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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
752,884 B MCC' t 6i&1
Date f 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).
( ) 1, 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 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:
Cartier Policy No.
R11PUDIC INDENWIT' 196700
(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 thos provisions. •/'"
Dater=T ,AApplicant <
Warning: Failure to secure Workers' Coensation coverage is unlawful and
shall subject an employer to criminal penal ies 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 I
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/Agentv ��Y-Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0412-302 TRACT
061 $ 85,7750 95 2932.1"
JOB SITE
ADDRESS
!A4�t,WAET_ __L jESi?A �L�
APN
fr09- -I3 3
OWNER -
CONTRACTOR / DESIGNER / EN (NEER
P01,MEROSA 1I0ARF9 .Il INC
POATDMOIRA kiOMM 1119('
400 3,1APIMU.,DR 31T'EP 103
400 S. FA,RI°.EI.. ISR SLILUB Ii 103
'PALM aY'tc IN S CA 92262
PALM RM'tiS 0".A 92262
(703)187.710 CYBUf .2340
USE OF PERMIT
5 30= E FANMY i)WZ,s'..T WG
SF0 • LOC 95, 1'LA14 3AXIC PERMIT DOES NOT 1NC1,TJD9 BLDC K
WALLS„ P0014FJP.A 01,1- I)MVEWAY A.PPI:D.fbCH. 7M. R91) ICTION TO PLAN
CHECK FFE DICIE TO M2 ULTIPLL• ISSUANCE OF SAME PT..i1N TYPE
TRACT CONSTRUCTION 303100 STS
I7OidCHIPA TIC) 50t).00 SF
CAR.F GEIC'ARPORT 681.00 SF
Iy I�,�A'I'.'I'r.D C'C9 ►I' 01, (,:C3.NS11-R 7'MON
&''5,775.50
C0 TROCTION FEE 101,-000-4.18«000 $44t'I,SO
,PL," CHFCK PRE 101-N)0.439-318 �iffrS.�0
Nt'ECHANIC.AL FEE 101X000,421-000 S981so
ELECTRICAL, PCE 101-000-420-000 $153.98
I?LUhi9IN0 VEP_ 101.000.419-000 V74.10
S'rRONO MOTION 7CE • fzES1tD 101-000-241-000 $18.SS
OUtii? O FEY, 101.000-423.001 $15,00
]D.%VL?i3OPT',it FAttPAC ' l�Ena $Z,�lf);.Qti
517 ='CONTMRUc"'TZ�JN AND 1?I..E►.1`T CRWK
$4,000.85
D °,AFn
. a:=3 PRE -PAID l
$0.00
TOTAL FFJ? ' MKS, DUE NOW
$4,wo ti
MAR 2 4 2004 -
CITY OF LA (Ju
FINANCE DIEP7 �!
RECEIPT
DATE
BY
DATE FI ALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs U0ezground Ducts
Forms & Footings!_ Ducts
Slab Grade Return Air
Steel 1 Combustion Air
_ _
Roof Deck
Exhaust Fans
- — -
O.K. to Wrap _ —
F.A.U.
_—
_—_
Framing
Compressor
_
Insulation
Vents
_
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final ID z oa
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
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
Electric Final
_
Waste Lines _/
Heater Final
Water Piping
umbing Final
_ _
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping (�7
Gas Test ,9f7
Appliances
Final
O e
Final / 0 77
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 2Z D
Final
Utility Notice (Perm)
COMMENTS:
1
-
m
O._•..____`_
�j
A ... .I� UINTA
BUIjLDIN F EPARTMENT
OF
it INSP. Q EST LINE
Ls� aUM 7-71
ner
FOND` A HOMES H, INC.
itractor PONDEROSA HOMES H, INC.
mit Number (0402=302
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
3 ADDRESS 1'
SFD - LOT 95, PLAN 3AXL. PERMIT DOES NOT .
INCLUDE BLOCK WALLS, POOL, SPA OR j
DRIVEWAY APPROACH
TYPE OF INSPECTION DATE INSP.
IPORARY POWER
BACKS
PLUMBING /WASTE
ELECTRICAL/ GROUNDING
)TINGS / STEEL
� JCRETE SLAB � ,�
DO NOT POUR CONCRETE tffiTIL OVE S
)F NAIL / PRE -ROOF
IY TO WRAP
ING COMBINATION
UGH ELECTRIC
JUGH PLUMBING
DUGH MECHANICAL
JLATION C
COVER NO WORK UNTIL ABOVE SIGNED
=RIOR GYP. BD. DRYWALL
ERIOR LATH
(TEST D
'TIC ABANDONMENT
VER CONNECTION
'TIC / GREASE INTERCEPTOR
MASONRY INSPECTIONS
)TINGS / STEEL
JD BEAM
POOL / SPA / WATER FEATURE INSPECTIONS
:-GUNITE / SETBACKS
PLUMBING
GAS
ELECTRICAL
-PLASTER (ALARMS/ BARRIERS)
FINAL INSPECTIONS
IP. USE OF PERMANENT POWER
MBING
*ANICAL
ILIC WORKS DEPARTMENT
AMUNITY DEVELOPMENT DEPT.
AI' I InC rf%RA01 CTCn
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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
001 CALLE ESPADA LOST 95, LA QUINTA CA
CEILINGS:
TYPE: BLOW MANUFACTURER: Certainteed THICKNESS: R-38
WALLS:
TYPE: BATTS MANUFACTURER: Certainteed THICKNESS: R-13
GENERAL CONTRACTOR: PONDEROSA HOMES II, INC LICENSE #
BY: TITLE:
PARAGON S MID BUILDING PRODUCTS A MASCO Company LICENSE # 221 17
BY: 4JITLE: ACCOUNT REPRESENTIVE: DATE: 6
This is tcL
regulation,
INSULATION CERTIFICATE
that insulation has been installed in conformance with the current energy
)mia Administrative Code, Title 24, State of California, in the building.leE
CEILINGS:
TYPE: BLOW MAUNF
WALLS:
TYPE: BATTS MAUNF
GENERAL C
L]7i
PONDEROSA HOMES II, INC
THICKNESS: R-38
THICKNESS: R-13
SE #
SCHMID BUILDING PRODUCTS A MASCO Company LICENSE # 221
TITLE: ACCOUNT REPRESENTIVE DATE:
r- 1
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Tight Ducts S TXV) CF -411
PROJECT INFORMATION Climate Zone, 15
Project Title: Mosaic @ Esplanade
Project Address: La Quinta
Builder Name: Ponderosa Homes Voice 0: 925.460-8900
Builder Contact: Jeff Nygren Voice #
Project ID * : 29323
Sample Group tK :
5 Phase: 5
Lot p:
95
Plan 0:
3
Address:
43-650 Calle Espada
HERS INFORMATION
HERS Rater:
Scott Johnson Jeyme Carden
Certification
CCNSJ6/4037 CCNJC615157
HERS Firm:
Action Now Voice 0: 948-631-2274
Address:
2575 Westminster Avenue, Costa Mesa, CA 92627
HERS Provider:
CHEERS Voice S: 1400-424-3377
HERS Address:
9400 Topengs Canyon Blvd., Chatsworth, CA 91311
HERS RATER COMPLIANCE STATEMENT
M T-24 Compliance Credit was Taken for Tight Ducts
x T-24 Compliance Crodit was Taken for TXV TXV Verified Yes
The house was:
X Tested / Verfied (Approved as a part of sample, but was not tested
x The installer has provi ed a copy of CF -6R
x 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 combination with
cloth backed, rubber adhesive duct tape to seal leaks at the connections.
MINIMUM REQUIREMENTS FOR DUCT LEAKAGE COMPLIANCE CREDIT
Duct Diagnostic Leaks a Testing Results (Maximum 6°% Duct Leakage)
CFA: CFA Leak Max Tested Leak
System Or
Indicate the max mum a owa Is Duct Leakage and the calculation used:
0.7 x Floor Area x (0.06) for Cllinate 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) 84
21.7 x (Heating Capacity in Thousands of Output BTU per hour) x (0.06)
Measured Fan Flow X.06
uc Pressurization Test Renu 5 PA) 81
t 00 x Test Leakage/ fan flow = % Leakage
Check Box for Pass or Fail (Pass = 6% or Less) Paas X ar
Systemof
Indicate the mmumum 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) 96
21.7 x (Heating Capaci in Thousands of Output BTU per hour) x (0.06)
Measured Fan Flow x .06
uct Pressurization Teat Resu 5 PA) 93
100 x Test Leakage/ fan flow = % Leakage 5.81%
Check Box for Pass or Fail (Pass = 6% or Less) Pass ai
Systemof
Indicate the maximum a owa Is Duct Leakage and the calculatlon 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
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 .08
D-0 Pressurization Test Results 5 PA)
100 x Test Leakage/ fen flow;; % Leakage
Check Box for Pass or Fell (Pass = ftor Less) Passa
Raters Certifying Signature
fan flow
Date 8/29/2004
V/ F2001-02 (4-02) Action Now T-24CF4RTD&TXVmacro.xls