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0305-105 (SATT)LICENSED CONTRACTOR DECLARATION U) I her.; affirm under penalty of perjury that I am licensed under provisions of 1—-Ohapter�_, (commencing with Section 7000) of Division 3 of the Business and WProfessionals Code, and my License is in full force and effect. O =) ch License # Lic. Class /r J Exp. -Date f tl ' Z Date I r' ! + Signature of Contractor t A-", r7 t •'� r -�_s — CD 0 J U OWNER -BUILDER DECLARATION W W 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). ( ) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business & Professionals Code). ce) () I am exempt under Section LO B&P.C. for this reason C\; 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. M workers' compensation insurance carrier & p Iicy no. are: Carrier '%TATE 3'�3NO 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 California, and agree that/if I should become subject to the workers' compensation provisions of Section 3700 of/te Labor Code, lishall forthwith comply with It ose provisions:!!; Date: 641V I L e 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. Signature (Owner/Agent) K �r'` .' r-±:�..+ y ' i _Date BUILDING PERMIT PERMIT#0110�IMS DATE VALUATION S199,734.90 LOT 107 TRACT 29858-1 JOB SITE 119 20 Ii}'.. e.90L A, SOL APN 772-400-M9 ADDRESS OWNER CONTRACTOR / DESIGNER / ENGINEER POB0,XG10 14158 U, QT. A;~ CA. CA 1225 s PF10MM,, Al 65034 4a502)257-165fa USE OF PERMIT IMMIX l;.t'�,°1riLY A= (,r,r1U'�..y .,. . 1'•a -:l. ! ie �.a,.. Y O U5�5 AY. .S O.a>4MIYJ L:>y- WALLO, P001, VA. OR bR V'Fv ' PPP",A.C( D FMAN 0 9 20103 TFftX1 4;C`N51I'�.UCTIO.N 3,294,0 OF i POk1C;;VP..A.`11;0 '7.43.08 �,F' CITY OF LA QUINTA 0AIi.A.OUC:,pRYORT MUD BF 'INANCE DEPT. �#►'ti� IATKID f i�ff OF GOMIS 1tdIl O%a `(''p�ryrry�* yy;;77��,, Sx PM :C.Bt�YJ1.F1'di>t`M i70.l��.A1YA.AI,.W 00140TRUC1'1034 1TO U 101 -000-41 1R.-000 PLAW CHIFt:K 023.57 MMANICM.,fts 101.000-42fl 000 MOO EL>PC:'e'� MAL EE 101-000-420-000 $zw.7,0 k`tJUNI'RM PEE M'-000-419-000 W0.00 ;: TRIC"a140 !MOTION FEE 101-000-,241-000 $14.97 � ORA lillOFEE %�J1�11�;I?�;�'a•Ot3Q - �1�.dn13 p DEVELOPER 1M13,1L(­T Mr STH_t-TOTAL C.Okb'KMUMION r`:I D PAY i l4l r'1W4K $4,313.34 LES.3 ?'1~E-Y"MD F%W $0.00 '1'C fAL:I'E:la'�➢"9.`1fEE5 Dy:l',T' NOW RECEIPT DATE � �� �� . 1 BY f� 11 + F f DATE FINALED �? INSPECT . F— - — 4 INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings 2'3- 3 Ducts Slab Grade -a 4- -_ Return Air Steel - ',_69- 3 Combustion Air Roof Deck - 3 - Exhaust Fans O.K to Wrap 6 F.A.U. Framing g— - Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath a- L Drywall - Int. Lath - Final Final - — BLOCKWALL APPROVALS POOLS - SPAS 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 a 4Z2 Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K for Finish Plaster Sewer Lateral Pool Cover Sewer Connection :.3 _ Encapsulation Gas Piping Gas Test Appliances F. Ej.­ Final Final Utility Notice (Gas) - ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels r Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final - Willy Notice (Perm) .. COMMENTS: �'��T �,�G`' ` �-'-� 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: 78-920 DE SOL A SOL ,LOT 107, LA QUINTA, California CEILINGS: TYPE: BATTS MANUFACTURER: Certainteed Thickness: R-38 WALLS: TYPE: BATTS MANUFACTURER: Certainteed Thickness: R-21 GENE C NT CT RJT H S LICENSE # ©G5V B : TITLE: SCP PGQ0, rb 4) pe -?o SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072 TITLE: ADMINISTRATIVE ASSISTANT DATE: 11/14/2003 j.i — 17_ INS ALEATION CERTIFICATE (page 3 .of 13) CF -6R Site Address rdrnnr nuiuuvr , DUCT•AKAGE AND DESIGN DIAGNOSTICS DUCTLLAiICA►G4 REDUCTION Pressurizatlon Test Results (CFM @ 25 PA) Test Leakage (CFM) -o Fan -Flow If Fan Flow Is Calculated as 400 cfrdton x number of tons, or @s 21.7 x Heating Capacity In Thousands of .Btu/hr, enter calculated value here If fan flow Is measured, enter measured value here Leakage Fraction - Test L,eakage/(Measured'or Calculated Fan Flow) o Pass if leakage. fraction <0.06 Pass Fail 0 For AEROSOL TYPE SEALANTS ONLY -The following diagnostic testing was completed: Duct Fan Pressurization at rough -in measured leakage (CFM) CHECK AFTER FINISHING WALL: O Yes .O No . d Pressure pan test or Hoose pressurization test. O Yes 0 No .0 Visual Inspection of Duct Connections o 0 Pass Fail rHERM0S'TATIC EXPANSION VALVE 7TXV) r 'es O No Tbermostaticc-Expansion Valve is installed and Access is -provided. for. inspection Yes'is a pass o /ass Fall DUCr DESIGN ACCA Manual D Design calculations have. been L O Yes O No completed, Duct Design ds on the plans and duct installation matches'plam. , 0 0 2. O Yes O No TXV is installed or Fan flow has been verified. If no TXV, Pass Fall verified fan flow matches design from CF -HL Measured Fan Flow = Yes for both i and 2 is a Pass - 0 1, the undersigned, verify thaftheabove diagnostic test results and the work I performed associated with.th'e test(s) is in conformance with.the requirements for compliance credit. [The builder shall provide a HERS provider. a copy of the CF -6R signed by the builder employees or sub-conuVeT certifying that diegnostic.testingand Ins anon meet the feguirements forcompliance credit. ] Tots Performed COPYTO: - BuildingDepartnUnt ` HERS.Provider (it applicabley Building Owner at Occupancy ostalling TbcornktMCWr (Co. Name) OR .General Co tractor (Co. Name) INSTALLATION CERTIFICATE (Page age 3 of 13) CF' -6R' 8119 Address Permit Number T DUCTUAKAGE AND DESIGN DIAGNOSTICS _AWJ' LEAKA" REDUMON Pressurization Teit Results (CFM 25 PA) Test Leakage (CFM)/ Fan -Flow If Fan Flow Is Calculated as 400'cfni/ton A number of tons, or 4s 21'.7 x Heating Capacity In Thousands of-Btu/hr, enter calculated value here If firlflow Is measured, enter measure-d.value- here Leakage Fraction Test Leakage/(Measured or Calculated Fan Mow) Pass if lcak4ge fraction <0.06 Pass Fail 0 For AERbS0L TYPE SEALANTS* ONLY *-Thifollowing diagnostic testing was completed: Duct Fan Pressurization at tough -in measured leakage (CFM) CHECK AFTER, FNISHING WALL: 0 Yes 13 No 0' Pressure pan test.or House pressurization- test. 0 Yes 0 No .0 Visual Inspection of Duct Connections 0 a Pass Fall g ZHERMOSTATIC EXPANSION VALVE ,(TM, -9Yes 0 No Thermostatic -Expansion Valve is installed And Access is - provided. for. inspection Yes is a pass G 0 DUCT DESIGN Pass Fall ACCA Manual D Design calculations have been L 0 Yes El No mpleted, Duct Design Is on the plans and duct Installation completed, matche3-plans., 2. 0 Yes 0 No TXV is installed or Fan flow has been verified. Lfno 7XV, 0 Pass 0 Fall verified fan flow matches design from CF -IR Measured Pan Flow Yes for both I and 2 is a Pass 0 1, the undersip.ed, verify that the above diagnostic test resulti and the -work I peMrrnqd associated with the test(s) is in conformance; . with the requirements for compliance credit [The builder shall provide the HER S provider ' a copy of the CF -611 signed by the builder employees or sub -contractors certifying that dia'Postic,testing and installation meet the requirements for compliance credit. I 7esp n;, Date Ins lling 6contractor (Co. Name) OF, patonod GeneralContractor(Co. Name) COPY TO: 'Building Department HERS ProVider (if applicable} Building Owner at Occupancy