAWA CAP-bM TA AT VALE LA Qu"frA [!MT No. MAP ON iZ6. AS SHOWN $Y II E IN goon 20, PAR3fi'SO OF bWA, RECORDS OF RIVERSME COUNTY. 0 9 BIMINIlYuItla of =.. D&Scd►pftn: Rlverside,CA Dooument-Year.MvID 2002:724341 Page: 3 of3 Order AE -02-13-2003 02.41.43 PM Comment: RCQISTRICT -PLANNING REVIEW. FORM This form is to be used by CDD staff for review of single family dwellings*in the RC (Cove Residential) District per Section 9.50.090 of the Zoning Code. Its purpose is to determine.: 1) . that the proposed housing design does not duplicate the same architectural' style of any house within 200 feet of the applicant, .and/or 2) if. there is a need for the applicant to file for Master Design Guidelines: If the applicant does need to file..a Master Design Guideline, please transmit this information to the Building and Safety Department a& part of your correction list. Please attach additional explanations as necessary. APPLICANT: 4�tJ/ SITE ADDRESS: l7q. — (PC) APN 114 - �2 4. CASE NO.: LEGAL: LOT _ 1 BLOCK 29 D UNIT S.C.@V.L.Q. CHECK AND APPROVED.BY: DATE: { Inform the assigned Building plan checker upon your assignment to this case. The CDD Executive Secretary maintains a log book to track applications. and assign case numbers. REQUIRED ITEM . Y N COMMENT/CORRECTION Verify legal and APN information Consistent with MDG on file, (as applicable) MDG filing required (5 filings since 9/3/98) Architectural variety within 200 8vf.urrounding area:$ O Planning Commission O City Council OW 'Community Dev. Dept. IZ Initials Case No. _t2 C .av- 9 _7( Exhibit R Wi1Pr@qB0YQfPA r'°feat Other Requirements: ti � - ,, •rw.�w.....�. +...+.�..o..r..r. �ic33�,t�.it�liila:; �*�' .'1'.:.�'y '�y .�. _.a.�..... ...�......,...�...w.. .. � .,,.�.....,..,...r.�.. — . — — CITY OF LA QUINTA SUB -CONTRACTOR LIST Jai ADDRES S .. PERMIT NUMBER -e OWNER BUILDERry , This form shall be•posted on the job with the Building Inspection Card at all times in -a conspicuous place., Only persons appearing on this list or their, employees are authorized,to work .on this iob. AnV chances to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result.in a stoppage.of vvgrk. and/or the voidance. Certificate of OccupancY j !9C � a� Build O- in & Safety Department F g Y p 7 I { This Certificate is issued pursuant to the requirements of Section 109 of the California Building Code, certifying that, at the time of issuance, this structure was in compliance with the ` F provisions of the Building Code and the various ordinances of the City regulating building { construction and/or use. t a� BUILDING ADDRESS: 77-660 CALLE TEMECULA z Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0403-262. a; ' Occupancy Group: R3 Type of Construction: VN Land Use Zone: RC a, J Owner of Building: LEGACY HOMES Address: P.O. BOX 696 City, ST, ZIP: LA QUINTA, CA 92253 / By: KIRK KIRKLAND Date: MARCH 11, 2005 Building Official } F POST IN A CONSPICUOUS PLACE FEE -17-2005 07:42'AM IrE OF FIF,,DVERIFICATION AND Project Title Prpje i51an Number 14;0111 Telephone ........... : . ............ Builder Contact 0 -G-m-p-leGrou Number T leph no HERS afar d — $`am—pleHou,- Number Dat P.02 CF -6, Itying signawreC di: 6, HERS Provider: 4 City/state/zlp: Sir ��e Copies tc: BuildefiHERS Provider .............................. RAT 0 VPL I NC ENT but -Was 1�j tested S TSL as Part Of samille testing, Sl� C Tested -�uses identified onj,1hls or The house WaS.� verification, I certify (�a% the 'd t s checked on this form, As the HERS rater providing dia2nostlO,,esting and field nts a - � ' T l with. the: diagnostic este comp ancerequirenn8 as plenul is or platform returns in lieu p (i.e., does not Use building cavities co ply system is fully ducted. ' nds I cloth backed, rubber adhesive duct 16Pe is Instducts) tic and drawb*i are used in-cornbioatlon, &Wherealledat duct coh, mas duct tape to Inst .n ectit with cloth backed, rubber adhesive Udi LEAKAGE REDUCTION COlMPLIAI, CIX CREDIT INIMUM REQUIREMENTS FOR D Duct Diagnostic Leakage Testing 6%` Duct Leakage) Results (MOXIMUM 'bjeasured values Duct Pressurisation . . Test I Results (CFM @ 25 Pe) . Test Leakage F16 w in CFM 4 numb 6ftovanseniT If farij, is calcul6tid,as 400cfm/tOn x ow calculated lue ller0(e lf,fan flow is measured enter measured value here Leakage Percentage (100 x Test Leakage/Fan Flow) C3 Ch6ck Box for pass o . r Fall (Pass=6% Or less.) . eras Fail THERMOSTATIC EXPANSION-VA01E I I 1)'or Co'mril!ssion Went V Thermostatic Expansion Valve (or Commission approved No equiValent) is installed and Access is pYovidi6a oasnspectic I C] MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT RCCA Man4-'Ib Design requirements have been n of i. -C3Yes C3 No V (rater has verif led that 'actual .Installation matches v �:ues in CF.IR and design on plan, 2. C3 Yes C3 No TXV Is installed . or Fan flow has; een verified.. if nc TXV. -1 verified fen flow Matches. desIgn bfrom CF R. Measured Fen Flow 7 Yes for both I and 2 a a Pass ass Fall NY Pass Fall