0302-055 (SFD)LICENSED CONTRACTOR DECLARATION
1 -hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing wilh 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
752884 B HIC 8/31/04
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 isnot 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 willmaintain 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 REPUBIC INDEMNIT' Policy No. 15671601
(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 WorkersCompensation 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.
Signature (Owner/Agent) Date
PERMIT #
BUILDING -PERMIT
0302-055
DATE VALUATION $165,244.70 LOT 48 TRACT 29323-1
JOB SITE
ADDRESS 79-690 PARKWAY ESPLANADE SOUTH
AP" 609-380-023
OWNER
CONTRACTOR / DESIGNER / EN (NEER
PONDEROSA HOMES Ii, INC.
PONDEROSAHOMES II INC
400 3, FARRELL DR. STE. B 103
400 S, FARRELL DR SUITE B 103
PALM SPRINGS CA 92262
PALM SPRINGS CA 92262
(703)187-710 CBL4 2346
USE OF PERMIT
SINGLE FAMILY DWELLING
SFD - LOT 48, PLAN 1 CXR OPTIONAL DEN). PERMIT DOES NOT
INCLUDE BLOCK WALLS, POOL, SPA OR DRIVE WAY APPROACH
TRACT CONSTRUCTION 2,728.00 SF
PORCHIPATIO 323.00 SF
GARAGE/CARPORT 654.00 SF
ESTIlVIATED COST OF CONSTRUCTION
165,244.70 "
PERMIT FET SU14N ARY
CONSTRUCTION FEE 101.000-418-000 $870.50
PLAN CHECK FEE. 101-000-439-318 $722.74
MECHANICAL FEE 101-000-421-000 $92.00
ELECTRICAL FEE 101-000-420-000 $142.06
PLUMBING FEE 1017000-419-000 $167.25
STRONG MOTION FEE • RESID 101-000-241-000 $16:52
GRADF140 FEE 101-000-423-000 $15.00
DEVELOPER IMPACT FEE $2,405:00
FEE DEPOSIT 101-000.439-318 $750.00
SUB -TOTAL CON=UCTIOAI AND PLAN CHECK
$4,431.07
LESS PRE -PAID FEES
-$750,00
TOTAL PERMIT FEES DUE NOW
$3,681.07
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSULATION CERTIFICATE
This is to certify that insulation has been installed in conformance with the.current energy
regulation, .California Administrative Code, Title 24, State of California, in the building located at:
79-690 Parkway Esplanade South, Mosaic at Esplanade, Lot 48, La Quinta, California
CEILINGS:
TYPE: BLOW MANUFACTURER: CERTAINTEED THICKNESS: R38
WALLS:
TYPE: BATTS MANUFACTURER: CERTAINTEED THICKNESS: R-13
GENERAL CONTRACTOR: Ponderosa Homes LICEN E #
l
BY: TITLE:
PARAGON SC D BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072
BY: TITLE: ADMINISTRATIVE ASSISTANT DATE: 5/23/2003
INSULATION CERTIFICATE
This is to certify that insulation has been installed in conformance with the current energy
regulation, California Administrative Code, Title�24, State of California, in the, building located at:
VOID
CEILINGS:
TYPE: BLOW MANUFACTURER:, CERTAINTEED THICKNESS: R-38
WALLS:
TYPE: BATTS MANUFACTURER:. CERTAINTEED THICKNESS: R-13
GENERAL CONTRACTOR: VOID LICENSE #
BY: TITLE:
PARAGON SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072
BY: TITLE: ADMINISTRATIVE ASSISTANT DATE: 5/23/2003
10/12/2005 08:49 9496312293 ACTION NOW MPH PAGE 01
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING
(Tight Ducts & TXV) CF -4R
PROJECT INFORMATION Climate Zone: 15
Project Title: Mosaic @ Esplanade
Project Address: La Cluinta
builder Name: Ponderosa Homes
Builder Contact: Jeff Nygren
Voice # : 925-460 8900
Project ID #: 29323
Voice #
Sample Group # : 1 Phase: Model
Lot #: 48
Plan #: 1
Address: 61UO-0 parkway_ splana-d South
HERS INFORMATION
HERS Rater: Scott Johnson Jayme Carden
Certification a : CCNSJ614037 CCNJC615157
HERS Firm: Action Now
Address: 2575 Westminster Avenue, Costa Mesa, CA 92627
/oice # : 949.631-2274
HERS Provider: CHEERS
HERS Address: 9400 Topanga Canyon Blvd., Chatsworth, CA 91311
Voice tt : 800.424-3377
HERS RATER COMPLIANCE STATEMENT
Bx
BT
-24
T-24 Compliance Credit was Tfiken for Tight Ducts
The
T-24 Compliance Credit was Taken for TXV
house was:
TXV Verified Yesr J
I
x
Tested / Verfied Approved as a part of sample. but was not tested
The installer has
Provided a copy of CF -6R
x
Air Distribution System is Fully Ducted (sheetmetel, ductboard or flex duct)
Where Cloth backed rubber adhesive duct tape is Installed, mastic and drawbands
are used in combination
cloth backed, rubber adhesive duct tape to seal leaks at the connections.
with
MINIMUM REQUIREMENTS FOR DUCT LEAKAGE COMPLIANCE CREDIT
Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage)
CFA: CFA Leak Max ['Tested Leak
System o
Indicate the maxrmum aowa le Duct Leakage and the calculation used:
V0.7 x Floor Area x (0,06) for Climate cone 8 through 15
0.5 x Floor Area x (0.06) for Climate Zones 1 through 7 & 18
x 400 x (Cooling Capacity In Nominal Tans) x (0,06)
21.7 x (Heating Capacity in Thousands Of Output BTU per hi
Measured Fan Flow x.06
uct Pressurization Test Resu is 5 PA)
100 x Test Leakage/ fan flow = % Leakage
Check Box for Pass or Fail (Pass = 6% or Less)
System M of Il b
Indicate the maximum a owe le Duct Leakage and the calculation used:
0.7 x Floor Area x (0.06) for Climate Zone 8 the ough 15
0.5 x FloocArea x (0.06) for Climate Zones 1 through 7 & 16
x 400 x (Cooling Capacity in Nominal Tons) z (0.06)
21.7 x (Heating Capacity in Thousands, of Output BTU per hour) x (0.06)
Measured Fan Flowx .06
uct Pressurization Test Resu Is 5 PA) fg —
100 x Teat Leakage/ fan flow = % Leakage
Check Box for Pass or Fail (Pass = 6-A or Less) Passx
Systempf
Indicate the ma mum a ow8 le Duct Leakage and the calculation used:
0.7 x Floor Acer - — — •-- ^"- -•- - ..
0.5 x Floor Ares
400 x (Cooling
21,7 x (Heating
Measured Fan
uct Pressurization T
100 x Test Leakage/ I
Check Box for Pass o
Raters Certifying Sign
fan flow
10/11/2005 11:34 FAX 925 734 9141 PONDEROSA HOMES -* CONSTR MOSAIC X1006
INSTALLATION CERTIFIC.,�TE. MOSAIC AT ESPLANADE- PLAN 2728 CF -6R
79-690 Parkway Esplanade West 48 0302-055
Site Address Lot # Pmtmat Number
An installation certificate is required to be posted at the building site or made available for all appropriate inspections. (The information
providiA on this form is required; however, use of this form to provide the information is optional.) After completion of steal inspection,
a copy must be provided to die buil ling department (upon request) and the building owner at occupancy, per Section 10-103(b).
HVAC SYSTEMS;
Heating Equipment
Erpcp.
Ty}v: (pit&, CEC Certifited Mrf Name
heat pump) & Model Nur:iber
Cornformaker NBF075F16G1
11 of
Ef iciency
thrct
Duct or Heating
Heating
Identical
(AFUE, eta)
Location
Piping Load
Capacity
Systems
a CF.) R value
(attic, eta) �
R -value (BUft)
(Btulhr)
— _
2
80%
Attic
42
75,000
CoolingEqulpment
if Rccir-
# of
Rated 1
Equip. CEC Certified Compessor
11 of
Cfficiency
Duct Cooling Cooling
Typ:: (pkg.. Unit Mrf Nar .. and
Identical
(SEER, etc.)
Location Duct Load Capacity
heat pump) Model Num':cc
Systems
2 CF -1R value
(attic, etc.) R -value (Btrftu) (BM hf)
Comfotvnaker NAC242AKA5
2
12
Attic 42 47,000
I, the uadersigned, verify that equipment listed above my signature (1) is actual equipment installed; (2) is equivalent to more efficient
than that specified in the certificate of compliance (Form CF -1R) submitted for compliance with the Energy Efficiency Standards for
residential buildings; and (3) the equipment meets or exceeds the appropriate requirements for manufactured devices (from the
Appliance Efficiency Regulations or Part -0, where applicable.
WATIL,R HEATING SYSTEMS:
Distribution
if Rccir-
# of
Rated 1
Tank
Effn-
External
Heater CEC Certified Mfr Type (Std:
culation,
Idenkal
Input (kW
Volume
ci=cy I
Stnndby I Insulation
TyT-. Name & Model Numl cr Point -of -Use)
-
Control Type
Systems
or BruA,r)
(&rllons)
(EF, RE)
lo!P (%) R -value
Arricd-;an FG624OT40-3NV Circulating Pump
Timer
One
40,000 BTU
50
.62
NIA N/A
For small gas storage (rated input,: 75,000 Bto/hr), electric resistance and heat pump water heaters, list Energy Factor.
For large gas storage water heaters rated input > 75,000 Brabr), list Recovery Efricicncy, Standby toss and Rated )input.
For instantaneous gas water heatcc:, list Recovery Efficiency, Standby toss and Rated Input
Faucets & Shower Heads:
All fauccts and showerheads installed are certified to the Commission, pursuant to Title 24, Part 6, Subchapter 2, Section 111.
I, the undersigned, verify that equipment listed above my signature (1) is actual equipment installed; (2) is equivalent to more efficient
than that specified -in the certificate of compliance (Form CF -1R) submitted for compliance with the Energy Efficiency Standards for
residential buildings; and (3) the equipment meets or exceeds the appropriate requirements for manufactured devices (from the
Applianet: Efficirncy Regulations or Pan 6), where applicable.
Signature, Date
COPY rO: Building Depattincnt/Building Owner at Occupany
L
PONDEROSA HOMES II, INC,
OWNER
u
"
10/11/2005 11:33 FaX 825 734 8141 PONDEROSA HOHES ~ C0NS?R H09AlC W0003
~
U� �� �����I��
�m��°�*��~w��w m~w�o m~w�m�w�m��~
W"3TAU LATION CE-RTIFICATE ALL PLANS CF -6R
FENESTRAJOMIGLAZING:
Manufactured
Operator nodurtS Labelled Site Buildt Product" Total
Type (e,9.. o-valueIs om Default Quantity Square C"mn=mw
m°"m�*"�+e=" mp"w fixed, CF -1 ev�uoz vm u�a/ 2 o
---- � --�--
(GROUP LIKE PRODUCTS)
1. �Milgard111OH O���W S| -_� ,5�W
2. Mi md � O Opw��|��h. �0 ----- ------ ----- ----' -----'---
-' -'� -- _------_'-- ------- -------- -------- ------ ___--'
o. MlIgard710R���i�u� /0 --- --- --- --- -----
----�--_----_' '-_' ----------- ------- -------- -_''__-- ' � �� �---___
4. Mi|gan145O���| �| d .58
----------- ------- --_'__ '--_� -_-------__
-
' ----------' ------' _- -�-- _� __-_' ------------
-
- - -_-__-__-- ---__- _ - �_-----_ -----' 7.
13. _-_ '_---__--------' ----------- __---_ --__---- - � '_-___--__
-
�
-- ' ---------- ------- -------- -------- ----- -----------
n�
---_ ' ----__-___ -----_� --_-_- '------------
,3.
- ----' ----'----'- ------ -' ------- -------- ----- ------------
14.
15. - _ ____ _.
°
Installed U-valuemust he less than or equal tovalue from CF -1 R. Altennatively, installed weighted
average U-xaluefor the Mill fenestration area isless than orequal bmvalue from CF -1R.
/. the undersigned, verify that the festraUon/glazing listed above mysignature (1)is the actual fenestration product
installed; (2)|nequivalent mmormore efficient than the specified \nthe certificate uxcompliance. (Form CF'1R)
submifted for compliance with the Energy Efficiency Standards for residenbal buildings; and (3) the product meets or
exceeds the appropriate mequi/emenksfor manufactured devices (from Part 6).where applicable.
PONDEROSA HOMES || |NC
------- '-- -
--
|tem#m Signature, Date OWNER
(if applicable)
oOPYTO:
Building Department
BuildIng Owner at Occupancy
I LICENSED CONTRACTOR DECLARATION
hereby affirm under penalty of perjury that I am licensed under provisions of
H f• (hapter 9 (commencing with Section 7000) of Division 3 of the Business and
N co Professionals Code, and my License is in full force and effect.
OE =) ch License # Lic. Class Exp. Date
d LOii;'-r. ter• t
cZ r-_ Date - Signature of Contractor
Q 11�f
J1.—
0 OWNER -BUILDER DECLARATION J
HWd I hereby affirm under penalty of perjury that I am exempt from the Contractor's
U) License Law for the following reason:
Z ( ) 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).
( ) 1, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
C'•) () I am exempt under Section , B&P.C. for this reason
N Date Signature of Owner
Q N
O)
Q WORKER'S COMPENSATION DECLARATION
o CC I hereby affirm under penalty of perjury one of the following declarations:
Lo FZ Q () 1 have and will maintain a certificate of consent to self -insure for workers'
X W compensation, as provided for by Section 3700 of the Labor Code, for the
mJ Q performance of the work for which this permit is issued.
Q C) ( ) I have and will maintain workers' compensation insurance, as required by
Q LOQ Section 3700 of the Labor Code, for the performance of the work for which this
0 M permit is issued. My workers' compensation insurance carrier & policy no. are:
It z Carrier I Policy No.
w 5
r` Q
J(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 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. I
Signature (Owner/Agent) C`.' ��: Date } -
t
BUILDING PERMIT PERMIT#
DATE VALUATION LOT
TRACT
JOB SITE - -
APN
ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
USE OF PERMIT
110101* 1400K WAiil lk NP -9: Cm MOV? WAV APPR(IP
I It �%(-r c:0.04 TR0C1 11(1h4 4?a Orr
P0K('.'fYPATI0 '5211w,
r[t{sACI1 R.•-AI}Z}4S4+►i1 i7
Vff
''YN.M 11111% Sb Nl MARY
f"i�r]t�:t'I(tit`•":'liCr:•Ii''k':I'. �{1i•tTi7Cr•33�.+-tJ!+fI it�7R+.R�
.;-•�1i �,II��r.,� ,�I':h' ii�1. ittJi,.,+jy��.:t if-: �'Ak.�
r'..'it,';.�1 C'�i}- Fi?3r. tL1l �iiii}rrlZ'f,.p{yt1
"I -Oil
i•.l .i',: ' ; I:.' : _+`. i ]`fr i� t tt l-(jUL-� 2{r- [lCJI� t
l�tf_t`di
101-TXN),41V-600
,'''i�'.;F!� i`.-.:'lr-+]i li:;i� !r'31?' V t]3 ••f.;[H:-��f 1•L1(ii:
$!r_:..
:Ii , :.f ,::.sr t•. i': I f' i } nl(!•477i-0CA!
FVY i_llV(; HI (ilI.,fk;,:r•+f 3'+ .3:
71r.1-7'f.*�tt�ki
G1 N 4iG 1DiF
RECEIPT DATE
BY
DATE FINALED
INSPECTOR
INSPECT -0 CORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings 0
Ducts
Slab Grade
Retum Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap_
F.A.U.
Framing_
Compressor
Insulation o
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lalh
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
Gas Piping
PLUMBING .APPROVALS
Gas Test
Electric Final
Waste Lines
-
Heater Final
Water Piping
Plumbing Final
Plumbing Tap Out _ _
Shover Pans f —
5ewer_t_Aeral _ _
Sewer Connection, a
Gds Piping
Gas Test
Appliancvs 1 _
Final
Utility Notice (Gas)
Equipment Enclosure
O.K- for Finish Plaster
Poo! Cover j
Encapsulation _
f
Final
COMlt ENTIZ.
�� q'1 �Cl.— ��✓
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rcugh Wiring—
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
_
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
G — - — NOPW