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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
?[32 n{a4 B HIC„� V31/04
Date _ Ji�9t �A. Signature of Contractor
OWNER -BUILDER DECLARATION
1 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 tH6 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 Policy No.
Ii1:'.PUBIC WDE1t NIS 18671602
(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 those,pis�ons{e
Date: - Applicant (�
Warning: Failure to secure Workers' ompensation 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. p`r
IMPORTANT Application is hereby made to the Director.of Building and Safety
for a permit subject to the conditions and restrictions set forth on hi f-�
application. - fjl
1. Each person upon whose behalf this application is made & each person 2�t f�",
whose request and for whose benefit work is performed under or pursuant toy
any permit issued as a result of this applicaton agrees to, & shall, indemnify)
& hold harmless the City of La Quinta, its officers, agents and employe s.
2. Any permit issued as a result of this application becomes null and vol If
work is not commenced within 180 days from date of issuance of s ch
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 at
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 pur oseS.
T�
Signature'~ (Owner/Agent) Date 7 -
BUILDING PERMIT PERMIT#
DATE r LVAL•UATION LOT �� TRACT
y 4 d $291.9Iz,.u0 29323.1
JOB SITE
APN
ADDRESS
3-«fWCIA- 7,87.AM
60080-023
OWNERCONTRACTOR
/ DESIGNER / ENGINEER
tt,yyTT
H WC
400 3, FARULL D% =M? B 103
400 .29, F'ARRE'►L DR UUrrr-,.D1 03
pti_?.SPRIU-4Cu Cts 9.262
PALM SrPR GS (!A 92262
c1m)1W7-710 C' BUB 2346
USE OF PERMIT
SFD , WT 918 PLAN XXL+ 179 3.V% OPTION,. PE?� M17 DOES NOT
i1< CLtFDS WIMK WALLS, P0014 SP A OR DRfVESYJ.Q4s"'.rnPPR().ACR?1°/,;
RKDUC;TIO1tif TO PLAN CHECK. FIS, DUD TO ,14ULaTIPLE. ISSUANCE OCA..CRs ��<t � �✓Qc_.
+'PACT C"STRUCTION XD100 OF
PCARCHIPAVO 300.00 SF
CAR±,.i_i1,IC',ARPOR i 502.0011W
EY-UMA -ED C;OYT OF C<C N&- ET CnON
19,'936.60
PEW&I M SUMMARY
CON'STRUC TION FEE 101-000-4,38-000 5961.30
PIAN CHECK. FES 10'1-00,0 439-318 $09,85
MECHANICAL, FEE, S9840
EL WTPUCAL FEAR 101-000-4,20-000 9.156.66
PL11MBI'9 O VC. R 101.000.419,,.000 $192,50
STI;C'JNO MCIT:0N FRE" RESID 101-000.241-000 $14.20
GIEADDIC FOR 101.000-423.000 SIs100
IJZVF,L0F`ZR IPt -PAC; I' FEL? $;kosm
&A
C6Yxd'�fRUC 1IOi� 1� PLAW GTI%.C:'TC
,4145.x:1
NAR 24200 XXSS PREPAID FMS
$0.00
Cir" OF !<ATOTA L YEIRM'3 Fn= D NOW
VP<` 6.21
F65tfabtq E rNTA
P7;
c:
RECEIPT
DATE.-. l /�^ i
ABY
DATE FI ALE
INSPEC
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
11 DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Slab Grade
Steel
Roof Deck
_� _ _
_ _r _ _
Ducts _
Return Air
Combustion Air
Exhaust Fans
O.K to Wrap
Framing
_ _ _ _ _
_ _ I _
✓ `
F.A.U.
r
Insulation
. .�
Fireplace P.L.
r—Fans&
Fire lace T.O.
trols
PartyWall Insulation
Condensate Lines
Party Wall Firewall
Drywall -Int. Lath �.
Exterior Lath-- — —
Final
Final
POOLS - SPAS
BLOCKWALL
APPROVAL
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPRCae/AL
Gas Test
Electric Final
Waste Lines
�/
Heater Final
Plumbing Final
Water Piping
Plumbing Top Out
7
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
_ /
Pool Cover
Sewer Connection
✓/
Encapsulation
Gas Piping
—
Gas Test
,p
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
_
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
f�— a3 Pus
CITY OF L/:1'UtNTA
BIUI4�QIpiC OF EPARTMENT
; ,-rlNSP_8&Tf(SN+REQ EST LINE
. ; a . 1 1 9-1 1J J
Owner PONDEROSA HOMES H, INC.
Contractor PONDEROSA HOMES 'H, INC.
Permit Number 0402-304
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
43-596 ESPADA
JOB ADDRESS '
SFD - LOT 93, PLAN 3CXL + 179 S.F. OPTION.
PERMIT DOES NOT INCLUDE BLOCK WALLS,
POOL, SPA OR DRIVEWAY APPROACH
TYPE OF INSPECTION DATE INSP.
TEMPORARY POWER
SETBACKS
U/G PLUMBING / WASTE
U/G ELECTRICAL / GROUNDING
IFOOTINGS / STEEL
CONCRETE SLAB �b
DO NOT POUR CONCRETE WNTI
ROOF NAIL / PRE -ROOF
OKAY TO WRAP
'MING COMBINATION
s UGH ELECTRIC
ROUGH PLUMBING
ROUGH MECHANICAL
INSULATION '
COVER NO WORK UNTIL ABOVE SIGN D
INTERIOR GYP. BD. DRYWALL
EXTERIOR LATH
GAS TEST o
SEPTIC ABANDONMENT )
SEWER CONNECTION '
SEPTIC / GREASE INTERCEPTOR
MASONRY INSPECTIONS
FOOTINGS / STEEL
i BOND BEAM
POOL / SPA / WATER FEATURE INSPECTIONS
PRE-GUNITE / SETBACKS
U/G PLUMBING
U/G GAS
U/G ELECTRICAL
PRE -PLASTER (ALARMS/ BARRIERS
FINAL INSPECTI NS
TEMP. USE OF PERMANENT POWER
ELECTRICAL
p' 11MBING
HANICAL
PUBLIC WORKS DEPARTMENT
COMMUNITY DEVELOPMENT DEPT.
FINAI / .IAR MMPI FTFn
t.
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 at
43-596 CALLE ESPADA LOT 93, LA QUINTA CA
CEILINGS:
TYPE: BLOW MANUFACTURER: Certainteed THICKNESS: R-38
WALLS:
TYPE: BATTS MANUFACTURER: Owens Coming THICKNESS: R-13
GENERAL CONTRACTOR: PONDEROSA HOMES 11, INC LICENSE #_
BY. TITLE:
PARAGO SCHMID BUILDING PRODUCTS A MASCO Company LICENSE # 221517
BY: TITLE: ACCOUNT REPRESENTIVE DATE: 6
1
�,zv^L%>.:u'i^: rxrr,;•�ri.[gr<v rv.^.'x.'�yv'am,ri,:2/�:'9�;Psr.;oaJ.a;rs9�zvilyiv:�.P:^.^.'h�:zunor Jan7�7G9 •z;oneat'a„o:;1:7:ayz:v-r.:v.:rw[%i /rws:�f�r-G!iv �zaxrarrzr./.•rl•1'/•.•cizr�:uv,%r..•.or.:•na !r!�+Fr
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
43-620 CALLE ESPADA LOT 94, LA QUINTA CA
CEILINGS: 2
v
TYPE: BLOW MAUNFACTURER: Certainteed THICKNESS: R-38
r
WALLS: r
TYPE: BATTS MAUNFACTURER: Certainteed THICKNESS: R-13 r
GENERAL CONTRACTOR: PONDEROSA HOMES II, INC LICENSE #
BY: TITLE:
PARAGON SCHMID BUILDING PRODUCTS A MASCO Company LICENSE # 221 17
BY: TITLE: ACCOUNT REPRESENTIVE DATE:
�%il:/�'.`.'%/%"//'/••."„�”/I:! /f l'//,/!/!!,?(!;!/.iVF/'%N✓//!il%!%nig%f:YiV//%I.yi[Hi6T•;9!'%1%li0!/1%f%/.;p:l/./l%I:;O!%I/S.%/A'9.%/%�/Yld:a!%9.I:o•.%1%Y.;O%7:t://%;!/Yit'J%/✓/.:4/.'%/%/iJ%!:4'%f•%Y/.!/J%I%/%/•%/%•/1.I/.:4•:'f:%: '.%/
V;.. i
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Tight Ducts $ TXV) CF -4R
PROJECT INFORMATION Climate Zone: 15
Project Title:
Mosaic ® Esplanade
Project Address;
La Quints
Builder Name:
Ponderosa Homes
Voice #: 925-AF50-8900
Builder Contact:
Jeff Nygren
Voice #
Project ID 0:
29323
Semple Group # ;
5 Phase: 5
Lot M
93
Plan #:
3
Address:
43-596 Celle Espada
HERS INFORMATION
HERS Rater;
Scott Johnson Jayme Carden
Certification # :
CCNSJ614037 CCNJC616157
HERS Firm:
Action Now
Voice # : 949-831-2274
Address:
2575 Westminster Avenue, Costa Mesa, CA 92627
HERS Provider:
CHEERS
Voice 4: 800-424-3377
HERS Address:
9400 Topenga Canyon Blvd., Chatsworth. CA 91311
HERS RATER COMPLIANCE STATEMENT
Mxx T-24 Complienw Credit was Taken for Tight Ducts
T-24 Compliance Credit was Taken for TXV TXV Verified Yes
The house was:
M
Tested / Verfled Approved as a part of sample, but was not tested
The Installer has Prov ed a copy of CF -8R
Air DIWbution System is Fully Ducted (sheetmetal, ductboard or flex duct)
Where doth backed rubber adhesive duct tape is installed, mastic and drewbands are used in combination with
Goth backed, rubber adhesive dud tape to seal leeks at the connections.
MINIMUM REQUIREMENTS FOR DUCT LEAKAGE COMPLIANCE CREDIT
Duct Diagnostic Leaka a Testing Results (Maximum 694 Duct Leakage)
CFA: CFA Leek Max Tested Leak
System o
Indicate the max mum a owe Is Duct Leakage and the calculation used:
0.7 x Floor Area x (0.06) for Climate Zone 8 through 15
0.5 x Floor Area x (0.06) for Climate zones 1 through 7 & 16
x 400 x (Cooling Capacity in Nominal Tons) x (0.06)
21.7 x (Heating Capacity in Thousands of Output BTU per hour) x
Measured Fan Flow j-"-1 x .06
D -5-d Pressurization Test Results 5 PA)
100 x Test Leakage/ fan flow = % Leakage
Check Box for Pass or Fail (Pass = 6% or Less) Pass
System L-�-J of
Indicate the maximum a ale Dud Leakage and the calculation used:
0.7 x Floor Area x (0.06) for Climate Zone 8 through 15
0.5 x Floor Area x (0.06) for Climate Zones 1 through 7 & 16
x 400 x (Cooling Capacity in Nominal Tons) x (0.06)
21.7 x (Heating Capacity In Thousands of Output BTU per h(
Measured Fan Flow x .06
D-0 Pressurization Test Results 5 PA)
100 x Test Leakage/ fan flow = % Leakage
Check Box for Pass or Fail (Pass = 6% or Less)
System of II
Indicate the maximum allowable Duct Leakage and the calculation used:
0.7 x Floor Area x (0.
0.5 x Floor Area x (0.
400 x (Cooling Capai
21.7 x (Heating Caps
Measured Fan Flow
D—uff Pressurization Test R,
100 x Test Leakage/ fan flo
Check Box for Pass or Fail
Raters Certifying Signature
9/29/2004
, , Certificate of Occupancy0 o
4
5
G� OF�w Building & 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: 43-596 Calle Espada
Use classification: Single Family Dwelling Building Permit No.: 0402-304
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: Ponderosa Homes II Inc Address: 400 S. Farrell Dr Ste B 103
City, ST, ZIP: Palm Springs, CA 92262
By: Daniel P. Crawford Jr.
Date: 10121/04 '
Building Official
POST IN A CONSPICUOUS PLACE _