0402-303 (SFD)LICENSED CONTRACTOR DECLARATION
U) I hereby affirm under penalty of perjury that I am licensed under provisions of
F- Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
c•1 W Professionals Code, and my License is in full force and effect.
=) C.,) License # Lic. Class Exp. Date
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W r- 52834,a �3�
oZ bate '0 7A, �' Signature of Contractor
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J U CD co OWNER -BUILDER DECLA ATION
W W I hereby affirm under penalty of perjury that.l am exempt from the Contractor's
~ a 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 B&P.C. for this reason
LO
O N Date Signature of Owner
0)
CL Q WORKER'S COMPENSATION DECLARATION
p M I hereby affirm under penalty of. perjury one of the following declarations:
Lo H O () 1 have and will mai6t.ain a certificate of consent to self -insure for workers'
X W u- compensation, as,provided for by Section 3700 of the Labor Code, for the
O � Q performance of the work for which this permit is issued.
m Q U ( ) I have and will maintain workers' compensation insurance, as required by
O U Q Section 3700 of the Labor Code, for the performance of the work for which this
13� rn H permit is issued. My workers' compensation insurance carrier & policy no. are:
? Z Carrier Cb 5 t iw q� Sgy57 A q Policy No. t } y !g y
l< (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 subiect to the
workers' compensation laws of California, and agree that if I should become
3 subject to the workers' compensation provisions of Section 3700 of the Labor
Code., I'half, 1 forthwith comply with,fts'e Provisions:
Date: /j'Applicant—
Warning:
pplicant Warning: Failure to secure Workers' Mmperisation overage 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, indemnif
& hold harmless the City of La Quihta, its officers, agents and employee'
2. Any permit issued as a result of this application becomes null and void
work is not commenced within 180 days from date of issuance of sue
permit, or cessation of work for 180 days will subject permit to cancellati m
I certify that I have read this application and state that the above informatio is
• correct. I agree to comply with all City, and State laws relating to the build ng
construction, and hereby authorize representatives of this City to enter u on
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) � 6i Date A LILY
BUILDING PERMIT PERMIT#
DATE VALt/ •ON LOT 040 1.3,03 TRACT
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• t!' V 19,59720 94 29323.1
JOB SITE
APN
ADDRESS
43-620 CAME ESPA ?A
•-3W-023
OWNER
CONTRACTOR/DESIGNER/EN INEER
POMEROS.A HOAM 1I INC
PONDER09A HONM U SI~3'C
4.00 S. FARIwML. Dr-. SUTM B 10.9
4.00 5. FARPM11. D11 MITE, B 103
PAL M. SPldi 109 C1: .922262
PALM SMONG3 C.A. 92262
703)18'1-710 Mlh 2346
USE OF PERMIT
MSOU FLi1.✓'X--;p L1wSiV G
,SFD . LOT 94, PLAN UBR+ 213 S.VF -OPT.ICIN. P •RM1T DDES 14OT
INCLUDE, BLOCK INAd L1% P004 e PA OR DRMTWAY APPROACH
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Tii,Wf CC+`laS'I'RU&JON V31102 V
PORC.f•IlPATIO 3111.00 SF
O.A.R.AA: EXARPORT 448.00 3F
7� +�. MD CONT OF Ct)�te�►"1' UC':1"ION
179,59720
'y:��pq
RAUFFELt
CONSTRUCTION FEE 101-000-418-000
PLAN CHECK ME 101-000-439-_i19
ME4;IiKOIC,AI. VEL 101-000.421.000 $105.00
LKLECTRICAL. FEE 1901-000-420-000 $149.25
P1.LIMBIN""' FRE 101.000-419.000 $1 6,50
STRONOHQ7'IMFEE•FLT ID 101-000.243-000 $17.911
GRAD W3 FEE 101.000.423.0100 $15.00
DrVELOPER IMPACT M? $2,405.00
:>% -: L`1i'f>i: CCS1 ' TtZI3C1lOt3 AISf I':PsE;li CI
$4,56534
Lf .43 1YR&P.AM FURS
$0.00
TMA -L �'r""P "PTYn, S IDUE NOW
$4,2%5,84
MAR 2 4 2004
CITU OF LA aA
QiJit
Ff9tl�klr°� r P r'i
_
RECEIPT
BY \
DATE FINALED
INSPECTOR
i
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
_
Forms & Footings /
Ducts
Return Air
Slab Grade
Steel _
Combustion Air
Roof Deck
Exhaust Fans '
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation .p
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath'
Drywall - Int. Lath L
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING AP VAI
Gas Test
Electric Final
_
Waste Lines '
Heater Final
_
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection 10 2✓'
Gas Piping
Encapsulation
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power 6
Final
Utility Notice (Perm)
COMMENTS:
TY OF LA QUINTA
UILDIL�G & S DEPARTMENT
CF'yof J --`-----�j7, , 012
�� �IfV$pE�Tl@N� EQUEST LINE
[[�� �� 153
Owner Q I os� ES H, INC.
. e. �, Ep,
Contractor POND ES II, INC.
Permit Number 0402-303
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 43-620 CALLE ESPADA
SFD - LOT 94, PLAN 2BXR + 213 S.F. OPTION.
PERMIT DOES NOT INCLUDE BLOCK WALLS,
POOL, SPA OR DRIVEWAY APPROACH
TYPE OF INSPECTION DATE INSP.
TEMPORARY POWER
I. SETBACKS
U/G PLUMBING /WASTE
U/G ELECTRICAL/ GROUNDING
FOOTINGS / STEEL
CONCRETE SLAB •'h_
DO NOT POUR CONCRETE UPTIL A139V
ROOF NAIL / PRE -ROOF �-
OKAY TO WRAP ify
C q'MING COMBINATION
COUGH ELECTRIC
ROUGH PLUMBING
ROUGH MECHANICAL
INSULATION ---y .e9-3•�
I
COVER NO WORK UNTIL ABOVE SIG
INTERIOR GYP. BD. DRYWALL 1
EXTERIOR LATH
GAS TEST
SEPTIC ABANDONMENT
SEWER CONNECTION ✓ '�
SEPTIC / GREASE INTERCEPTOR
MASONRY INSPECTIONS
FOOTINGS / STEEL
BOND BEAM
POOL / SPA / WATER FEATURE INSPECTIONS
PRE-GUNITE / SETBACKS
U/G PLUMBING
U/G GAS
U/G ELECTRICAL
PRE -PLASTER ALARMS / BARRIERS
FINAL INSPECTIONS
TEMP. USE OF PERMANENT POWER 0
ELECTRICAL
P1 UMBING
fHANICAL
rvBLIC WORKS DEPARTMENT
COMMUNITY DEVELOPMENT DEPT.
E-.
INSULATION CERTIFICATE
This is to c'tinsulation has been installed in conformance with the current energy
regulation, dminisfrative Code, Title 24, State of California, in the buildin
43-5 . CALLE ESPADA LOT 93, LA QUINTA CA
CEILINGS:
TYPE: BLOW MANUFACTU : Certainteed THICKNESS: R-38
WALLS:
TYPE: BATTS MANUFACTURER:
GENERAL CONTRACTOR: POND
BY:
PARAGON,SCHMID 5101 -DING
THICKNESS: R-13
ROSA HOMES NC LICENSE #
TITLE:
DUCTS A MASCO Compan LICENSE # 221517 .
TITLE: ACCOUNT REPRESENTIVE TE: 6
�'s.Y/'^/. YY.:V.%:^i?c'M.:�r,;.l,/J!/rJ6sG(t TfVimil:9+'O.%✓f .: J%!.:'YN•3TA✓Y.:9:tF,•)Y.e"1,p!Z/dll/a'9•:oi0^.77:7'O. W.'A�JY.Mdl.%!A'7'9:a'o,Yl�✓.i'�'.fT.:'l.:'7'^J.Y/.•:?.:O.L'9.:O.:li"v:Y/`N....:'d;YK!:'Ya'oC�.'.Gr/..'P./J'/.T'MYl•:'/u`Gcf'/.(�J'.: �.v.•J...�XIn'/+�3'•'Y!/:F..
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INSULATION CERTIFICATE
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This is to certify that insul s been i ormance with the current energy
regulation, Califo ministrative Code, Title 24, State of a rfli in the building located
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43-620 CALLE ESPADA LOT 94, LA.QUINTA CA
CEILINGS:
TYPE: BLOW . MAUNFACTURER: Certaintee : �R-38 Y
WALLS: F
TYPE: BATTS MAUNFACTURER: Certainteed THICKNESS: R-13
GENERAL CONTRACTOR: PONDEROSA HOMES II,. INC LICENSE #
r BY: TITLE:
PARAGO SCHMID BUILDING PRODUCTS A MASCO Company LICENSE # 221 17
BY: TITLE: ACCOUNT REPRESENTIVE DATE: a
F
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CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (fight Ducts & TXV) CF -4R
PROJECT INFORMATION Climate Zone: 15
Project Title:
Mosaic C Esplanade
Project Address:
La Quinta
Builder Name;
Ponderosa Homes
Voice # : 925-460-8900
Builder Contact:
Jeff Nygren
Voice #
Project ID 0:
29323
Sample Group #;
5 Phase; 5
Lot #:
94
Plan #:
2
Address:
43.620 Calle Espada
HERS INFORMATION
HERS Rater:
Scott Johnson Jayme Carden
Certification # ;
CCNSJO14037 CCNJC615157
HERS Firm:
Action Now
Voice 0: 4149-631-2274
Address:
2575 Westminster Avenue, Costa Mesa, CA 92627
HERS Provider:
CHEERS
Voice #: 800-424-3377
HERS Address:
9400 Topange Canyon Blvd., Chatsworth, CA 91311
. ,
HERS RATER COMPLIANCE STATEMENT
T-24 Compliance Credit was Taken for Tight Ducts
X T-24 Compliance Credit was Taken for TXV TXV Verified YesO
The house was:
M
Tested/verfied Approved as apart of sample, but was not tested
The installer has provided a copy of CF -6R
Air Distribution System is Fully Ducted (sheetmetal, ductboard or flex duct) .
Where cloth backed rubber adhesive duct tape Is installed, mastic and drawbands are used In comoination with
Goth backed, rubber adhesive duct tape to seal leaks at the connections.
MINIMUM REQUIREMENTS FOR DUCT LEAKAGE COMPLIANCE CREDIT
Dud Diagnostic Leak a Testing Results (Maximum 6% Duct Leakage)
CFA:CFA Leak Max Tested Leak
System o
Indicate the max mum a owa le 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 (0.06)
Measured Fan Flow x .06
D—ua Pressurization Test Results 5 PA)
100 x Test Leakage/ fen flow = % Leakage
Check Box for Pass or Fail (Pass = 6% or Less) Pass x
System [Z] of
Indicate the maximum aowa le 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 Capacit in Thousands of Output BTU per hour) x (0.06)
Measured Fan Flow x.06
U-0 Pressurization Test Resu 5 PA)
100 x Test Leakage/ fan flow = % Leakage
Check Box for Pass or Fail Pass = 6% or Less) Pass x
System [7] of
Indicate the maximum aowa le Duct Leakage and the calculation used:
0,7 x Floor Area x
0.5 x Floor Area x
400 x (Cooling Cap
21,7 x (Heating Cal
Measured Fan Fkne
U53 Pressurization Test
100 x Test Leakage/ fan f
Check Box for Pass or Fa
Raters Certifying Signatur
fan flow
9/29/2004