0403-225 (SFD)Ft, LICENSED CONTRACTOR DECLARATION
�' hereby affirm under penalty of perjury that I am licensed under provisions of
apter 9 (commencing with Section 7000) of Division 3 of the Business and
C"
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
7,66241 A l� / MI NO3
r, Date �� ��/Signature of Contractor��"�/�
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 Lnder.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 37001 of the Labor Code, for the
performance of the work for which this permit is issued.
( 14) 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 :A.M131'zlUN CASUAL Policy No. WC Is
(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, Ihall•forthwith comply with/those`provision's.
Date: �7' l/ '!��/ Applicant -'..j/ f/ ,/i fly.' 4
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 benefitlwork 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 f/o`/r inspection purposes. .
Si r �r
Signature (Owner/Agent) i+-• / s Date
e BUILDING PERMIT PERMIT#
DATE / VALUATION 7 tp� LOT TRACT
54 3 05 21
JOB SITE
ADDRESS'
APN
OWNER
CONTRACTOR / DESIGNER / EN &NEER
U. MITAR Colldmugff.m
L1E1`T, AR COMMURMS
M800 CI-TaSLA?TrA DRIVE #200
2A-0QN�iUM D_RMk-100
y1MON `YTRJO C.A. 92691
y331/jv4o CIA 9246-01
(949)598-$500 CBLO.3434
USE OF PERMIT
MIX ITAIM-Y DW MUING
`YD, LA)T 54 PIAN 3C. PEad.TK1 T .%SOILS, NOT 'INCLUDE VIOC'K:'Wi ALA,
FOOLt SPA OR i}AWKt1lfi,Y,#+.PPRO.AC`."H.
TRACT, CONS'd`RUfN'#`IaN
P aRM41R,AIO 2S6.f3ii SP
OA)3AGEICA1i.2 MIT 426,00 P `
YSTUMAW., CUM OF CONSTRTICU-Oft
1:57.17530
S J�Sti�n"YS�.l• d1ry81eL':. 3�, IJ.Ii`itLCS'L'6CI.6 S
.
C a d iPa1TG'FICl1� f?1;.� 3 01 000
PLAN CHECK MLe 101 _gOW_439_311 r $69118
MECHANICAL FM 101-000.421-000 $60.00
ELS.` RIC"AL, .VVE, 101-000-420-000 $135.93
PLC1Mt33.1+It. T-TH 101.000.419.000 2167.25
aTRO14014OTIONT M o RZ-511D 9 01-000-2 I -000 $15,W
CIRA.F. -0 1''I °, �1 SIA
DLV1,10PER IMPACT FEE S2�41a�1.Ut►
_
qqJR-'AfyALt^LZ-f RU(_-,ylf`+q*q1`7L1U /3LTfr.
y43
.uEnine PRD' 'PAID FM
r;
J APR 0 6,t
s
Circ OF LA
FP'A,-XE 1)
RECEIPT '
DATE
BY /
Il
DAT FINA 1)
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
_
Forms 8 Footings
A
Ducts
Slab Grade
Steel
Roof Deck
b _
_ _
Return Air
ombustion Air
Exhaust Fans
_
O.K. to WrapF.A.U.
_
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
r
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - IM. Lath
Final
Final 4 `
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
..Final
Gas Piping
PLUMBING APP OVA.,
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
, p
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit r
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
D
ENERGY s,1-- ' C A o E s
SBMWs
P0. Box 621 Ph/Fax (760) 564-2044
Rancho Mirage, CA 92270 Cell: (7601 250-1852
Email: DESNRG OAOL.COM
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I pf 7)
CF -4R
LA QUINTA DEL ORO 09-30=04
Date
Project Title
8 G IL NTON ST, rNrnn rA I ENNAR H MFS
FRED WARING Builder Name
Project Addre
NACHOs8ASTENADA 76078-6968 PLAN 3 . 2 UNITS
Builder Contact Telephone Plan Number
ALAN WEAVER . 760-880-5504 GROUP 1
HERS kqter Telephone Sample Group Number
#CCNAW183226 09-29-04 _ 54-2
Certifying Signature Date Sample Lot Number.
Firm: DESERT ENERGY SERVICES LLC HERS Provider: CHEERS
City/State/Zip.RANCHO MIRAGE, CA. 92270
Street Address: P.O. BOX 621 .
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:
❑ 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 drawbands are used in,combination with cloth
leaks at duct connections.
backed, rubber adhesive duct tape to seal
• 4
❑ 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
If fan flow is measured enter measured value here
Leakage Percentage (100 x Test Leakage/Fan Flow). _El a ^
Check Box for Pass or Fail (Pass=6% or less) Pass Fail
r
❑ THERMOSTATIC EXPANSION VALVE (TXV)
❑ Yes ❑ No Thermostatic Expansion Valve is installed and Access is I El
❑
provided for inspection
WESTERN INSULATION9 LoPo
42 t ! Lr]Pbwn Strcelt, 12ivbiyitle, tr.W fomia 92501
Tei. (951) 686.8760 Fax (951) 686.8786
CF6R WSULATION 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: LA QUINTA DEL ORO f PHASE 2 ,
LOT
64
SITE ADDRESS:
-- ----------------
76.380 VIA PAVION - LA QUINTA, CA
---------.-------------------- ----- - r ---
C-P�-gS, PLAPNS
2 �L 4:_ j BLOWN INSULATION
MANUFACTURER:
I GREENFIBER THICKNESS: 10.3" R- VALUE: R-38
CEILINGS LI PIANS
2 & 4: j BATTS
MANUFACTURER:
JOHN$ MANVILLE THICKNESS: 13" R- VALUE; R-38
BLOWN INSULATION
MANUFACTURER:
GREENFIBER THICKNESS: .8.1" R- VALUE: R-30
2EILLGS;
BATTS.
MANUFACTURER:
JOHNS MANVILLE THICKNESS: 11" R- VALUE; R-30
EXTERIOR WA LS:''.
BATTS
MANUFACTURER:
KNAUF THICKNESS: `3 1/2" R- VALUE R-"3
gENERAL 9O
OFA: LENNAR HOME
BY:
TITLE:
I i
DATE: ^_
"
INSULATION COIN FiACTg a WESTERN INSULATION, L.P.
`. LICENSE 9 ARA
BY:
TITLE:. PRODPAVON MANAGER �
DATE: SEPTEMBER 30, 2004'