0402-299 (SFD)i LICENSED CONTRACTOR DECLARATION
U) I hereby affirm under penalty of perjury that I am licensed under provisions of
I— Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
N W Professionals Code, and my License is in full force and effect.
O =) M License # Lic. Class Exp. Date
r- Ci LO
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7s t;4 �r� 1l0
o Z Date"! < t/ Signature of Contractor
(O 0 � \ f
J U
C:) OWNER -BUILDER DECLARATION VVV
HWd I hereby affirm under penalty of perjury that I am exempt from the Contractor's
U) License Law for the following reason:
Z ( ) I, asowner 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. •7.044, Business & Professionals Code).
( ) I, as owner'of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
c'') () I am exempt under Section ' B&P.C. for this reason
LO
O N Date Signature of Owner
N
0)d Q WORKER'S, COMPENSATION DECLARATION
o CcI hereby affirm under penalty of perjury one of the following declarations:
U') 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
m� Q performance of the work for which this permit is issued.
Q 0 ( ) I have and will maintain workers' compensation insurance, as required by
O UQ Section 3700 of the Labor Code, for the performance of the work for which this
d 0 Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
CY
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
subject 3 to the workers' compensation provisions of Section 3700 of the Labor Code, I•sh I forthwith comply withcos p wslons.
i o\� Applicant [
Warning: Failure to secure Workers' A04ensation verage 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.
a 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 r
whose request and for whose benefit work is performed under or pursuant to L
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 android if
work is not commenced within 180 days from date of issuanceofsuch
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 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 propert0fo i pection purposes.
Signature (Owner/Agent) ``' 6' 1 Date
BUILDING PERMIT PERMIT#
DATE • • VALUATION LOT 0402•-299 TRACT .
°
r[ i 1:5,77 F1I 29323-1
JOB SITE
APN
ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
PON)DIMOSAHOMMIEWC
110NDMOSA140Y.—EIS 11 INC
400 S� FAMMI L DR SFE BI 03
40.9 3, F,R?.�'.L L DR RIME B 103
PAUI VRIUCIS CA 92262
PIU Ivl SPRINGS CA 92262
(703)187-7117 CBi4 2346
USE OF PERMIT
SINGLE FA1"_Y DW LING
WPLI • LOT 81, PLKN 3aX.R. PERMIT DOES NOT INC1..LiOLf SLAXK
TALL% Pot, SP 1, OR DRtt Lrw.&Y APr Rous i, 7,.q% ,'at)1JVT[O-H TO PLAw
CHECK 'F'EE DUE TO X1111; AIPLE tSS11.9NCE OF SAME PLAN TYPE
TRACT C014STh UCTION 3,010D SP
FOR,Ci°UP TiO' 500.00 Sr
k'1.6rAA01YCAItP6RT 681,00 SF
leyr ,�3: RJ OOtiI' OF C.$7i ":fat7C`i'L�D.0
185,775-
P.1s:l`at+fit f 1t'> M, 9'1311i1K1.` Y
CONSTRUCTION FEE 101.000O :18.000 $944,30
PLAN C1i'ECK : FE 101-000.439-318 $194.80
MECHANICAL F'e•L 101-000-421-000 89&,50
EL X,*T-R3CFiL FEE 101 -O00 -K420.000 S153.9a
,
PLUMT"Tw FEF; 101--000-419-000 $174,S0
STRONG MOTION FIES • M51117 101...001 -241-.000 $18.5&
OR.t#DINO FEE 101-000423-060 $15.00
DEVELOPER 1MRA.CT FEE $A405,8D
t✓OMSIiTMON qm PLAN CI K
$4,000.86
LE9,1, PRE-PAMFERS
MAR 2 4
$0,00
2004 "t S?TAI. FE.RIHI' FEES DDY NOW
S4100026
CITY OF LA QUINTA
FINANCE DEPT. .p
V
RECEIPT
DATE;'
BY r!p
GATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms 8 Footings fu_
Ducts
Slab Grade
Return Air
Steel
mbustion Air
_
Roof Deck
Exhaust Fans
_
O.K. to Wrap _
Framing
F.A.U.
Compressor
Insulation_
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
ondensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
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 P OVAL
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
Encapsulation
Gas Piping -
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
Final
Utility Notice (Perm) KEA A-/
COMMENTS:
u
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Tight Ducts & TX V) CF -411
PROJECT INFORMATION' Climate Zone: 16
Project Title:
Mosaic Q Esplanade
Project Address:
La Quinta
Builder Name:
Ponderosa Hames Voice # ; 925-46M900
Builder Contact:
Jets Nygren Voice 0:
Project ID #:
29323
Sample Group # :
5 Phase: 5
Lot #:
61
Plan e; 3
Address;�43-675 Calle Espada
HERS INFORMATION
HERS Rater. Scott Johnson Jayme Carden
Certification # : CCNSJO14037 CCNJC615157
HERS Firm: Action Now Voice #: 549-631-2274
Address: 2575 Westminster Avenue, Costa Mesa, CA 92627
HERS Provider. CHEERS Voice 0: 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 Yes
I �x
The Ouse was:
x Tested / Verfled =Approved as a pan of sample, but was not tested
x The Installer has provided a copy of CF -0R
x Air Distribution System is Fully Ducted (sheetmetal, ductboard or flex duct)
Where doth backed rubber adhesive dud tape is Installed, mastic and drawbands are used in combination with
doth backed, rubber adhesive dud tape to seal leaks at the Connections.
MINIMUM REQUIREMENTS FOR DUCT LEAKAGE COMPLIANCE CREDIT
Duct Diagnostic Leaka a Testing Results (Maximum 6% Duct Leakage)
CFA: CFA Leak Max Tested Leak
System
Indicate the maximum a owe 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 t 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 I Ix.06
uct Pressurization Teat Resu 5 PA)
100 x Test Leakage/ fan flow = % Leakage
Check Box for Pass or Fail (Pegs = 6°% or Less) Pass x
System M of alb
Indicate the maximum owa is 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 (0.08)
21.7 x (Meeting Capacity in Thousands of Output BTU per hour) x (0.06)
Measured Fan Flow , X,06
tllu—a 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 � of
Indicate the maximum allowable 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 -
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 Resu 5 PA)
100 x Test Leaka* fan flow = °% Leakage
Check Box for Pass or Fail (Pass = 81,6 or Less) Pass
Raters Certifying Signature
fan flow
fen flow
Date 9/29/2004
F2001-02 (4-02) Action Now T-24CF4RTD&TXVmacro.xls
14
INSULATION CERTIFICATE:
This is to certify that insulation has been installed in conformance with the, current energy
P regulation, California Administrative Code, Title 24, State of California, in the building at
43-675 CALLE ESPADA LOT 81, LA QUINTA CA
CEILINGS:
TYPE: BLOW MANUFACTURER: Certainteed THICKNESS: R-38
WALLS:
TYPE: BATTS MANUFACTURER: Certainteed THICKNESS: R-13
GENERAL CONTRACTOR: PONDEROSA HOME INC LICENSE �R
..BY: TITLE: `
PARAGON ID BU DING PRODUCTS A MASCO Company LICENSE # 221517
BY: 'TLE: ACCOUNT REPRESENTIVE DATE: oC,
INSULATION CERTIFICATE
This is to ify that insulation has been installed in conformance with the current energy
regulation, Ca is Administrative Code, Title 24, State of California, in the building loci
CEILINGS: `
t TYPE: BLOW MAUNF
f
WALLS:
TYPE: BATTS MAUN
BY:
Certainteed
LICENSE #
THICKNESS: R-38
THICKNESS: R-13
PARAGON SCHMID BUILDING PRODUCTS A MASCO Company LICE14SE #
BY: TITLE: ACCOUNT.REPRESENTIVE DATE:
17