0306-445 (SFD)LICENSED CONTRACTOR DECLARATION
I 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 Exp. Date
t � .
Date"-� (" { _� signature of Contractor
. n -
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 tof construct the project (Sec. 7044, Business & Professionals
Code).
O I am exempt under Section B&P.C. for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affi m,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 Sl'A' RMID Policy No. 44.03411-3 .
(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 37,00 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
•Rr. -S
any permit issued as a result of this applicaton agrees to, & shall, indemnity
& 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 enterVupon
the above-mentioned property forinspectionpurposes.
Si nature Owner/A en; 1 �� �,,� =1ti R\ Date
9 ( 9 )
BUILDING PERMIT PERM'Taatr�
DATE VVALUATION LOT' �y TRACT,`^
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JOB SITE
ADDRESS �fAY,?tYG,,n.�.
APN i�•�a'fi4i�
OWNER
CONTRACTOR / DESIGNER / EN &NEER
t kIRZI R
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j�001, SRO, C .I DR,A"�';F'`VAY Ai'3�1�C�.<�CH. 75% �l�'.CIC ION T �'i:.�� Cf5
! I7UR `i O tAIJI Pi.X) I.33taAMCKOF °.,.+`1MIR PLAfu TYPE
6U*S7'OM C.',Iz,�4',,',TPu. Jt'1'IC'2t Z423,01t 9F
21110 SF
�ad4R.LOFT ^t^rsPC_''ft'f 466.9!v 3F
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Crry OF .LA�QUINTA.
EIW€1MCE DEPT.
RECEIPT
DAddTE
BY `v f
DATE FI ALED
INSPECT R
l
71 �
kJ
INSPECTION RECORD
OPERATION
I DATE
I INSPECTOR
BUILDING
APPROVALS
Set Backs
Footings
Forms & Footings
Bond Beam
Slab Grade
Steel
Roof Deck
_
6
OX to Wrap
Final
Framing
S o 6
Insulation A
/g
Fireplace P.L.
Water Piping
Fireplace T.O.
Plumbing Top Out
Party Wall Insulation
Shower Pans
Party Wall Firewall
Sewer Lateral
Exterior Lath
Sewer Connection z
Drywall - Int. Lath
3Z7
OPERATION I DATE I INSPECTOR
MECHANICAL APPROVALS
Underground Ducts
Ducts
Return Air
Combustion Air
Exhaust Fans
F.A.U.
Compressor
Vents
Grills
Fans & Controls
Final
COMMENTS:
Final
Utility Notice (Gas) I _f / / .
ELECTRICAL APPROVALS
Tema. Power Pole
Low Voltage Wiring
Fixtures
Main Service v
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Tema. Use of Power
Final
Utility Notice
Final
Final 3 D.r
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 APPROVAL
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 z
Encapsulation
Gas Piping
Gas Test
Final
COMMENTS:
Final
Utility Notice (Gas) I _f / / .
ELECTRICAL APPROVALS
Tema. Power Pole
Low Voltage Wiring
Fixtures
Main Service v
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Tema. Use of Power
Final
Utility Notice
REGISTERED INSPECTOR'S WEEKLY REPORT
JON TANDY
78-194 Elenbrook Ct.
Palm Desert, CA 92211.
Office (760) 772-7192
Fax (760) 772-7193
Pager (760) 776-3338
TYPE OF
INSPECTION
PERFORMED
0 REINFORCED CONCRETE
0 POST TENSIONED CONCRETE
0 REINFORCED MASONRY
0 STRUCT. STEEL ASSEMBLY (pp' &PZl04
0 ASPHALT 0 OTHER
0 FIRE PROOFING
JOB LOCA 1 N
ISS -
9S
w �
REPORT SEQUENCE N0.
Tr OF STRUCTURE
l z
� PERMIT NO.
L � s
DATT_
Ll i W
DAY OF WEEK
-r6-,v---� -
MATERIAL DESCRIPTION RCHITECT
. r^ S o Sed c.
INSP T R
HRS. CHARGED
Exr,ll
?-ME
ENGINEER
(:�.
ASSSTANTS
MRS. CHARGED
INSPECTION
DATE
GENECORAL �� r
NTRACTOR d PosC
SUB
CONTRACTOR
r S
i
S a
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C
Lai
morkV, V, %(Nock
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COPY SENT TO CLIENT 0
CONTINUED ON NEXT PAGE O
PAGE
OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT t HAVE INSPECTED TO THE BEST OF MN
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE
NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED
PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS.
(SIG
NEAT OF IIEG13TERE I(N'SSPECTOR
nC �G V
DATt OF REPORT REGISTER NUMBER
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Part 1) CF-4R
-THE LAURELS - Z-- -05
Project Title Date
55095 Winged Foot, La Quinta, CA. First Pacifica Dev. Carp.
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
�`--"
'
=—/2005. 8 Svs.1 Track 29121
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: ❑ 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.
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 R,
returns in lieu of ducts) -
❑ Where cloth backed, rubber adhesive duct tape is installed, mastic and draw bands ar used in
combination with cloth backed, rubber adhesive duct tape to seal leaks at duct connections.
,.
/ MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLL,NCE CREDIT
,
Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage)
'Measured
w
Duct Pressurization Test Results (CFM @ 25 Pa) values -
Test Leakage Flow in CFM
i
If fan flow is calculated as 400cfin/ton'x number of tons enter
calculated value here1000
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
❑X 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
Y_ . January 5, 2001
; -
r
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Part 1) CF -4R
THE LAURELS 2 ' X05
Project Title Date
55095 Winged Foot, La Ouinta, CA. First Pacifica Dev. Carp.
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
/2005 8 Sys. 2 Trac( 29121
Certifying Signatur Date Sample House Numter
` Firm: Energy Calc Services, Inc HERS Provider: CHEERS
Street Address: 16551 Mockingbird Cyn. Rd. City/State/Zip: Riverside, CA 93504-9638
Copies to: Builder, HERS Provider
HERS RATER COMPLIANCE STATEMENT
The house was: ❑ Tested ® Approved as part of sample testing, but was rot 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 clothbacked, 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.
:
D -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
t calculated value here 1600
F
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
❑X 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
F. January 5, 2001 f
,
Dep 16 04 11t46a Energy Calo Servioes Inc. 780°-0558 — P.3
o5 S W L^'`5
INSTALLATIOV.CERT,IFICATE
Site AdOCK11
Vertuit Number
DUCT LEAKAGE AND DESIGN DIAGNOSTICS
Wil:` 1: 1)1�("t' 0,l;AKAG1; 1<I{I)ti(-1'I(1N
ProsruMAIIOn Test Resufts (CIM 0 2b PA)
l "I l Awk.a1w (C l: 1A),
I',m 1'111u .. .
I t Fan Flow IE Caloul,ilod as do0 choon x n'Umbor of tons, at or. 21.7.x Hoatirg Cv"pocily
in Thousands of Stun(, actor calculatod vacuo hornIf fan flow is measured, eater measured Value.here
leakage Frat;tlon Test Leakaoe/(Measured or Calculated Fan Flow) b
Pass if loakage fraction -/- 0-06 �� ❑
P; g Feil
X1:1:: 11111("1't,KAKA( F,JACM1('1'ION
mx- !tion Test ROsulls (CFU raQ 25 PA)
•tux! i'xa6a;tc ((_'I�.'vl) -
Fan Fknv
n Fan Flow is Calculatod ac 400 cfm/tcn x numbn-r of tons, or as 21.7 x Hootmq Capncity, 1�1
m' ThOasandx Of Btu/hr, entor raloulatrd valur. hero 1
If fan flow is measured, enter measured value hero
Leakage Fraction n Test Leak.agei Measured or Calculated Fon Flow) r ❑
Paas if loakngo friction • /• 0.06" _
Parti Fail
For AEROSOL TYPE SEA1ANTS ONI -•'rho following diagnostic tosting was eomplofod:
Duct Fan Pressurization of rougn-in moacurod Ieaxago (CFM)
CHECK AFTER FINISHING WALL:
Yos ❑ No 0 Pfossuro Pon Lost or Houco pmocun¢ation tort
Yes ❑ No ❑ Visual Inspection of Duct Connoctiuns ❑ ,
_.. Vail
1\..XWEXPANSION VALVE
Yqs ❑ No. Thomtostatic Expansion Valve is mstallnd and Accagy is
providod for Innpm ton
YQ+ is rr paws iI
Ini<'f 11F;NIt:N
\ Y&S. ❑ No ACCA Manumf b Design calcu%ttlons have been
cornplutod Duct Dowon w on tho plana and duct car fallabon
matches plans.
7 YOF. 0 No TXV is inrtUllod or Fan flow h;iy boon vonfioA. It no TXV,
'Ord -d fill flow matches dewgr. from CF -1R
Measured Fan Flow =
J Yos for Doth 1 and 2 is a Pass I -al'
°t tpt 11 tho unoerstgnaa, var�fy that the abavo dragnost4 cast n+auiw and the work l performed associated ,with the tests) iso
con mons, with tho reotutoenonts for comphanai crodd. (fho buildor nhau proV40 Ino HERS providor tj copy, of tho (;F -6R
;.OrWo by Me builder employ000 Of, bub-C011iVoctoru C(:ndy;ng that tasting and installation mrxii tht wQuu(emnnt::
for compliance crodit.);
frhto Signature. Data Installing Subcontractor (co. Name) OR
Porfofmod General Contractor (Co. Name)
COPY T0: Buddlnq 0opartmant
HERS Nrovldur.d apptu'ablu) .
building Owner at Occupgncy
Comphanco Forms ' :�npa mbc!r 2W2, q "!j
F
JSTALL'ATION CERTIFICATE. (PAGE 1 OF 8)
Laurels pl..3
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. #OF EFFICIENCY DUCT DUCT OR HEATING HEATING EQUIP
NAME IDENTICAL (AFAU ETC.) LOCATION PIPING OAD CAPACITY
TYPE AND SYSTEMS CF -1R VALUES (ATTIC ETC.) (R-VALUE)-,BTU/HR) (BTU/HR)
HEAT PUMP ' . MODEL # .
FAU CARRIER 58STX070112 1 80% ATTIC 4.2 87K 70K
FAU CARRIER 58STX090116 ' 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 LOAF• CAPACITY
1-117, AT PUMP MODEL NUMBER SYSTEMS (CF -IR 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.
WILLIAMS HEATING CO.
SIGNATURE, DATE INSTALLING SUBCONTRACTOR (CO NAME
OR GENERAL CONTRACTOR (CO NAME) OR OWNER
THERMOSTATIC EXPANSION VALVE (TXT)
YES THERMOSTATIC EXPANSION VALVE (OR COMMISSION APPROVED EQUIVALENT) IS INSTALLED AND ACCESS IS PROVIDED FOR INSPECTION.
CJ
YES ISA PASS / PASS" -FAIL
COPY TO: BUILDING DEPARTMENT
HERS PROVIDER (IF APPLICABLE)
BUILDING OWNER AT OCCUPANCY
Western
tion L.p,
RESIDENTIAL CONTRACTING
4211 Latham Street • Riverside, California 92501 • Phone: (909) 686.8760 • Fax: (909):686.8786
License # 794484
CF611 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:' '
TRACT/PHASE: THE LAURELS/ PHASE 1
LOT . 8 '
SITE ADDRESS: 55.095 WINGED FOOT — LA QUINTA, CA y
C LEI INGS: BATTS ,
MANUFACTURER: JOHNS MANVILLE THICKNESS: 13" - R- VALUE: R-38 "
CEILINGS. BLOWN INSULATION
MANUFACTURER: GREENFIBER THICKNESS: 8.1° R- VALUE: R-30
CEILINGS: BATTS
MANUFACTURER: KNAUF THICKNESS: 11r R- VALUE: R-30
CEILINGS: BATTS
MANUFACTURER: KNAUF THICKNESS: 6'/z R VALUE: R-19
ExTERIOR WALLS: BATTS
MANUFACTURER: KNAUF THICKNESS: 3W' R- VALUE: R-13
INTERIOR WALLS: 13ATTS
MANUFACTURER. KNAUF THICKNESS: 3 W R - VALUE. R-11
GENERAL CONT THE BREHM COMPANIES
BY:
TITLE:
DATE:
INSUL&TION CONTRACTOR: WESTERN INSULATION, L.P.
LICENSE N BER: 794464
BY:
TITLE: PRTPLICTION MANAGER
DATE: JANUARY 11, 2005.
bi/b0 3Jdd NOIviiISNI Nd31S3M 9BL89B9196 L9:80 900Z/L1/10
r
u� I�� QAC �°.� —... {• � - _ rr
(j'�- - tt Cert�f cate o,f Occppany�
4
Iva ' } �' c,� x. ; �; ".t . •':� ;s �`'
t . '" �: (i
^ ..
CCC�V� oF. ��F BOW E &-S O "t`• Department
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-.. `. � � - - 'p � X - - n � - , r � Ste•
�
-1
, This ;Certificate. is issued pursuant t&lhe requirements of Section,109 of the .California Building `
:certifying that, atk, the time '. of issuance,,, this structure was in. 'compliance. with, the
k5'provisions �,of the, Buildir►g Code and the wear ous ordinances of City�`regulatincr building
.the
construction use.
-and/or
c
�•�' '� - `BUILDING ADDRESS: °55=095 55'095
-WINGED,
V 41 yf
Use `cla`ssification: SINGLE_ FAMILY_ DWELLING- =;. ' �' � Bu ldiAg permit No., 0,306-445,,'
Occupancy Group..R-3 i' Type.of Construction: V -N �� ' - :" Land Use Zone; RL
�4�
yGENERALBANK=��<�� 4�.
�OwnerofBuildin Address: 1420 E.:VALLEY BLVDT. .
City, ST, ZIP: ALHAMBRA, CA�91801
��
By: GARY HARTMAN
r
Date: March: 9, 2005.1 _
77 7-
. �-Building Official
J -._
' `�. n -,�- , �� �•' ..'}• �' . ,� [ - aft... ' ; � v 5 � { �,
POST IN .A CONSPICUOUS PLACE
�
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