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0311-075 (SFD),f LICENSED CONTRACTOR DECLARATION AI 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 Professionals Code, and my License is in full force and effect. License # Lic. Class ti Exp. Date 76004.4 Date O�,^�?`SignatureofContracto,� ,_ • n�Y _��!M�� 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 ST.A1'1A3 ldi? Policy No. 46-03.9353 (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 witb those provisions. Dale: 11, 7Applicant ,— 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 L'a 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') .s. .�_ .moi' i i�l�` Date! C5 BUILDING PERMIT- PERMIT# 11-07 DATE VALUATION LOTTRACT 29122 JOB SITE ADDRESS 5!1,,1 ,f AV1,VJL%ir ya�<Ii.lt! APN I7 dGD-i1U�+ OWNER CONTRACTOR / DESIGNER / EN (NEER GMTER 1?.. BANK PIM I�A,.CTFICA DEV'ELOP'MENT CORP, 1420 X V A►JIZY BLVD. S E CMNUS AVE,:317, 205 AGRA►tt RA CA 91801 R3IANM Cid. 92373 CRUP 4911 USE OF PERMIT SINCKE FAM3: Y D4_i d:f;?JG S70 - LX)7 6, PLAN 2B. Pf.1RR IT DOES NOT iNcl UGF, S;:c=, 'WALI S, P001t SPAS OR DRIVEWAY APPROACH CUSTOM CONSTRUCTION z295,08 ��'•, PORCHIPATIO 307.00 SI', GARASlI+'�lGARPORT 431.00 SF EFIM"TKD COSI' SAI)' VIONS11RUCTIO � 18%17b.20 .�'�:t�l�ixx :ilj'1e�Tf', ✓�'C�"ftdJ�;:�.t1rY ' ' _ _ • . . fN`ONSTRstr`1`3'ON ;vER . 101.000-418.000 $954.50 PLA -0 CHECK.F71 101-000,439•:319 VK04 MEMIA141r.As. FES• 101.0004,21.000 8116.00 P9.p£.11}iiit11".��yy'�91*C//A1��.pp.�•i�pppF.r',E � 1.473-p0�(4�/iyl_-p2>8�-/(pJ/i�10 @$1370`5 C.lIUM. ING Pd.'E loo-000-419-wo $1733,25 . STRC NO 11BC. HON FEE • . M1.0 101.004- `24.1.004 $19.92 GRAD1W FEL 101-000-423-i'Ooo $Iuo iJl?Y 411PE11 IMPACT FEE 5 MYS-` OTAL ib0N1-1MLrVt10X AND P'LPH;C''If� • $4,601176 LM3 PRE -PAID FRES $0.00 TOTAL PERMTORIES DUE NO'S $4408.76 DEC 0-.1 2003. RECEIPT fvl t : 7F DATE t P4T BY . ' / f DATE FJNALE9 INSP CT R INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab GradeReturnAir Steel Combustion Air Roof Deck Exhaust Fans O.K to Wrap S ,3 o F.A.U. Framing L Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Q Drywall - Int. Lpth rV 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 APPROVA 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 d 4 Appliances - Final COMMENTS: / 1 I \ 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 U Utllity Notice (Perm) La� Q,c Certificate of Occupancy0 4 isa G.1i OBuilding Y p & Safety Department 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 provisions of the Building Code and the various ordinances of the City regulating building construction and/or use. BUILDING ADDRESS: 55-154 LAUREL VALLEY Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0311-075 L Occupancy Group: R3 Type of Construction: VN Land Use Zone: RL Kj Owner of Building: GENERAL BANK Address1420 E. VALLEY BLVD. City, ST, ZIP: ALHAMBRA, CA 91801 —1 64n By: GARY HARTMAN Date: FEBRUARY 11, 2005 Building Official POST IN A CONSPICUOUS PLACE CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Part 1) CF -4R THE LAURELS a- " 'Z--05 Project Title Date 55184 Laurel Valley, La Quinta, CA. First Pacifica Dev. Corp. Project Address Builder Name Dave (909) 841-1942 2-S Builder Contact Telephone Plan Number Tim Topham (951) 780-7265 1 HERS Rater Telephone Sample Group Number -ZAZ /2005 6 Sys. 1 -ra-k. 20i 122 Certifying Signature Date Sample House Number Firm: Energy Calc Services, Inc HERS Provider: CHEERS Street Address: 16551 Mockingbird Cyn. Rd. City/State/Zip: Riverside, CA 92504-9638 Conies to: Builder, HERS Provider HERS RATER COMPLIANCE STATEMENT , The house was: ❑ Tested Pr I 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. ❑x 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 draw bands are used in combination with cloth backed, rubber adhesive duct tape to seal leaks at duct connections. ❑X 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 Test Leakage Flow in CFM If fan flow is calculated as 400cf Vton x number of tons enter calculated value here 1200 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) ❑ ❑ Pass Fail ❑ THERMOSTATIC EXPANSION VALVE (TXV) or Commission approved equivalent ❑ Yes ❑ No Thermostatic Expansion Valve (or Commission approved equivalent) is installed and Access is provided for inspection ❑ ❑ Yes is a pass Pass Fail January 5, 2001 CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Part 1) CF -4R THE LAURELS Project Title 55164 Laurel Valley, La Ouinta, CA. Project Address Dave (909) 841-1942 Builder Contact Telephone -2-2— -05 Date First Pacifica Dev. Corp. Builder Name 2-S Plan Number Tim Topham (951) 780-7265 1 HERS Rater /f Telephone Sample Group Number Z- /2005 6 Sys. 2 Certifying Signature Date Sample House Number Firm: Energy Calc Services, Inc HERS Provider: CHEERS Street Address: 16551 Mockingbird Cyn. Rd. _ City/State2ip: Riverside, CA 92504-9638 Conies 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. ❑X 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 draw bands are used in combination with cloth backed, rubber adhesive duct tape to seal leaks at duct connections. 0 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 Test Leakage Flow in CFM If fan flow is calculated as 400cfm/ton x number of tons enter calculated value here 1200 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) ❑ ❑ Pass Fail ❑ THERMOSTATIC EXPANSION VALVE (TXV) or Commission approved equivalent ❑ Yes ❑ No Thermostatic Expansion Valve (or Commission approved equivalent) is installed and Access is provided for inspection ❑ ❑ Yes is a pass Pass Fail January 5, 2001 Doo 16 04 11 t 46a Energy Calo Servioes Ino. 780•-0558 X54 p, 3 INSTALLATIOV.CERTMICATE p'agc 3.uf 13) Cif -GR. �4c Addrex+ r Permit Number DUCT LEAKAGE AND DESIGN DIAGNOSTICS :.I: titin• LEAKACE 103MICILI )N ressurtzsUoA Test Resultx (CFM tit 2!PA) I'oxt l.wikCI-IA) 1'iw Fllru• . It F;tn Flow IL. Calculalod as 400 .chVion x numbor of tons, or or, 11. % x Hoatintj Capacity 30 in Thousands of Btu/nr, anter ealculnWd value novo __ _ If tan Now is measured, enter measured value. here -T Leakage Fraction Test Le�kagt;/(Measured or Calculated Fan Flow) b Pass if leakage fraction -/- 0.06 ❑ Pbss Fail �.t �1:� �: U{1("1' 1;►;,�i(A(:F; 321:1)U<'1'tt)N \Fjroxaurwition Tota Rosults (CFM rN 25 NA) I ;m Plow , II Fan Flow it; Calculalod or, 400 cfm/ten x numbor of tons. or as 21.7 x Hcaang Copncity Int Thaasariox of Stuft, anter rtllbulated w+lu+: If fan flow is measured, enter measured value horn Leakage Fraction = Test Leak.age/(Measured or Calculated Fon Flow) Paas if loakago litachon • /- 0.W. ❑ . Palo Find For AVRONOI, rt l•N: Nh;Al AN7:S MIX- Tho following aloanostie tooting was completed: \ Duct Fan Pressurisation at rougn-in moacuroo leakage (CFM) CHECK AFTER FINISHING WALL: Yos ❑ No ❑ Prossuro pan tort or Houco procour¢ation tend Yes ❑ No ❑ Visual Inspection of Duct Connectiuns ❑ Pass Fan 1S' Y' Yqs ❑ No. Thomlostatic Expansion Valva is tnstaltnd ano Acu,s-.>, Is T^ p(ovtdoa for innpocllon El YON is a p; -WN Bass Fid Yt�6. • • r ❑ No AGCA Manual D Design calcul;+tions have been cornplutod Duct Dustgn tU on thu plan:; and duct vir.Wilabon matches plans, - 7, Yor. ❑ No TXV is inrt;tllod or Fin flow tim, boon vonAoA, if no TXV, ve-rdKid fin flow mitchets deslgr. from CF -JR' Measured Fan Flow = Jt�7' ❑ Yes for doth 1 and 2 Is a Pass N:,:::; I -;II, I, trio unaersignea, vf2rtfy that th& abavo diagnostic tfeat rvsviW and the work I performed 3SSJCi3ted with the test(S) 16.p confoemonoo with the Mqurrgrnonto for complaonvi credo [Thr butldrr ,hall provit) tnO MLRS provtdor a COPY or tho CF -6R s-gnoo by trio builder employ000 or uub-eoMractoru curtttymg that diogno,;tte Costing and installation mrKti the requir:mtlnt for complianeo credit.) PorfPorto Signature. Dato Instalbng' Subcontractor (cc. Name) OR ormtW General Contractor (Co. Name.) COPY T0: Building Dopartment HERS Peovidur id appttciblu) Guildang Owner at occups+ncy ConlphoAeo F6m-1s :inpUtmbcrr 200? — A? , t'T/ZT 39Vd AIIII'llplop, OF qp\ 4211 Latham Street - RiVersld®, California 92501 a Phone: (809) 686-8760. Fax: (909) 686.8786 License 0 794484 CF6R 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: TRACTIPHASE: THE LAURELS/ PHASE 1 LOT 6 SITE ADDRESS: 65-154 LAUREL. VALLEY - LA QUINTA, CA CEILINGS: BATTS MANUFACTURER: JOHNS MANVILLE THICKNESS: 13' R -VALUE: R-38 OWNS: • : BLOWN INSULATION MANUFACTURER GREENF/BER THICKNESS: 8.1" R- VALUE: R-30 CEILINGS: BATTS MANUFACTURER: KNAUF THICKNESS: 10" R VALUE: R-30 CEILINGS: BATTS MANUFACTURER: KNAUF THICKNESS: 6'/; R- VALUE: R-19 IFTERIOR WALLS: BATTS MANUFACTURER: KNAUF THICKNESS: 3 N' R- VALUE: R-13 INTERIOR WALLS: BATTS MANUFACTURER: KNAUF THICKNESS_ 3W R — VALUE- R-1 I GENERAL CQNTRACT-0k THE BREHM COMPANIES BY: TITLE: DATE: BY: TITLE: P CTIOI DATE: JARUARY 11, 110I1dif1SNI N831S3M WESTERN INSULATION L.P. 9818989196 L8:80 S®0Zaim