0402-297 (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
N W Professionals Cod, and my License is in full force and effect.
O =) ch License # Lic. Class Exp. Date
'� Wr- f 732 84 W 1/04
ZO r— Date �g .r �` l 7 '� Signature of Contractors ,�—A
J U C:) OWNER -BUILDER DECLARATION
W UJ I hereby affirm under penalty of perjury that I am empt 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).
ce O I am exempt under Section' , B&P.C. for this reason
L
N Date Signature of Owner
ON
0
Q WORKER'S COMPENSATION DECLARATION
C) Cc 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 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 U ( ) I have and will maintain workers' compensation insurance, as required by
D U Q Section 3700 of the - Labor abor Code, for the performance of the work for which this
dLOH- permit is issued. My workers' compensation insurance carrier & policy no. are:
Z Carrier Policy No.
cb O RE1 BIC i1IND1G1 HIT` 13671602
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 tc(become subject to the
,I 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, II hall forthwith comply w1, h.those provisions.
ate 4Applicant / +!
• Warning: Failure to secure Workers' m ,, ensation 0 ve( ge is unlawful and
shall subject an employer to criminal penalfies 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
• 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) �'� < , Dates �wlil
BUILDING PERMIT PERMIT#
DATE -s. VALUATION LOT 04(* -2„07 TRACT
Sii ,77 tt 79 2 323.1
JOB SITE
APN
ADDRESS CAL
y7 p. ADw
609-380-023
OWNER
CONTRACTOR/DESIGNER/EN (NEER
POi3i)MOSA:ri0las R IXC
POND M- OS,AA FiC.11+A M, U WC
400 3, FMMIUL . DIZ. ►=2B 143
400 S,1?ARMi.LD11,SWE D 103
pAIM HVIRW:#N{ CA 92262
PALIA &P1k J(33 CA 92262
('303)187«710 Mldff 2346
USE OF PERMIT
SWOU T'ha Il.i' 1?V'M_ U11TG
SIM, T.OT ?9, PLAN 3AX& PERMIT MIMS',NOT INCLUDE BLOCK
WALM P004 SPA ORI SR.iVEWAYAPPROACH
TRACT CO?dMUC`t'ION V53100 SF
PORCWPATIO 50.00 Sp
GARAO.WCABYPOM 681.00 8F
EVI' A't" A) Cr3:3T Or, COMMUr:f3 N
U13177115..
CONUTlZiir„T O .ME 101-000-4113-00 $996,50
.FLAW CH I:,CK FEE .20
M@t°lie'4AIC.&L, FEE 101-000.42.1-000 $98.50
EI.Li TRICAL FEE 101-•000-120-000 $153.93
1'I..LfIVIRYNO PER 101.000.419.000 $174,50
STRIM- 51 MOT1014 IEEE - MUM 101-000-241-000 $18.58
011ATITY1e0 F99 101.000.423-000 $1,5100
DZVELOPE1? IMPACT 1??Z $2,403,00
4
. ,
$4,595,26
�Dl X2 ASN I E33 PREPAID k,=
$0.06
MSR 4 210 T �rMj r-� UO E8 DUE N0W'
CITY O LA QU6N3A
EIMAHCE DEPT,
RECEIPT
DATE
By /'(
DATE FINALED O
I INSPECTOR
(I...__....—
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
_APPROVALS
y MECHANICAL APPROVALS
Set Backs
_
Underground Ducts
Forms & Footings
'O
Ducts
Slab Grade
_ _
X
Return Air
Steel
_ _
Combustion Air
Roof Deck
_ _
Exhaust Fans
O.K to Wrap
_ _ _
_ e
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
_
I -
Drywall - Int. Lath
Final
Final 1
7 / --1.
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 APPROVALS
Gas Test
Electric Final
Waste LinesKL
Heater Final
Water Piping
_� '
Plumbing Final
Plumbing Top Out
_
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Sewer Connection
/
�6
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
zz
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
_
Rough Wiring
'
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
4100,
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
—/ —
Utility Notice (Perm)
V 7—
u
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Tight Ducts & TXV) CF4R
PROJECT INFORMATION Climate Zone: 15
Project Title: Mosaic Q Esplanade
Project Address: La Quinta
Builder Name: Ponderosa Homes Voice #; 925460-8900
Builder Contact: Jeff Nygren Voice
Project ID 0: 29323
Sample Group #: 5 Phase: 5
Lot #: 79
Plan #: 3
Address: �43 705 Calle Espada
HERS INFORMATION
HERS Rater:
Scott Johnson Jayme Carden
Certification # =
CCNSJ814037 CCNJC815167
HERS Firm:
Action Now Voice 0: 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
Mxx T-24 Compliance Credit was Taken for Tight Ducts
T-24 Compliance Credit was Taken for TXV TXV Verified yes0
The house was:
M
Tested/Varfied Approved as apart of sample, but was not tested
The installer has prow, ed a copy of CF -6R
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 dud tape to seal leeks at the connections.
MINIMUM REQUIREMENTS FOR DUCT LEAKAGE COMPLIANCE CREDIT
Dud Diagnostic Leaks a Testing Results (Maximum 6% Duct Leakage)
CFA: CFA Leak Max OTested Leak
System
Indicate the maximum a owa Is 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)
21.7 x (Heating Capacity in Thousands'of Output BTU per hour) x (0.06)
Measured Fan Flow x .06
D-0 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 =1 of [ ]
Indicate the maximum a olwabIs 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 (0.08) 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 Results5 A)
100 x Test Leakage/ fan flow = % Leakage
Check Box for Pass or Fall (Pass = 6% or Less) Pass
System L --J of
Indicate the maximum a owa le Dud Leakage and the calculation used:
0.7 x Floor Area x
0.5 z Floor Area x
400 x (Cooling Ce',
21.7 x (Heating C:
Measured Fan Flo
D—ua Pressurization Tesl
100 x Test Leakage/ fan
Check Box for Pass or F
fan flow
Raters Certifying Signatl
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
43-705 CALLE ESPADA LOT 79, LA QUINTA CA
CEILINGS:
TYPE: BLOW MANUFACTURER: Certainteed THICKNESS: R-38
WALLS:
TYPE: BATTS WIPJVUFACTURER: Owens Coming THICKNESS: R-13
GENERAL CONTRACTOR: PONDEROSA HOMES INC LICENSE #
BY: TITLE:
PARAGON MID BI �IG PRODUCTS A MASCO Com any LICENSE # 221517
A-
BY: TITLE: ACCOUNT REPRESENTIVE DATE:
This is totes
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 logg
CEILINGS: "N'
TYPE: BLOW WIAUNF
WALLS:
TYPE: BATTS P!ANM
GENERAL CONT CTOR:
BY:
ACTURER: Certaft
r,
LICENSE #
TITLE:
THICKNESS: R-38
THICKNESS: R-13
ON SCHMID BUILDING PRODUCTS A MASCO Company LIC0NS&# 221517
BY: TITLE: ACCOUNT REPRESENTIVE DATE:
- ,- Certificate of Occupancy
c` OF'T9� Building & 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: 43-705 CALLE
Use classification: S.F.D. Building Permit No.: 0402-297
Occupancy Group: R-3 Type of Construction: V-N Land Use Zone: R-L
Owner of Building: PONDEROSA HOMES II INC. Address: 400 &FARRELL DR.SUITE B 103
City, ST, ZIP: PALM SPRINGS CA 92262
By: G SHOWALTER
Date: 09/15/04
Building Official
POST IN A CONSPICUOUS PLACE