0311-077 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
r"hapter 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 Exp. Date
76 RM4 B 0:3/31121c
Dated 1-" 1�' Signature of Contracter • ....� �— �_". `�`
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).l
( ) I am exempt under Section• B&P.C. for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
1
I hereby affirm under penalty of perjury one of the following declarations:
( ) I have and will maintain arcertificate of consen(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 QTA `, FUpID Policy No. 44 ®3-i33S3
(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..tose provisions. 1
Dade:
aie:l2' v 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
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 inspections purposes.
S ignature,(Owner/Agentj�::)- ._1 )�/1'�s � DateO
BUILDING PERMIT PERMT#
DATE VALUATION LOT TRACT
1,911 ' : $�2aq 4 �r70 -8 2.9122
JOB SITE
ADDRESS r 10T AVREL VALI.;$`Y
APN
775 -340 -Ci
OWNER
CONTRACTOR / DESIGNER / EN (NEER
GFAIT.: JJI '. 3A13iC _
F=f PACT MCA T nFJ,C3IxhriMX' CORP.
1420 £, VAT.EY BLVD. D.
5 E. MT.% 3 AVE, UM 205
A'GI1W,-BRA CA 91801
TbMLANDS CA 92373
(909)798.3688 C'Mig 4911
USE OF PERMIT
SINGLE FAp+o..y DWELT ]No
SFD LOT f:, -PIA14 311tt PXfiMIT L70FS ta0'! liiC°;.ZSOLI;t?Ga,' WALLS,
POO14 SPA, OR DRIVEWAY APPROACH. 75% REDUCTION TO KKK CHECK
PER DUE TO MULTIPLE ISSUA14CE OF SAME PLAN TYPE?
ClUJUTOM CONI13TRUS:TION 2,422.40 BF ,
PORC>• IPAT1O 211.00 SP
0AR& }ElCAUORT 466.40 OF
ES7'F1 AMM COW OF CC8Nly�. IMCITON
�'tYCD,�vl�fry
COW ST12UO T ION 1,7E, 101X000-418-000 599100
PLAN CHECK "M 101'000-439-318 $204.49
IMECHANICA1, "Er.N .101.000.421-000 51.18.00
ELECTRICAL L IMEE101400.4.20-000 $142.39
101 d0i 0-X415+-i1(1(i 51.73,25
PLUMB1110FEEs-101-000-241-000
STROND M.OT'101 FELL - BSIi1 1Q} _Ui?Q-?, 1-'CfQO '�ZO.116
ORADINO T,9 101-0010423-000 ' sisrVt+
DEVEWPM IMPACT FES . �2,4tl3.00
.A:r+`'E' TAF PUBLIC: PLA.CM - X3.i?..111270n-0 0-4.45.00Q MOO
''1~LXD-1"CifA)L. C'CJN9MUC-TION AaM P. L ' CIM -T
1'i3' ',flak, P =MIT MS DM NOW
DEC 0
1.2b03
CITY br LA. C2WNTA
RECEIPT
DATE " '
BY , j
DATE FINALED
INSPES,T R
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
`�
Return Air
Steel
WCombustion
Air
Roof Deck
Exhaust Fans
O.K. to Wrap
%
F.A.U.
Framing
d
Compressor
Insulation
a
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
B
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALf
A PROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Appry al 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
Sewer Connection
Pool Cover
Encapsulation
Gas Piping
Gas Test
d
Appliances
Final
COMMENTS:
Final p
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit ,
Rough Wiring
Law Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
f
1•
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Part 1) CF -4R
THE LAURELS X --L-- -05
Project Title Date
55110 Laurel Valley, La Ouinta, CA. First Pacifica Dev. Corp.
Project Address Builder Name
Dave (909) 841-1942 3-R
Builder Contact Telephone Plan Number
Tim Topham (951) 780-7265 1
HERS Rater Telephone Sample Group Number
r7-,-- /2005 8 Sys. 1 Track 29122
Certifying Signature Date Sample House Number
Firm: Energy Calc Services, Inc HERS Provider: CHEERS
Street Address: 16551 Mockingbird Cyn. Rd. City/StatefZip: Riverside, CA 92504-9638
Copies to: Builder, HERS Provider
- HERS RATER COMPLIANCE STATEMENT
The house was: Tested 4M 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.
0 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 CFM5
If fan flow is calculated as 400cfm/ton x number of tons enter
calculated value here 1000
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
0 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 ass Fail
January 5, 2001
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Part 1) CF -4R
THE LAURELS
Project Title
55110 Laurel Valley, La Ouinta, CA.
Project Address
Dave (909) 841-1942
Builder Contact Telephone
Z— % -,
Date
First Pacifica Dev. Corp.
Builder Name
3-R
Plan Number
Tim Topham (951) 780-7265 1
HERS Rater Telephone Sample Group Number
!/ /2005 8 Sys. 2 Track 29122
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
Copies to: Builder, HERS Provider
HERS RATER COMPLIANCE STATEMENT
The house was: WTested JW 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.
0 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 r7 Z
If fan flow is calculated as 400cfm/ton x number of tons enter
calculated value here 1600
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
0 THERMOSTATIC EXPANSION VALVE (TXV) or Commission approved equivalent
IK 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
Deo 16 04 11246a Energy Calo Servioes Ino. 5;58
UC
%�r�l VP 3 '
INSTALLATIOXCERT.LFICATE p'agc 3 uf.13)
C.1 VR.
SBP Addeem
10•rtuit Numhcr
DUCT LEAKAGE AND DESIGN DIAGNOSTICS
1(1:'0114-110N
Nr:lssuficalion Test Results (CFM 0 2S PA)
fust l.uuk_a x (CHH)
I'III I'tilU •
It Fan Flow is Calculated AL 400 0MIon x nurnbtlr of tont, or on 21.7.x Hooting CopnClly
in Thau38nd8 Of Btu/hr, drier CAICYIatad VAIUO
If fon flow Is measured, e,'tter measured Value. here
leakage FraCtbn Test Letlkage/(Measured or CalcvIMed Fan Flow) b
Paso If leakage fraction -/- o_06
❑
11:\ 1111("1. 1YA 1A(:1: H UMN'1'ION
N 111-yewioon Tost Results (CFM ip ?.5 VA)
I linOW
II Fan Flow is Calculalod as 400 Cfm/ten x numbor of tpna, or as 21.7 X Hoatinq Capncily
In' Thouaanos of StWhr, enter calculatod vmluel hero
If fan flow is measured, enter measured value hero
Leakage Fraction - Test Leakage/(Measvraed or Calculated Fan Flow) r
POISS If loukago traction • /• o.Oti.
� ❑
•
Pa"s� Had
For All-MOMM, TYPE SI' AJ ANTS <rNl.,ti' - Tho folloWing alagr=tir: tosflnp Was completed:
\\ Duct Fan PressuNzatlon at rougn-in measured leakage (CFM) '
CHECK AFTER FINISHING WALL:
Yos ❑ No ❑ Pressure pan test or Houco prnacur¢atlon tort
Yes ❑ No ❑ Visual Inspection of Duct Connections ^ ❑
Pass Fan
YQ'.% ❑
No. Thermostatic Expansion Valve is Instalind and Accrlsy is
providoo for ennpeclaon
yAS is Al pass n,-vr. Fid
Yes. ❑ No RCCA Menultl O D". iqn calculation. have been
eanplutud Duct Duaagn iu on the plan:; :end duct vir.Wilabon
matches plans,
2 Y� Ypr. ❑ No TXV is Inr4i4od or, Fan flow Nal. boon vonflgd. If no TXV,
verdKid tan flowmstchesdesigr. from CF -1R
Measured Fan Flow
Yes for both 1 and 2 is a Pass N:I:c:; F:ol
I, tho uneerstgned, verify that the above diagnostic text resuittt and lite work I pertormed associated -with thq tests) i5 .n
cenrw neo with the rogveroenonts for complionrii Crodil. (Trio buiaar ihali provido the MFRS provider a copy of the CF-6R,'grk)o oy trio builder omploy000 or bub-t:onvoctoru Ctrtitying that dibgno,,tic tosting and inslallalion ftxli th(! mquirt mrint:;
for compliance t:rodit.)
frhto Signature. Data
Porformod
COPY TO: Bulldlnq Onpartmont
HERS Nrovidur id app;icablu)
Building Owner al Occup ricy
Installing' Subcontfactor (co. Nremu) OR
General Contractor (Co. Name)
CompbaAco Few,
A.,
Vo (le
Laurels plA
INSTALLATION CERTIFICATE (PAGE I OF 8) CF -6R
SITE ADDRESS PERMIT NUMBER
AN INSTALLATION CERTIFICATE IS REQUIRED TO BE POSTED AT THE BUILDING SITE OR MADE AVAILABLE FOR ALL APPROPRIATE
INSPECTIONS. (THE INFORMATION PROVIDED ON THIS FORM IS REQUIRED; HOWEVER USE OF THIS FORM TO PROVIDE THE
INFORMATION IS OPTIONAL.) AFTER COMPLETION OF FINAL INSPECTION, A COPY MUST BE PROVIDED TO THE BUILDING
DEPARTMENT (UPON REQUEST) AND THE BUILDING OWNER AT OCCUPANCY, PER SECTION 10-103(b).
HVAC SYSTEMS:
HEATING EQUIPMENT CEC CERTIFIED MFG.
NAME
TYPE AND
HEAT PUMP MODEL #,
FAU CARRIER 58STX070112
FAU CARRIER 58STX090116
#OF EFFICIENCY DUCT DUCT OR HEATING HEATING EQUIP
IDENTICAL (AFAU ETC.) LOCATION PIPING LOAD CAPACITY
SYSTEMS CF -1R VALUES (ATTIC ETC.) (R -VALUE) (BTU/HR) (BTU/HR)
1 80% ATTIC 4.2 87K 70K
1 80% ATTIC 4.2 112K 90K
COOLING EQUIPMENT
EQUIP CEC CERTIFIED COMPRESSOR
# OF -
EFFICIENCY
DUCT
DUCT
COOLING
COOLING
TYPE PKG UNIT MFG NAME AND
IDENTICAL
(SEER ETC.)
LOCATION
R VALUE
LOAD
CAPACITY
HEAT PUMP MODEL NUMBER
SYSTEMS
(CF -1R VALUE)
(ATTIC)
(BTU/HR)
(BTU/HR)
A/C CARRIER 38HDC0303
1
12 SEER
ATTIC
4.2
30K
29.2K
A/C CARRIER 38HDC1483
1
12 SEER
ATTIC
4.2
48K
47.7 K
I, THE UNDERSIGNED, VERIFY THAT EQUIPMENT LISTED ABOVE IS (1) IS THE ACTUAL EQUIPMENT INSTALLED (2)
EQUIVALENT TO OR 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) EQUIPMENT THAT MEETS OR
EXCEEDS THE APPROPRIATE REQUIREMENTS FOR MANUFACTURED DEVICES (FROM THE APPLIANCES EFFICIENCY REGULATIONS ON
PART 6), WHERE APPLICABLE.
I / r WILLIAMS HEATING CO.
SIGNATURE, DATE INSTALLING SUBCONTRACTOR (CO NAME)
OR GENERAL CONTRACTOR (CO NAME) OR OWNER
THERMOSTATIC EXPANSION VALVE (TXV')
k I'IC EXPANSION VALVE (OR COMMISSION APPROVED EQUIVALENT) IS INSTALLED AND ACCESS IS PROVIDED FOR INSPECTION.
�mcl
YES IS A PASS t PAS,S;P� FAIL
COPY TO: BUILDING DEPARTMENT
HERS PROVIDER (IF APPLICABLE)
BUILDING OWNER AT OCCUPANCY
. 4
Westerassu$rre�nr.
Im0
4211 Latham Street • � N
Riverside, California 921x01 - Phone: (908) 688.8780 - Fax: (909) 886.8786
License 4 794484
c�R nvsvr,�►Tr x c��rrnFicwr�
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 BUILD143 LOCATED AT:
TRACT/PHASE: THE LAURELS/ PHASE I
LOT s
SITE ADDRES6:--
- - - - 85-110 LAUREL VALLEY - LA QUINTA, CA
# '3'
MANUFACTURER-
MANUFACTURER:
glum
MANUFACTURER.
I
MANUC URER:
BATTS
JOHNS MANVILLE THICKNESS:
13" R- VALUE: R-38
GREENFIBER
KNAUF
KNAUF
EXTERIDR W t �;
MANUFACTURER: KA14UF
1
MANUFACTURER;. KNAUF
BLOWN INSULATION
THICKNESS:
8.1"
BATTS
THICKNESS:
10°
BATTS
THICKNESS:
g V4"
SAM
THICKNESS:
r
3%u
BATTS
THICKNESS:
3 Va-
'� C . T T : THE BREHM COMPANIES
S
TITLE:
DATE:
LIC IONI CQ '' CTOR: WESTERN BER; 794484 N INSULATION, L.P.
BY:
TITLE: PR DUCTION MANAGER
DATE: JANUARY i1, 2008
0I/01 39Vd NOIIV-nSNI N831S3M 98LB989196
R- VALUE: R-30
R- VALUE: R-30
R VALUE: R-19
R VALUE: R-13
R — VALUE: R-11
L9:80 980Z/L1/10
,- Certificate of Occupancy
--= -�
ot
Lrconoengn �'�
G� OF'Tk 9�� Building 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: 55-110 LAUREL VALLEY
Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0311-077
Occupancy Group: R3 Type of Construction: VN Land Use Zone: RL
Owner of Building: GENERAL BANK Address1420 E. VALLEY BLVD.
City, ST, ZIP: ALHAMBRA, CA 91801
By: GARY HARTMAN
Date: FEBRUARY 11, 2005
Building Official
POST IN A CONSPICUOUS PLACE