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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 eff ct.
License # Lic. Class Exp. Date
Date' " - Signature of Contrary OWNER -BUILDER DEC RATION
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 isnot 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
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.
PAXIFIC MILK INN, MOD=
(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 manneso as too become subPdetcom o e
workers' compensation laws of California,r that if I sho esubjectto thepworkers' compensation prow�S�W,
g Section 7 0;Labor
Code, I shall forthwith comply with thos s.
Date:�Z�A o Applicant
�.+ " 7 '
Warning: Failure to secure,Workers',Eompensation 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 aboyye information is
correct. I agree to comply with allC' hdAtate laws rg11a96g to the building
construction, and hereby authoriz Bore ntative o�tlii City to enter upon _
the above-mentioned property fo ieAnpur s
Signature (Owne0Ag6n„t _ � Date/L__
BUILDING PERMIT PERMITk
DATE VALUATION LOT 0..O,n) TRACT �
193 S.. I-
JOB SITE '
APN
ADDRESS
qq_ /� yyyy ��pp p t♦7 �0��y ga �(y9q
Igw {�f� f�q �{
OWNER
CONTRACTOR/DESIGNER/ENGINEER
16940VON KNNUMa%M E, :?M;f 200
23 CORPOM!YMMAMYM, 245
.ice 41NE CA 92,606
WL 'ORT BE .11 Cit. 926150
(94-4)719.49'75 MIX 6364
USE OF PERMIT
IN -011E OhMILY'DWEY11 M101
w;ls .r .f dJ 17, PIAN Rfflt ;�'I+;13MIT t3C.1#Z NOT INCLUDE%I OCK i
WJbT L.%PCIOU;dPAOR 1?Ri.1xll,'WAY'AYTROACH, 75%P-LA14 CRECK VES
ptFMUCTION FOR ISSUA14CE OF SANE PLAN TY'PR
PORc:;HIPA`I'i0 W8.60 1F
a �AlA.O'FOCARPORT MDO 3F
NFX.D coyr 010 C0�7,�i7 UC')�".�e3:N
4"ONSTAIT(°i ON MY 101 •.0610-x!18.000
'PIAN CHFIZ9 VIFLr 101 W0t*••439-318 $20 117
IVLECK&NICAL MR 101.00D-4211.000. M4.00
&I.JN',''T)Z1C-.AL ",Z # t?1 �f1ti;3�32�1 f�33Q 1�I a.1
PI L lND%30 HI 101.000.419.000
S`r'R.0140 la OTIONI 'M - RSSIE) 101-000-241.000
0111AP DIOREM 101.000-423.000 (20,110
FEL $1,40%41f1
ART 1N PUBLIC PLACES - RESIT 270.01010-4=45.000 $203.61
8tT�+�prr k n,� r+s�q�_ ;t 9• py7/ e,�u�y,�y YT 4y,{.+�•� },r�Y 4:
.PJ^�rOT"AL C:�A.Lwe�Ri:.4s�-:.1.f.01 AMI 4..rA.'13!dl�K
$4,ZMu•Y.-1`J
1, �PADF-I{S
$0100
tNil rMu'vi.':$` M.S &�I:F:1'<.fi1CdW
tSEP
PF
X207:37
1 2001
CITY OF LA QUINTA
FINANCE DEPT.
RECEIPT
DATE:.:BY;;;
DAT I ALE
INSPECTO
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings MCAD
Slab Grade ("
A l/ _ _
/
Underground Ducts
Ducts
Return Air
Steel
_ `
Combustion Air -
Roof Deck
�l/�9�d�
Exhaust Fans
O.K. to Wrap
Framing
%1i/�3/� �7I'
F.A.U.
Compressor
Insulation/b/
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
BLOCKWALL APPROVAII S
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 Lines
q./,�/o�
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
Encapsulation
Gas Piping
Gas Test
%I%��bl�/�d,��Q±✓
Appliances
Final
COMMENTS:
Final
4w v Sf /10Z bl "
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
�/
�%/r1/
Utility Notice (Perm)
6
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:
a
TRACT/PHASE: THE LEGENDS @ PGA WEST #28838-1 i-2, PHASE 2
LOT #: 2027
SITE ADDRESS: �81-260 GOLF VIEW DR. LA QUINTA-,� CA
EXTERIOR WALLS:
MANUFACTURER: JOHNS MANVILLE THICKNESS:
CEILINGS:C:BLOW
!�TS�
MANUFACTURER: JOHNS MANVILLE THICKNESS:
3 5/8 " R -VALUE: R=13
11 " R -VALUE: R-30
GENERAL CONTRACTOR: WESTERN PACIFIC HOUSING
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, L.P.
LICENSE NUMBER: 794484
BY:
TITLE: POD ION MANAGER
DATE: AYCLIARY 28, 2002
o
INSTALLATION CERTIFICATE (Page 3 of 13) CF -6R
Slte Address $i2h Crj0VF VlI5��,Z 'DP- • tio'i -5q ermit Number
DUCT LEAKAGE AND DESIGN. DIAGNOSTICS `
E7bUCT LEAI:AGE REDUCTION
Pressurization Test Results (CFM @ 25 PA)
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 Btuhtr, enter calculated value here
If fan flow is measured, enter m6a' s&ed value here
Leakage Fraction ='fest Leakage/(Measured or Calculated Fan Flow)
Pass if leakage fraction 5 0.06 []
Pass Fail
❑ For AEROSOL TYPE SEALANTS 0,NIY 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)
❑r+Yes ❑ No Thermostatic Expansion Valve is installed and Access is
provided.for inspection .�
Yes is a pass Pass Fail
❑ DUCT DESIGN
1- ❑ Yes ❑ No
.. . ' 2.
❑ Yes ❑ No
ACCA Manual D Design calculations have"been
completed, Duct Design is on the plans and duct installation
matches plans.
TXV is iinstalled_ot. Fan flow has been verified. If no TXV, .
verified fan flow -'matches design from CF -1R.
tea.
Measured Fan Flow =
JF Yes for both I and 2 is a Pass
❑ ❑
Pass Fail
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 -611.
signed by the builder employees or sub -contractors certifying that diagnostic testing and installation meet the requirements
for compliance credit.]
�`
Tests _ere, Date . Installing Subcontractor (Co. Name) OR
Performed General Contractor (Co. Name)
COPY TO: Building Department i .
HERS Provider (if applicable)
Building Owner at Occupancy
Compliance Forms
e� N 8:)x (0
Auqus12001
—A-25 .
o
.♦ i! • --
' INSTALLATION CERTIFICATE (Page 3 of 13) CF -6R
Site Address SlVvO C,-toV v tet/ 'DR- Lal w- lei ermit Number
DUCT LEAKAGE AND DESIGN. DIAGNOSTICS 3 -
Ef DUCT LEAFAGE REDUCTION -
Pressurization Test Results (CFM @ 25 PA)
Test Leakage (CFM) lmly_
Fan Flow
If Fan Flow is Calculated as 400 cfrti/ton z number of tons, or as 21.7 x Heating Capacity
in Thousands of Btu/hr, enter calculated value here �2-
If fan flow is measured, enter measured value here
Leakage Fraction = 'rest Leakage/(Measured or Calculated Fan Flow) �,/
Pass if leakage fraction:5 0.06 pr []
Pass Fail
❑ For AEROSOL TYPE SEALANTS 0,NIY -The following diagnostic testing was completed:
Duct Fan Pressurization at rough -in measured leakage (CI -M)
CHECK AFTER FINISHING WALL:
❑ Yes ❑ No ❑ Pressure pan test or House pressurization test
❑ Yes ❑ No ❑ Visual Inspection of Duct Connections ❑ ❑
Pass Fail
❑ THERMOSTATIC EXPANSIOti VALVE (TXT
E Yes 0 No Thermostatic Expansion Valve is installed and Access is
provided.for inspection ❑
Yes is a pass• Pass Fail
❑ DUCT DESIGN
❑ 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 rXV, .
verified fan flow matches design from CF -1R.
Measured Fan Flow
Yes for both I and 2 is a Pass Pass 'Fail
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
sign. -d by the builder employees or sub -contractors certifying that diagnostic testing and installation meet the requirements
for compliance credit.)
Tests :: :ere, 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
cc. i\N_s:;-s IQ
August 2001
—A-25 .
• a
' INSTALLATION CERTIFICATE (Page :3 of 13) CF -6R
Site AddressIB42.490 G7OLF Wg�L`3 A"-• ()U"t'O-- 2°7 ermit Number
DUCT LEAFAGE AND DESIGN DIAGNOSTICS
2t/DUCT LEAN.AGE REDUCTION
Pressurization Test Results (CFM @ 25 PA)
Test Leakage (CFM) 3 4P
Fan Flow
If Fan Flow is Calculated as 400 cfrri/ton x number of tons, or as 21.7 x Heating Capacity
Ll 0
in Thousands of Btu/hr, enter calculated value here _
If fan flow is measured, enter measured valve here
Leakage Friction = `rest Leakagel(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 tat or House pressurization test
❑ Yes ❑ No ❑ Visual Inspection of Duct Connections ❑ ❑
Pass Fail
❑ THERMOSTATIC EXPANSIONVALVE (TXV)
❑r Yes ❑ No Thermostatic Expansion Valve is installed and Access is
provided.for inspection
Yes is a pass' Pass Fail
❑ DUCT DESIGN
1 ❑ Yes ❑ No ACCA Manual D Design calculations have been
completed, Duct Design is on the plans and duct installation
matches plans.
'- ❑ 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 I and 2 is a Pass Pass Fail'
0/1"i, the undersigned, verify that the above diaenostic 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 -8R
signed by the builder employees or sub -contractors certifying that diagnostic testing and installation meet the requirements
for compliance credit.)
f �1b
Tests�- z:_re, Date. Installing Subcontractor (Co. Name) OR
Performed General Contractor (Co. Name)
COPY TO: Building Department
HERS Provider (if applicable)
Building Owner at Occupancy
:i;.::'•....'::.. Compliance Forms August 2001 "'A-25 .
JUL.11.2002 13:31 17602334081 KPLYER R00FING #2917 P.001/007
� D
Corporate Office:
P.O. Box 462890 � ® , Pliiinc: (700) 737-8389
Escondido, CA 92046 dR FAX: (760) 737-0350
I.iiZ.��u � fih3.5R1
WESTERN PACIFIC HOUSING
LA QULNTA
760-564-7022 (FAX)
Attn: JOHN
Roofine on "UGENDS (a) P.C.A. WEST" Ph 2 LOT #27
U7-11-02
Mayer Rooting has suppliul and installed '13 " U'h&gin cloaked roof vents, on lot #27
at R1-2.60 GOLF VIEW DRIVE., Tile vents have bcen installed per manufacturers specifiication%.
Nate: Exact vent locations are determined. by builder
RESPECTFULLY SUBMITTED
SCOTT BEECH"
OPERATIONS MANAGER
Mayer Roofing, Inc.
Page 1 of 1
558 Librury Street . Sail Fe.rumido.'CA 9134o 193 Orange strcct . Riverside, CSA 9250-2
(8 19) R38-6064 . t,AX (8) 8)838-4493 (909) 782•l bol - FAX (909)782-0,104
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Tight Ducts) CF -4'R
PROJECT INFORMATION
Projeet Title:
La Cela
Project Address:
Ls Quints
Builder Name:
Western Padfic Homes. Michene Lopez
Voice e :
949-4426199 x 462
'Builder Contact:
John Zleman
Voice 4;
780-564-7555
Project 10 0 :
28838.2
Sample Group S:
Phase 1
Lot d:
2032
Plan s
8
Address:
81-210 Golf View Drive
HERS INFORMATION
HERS Rater.
Scott Johnson
CertAmition 0:
CCCSJ614037
HERS Finn:
Acton Now
Voice
949-831-2274
Address:
2575 Westminster Avenue. Costa Meta, CA 92827
HERS Provider:
CHEERS
Voice >r ;
818407-1500
HERS -Address:
8400 Topangs Canyon Blvd, Chatsworth. CA 91311
HERS RATER COMPLIANCE STATEMENT
x T-24 Compliance Credit was Taken for Tight Ducts
VM:
x Tested CApprovdd as a part of sample, but was not tooted
x The installer has pro a copy of CF -SR
x Air Distribution Systsm is Fully Ducled (sheetrnetai, duotboard Or flex duct)
Where cloth backed rubber adhesive duct tape is installed, maelic and drawbands are used in combination with
cloth balked, rubber adhesive duct tape to sea! leaks at the comedians.
MINIMUM REQUIREMENTS FOR DUCT LEAKAGP— COMPLIANCE CREDIT
III Duct DiagnoWmum
Tasting Resub (Maximum 5% Duct Leakage)
CFAFA Leak Max Tested Leak
System
Indicate theowe Is Duct Leakage ane the calculation used:
0.7 x Flow 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 (Coding Capacity in Nominal Torts) x (0-06)
21-7 x (H Wng Capacity in Thousands of Owtpu: BTU per hour) x (0.06)
Other
uct Proeauitation Test Results (CFM @ 25 PA) 70
100 x Test Leakage 1 Fan Flow e % Leakage 3.9
Check Box for Paso or Fail (Pass ■ 8% or Lose) passl xfail!
System of
Indicate the max um a le Duct Leakage and the calailation used:
0.7 x Floor Aim x (048) for Climate Zone 8 through 15
0.6 z Roar Arm x (0.017 for Glrnate Zones 1 through 7 & 16
x 400 x (Cooling COPWIty in Nominal Tons) x (O.OS)
21.7 x (Resting Capacity in Thousands of Output STU per hour) x (0.08)
Other
MR PrasaurftWn TKt Results (CFM ® 25 PA)
100 x Test Leakage / Fan Flow a % Leakage Tgr
Check Box for Pass or Fait(Pass � 6% or Lasa) Pass z a
Ill
System EM of j"�"I
Indicate the maramum 4ZMVowe0 10 Duct Leakage and the Wlculatign used:
0.7 x Flow Area x (O.DS) for Climate Zone 8 through 15
0.5 x Floor Area x (0.08), for Climate Zones 1 through 7 & 1t;
x 400 x (Coonng Capacity In, Nominal Tons) x (0,06) 48
21.7 x (Heaths Capow irl,7hausands of OuOut BTU per hour),x (0.06)
Other
Pressurisation Tod Results (CFM 26 PA)
100 x Testieakage / Fan Flow. -%Leakage
Check Box for Pass or Felt (Paas or Lase) sea x
Aatare can�ytng $ gnatuis
F2W1-02 (J -t2) Action NWT 24CP4RTDMA=xle
r
- fif.c•7i'iF�.i'riA..k.....i�:..s+.r..«{"--...4t...�.. .-..e.�..,..,..... -__ ...,
Certificate of.0ccupancy
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: 81-260 GOLF VIEW DRIVE
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0109-055
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: SHLR OF CALIFORNIA INC.
Building Official
Address: 23 CORPORATE PLAZA SUITE 245
City: NEWPORT BEACH, CA 92660
By: DANIEL P. CRAWFORD JR.
Date: 9/13/02
POST IN A CONSPICUOUS PLACE