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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
Dpt'e I Signature of Contractor
OWNER -BUILDER D CLARATION t__"""
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 I I _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:
Carrier Policy No.
1�4..,'133.�1�# U.SA M0 Policy
(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 those provisions.
Fate: Applicant
Warning Failure t secure Workt?'rs' Compe st 1, 'ge"ts-rlMavrifuf"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.
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 ove-mentioned property for inspection purposes.
L91110nature (Owner/Agent)'_ '� Date ✓TMs
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0101-319 TRACT •'
9314AMW ;2
JOB SITE
APN
ADDRESS
Q; •�QQp� Q� p y� KJoq�p +��y�qq�
Y. 01-2f.O(391 .i� 'ft.Z dJi[3A E.'
�jf ay fnpy (q�j
({idi.•'.Y,fMA—[lM �.
OWNER
CONTRACTOR / DESIGNER / EN (NEER
kr %iA OF C.A1JxVFP. RA.1I+7C
SERA OF G!3►X t+ RXiANC
NEWPO 1 BEAM -1 QA 9124660
NEWPOFtT BF kG11 f;A 92.'*660
(9145)719.4975 CF3].A 6364
USE PERMIT
(O{JF
MIMEyh ��7 y�y�y/ry y yq�
N. 0111 ✓ Vl'�l.'.+Wi c1. 40
j v
S1fD4-PL.1'.,X6C 11)7,'32 5s1UMI'ti 00 V3140TINCLUDE,
y Y,
91.�iI" lli ,�,, 1�yt c23�i�.Rl�t ib� l�P, °1�rJs3C�1. 75°� PLAN CHFCK FEE
U. DUC: HO:N' FOR ar11.If.,TIPL? 1i:1SUA110E OF SAKE PLAN TYPE.
C:IISTOM OONSTR€ACTION V99.00 SF
PORCi-1iFATIO 712.00 9?
0ARA+t1Ff;"ARPOiaT (2F} 15,9.M.40
1L'.!�n.E.A1WAe'tIx.YwD C0,4 ./i. QF 4..0,FV0.F.6X&+(.7.P.10dl
314,4X,20
CONSTRUCTION PRE 101-000.438.000 sj,3.Qm10
PLAN CHFCXIME '10191-000-439-319 $29.1.41
M.ITILKNIC".ALWS 101.000-421-000 $117,10
°fAJXTRJC A), PER, 101•-0400-420.000 $X21
P1111mill o PC, U 101 -000 419.000 $19`1,75
1 -'00 $�O•{p
Sy7�°y,KflCya�hYytTl .MOT�yION r aE • RF—SIX) 9101-000,423-000
p01-51�00g-7Ar.3]
) 9A.+5
0
0XV&OP1;1Z' IMP CTFU, $1,907,00
ARIAX I1U'.SLIO PLACe7s •. USE 701-000.255.000 $286..20
3�''t'OT& COX PXID k?LAN CMICK
T-4,4 39.59
FP
JUL 2 ,,TO dMIYET"S DUENOW
S4,43052
CITY OF LA OUINTA `
FINANCE DEPT •{ .
RECEIPTDAT
BY
DAT I Lip ^
AJC 'r/1�
INSPE TO
i /*
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings �/b//L
''dry
_ _
_ _
Underground Ducts
Ducts
Slab Grade
O(
Retum Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to WrapSl,/
Framing
F.A.U.
Compressor
Insulation
d_ ��� b�
��
/ /
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
_
Exterior Lath
Drywall - Int. Lath
G�
_
Final
Final9
4
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond eam
_
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
_
/I/21�b/
Heater Final
Water Piping
`
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
_ _
Pool Cover
Sewer Connection
%�'lQ/
Encapsulation
Gas Piping
Gas Test
_
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)
WESTERN INSULATION, L.P.
4211 Latham Street, Riverside, California 92501
Tel. (909) 686-8760 Pax (909) 686-8786
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 LOCATED AT:
TRACT/PHASE: THE LEGENDS @ PGA WEST #28838-1/-2, PHASE 1
LOT #: 2032--------- -- - --- - - >
SITE ADDRESS: X81-210'GOLF VIEW DR. LA QUINTA, CA
------------------- = =-------------------------------------------
EXTERIOR WALLS:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 5/8 " R -VALUE: R-13
CEILINGS: ATTS 1, BLOW
MANUFACTURER: JOHNS MANVILLE THICKNESS: 13 " R -VALUE: R-38
GENERAL CONTRACTOR: WESTERN PACIFIC HOUSING
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, L.P.
LICENSE NUMBER: 794484
BY:
TITLE: PR UC N MANAGER
DATE: JXNVOY 28, 2002
-UL.11.2002 13:34 17602334091 KAYER ROOFING
. b
Corporate Officc:
P.0. Rax 462890
Escondido, CA 92(46 I O TE
r.fceae!! r635S1
WESTE10 PACIFIC HOUSING
LA QUINTA
760-564-7022 (FAX)
Attn: JOHN
#2917 F'.007/007
Kmofinz_on "LEGENDS n P.G.A. WEST" Ph 1 LOT 032
Phone; (760) 73748999
FAX: (760)737-0350
07-11-02
Mayer Roofing has.supplied and installed "27 " O'ha& glt>,aked roof vents, on lot #32
at 81-210 GOLF VIEW DWVE, '1'i1c vents have been installed per manufacturers specifications.
Note: Exact vent locations are determined by builder
RESPECTFU ,LV SUBMITTE D
SCOTT BEECHAM
OPERATIONS MANAGER
Mayer Roofing, Inc.
Page 1 of. 1.
559 Librruy SUM . San Fernando, (A 91340 193 Oe,I.age. Street . Riverside, ('.A 02502
(ti 18) 838-6064 - FA (91 R) 838-4493 ' (909) 752-0601 . FAX 7K2-0804
` INSTALLATION CERTIFICATE (Page 3 of 13)
CF -6R
Site Address. Yl- SIO GiD Vf:- Y I 'ermit Number
DUCT LEAKAGE AND DESIGN. DIAGNOSTICS
}
U DUCT LEAKAGE REDUCTION
Pressurization Test Results (CFM @ 25 PA)
Test Leakage (CFM) _k&
Fart Flow
If Fan Flow is Calculated as 400 efai/lon z number of tons, or as 21.7 x Heating Capacity
in Thousands of Btu/hr, enter calculated value here
If fah flow is measured, enter measured -value here
Leakage Fraction = Test Leakage/(Measured or Calculated Fan FIow) =
Pass if leakage fraction:5 0.06Pre
[]
Pass Fail
❑ For AEROSOL TYPE SEALANTS 0A2Y - The following di'2gaostic testing was completed:
-Duct Fan Pressurization at rough -in measured leakage (CFM)
'
CHECK AFTER FINISHING WALL:
❑ Yes ❑ No ❑ Pressure pan test or House pressurization test
❑ Yes 13 -No ❑ Visual Inspection of Duct Connections
❑ ❑
Pass ' Fail
❑ THERMOSTATIC EXPANSION VALVE =V)
9'Yes ❑ No Thermostatic Expansion Valve is installed and Access is -
provided. for inspection -
Yes is a pasr Pass Fail
❑ DUCT DESIGN
I• ❑ Yes ' ❑ No ACCA Manual D Design calculations have'been
completed, Duct Design is on the plans and duct installation
matches plans.
2•11Yes ❑ No TXV is installed or Fan flow has been verified. lf.no TXV, .
verified fan now matches design from &411.
Measured Fan Flow a
Yes for both I and 2 is a Pass Pass 'Fail
0/1"I" the undersigned, verify that the above diagnostic test results and the work I performed associated with the test(s) is in
conformance with the requirements for compliance credit (The builder shalt provide the HERS provider a copy of the CMR
signed by the builder employees or sub -contractors certifying that diagnostic testing and installation meet the requirements
for compliance credit.]
d) r7 1.�4611
E
Tests � � .«tore, Date. Installing Subcontractor (Co. Name) OR
Performed General Contractor (Co. Name)
COPY TO: Building Department
HERS Provider (if applicable)
Building Owner at Occupancy
cc, N 6�
Compliance Forms August 2001 ""A-25 .
' INSTALLATION CERTIFICATE (Page3 of 13)
CF -6R
Site Address.13l ` MV C1 o U= V l f; /� tio.l #h- ^ermit Number
DUCT LEAKAGE AND DESIGN. DIAGNOSTICS
C DUCT LEAKAGE REDUCTION
Pressurization Test Results (CFM @ 25 PA)
s
Test Leakage (CFM)
Fan Flow
If Fan Flow is Calculated as 400 cfm/ton x number of tons, or as 21.7 x Heating Capacity
in Thousands of Btwly, enter calculated value here _
If fan flow is measured, enter measured value here
Leakage Fraction = Test Lcakage/(Measumd or Calculated Fan Flow) =
Pass if leakage fraction :5 0.06
, []
Pass Fail
❑ For AEROSOL TYPE SEALANTS 0,N1Y - The following diagnostic testing Was completed:
Duct Fan Pressurization at rough -in measured leakage (CFM)
'
CHECK AFTER FINISHING WALL:
❑ Yes '❑ No ❑ Pressure pan tat or House pressurization test
13 'Yes 0 -No ❑ Visual Inspection of Duct Connections
❑ ❑
Pass Fail
❑ THERMOSTATIC EXPANSIONVALVE (MV)
Er'Yes ❑ No Thermostatic Expansion Valve;is installed and Access is
provided.for inspection
Yes is a pass
❑ DUCT DESIGN
1 ❑ Yes ' ❑ No ACCA Manual D Design calculations have'been
completed. Duct Design is on the plans and duct installation
matches plans.
2• ❑ Yrs D No TXV is installed or Fan flow has been verified. If no TXV, .
verified fan flow snatches design from CF -1R.
Measured Fan Flow a
Pass Fail
,❑ . ❑
Yes for both I and 2 is a Pass Pass Fail`
0/1, the undersigned, verify that the above diagnostic test results and the work 1 performed associated with the test(s) is in
conformance with the requirements for compliance credit. [The builder shall provide the HERS provider a copy of the CF -AR
signed by the builder employees or sub -contractors certifying that diagnostic testing and installation meet the requirements
for compliance credit.]
Tests, .�attre, Date . Installing Subcontractor (Co. Name) OR
Performed General Contractor (Co. Name)
COPY TO: Building Department
HERS Provider (if applicable)
Building Owner at Occupancy
Compliance Forms August 2001 `'A-25 .
INSTALLATION CERTIFICATE (Page 3 of 13) CF -6R
Slte Address. gt •°1..10 G-ptl, - vw-,w Ubi- 4 S2. : ermit Number
DUCT LEAKAGE AND DESIGN. DIAGNOSTICS Ta N
S DUCT LEAY.AGE REDUCTION
Pressurization Test Results (CFM @ 25 PA)
Test Leakage (CFM)?
Fan Flow
If Fan Flow is Calculated as 400 cWton x number of tons, or as 21.7 x Heating Capacity 8
in Thousands of BwAir, enter calculated value here _
If fail flow is measured, enter measured -value here
Leakage Fraction = Test Leakaget(Measured or Calculated Fan Flow) s
Pass if leakige fraction 5 0.06[]
Pass Fail
❑ For AEROSOL TYPE SEALANTS ONLY - The following diagnostic testing was completed:
Duct Fan Pressurization at rough -in measured leakage (CFM) '
CHECK AFTER FINISHING WALL:
[]!Yes ❑ No ❑ Pressure pan tat or House pressurization test
❑ Yes ❑ No ❑ Visual Inspection of Duct Coancctions ❑ ❑
Pass Fail
❑ THER,IMOSTATIC EXPANSION VALVE =V')
9'Yes ❑ No Thermostatic Expansion Valve is installed and Access is
provided.for inspection -,
Yes is a pasr Pass Fail
❑ DUCT DESIGN
I. ❑ Yes ' ❑ No ACCA Manual D Design calculations havebeen
completed, Duct Design is on the plans and duct installation
matches plans.
2
11 Yes ❑ No TXV is installed or Fan flow has been verified. If no TXV, .
verified fan flow matches design from &4R.
Measured Fan Flow a
Yes for both I and 2 is a Pass Pass Fail'
l� I, the undersigned. verify that the above diagnostic test results and the woek l performed associated with the tests) is in
conformance with the requirements for compliance credit. [The builder shall provide the HERS provider a copy of the CF -8R
signed by the builder employees or sub -contractors certifying that diagnostic testing and installation meet the requirements
for compliance credit.]
Tests ..z'.ere, Date, Installing Subcontractor (Co. Name) OR
Performed General Contractor (Co. Name)
COPY TO: Building.Departmcnt
HERS:.Piovider (if applicable)
Building Owner at Occupancy
Compliance Forms August 2001 'A-25 .
HVAC INSTALLATION CERTIFICATE for Tested Duct Leakage & TXV Page 2 of CF -6R
Site Address: 161—VO Crtbl- ' U 1SW
Tract Number:
Lot Number: V�,- 3�
Permit Number:
System [= of
Indicate the maximum aIl owab 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
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)
Other
uct Pressurization Test Results (CFM @ 25 PA)
100 x Test Leakage / Fan Flow = % Leakage .
Check Box for Pass or Fail (Pass = 6% or Less) •Pass j (EE
�T-24 Compliance Credit was Taken for TXV TXV was installed
System of
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 (0.06) 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 hoL
Other
uct Pressurization Test Results (CFM @ 25 PA)
100 x Test Leakage / Fan Flow = % Leakage
Check Box for Pass or Fail (Pass = 6% or Less) P
=T-24 Compliance Credit was Taken for TXV TXV was
ystem L_�_j 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 hou
Other
uct Pressurization Test Results (CFM @ 25 PA)
100 x Test Leakage / Fan Flow = % Leakage
Check Box for Pass or Fail (Pass = 6% or Less) P
T-24 Compliance Credit was Taken for TXV TXV was
ystem L__J of
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 (0.06) for Climate Zones 1 through 7 & 16
400 x (Cooling Capacityin Nominal Tons) x (0.06)
21.7 x (Keati6g Capacity in Thousands of Output'BTU per hOL
Other
uct Pressurization Test Results (CFM @ 25 PA)
100 x Test Leakage / Fan Flow = % Leakage
Check Box for Pass or Fail (Pass = 6% or Less) P
QT -24 Compliance Credit was Taken for TXV TXV was
'2 -,-b "
J
I, the undersigned, verify that the above diagnostic test results and the work I performed associated with the test(s) is
in conformance.with the requirements for compliance credit. (The builder shall provide the HERS provider a copy of the
CF -6R signed by the builder employees or sub -contractors certifying that diagnostic testing and installation meet the
requirements for compliance credit.)
CL Q�� q 29 ( 6
esti is — ignat ateInstalling Subcuntractor(Co.Name)
Performed ' General Contractor (Co. Name)
COPY TO: Building Department
HERS Provider (if applicable)
Building Owner at Occupancy
PAGE 2
F2001-01 (4-02) Action Now T-24CF6-RTD&TXV macro
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING ht Ducts CF4R
-PAOJECT INFORMATION -
Project Tft1a:
Lo Cala
Project Address:
La Quints
Buikbr Nance:
Weetern Pacific Homes, Michelle Lopez
Voice # : 949-442-6199 x 462
BuiWor Contact:
John memen
Voice 0: 760464-7555
Project ID
28838-2
Sample Group # :
Phase 2
Lot 0:
27
Plan #
8
Addrme
280 W View ON"
HERS INFORMATION
HERS RaNr.
Scott Johnson
Certification 0:
CCCSJa314037
HERS Firm:
Action Now
Voice aX : 949-631,2274
Addnsss:
2876 Westminsier Avenue, Costa Mesa, CA 92627
HERS Provider:
CHEERS
Voice 0:. 818-407.1500
HERS Address:
9400 Topanga Canyon Blvd, Chatsworth. CA 91311
'TIERS RATER COMPLIANCE STATEMENT
j z 1 T-24 Compiler%* Credit was Taken for Tight Ducts
he house was:
Te15ted x Approved as a part of sample, but was not heated
x The installer has p—rm--Ted a copy of CF -8R
x Air Distrilboution System Is Fully Ducted (aheetrnetal, ductboard or flex duct)
Where door backed rubber adtu:sive dud twm Is installed, mastic and drawbards are used In mrnbination with
dotty backed, rubber adhesfva duct tape to seal leaks at the connections.
MINIMUM REQUIREMENTS FOR DUCT LEAKAGE COMPLIANCE CREDIT
Duct Dlagnoetle l.eaka Te►sting Results (Maodmum 6% Duct Leakage]
CFA: CFA Leak Max ��Tested Leak
System
Indicate the maximum a owe Is Dud Leakage and the calculation used:
0.7 x Floor Anse x (0.09) for Climate Zone 8 through 15
0.5 x Ft= Arm x (0.06) for Climate Zones 1 through 7 & 16 40
x 400 x (Cooling Capacity in Nominal Tats) x (0.09)
21.7 x (Heating Capacity in Thousands of Output BTU per hour) x (0.06)
Other
Pretss rbtation Test Results (CFM ® 25 PA)
100 x Test Leakage / Fan Flow = % Leakage
Check Box for Pass or Fail (Pass ■ 6% or Less) Pass I Faill
System Mom
indicate tyre maximum allowable Duct Leakage and the calculation used:
0.7 x Foot Area x (0.08) for Climate Zone 8 through 16
0.5 x Floor Area x (0.06) for Climate Zonas 1 through 7 & 16
x 400 x (Coding Capacity in Nomir* Tons) x (0.05)
21.7 x (Heating Capacity, in Thousands of Output BTU per hour, x (0.06)
Other
15-0 Pressurization Test Results (CFM Q 25 PA)
100 x Test Leakage / Fan Flow a % Leakage
Check Box for Pass or Fell Pose = 69A or Less) Pass
Smem I J I of
;ta.+
t;
Certificate of Occupancy
City of La Quinta
Building and Safety Department
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code,
certifying that, at the time of issuance,. this structure was in compliance with the various ordinances
of the City regulating building construction or use. For the following:
BUILDING
ADDRESS: 81-210 GOLF VIEW DRIVE
Use Classification:
SINGLE FAMILY DWELLING
Bldg. Permit No.: 0101-319
Occupancy Group:
R-3 Type of Construction:
VN
Land Use Zone: RL
Owner of Building:
SHLR OF CALIFORNIA INC.
Address:
23 CORPORATE PLAZA SUITE 245
City:
NEWPORT BEACH, CA 92660
By:
DANIEL P. CRAWFORD JR.
Date:
9/13/02
Building Official
POST IN A CONSPICUOUS PLACE