0402-300 (SFD)N_ C0
w
O =) M
Q In
LLJ
r
c; :gyp Z
r o
H�
U�
~ a
Cn
Z
co
N
ON
U °)
CLa
T IX
Q O
0 J J
mVU
D
rn H
Iq Z
ado O
J
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€384 BW V3IiOA.
Date+� �� Signature of Contract or
OWNER -BUILDER DECLARATION�i
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 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.
REPUDIC INDENIN) ..'.. . • 15671601
(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 h' II othwit , comply with, -those prove ions �../
Date: I' Applicant � ""°zlk,`'
Warning: Failure to secure Workers' Rd ensation 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;asr`rovided 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
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
BUILDING PERMIT PERMIT J/
DATE VALUATION LOT 04CD.eW13M TRACT
JOB SITE / APN
ADDRESS
OWNER " CONTRACTOR/DESIGNER/ENGINEER
POW. HtOW.811 WC PONDTR08A 110hM U 19C
•400 3. FQ-MOZ D R 0'U 17, B 103 400 ;3, FATUI IJ DR � A 103
Pia 8..RMS CA 92262 PALM ,Os�2e`'iNGS CA 97262
(703)197-,710 C* 2346
USE OF PERMIT d
mwi x: FJts1aix riw&Lwo
3FD . LOT 33, PLAN 2AXL PLT;MI T' OO&S NOTINCLUDE BLOCK
WALL*% t=4 9PA OR DRIVL°WAY APPROACI i
RACT C01431 RUC".TICN 2183100 101F
FO2MPATTO 387.00 pip
0ARAMUCARi ORT 671.00 OF
ENIMM TED C09F OF CONSTRITCr310H
CONSTRUCTION FFIR
101 8.000
MUD
PLAN CHECK PC TP
101-000-4394•3;18
$ ..96
MECHANICAL FEZ
101.000.421.00 ,
$105.00
ELECTRICAL F99
1€ 1-000-X120-000 bti
$.46.25
TILUI4 B)HO FLM101.000.419,ib6
%I68,�0
STROHQ MOTION FES• .R.M'11 a
101-000-241-000
$3-1.24
ORAAE: NO ITL
101.000-423.000
$15.00
1 ]V1,VF A:)PZP. !98C ACT MZ
$?y 5.017
ff",-TOTAL CONSTRUC'MON AND lc►I,A24 MEW K
LCRS PRE -PAD FE
I •-
14AR 2
Or -
DATE FINA D. oINSPECTOR
/O - to
172,402.10
$0.00
INSPECTION RECORD
OPERATION
DATE
INSPECTOR OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs _ _ _
nderground Ducts
Forms & Footings
Ducts
Slab Grade ' "�_
f
- Return Air
_
Steel
Combustion Air
_✓
Roof Deck .� _,
xhaust Fans
0. K. to Wrap _
--F.A.U.
Framing
J -
ompressor
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 •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,,f,PMO A' S
Gas Test
Electric Final
Waste Lines I ' _
_
_
Heater Final
Water Piping l2?
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection �•�/ �_
capsulation
Gas Piping Q_ l
~
Gas Test O'
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)
1
CERTIFICATE OF. FIELD VERIFICATION AND DIAGNOSTIC TESTING (Tight Ducts & TXV) CF4R
PROJECT INFORMATION Climate Zone: 15
Project Title:
Mosaic a Esplanade
Project Address:
La Quina
Builder Name:
Ponderosa Homes Voice # : 925-46068900 .
Builder Contact:
Jeff Nygren Voice # :.
Project ID # :
29323
Sample Group 0:
5 Phase: 5
Lot #:
82
Plan #: 2
Address: r-43=655 Calle Espada
HERS INFORMATION
HERS Rater. Scott Johnson Jayme Carden
Certification # : CCNSJ614037 CCNJC615157
HERS Firm: Action Now Voice # : 949-631-2274
Address: 2575 Westminster Avenue, Costa Mesa, CA 92627
HERS Provider: CHEERS Voice #'- 800-424-3377
HERS Address: 9400 Topanga 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 yes
house was:
M
Tested / Verfied I—Approved as a part of sample, but was not tested
The Installer has pr0v ed a copy of CF -6R
Air Distribution System is Fully Ducted (sheetmetal, ductboard or flex duct)
Where doth backed rubber adhesive dud tape is installed, mastic and drewbands are used in combination with
Goth backed, rubber adhesive duct tape to seal leaks at the connections.
MINIMUM REQUIREMENTS FOR DUCT LEAKAGE COMPLIANCE CREDIT
Dud Diagnostic Leakage Testing Results (Maximum 5% Dud Leakage)
CFA: CFA Leak Max Tested Leek
System L I J of 2
Indicate the maximum 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 (0.05) 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
DUU 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 --.c J of
Indicate the maximum avow -ails 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 hour) x (0.06)
Measured Fan Flow x .06
u Pressurization Test Results 5 PA)
100 x Test Leakage/ fan flow = % Leakage
Check Box for Pass or Fail (Pass = 6% or Less) Pass x
System [::j of
Indicate the maximum aowa Is Duct Leakage and the calculation used:
0.7 x Floor Area x (0.0
0.5 x Floor Area x (0.0
400 x (Cooling Capaci
21.7 x (Heating Capac
Measured Fan Flow
t5a Pressurization Test Re.
100 x Test Leakage/ fan floes
Check Box for Pass or Fail (I
Raters Certifying Signature
9/29/2004
!'D
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 tho building at
•."'•/'�'l//////AfYF/.r�•./FF/d+yl/t/l/Y'�%F/!//////./IYl/.F/!/fYl/l/i/F/l///I/F/F/!//%1/I/l/1%//F/Y/ryfyl/F///l/F/!/l/!/LY.*`/F/t'/t/!/1i1//il/l/F/F/I:'!/I'i�n/.d'/!l!/l/ lF,!!/I/////e!l%JV/'/I//•'•%!.'�:'l:
INSULATION CERTIFICATE
This�to ify that insulation has been installed in conformance with the curve rgy
regulation, Ca i is Administrative Code, Title 24, State of California, in wilding located
CEILINGS:
TYPE: BLOW MAUNFACTUR : Ce mteed THICKNESS: R-38
WALLS:
TYPE: BATTS MA ACTURER: Certainteed THICKNESS: IR -13
GENERAL CONT TOR: LICENSE #
BY: TITLE:
SCHMID BUILDING PRODUCTS A MASCO Company LICENSE #2-Z,1 517
BY: TITLE: ACCOUNT REPRESENTIVE DATE:
r..
43-655 CALLE ESPADA LOT 82, LA QUINTA CA
r,
CEILINGS:
TYPE: BLOW
MANUFACTURER: Certainteed THICKNESS: R-38 r
WALLS:
TYPE: BATTS
MANUFACTURER: Certainteed THICKNE-�S: R-13
GENERAL CONTRACTOR: PONDEROSA HOME I, INC LICENSE #
r
BY:
TITLE: k;�
PARAG
HMID BU DING PRODUCTS A MASCO Company LICENSE # 221517
(
BY:
'a
TITLE: ACCOUNT REPRESENTIVE DATE:
f
•."'•/'�'l//////AfYF/.r�•./FF/d+yl/t/l/Y'�%F/!//////./IYl/.F/!/fYl/l/i/F/l///I/F/F/!//%1/I/l/1%//F/Y/ryfyl/F///l/F/!/l/!/LY.*`/F/t'/t/!/1i1//il/l/F/F/I:'!/I'i�n/.d'/!l!/l/ lF,!!/I/////e!l%JV/'/I//•'•%!.'�:'l:
INSULATION CERTIFICATE
This�to ify that insulation has been installed in conformance with the curve rgy
regulation, Ca i is Administrative Code, Title 24, State of California, in wilding located
CEILINGS:
TYPE: BLOW MAUNFACTUR : Ce mteed THICKNESS: R-38
WALLS:
TYPE: BATTS MA ACTURER: Certainteed THICKNESS: IR -13
GENERAL CONT TOR: LICENSE #
BY: TITLE:
SCHMID BUILDING PRODUCTS A MASCO Company LICENSE #2-Z,1 517
BY: TITLE: ACCOUNT REPRESENTIVE DATE: