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0111-035 (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 ens#••�i t f'DLic. Class Exp. Date 1103 Date it «�r�� Signature of,ContractorN 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 constructthe 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:' Carver ZIUi'dd'£H INS, CO. Policy No.' &Q.3W5,d►.fi. (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 t,,ose provisions. Date: i • * P %' Applicant,��.• �" _L�_ Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706!' of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of. Building and Safety, for. a permit subject to the conditions and restrictions .set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold .harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is. correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. Signature (Owner/Agent)�7�',T.�.� �Date PERMIT # BUILDING PERMIT DATE VALUATION znv,4 3m LOT 1`8_ -- - / TRACT .187319 JOB ADDRESS ^8 .$J°� °��11 +1 � ; �E ` � APN M. -2904 OWNER CONTRACTOR/DESIGNER/EN (NEER YAWTA )OLP A :�..k QtrWTA 701.X; CA !P20123 C.'`9i: O 341 USE OF PERMIT 3 • > �,�, '. a x ::. talt� e .� r xt st va ara .t»;ut ��e :. 'N.1�LL% POOLIS,PA- C1ADPnl;'ti'`MA APk"RC?.ACH 13% PLA 'K C`FIECK F.8% REDUCTION FOR �tt3E.`f:`&iiyLK ISSUANCE OF f�KNIZ � LAW TYPE CUSTOM 00*10.WCTIO?ti 2,,985,0PSF >rzt'3f:.Ci P 010 ? S.OQ ria' LARe GRIC.t4iif'ORT 674.00 Sit X.S�.�:€iCWX.EM OF CON LP 6I.'1Ur.J L00 25A),463A0 tIONSTa\UCTI,MIME 101-000'°418-000 $1,9100.09 PLAN CHECK FEE 101=000-439418 39418 $239.04 MECHANICAL FFIF, 10i.000-1-21."100 S.12100 2 UASC't kiC,AL, FVf, 101-00'04 0-000 $ 9'1 .96 - 1'LUMINNO VRE 101 X060-419.000 $11M.25 STR.013'i0 H01146N iia. - %1Y? 101-000--241-000 _V15.05 l Wt IN PUBLIC PLACES -.REME 270-0 0t3-- 45-000 3126.16 x 4RUM101..4 .A't�9�s .X��AU C33rr.X $0,00, Fav f:9 1 (I .P=M. �f7KE, Ei DV NOW IbBYV®EPLAQUB�IYA MYY RPRANCIF RECEIPT DATE BY I.. DATE FI AL d I SP CTOR ..: ~:. Am OPERATION DATE INSPECTOR OPERATION DATE I INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Forms & Footings �%Q.� �� (•rv� 7 p �_ Underground Ducts Ducts Slab Grade - _��9/Q/ �iC% Return Air Steel Roof Deck _ �� ��p� Combustion Air Exhaust Fans O.K. to Wrap O% [�V,✓ fv F.A.U. Framing Insulation _ d �GG� a,— $/� Compressor Vents ogas� Fireplace P.L. Grills Fireplace T.O. Fans 8 Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall -Int. Lath - Final f'O�iS�63 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 I Gas Piping PLUMBING APPROVALS Gas Test Waste Lines /4�6��i1Q! a Electric Final Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral _ _ Pool Cover Sewer Connection /a/(j�� Encapsulation Gas Piping Gas Test _� % /�O" � Appliances " Final COMMENTS: Final Utility Notice (Gas) ELECTRICAL APPROVALS/ oh/ 6� Temp. Power Pole �/�170�V "'�' �z Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final A� Utility Notice (Perm) � sem• ��►-���,� . �r ; - . • � :. . r Desert Z ,. ENERGY CAi)I:C ervices — P.O. Box 621. Ph/Fax (760) 564.2044 Rancho Mirage, CA 92270 Cell: (760) 635.7-939 ' a" Email: RKrown6237@aol.com CERTIFICATE OF•FIEL•D VERIFICATION AND DIAGNOSTIC TESTING (Page 1 of 7)' CF -4R Ad5ADL 2 QF4• T- c �►J� 4lIS IG�o� roject Title' '' Date " •P _ �SNP�RoOK �,�MNIyh�IT1ES 4 a � .sT. ro'ect Address Builder Name gqYE Vail LL1E JL f Geo\ 901-30)01 RL.A�J Z Buil er Contact Telephone Plan Number .qe_HPkDF:.,K�BovjtJ Mao) 835r�93c) } G(todP l HERS ate Telephone Sample Group Number 'f�C e-).1 R �O 13 2 �j 2 . 5 fiiG 3 ` , �•.o T : � S � � 0►� 2 Certifying Signature + Date Sample House Number— Firm: DESERT EFjF_ CC `( SER\/I LE5 HERS Provider: L° • N •�-•�.R.S . Street Address: R0- BOX (P2 City/State/Zip: 0.'_HIIlk 4E. GSA• °22270 •, Copies to: Builder, HERS Provider HERS RATER COMPLIANCE STATEMENT The house was: lJ Tested ❑ Approved as pan 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.! ' y Z�The installer has provided a copy of CF -6R (Installation Certificate. Er Distribution system is fully ducted (i.e., does not use building cavities as plenums or platform retums in lieu of ducts) Q"Where cloth backed, rubber adhesive duct tape is installed, mastic and drawbands art used in'combination with cloth backed, -rubber adhesive duct tape to seal leaks.at duct.connections: ' t9 MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT Duct Diagnostic Leakage.Testing Results (Maximum 6%.Duct Leakage) ` f, Measured Duct Pressurization Test Results (CFM @ 25 Pa) values * ' Test Leakage Flow in CFM_ If fan now is calculated as 400efm/ton x number of tons enter calculated _ value here V ' - If fan now is measured enter measured value here Leakage Percentage (100 x Test Leakage/Fan Flow) !L0 , • Check Box for Pass or Fail (Pass=6%o or less) ❑ Pass Fail &TH ERMOSTATIC EXPANSION VALVE (TXV) q,. LJ .Yes ❑ No Thermostatic Expansion Valve is installed and Access is provided for inspection [� ❑ " Yes is a pass Pass Fail Fr _ 11 Desert ENERGY �AaI:C Services — P.O. Box 621 Ph/Fax (760) 564-2044 Rancho Mirage, CA 92270 Cell: (760) 835-7939 Email: RKrown6237@aol.com CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTINiG (Page 1 of 7) CF -4R SAr, >L 2 QF4• �<=5°jED ��; 4 15 ►G�°3 ct Title Date A 5Fi � (ZD' 1, & M m � h l'TI E S ro'ect Address' Builder -lame VE VA L Li E: Z 1'!w1 961-3&)01 Bur Contact Telephone Plan Number �(o 0 3 3 G 2Oy P HER ter Telephone - Sample 3roup Number 01 �- -T - # 5s 2 2 Cerci ing Signature Dae Sample House Number r Firm: DESERT �I.l�fc�,(SER�I LES HERS Provider. C • N •�•E •R.5 Street Address: RO- BOX W City/State/Zip: �AIJCHO i1RA<E: CIA 01221n Copies to: Builder, HERS Provider HERS RATER,COMPLIANCE STATEMENT Z 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. LJ 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 retums in lieu of ducts) Where cloth backed, rubber adhesive duct tape is installed, mastic and drawbands are used in combination with cloth backed, rubber adhesive duct tape to seal leaks at duct connections. MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage) Measured Duct Pressurization Test Results (CFM t7n 25 Pa) values Test Leakage Flow in CFM g If fan now is calculated as 400cfm/ton x number of tons enter calculated value here Ott If fan now is measured enter measured value here Leakage Percentage (100 x Test Leakage/Fan Flow) = rj Check Box for Pass or Fail (Pass=6% or less) IP 0 Pass Fail MTHERMOSTATIC EXPANSION VALVE (TXV) T(Yes ❑ No Thermostatic Expansion Valve is installed and Access is provided for inspection ❑ Yes is a pass Pass Fail ert�fiC.ate f Ocqypancy,...,. _. Laoavoarm YC, aqu •G of�w; y y- " Buildin & 'Safety Viepattifi6nt- This, Certificateis issued pursuant•to therequirements of Section 109 of the. Califia Building ,. 'in Code, zycertifying : that, at • the time "of issuance, .,this •structure was in compliance with -.the provisions -of- the` au,ildi'ng Code and the various - ordinances of the. City regulating building „. construction and/or use.. BUILDING ADDRESS: 56-035 WINGMTOOT ..yrs _` 7.. '_ .. -• _, ,, r <_ ' ' Useclassification: SINGLE FAMILY DWELLING Building Perrriit 'No.: 0111-035 ,, • +- " - - � • , `n1 Occupancy Group:'R-3 Type of Construction: VN Land Use Zone: RL Special`Conditions: NONE.- Owner of.Building: CRV LA QUINTA 70"LP r .' Address: 200 E.-WASHINGTON 'City, ST, ZIP:•ESCONDIDO, CA,92025 By: DANIEL P. CRAWFORD JR. rd (-;d!Z" l J _ .. i ¢> . • 'Date -;"6/10/03 Building Official _; } r _POST INA CONSPICUOUS PLACE'