0402-301 (SFD)LICENSED CONTRACTOR DECLARATION
U)I hereby affirm under penalty of perjury that I am licensed under provisions of
f' H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
(V W Professionals Code, and my License is in full force and effect.
O =) Ch License # Lic. Class Exp. Date
W
1�- 75288+1 B €rCr£ti £/31/04
oZ � Date �>�7 A 04 Signature of Contractor �� r
(O 0 � t
r- (-) C) OWNER -BUILDER DECLARATION
W a rl- I hereby affirm under penalty of perjury that I am exempt from the Contractor's
U) 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).
co () I am exempt under Section , B&P.C. for this reason
LO
N Date Signature of Owner
ON
EL Q WORKER'S G�OMPENSATION DECLARATION
p Cc I hereby affirm under penalty of perjury one of the following declarations:
r IF— O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W L= 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 I have and will maintain workers' compensation insurance, as required by
OQ Q Section 3700 of the Labor Code, for the performance of the work for which this
0 Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
Cb O REPUBIC tY1�'I'A011'T' '15671602
J (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
3 subject to the workers' compensation provisions of Section 3700 of the Labor
Code I shall forrthwith comply with`thos iprovisions.
Date: N14 k I 11A Applicant—
Warning:
pplicant 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
1111110 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 Iof 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) Date 5 ZALL, I
BUILDING PERMIT PERMIT# ,
DATE ' i� VALUATION LOT .0402-30i TRACT
2932�1
JOB SITE
APN .
ADDRESS 43-635 C*AJ : F F51'ADA
6M.3M0'2' .3
OWNER
CONTRACTOR / DESIGNER / EN INEER
P0141)TKI; OSA.riCW—Z JU XN(4,
POItlDE°t: 5A FTO�f. S Ir WC
400 .1. VARRJ1- Z DR : YJM B 1. 03
4 000. I+'AEME.,1.'�., DR SbIE�, B 103
PALM 07-PP2409 O'.A. 92262
MUM SPRI 308 t.`.A 92202
(103)187-710 MIA 2346
USE OF PERMIT
aN'3IZ 17MLY YJ'i +r' T 4T;TL�IL�
SFD . LOT 83, PLAN 38XR. •h t79 SY, OiY`t'10'[J. PFAMIT GOES 13OT
MClat OK,DIANCK WALL,% POO1, SP.)! OR � iRNMAY �+.J'PRoACH
TRACT C.ONS'T#LI,CT,JON 3141 2.00 WFC
PORi"P1;1%A T10 500.011.317
O. RAc31�,lt�:A RPORT 502.60 OF
g').1.w=D COST \. i i.✓wS'd.'1}S+b.CR.i/if8.C,11aP
�,•i1f uG'L�
CONSTRUCTION ME 101 -000-418-000 5961,30
PLAN CHECFE1:11-000-439-' 18 'M9.99
ME01AiYC;,d>.L FEE 101-000»421.-000 $98's4
Ft,F:C:TPtIf:AI, FRE 101-00a,420-000 $156.66
PL,UMSTNO FF?F, ' 101-000.419.000 5192.30
STRONG PACIT10A4 112 - RE31..0 101 X000-241-000 $19.29
GRADW IME 101-000-423-000 $15.0101
D1W, Z1,UPER IMPACT VER $2,405.00
SRYE-1'CF :' CON',S-I ' UC°!I'101J ANI) P.C" C` 3)M
$4,M77.75
MAR 2 4 Qp LFW PRE-PATIDM3
$0,00
CITY OF L A i��it'1 dA 'TO'.1'1 , P]MAW JK1 8 D lYC)'W
S4,M7,75
FINAAICE DEPT
RECEIPT
DATE,7,! {,
BY
•DATEFINALED
INSPECTOR
1�
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE-
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts "
Forms & Footings
— _ a�
Ducts
Slab Grade
Retum Air
Steel
Roof Deck
_
_ _ _
Combustion Air
Exhaust Fans
O.K. to Wrap
Framing✓
_ _
_ _
A.U.
Com ressor
Insulation
_
Vents
Fireplace P.L.
_
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - IM. Lath
Final
Final
a— -a
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
Gas Piping
PLUMBING P OV S
Gas Test
Electric Final
Waste Lines
eater 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
Appliances
FZ
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)
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (fight Ducts & TXV) CF -4R
PROJECT INFORMATION Climate Zone: 16
Project Title:
Mosaic Q Esplanade
Project Address:
La Quinta
Builder Name:
Ponderosa Homes
Voice # ; 925.460-8800
Builder Contact:
Jeff Nygren
Voice #
Pro)ect ID #:
29323
Sample Group #:
5 Phase: 5
Lot f!;
83
Plan it
3
Address:
43-835 Calle Espada
HERS INFORMATION
HERS Rater.
Scott Johnson Jayme Carden
Certification #.,
CCNSJ614037 CCNJC615157
HERS Flan:
Action Now
Voice #'. 949-631-2274
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
x T-24 Compliance Credit was Taken for Tight Ducts
x T-24 Compliance Credit was Taken for TXV TXV Verified yes0
The house was:
x Tested / Vem*d . =Approved as a part of Sample, but was not tested
x The installer has provided a copy of CF -BR
x Air Distribution System is Fully Ducted (sheetmetal, dudboard or flex duct)
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 the connections.
MINIMUM REQUIREMENTS FOR DUCT LEAKAGE COMPLIANCE CREDIT
Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage)
CFA: CFA Leek Max Nested Leak
System o
Indicate the maximum aowa Is Duct Leakage and the calculation used:
0.7 x Floor Area x (0.08) 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 X.06
u Pressurization Test Resu 5 PA)
100 x Test Leakage/ fen flow = % Leakage
Check Box for Pass or Fail (Pass = 6% or Less) Pass
System L -.!.J of I Z]
Indicate the maximum a owa le 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 8 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
b -U -a PresSuftation Test Resu 5 PA)
100 x Test Leakage/ fan flow = % Leakage
Check Box for Pass or Fail (Pass = 6% or Less) Pass x
System E—] of
Indicate the maximum a a Is 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 Flov
D-0 Pressurization Test
100 x Test Leakage/ fan 1
Check Box for Pass or Fa
Raters Certifying Signatw
fen flow
9/29/2004
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
43-635 CALLE ESPADA LOT 83, LA QUINTA CA
CEILINGS:
TYPE: BLOW MANUFACTURER: Certainteed THICKNESS: R-38
WALLS:
TYPE:BATTS MANUFACTURER: John Manville THICKNESS: R-13
GENERAL CONTRACTOR: PONDEROSA HOMES 11 INC LICENSE #
BY: TITLE:
PARAGOL,&MID ALDING PRODUCTS A I MASCO Compan y LICENSE # 221517
BY: U4L4�a Z&Z TITLE: ACCOUNT R'EPRESENTIVE; DATE:-
Xr' xr"
INSULATION CERTIFICATE
Thisis to certi t insulay
gu Californiaition has been installed in conformance with the current energy
regulation, Cnistrative Code, Title 24, State of California, in the building locat
CEILINGS:
TYPE: BLOW
WALLS:
TYPE: BATTS
GENERAL COh
BY:
MAUNFACTURER: Ce * teed
NFACTURER*Ce
teed
d
MAUNFACT Certainteed
LIC S 4
TO LICENSE #
TITLE:
ICKNESS: R-38
ESS: R-13
PAR�eON SCHMID BUILDING PRODUCTS A MASCO Company LICENSE # 221
BY:
TITLE: ACCOUNT REPRESENTIVE DATE: