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0402-298 (SFD)LICENSED CONTRACTOR DECLARATION U) I hereby affirm under penalty of perjury that I am licensed under provisions of H Chapter 9 (commencing with Section 7000) of Division 3 of the Business.and cv W Professionals Code, and my License is in full force and effect. O =) ch License # Lic. Class Exp. Date r-CiL W } S2 4 BM ' 8/39/04 Z r --Date - Signature of Contractor Oi (\ CO 0 v J U (0 / / OWNER -BUILDER DECLARA ION W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's ~ tl 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 contfacting with licensed contractors to construct the project (Sec'. 7044, Business & Professionals Code). Cf) () I am exempt under Section , B&P.C. for this reason Ln N Date <,. Signature of Ownee Q. N " a Q WORKER'S COMPENSATION DECLARATION C:> Z I hereby affirm -under penalty of perjury one of the following declarations: Lo H O () 1 have and'will maintain a certificate of consent to self -insure for workers' X W �= compensation, as provided for by Section 3700 of the Labor Code, for the mJ Q performance of the work for which this permit is issued. Q L) ( ) I have and will maintain workers' compensation insurance, as required by Q U Q Section 3700 of the Labor Code, for the performance of the work for which this rn I- permit is issued. My workers' compensation insurance carrier & policy no. are: It Z Carrier Policy No. ob O TtLi iiR31iP YNDEMN1T' 18G?96fl^� 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 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, ` hall orthw'th comply with-thoee provisions. Date: 7 1 � Applicant Warning: Failure to secure Workers' nor pensatiomcove rage is unlawful and r 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, 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 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 proper_'for inspection purposes. Signature (Owner/Agent)�� Date14A - BUILDING PERMIT PERMIT# DATEVALUATION LOT 0402—'198 TRACT .. t1. .( V8C5.244,70 s0 29323-1 JOB SITE ADDRESS APN 43.695 tiA�LU. E�'4'�'.F DA OWNER CONTRACTOR/DESIGNER/EN INEER 1'09Mi OS.A,H01vW IMTC POS+ DEROSA HON!WS U 1KC! 400 R FAiiRI J, DR SUrfE B 103 400 8. FAIlR.a.,T.;L DR MRIT B 103 PALM SPRNGS C,►t. 92262 PALM SPE -U G's CA 922+62 (703)187.710 CDU 2346 USE OF PERMIT 324G&E FA1N9t1:.Y D W.1<WWO SFCS . LOT &E -FAN E 87XL PR?,M1T DUES NOT INCLUDE ELOCIC WA.[:W, P0014 SPA. OR Y3MVEAVAY APPROACH 2723-f00, sp .� tT�T'ycP.C'����Cynls'!TS'TRUC'bION PORa.�i PATIO Sr).00 SP + QA.R ACI IC.ARPORT 654.00 3F W.STM ED (.¢QST OF c onkar e'170H PST. X WhOLU'lly CONI71'RUCTIC*1FEE 101-000.41E,000 �67St.30 PLAN CII X.X FEE .101-M)-439-318 MEC111"ICAL FEE 101.000"421-000 $92.00 feAAEC TRICf1 ER 101.-000-420-000 5142.0151 PLU.Mi t4b FEZ 101-000-419-000 $167,25 STI" ONO M0 T ff3N FEE - RESID 101 -000-241-000 P6.52 N e.R"M 0 ME 101-000.423-000 SUN DEVELOPER MPA.CT FRE ;62,405.60 gty?�i`�I 17iLM©M AMMAN CRECY, 3.9 PRE -PAID FSS $0.00 MAR 2 4 2004 WWI. PERM FET: DUE NOW CITY OF LA QlIiAdF�q FIfV,gNCE DEPS / RECEIPT DATE,, �,// By DAT FINALED INSPECTOR �. , `•,INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Forms & Footings Slab Grade 41 Steel _ _ Roof Deck Underground Ducts Ducts Return Air Fz Combustion Air E)Maust Fans _ O.K. to Wrap F.A.U. _ Framing i Compressor _ Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wail Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final — Final — - '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 PP OVA .S 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 ' _,Lncapsulation Gas Piping Gas Test Appliances Final COMMENTS: Final Utility Notice (Gas) -44 ELECTRICAL APPROVALS Temp. Power Pole _ Underground Conduit Rough Wiring Low Voltage Wiring Fbdures 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 Duds & TXV) CF -413 PROJECT INFORMATION Climate Zone: 15 Project Title: Mosaic (fit Esplanade Project Address: La Quinta Builder Name: Ponderosa Homes Voice # : P25-460-8900 Builder Contact: Jeff Nygren Voice # Projed lD 0: 29323 Sample Group 5 Phase: 5 Lot #: $0 Plan #: Address: I 43-695 Calk Espada HERS INFORMATION HERS Rater: Scott Johnson Jeyme Carden Certifications : CCNSJ614031 CCNJC615157 HERS Firm: Action Now Voice 0: 94931-2274 Address: 2575 Westminster Avenue, Costa Mesa, CA 92627 HERS Provider, CHEERS Voice 0: 800.424-3377 HERS Address: 9400 Topanga 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 Ve"ad Yes The house was: x Tested / Verfkd I—lApprovod as a part of sample, but was not tested x The installer has prov ed a copy of CF -8R x Air Distribution System Is Fully Ducted (sheetmetal, dudboard or flex duct) Where doth backed rubber adhesive dud tape is installed, mastic and drawbands are used In combination with cloth backed, rubber adhesive duct tape to seal leaks at the conriections. MINIMUM REQUIREMENTS FOR DUCT LEAKAGE COMPLIANCE CREDIT Dud Diagnostic Leaka Testing Results (Maximum 6% Dud Leakage) CFA: CFA Leak Max Tested Leak System 0 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 & 16 x 400 x (Cooling Capacity in Nominal Tons) x (O.DS) 21.7 x (Heating Capacity in Thousands of Output BTU per hit Measured Fan Flow X .08 D -u -a Pressurization Test Resu 5 PA) 100 x Test Leakage/ fan flow x % Leakage Check Box for Pass or Fail (Pass = 6% or Less) System of Indicate the maximum allowable 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 Measured Fan Flow X.06 D-0 Pressurization Test Resu 5 PA) 100 x Test Leakage/ fan flow a °% Leakage Check Box for Pass or Fail (Pass = 6% or Less) Pass System L --J of Indicate the maximum a owa 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 & 16 400 x (Cooling Capacity in Nominal Tons) x (0.08) 21,7 x (Heating Capacity in Thousands of Output BTU per hour) x (0.06) Measured Fan Flow X.06 DUE Pressurization Test Results 5 PA) 100 x Test Leakage/ fan flow = % Leakage Check Box for Pass or Fad (Pass = §qb or Less) 1, Pass Raters Certifying Signature fan flow 0 Date 9/29/2004 F2001-02 (4-02) Action Now T-24CF4RTD&TXVmacro.xis 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 43-695 CALLE ESPADA LOT 80, LA QUINTA CA CEILINGS: TYPE: BLOW MANUFACTURER: Certainteed THICKNESS: R-38 WALLS: TYPE: BLOW MANUFACTURER: Certainteed THICKNE:iS: R-23 GENERAL CONTRACTOR: PONDEROSA HOME C LICENSE # J BY: TITLE: PARAGO HMID IL ANG PRODUCTS A MASCO Company LICENSE # 221517 BY: TITLE: ACCOUNT REPRESENTIVE DATE:1 23 d INSULATION CERTIFICATE This i certify that insulation has been installed in conformance with the current en regulation, lifornia Administrative Code, Title 24, State of California, in the building CEILINGS: TYPE: BLOW MAUNFAC ER: Certainteed THICKNESS: R-38 WALLS: TYPE: BATTS MAUNFAC ER: Certaint THICKNESS: Ft -13 GENERAL CONTRACTO LICENSE # BY:TITLE: r PARAGON SCHMID BUILDING PRODUCTS A MASCO Company LICEII4:#221517 Y 'r Y: TITLE: ACCOUNT REPRESENTIVE_ DATE: 5 E. .%,::I/.'/%:+/F>!/l//,%%/W.i/%/F:+i%//�jI%!H•:S:'lfiYl1/.'a%/,H'N%/U:(7%l:9//.%Iry/✓/%Y.%I%l/•%l.%/fl,/'.ri7ry.;Y%1.A!%7%y.)O'✓'%%In:%l.•%'%/y.•G:!/%/iYF/JP'/):y///J!//liliJ.'%:J//I%//..'% //i //f//+'/.:/I+/.f; /14 ,- Certificate of Occupancy0 QUM& I�coaoRATM OF'T1Building & Safety Department This Certificate is issued pursuant to the requirements of Section 109 of the California Building Code, certifying that, at the time of issuance, this structure was in compliance with the provisions of the Building Code and the various ordinances of the City regulating building construction and/or use. BUILDING ADDRESS: 43-695 CALLE ESPADA Use classification: S.F.D. Building. Permit No.: 0402-298 Occupancy Group: R-3 Type of Construction: V -N Land Use Zone: R -L Owner of Building: PONDEROSA HOMES II INC Address: 400S FARRELL DR. SUITE B 103 City, ST, ZIP: PALMS SPRINGS CA 92262 By: G SHOWALTER Date: 09/16/04 Building Official POST IN A CONSPICUOUS PLACE