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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 ff ct.
License ,# Lic. Class xp. Date
Dater d� Signature of Contractor
OWNER -BUILDER DECLARATION
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).
( ) 1, 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
Itt,
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:
Cartier Policy No. I .
PACIIi1C; RAOLE 1'O. 4.I -0i£=3
(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 I sued,
I shall not employ any person in any mann as�//to become sIe to the
workers' compensation laws of Californiajfa� agfee that if I ffo come
subject to the workers' compensation��6y_i
f SecYn
Q ofthe Labor
Code, I shall forthwith comply with thos,,/�
Date: - -� Applicant -��.
Warning: Failure tosecurAorker Compensation 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 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 nformation is
correct. I agree to comply with all Cid St� laws rel In o the building
construction, and hereby authorize e e.se t`atives of t ig o enter upon
the above-mentioned property for 'h pectl purpo s
Signature (Owner/Agent r� •� � � Date a /_)A
BUILDING PERMIT PERMITN
DATE VALUATION LOT TRACT
0R1 442A)
JOB SITE
APN
ADDRESS _
OWNER
CONTRACTOR / DESIGNER / EN (NEER
Hm
SIER OF CKt.S ORNLIk C-4
169-10 VON KARMA14 AVK MY— 200
.13 C ORTIO:t%M YLPZA W3T:'L 24 S
MVIDNE CA 92606
4T?,WPa rBHA(N, CA 92"0
(849)719.4.975 CTA,,# 6364
USE OF PERMIT
'013.1.0T !7, PLAN Sn1L PERMIT LaCflr,> 1dC3'i' IZdlrf.ao.i?1r kliR3Cr!
4E1'.>'+,.LL,% 1±000.9P.4 OR DRrV'FWA.Y APPROACH, W't PT A)4 CFIPrl: FEE
RZT)UCT1014 FOR IM'UA1402, OF BAME PLANTYPE
CUSTOM CONST°RU t1ON1,30&00 �,qIv
PORCIWPATIO 760.00 SF
GJ�.R.ACiLPIf°,l`�.tPl'e�R`T 4C�,9a ��
XM) COST OF :O1S'MC.nox
2SIA,220
ytiIAyyyW pLWSM`Y
CO STR11CT1Os ;EE: ]01-W10.418.000 Sl+aib.so
PI.AX CHECK FCL 101-000439�3 t I3 $260.17
WCHA1,11CAL nt+i. 101-000-421-000 $124.00
LLi CTRICAL ITER 101-000-420-000 $192.20
PLC,rIHli3ING FEE 101-000-419-100.0 $20.115
SY'R.ONa MOTION FLS', • RZSW 101 -Ut30-2v14)OD $23.0
C1tb.AE'j#?Rt0 FEY. 101!-000-423-000 3I�a•09
,
t1E1{Ei.+ PER 1:I19.PA.C;'T PIPSO
,ART 11'1 PI.1BIAC PLACPS - R-WIL 270.000.445.000 �293,tIk
S IB"' tAL, t 41MU4`.IY;fUI•'i' AND I Abl CHECK,207.37
SEP 112001 ..� ►.�' '
$0.00
XUAL P'ER e T1' E"...`.',•1:'6 DUE 400
CITY OF LA QUINTA
FINANCE DEPT.
VM)7_37
7
FjECEIPT
DATE, ;. ,.a
BY `' J
DAT FI LEDINSPECT
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms &Footings zk�llj�5�0/
Slab Grade �p�l6lpj �1
Underground Ducts
Ducts
Return Air
Steel
Combustion Air,
Roof Deck
_
/ ��(%
Exhaust Fans
0. K. to Wrap
F.A.U.
Framing
��
Compressor
Insulation
/�'fi
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
POOLS - SPAS
BLOC KWALL APPROVALS
steel
Set Backs
'y
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Waste Lines
/ds�
Electric Final
Heater Final
Water Piping
_
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
_
Pool Cover
Sewer Connection
1t��s/6�
Encapsulation
Gas Piping
Gas Test
����� of
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)
N
WESTERN INSULATION, L.P.
4211 Latham Street, Riverside, California 92501
Tel. (909) 686-8760 Fax (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 i-2, PHASE 2
LOT #: 2037
SITE ADDRESS: 81-245-GOLFVIEW-DR. LA-QUINTA, CA
EXTERIOR WALLS:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 5/8 " R -VALUE: R-13
CEILINGS: BATTS BLOW
MANUFACTURER: JOHNS MANVILLE THICKNESS: 11 R -VALUE: R-30
GENERAL CONTRACTOR: WESTERN PACIFIC HOUSING
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, L.P.
LICENSE NUMBER: 7 4484
BY:
TITLE: P OD ION MANAGER
DATE: JA ARY 28, 2002
j
MA".06.2002 09:53 17602334091 MRYER ROOFING
� o
(;orporate Office:
RD, Rax 462890
Escoadido. CA 92046 rNcoaPa ATED
Licensc # 03381
WESTERN PACIFIC HOUSING
LA QUINTA
760-564-7022 (FAX)
Attn: JOHN
T2543 ?.007%009
Roofing on_"LEGEND R E.G.A. 3YEST" Ph 2 LOT #37
rhonc: (760)737-8888
rAX: {76{)) 7:37-0350
Og-6-02
Mayer Roofing has supplied and installed "12 " O'haa in cloaked roof vents, on lot #37
at 81-245 GOLF VIEW DRIVE Tile vents have been installed per manufacturers specifications.
Note: Exact vent locations are determined by builder
RESPECTFULLY SUBMITTED
r a
SCOTT BEECHAM
OPERATIONS MANAGER,
Mayer Roofing, Tnc.
Page I of 1
118 Library Street . Sari Fermindo, (.,A 91340 193 Change Strcct . Riverside, CA 9-7502
($18) 835-60(4 . FAX (818) 938-4493 (*909)X.78"-06011 . FAX(909)7K2-08(14
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Tight Ducts & TXV) CF -4R
PROJECT INFORMATION
Project Title: LaCala
Project Address: gl—Z�iSGo(�'!/;e�,1 OR
Builder Name: Western Pacific Voice #:
Builder Contact: Michelle Lopez Voice #: 442-6199 ext462
Project ID #: ZW3E- -Z-
Lot
iLot # -3 7
Plan # 1W
Sample Group #:
HERS INFORMATION
HERS Rater: Scott Johnson
Certification # : 30027
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 Oakdale Avenue, Chatsworth, CA 91311
HERS RATER COMPLIANCE STATEMENT
24 Compliance Credit was Taken for Tight Ducts
T-24 Compliance Credit was Taken for TXV TXV Verified YesO
The house was:
Tested/ Verfied Approved as a part of sample, but was not tested / verified
The installer has prove 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 duct tape to seal leaks at the connections.
MINIMUM REQUIREMENTS FOR DUCT LEAKAGE COMPLIANCE CREDIT
Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage)
CFA:
System EIJ of 1 1
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 hour) x
100 x Test Leakage / Fan Flow
Other
uct Pressurization Test Results (CFM @ 25 PA)
Check Box for Pass or Fail (Pass = 6% or Less) Pass
System L:�-- 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 hour) x
100 x Test Leakage / Fan Flow
Other
uct Pressurization Test Results (CFM @ 25 PA)
Check Box for Pass or Fail (Pass = 6% or Less) Pass
System 1 �3 1 of
Indicate the maximum a ov
0.7 x Floor Area x (W
0.5 x Floor Area x (0.1
400 x (Cooling Capac
21.7 x (Heating Capa
100 x Test Leakage /
Other
uct Pressurization Test R(
Check Box for Pass or Fail
Raters Certifying Signature
S7,
rcuu i-uc ky-uc)mcuon rvow, i-zw%.r-4m i va i nvmaciu.xiS
` INSTALLATION CERTIFICATE (Page 3 of 13)
CF -6R
Site Address 8j2JJT L7a - Q T 3 1 Permit Number
DUCT LEAKAGE AND DESIGN DIAGNOSTICS 2 -00 0.l
ff DUCT LEAKAGE 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
in Thousands of Bt0ir, enter calculated value here
If fan flow is measured, enter measured value here -
Leakage Fraction = Test Leakage/(Measured or Calculated Fan Flow) =
/
Pass if leakage fraction <_ 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 test or House pressurization test
❑ Yes ❑ No ❑ 'Visual Inspection of Duct Connections
❑ ❑
Pass Fail
❑ THERMOSTATIC EXPANSION VALVE (TXV)
❑ Yes ❑ No Thermostatic Expansion Valve is installed and Access is
provided for inspection ❑ ❑
Yes is a pass 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• ❑ Yes ❑ No TXV is installed or Fan flow has been verified. If no TXV,
verified fan flow matches design from CF -IR. .
Measured Fan Flow =
Yes for both 1 and 2 is a Pass
❑ ❑
Pass Fail
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 b -contractors certifying that diagnostic testing and installation meet the requirements
for compliance credit.] l %
3
Tests Ognature, 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 .
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: 81-245 GOLF VIEW DRIVE
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of Construction:
Owner of Building: SRHI, LLC
Building Official
Bldg. Permit No.: 0109-058
VN Land Use Zone: RL
Address: 16940 VON KARMAN AVE, STE 200
City: IRVINE, CA., 92606
By: DANIEL P. CRAWFORD JR.
Date: 6/5/02
POST IN A CONSPICUOUS PLACE