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0109-052 (SFD)CO fY N W perC) ti W � r tY o Z CD 0 WW iF- a U) Z M LO N ON (.5 °) d Q Z Lo Q 0 XW�: mVU O � 0) 1-t Z_ co 5 �a a J LICENSED CONTRACTOR DECLARATION 1 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 ffect. License # Lic. Class Exp. Date Date Signature of Contracgr' 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). ( ) 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 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: Gamer Policy No. PACIFIC RAOLE INS. WO( .,$ (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 manne s,) as to becomes Yt to the workers' compensation laws of California �cf agyl�e that if I s • oyld become subject to the workers' compensation�eR a;lol�4bf Sectign 700+of the Labor Code,�kall fohw,idt� comply with t ov dons. Date:J�' Applicant . a -,�y� Warning: Failure to secure f rkers'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 thea ove information is' correct. I agree to comply with all ty�,ran IState laws ng to the building construction, and hereby author)3s re entatives • Is City to enter upon Y the above-mentioned property f�pf"i f p etion Pt r�i e 1 Signature (Owner/Agent) I *`-'�"` �� Date BUILDING PERMIT PERMIT# �' DATE VALUATION LOT gY( TRACT It.1474. 1716,110 24 2R1R-1-2 JOB SITE APN ADDRESS 81.-�ff c`�, 01X V7.[;'i�r ><iR 762--390.013 OWNER CONTRACTOR/ DESIGNER/ EN INEER 165940 VON SN"' . VF_ REIT. 7,00 23 CC ;4%7:'0?.An,,T1JV.,A 9tirM 263 Mvilar, OA 92606 WKPOIR I GSI CA 92"A Ir (949)719 4975 Cv:8Vf 6364 USE OF PERMIT VD. u. LDT 24, PLS' V Vit":. PYt61 IT DOI,%'.NOT INCLUDE, DIDC:FC;WAl,?A )!yOC, WRA OR iii-di`iEWAY,(#PPW.ACH, 755% VIM CH9P__K M F EMUCTI'ON 1(011 YMSU fl.FfiCE OF SAW, PLAN "L?Vlt Mffom V011436 TRUCT1014 131$815.01D By KOR:MPk't'f IO SIZ0113 ISF QXRA.lrWG'ARPOWY R U.0 SF 'fi O"TED CONT M CO.PiRR'UC'I'LON .3,2A,726.N.) �1 t3'Cld'I3 t"b3t.`� i�J71FER 101-000-4-18-000 SiA27,00 Dx1.,,AW Cai1*•bX FEE 01-000-439-318 00.4.39-318 12#63.00 F-yZaTIZfC,A.r.; ifal•q.*"J 2U�y�b $%C�3.Ofi PLUMM"o RIS STRUNQ MtMHCIX FEE' -:VY..WD 101.1304'•241-000 VIA? 011ZANNO, E9 141.000-423.000 t2o.80 l:5LYZ"seC�PF,Li IMPACT FZZ $1,901.00 .A,,1 T H PUBLIC P% XF1- P.WME 270,000-445-000, a- [ UCC 110W AND PLM' OMWX $4,513.10 laW TIRE-11AM FRO $0,00 SEP 112001 CITY OF LA QUINTA FINANCE DEPT. RECEIPT DATE By DATA F E INSPECT FA HOW] Z01, OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS. MECHANICAL APPROVALS Set Backs Forms & Footings Slab Grade _ _ [p/[ �O _ _ �0//s/D� Underground Ducts Ducts Retum Air Steel Roof Deck�/ Combustion Air Exhaust Fans O.K. to Wrap F.A.U. Framing /2�y�� j(/ Insulation _ �� d5W t /Z/�� / Compressor Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath d _ _ n Final BLOCKWALL APPROVALS Final POOLS - SPAS 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 _ Waste Lines Water Piping Gas Test Electric Final Heater Final Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral _ Pool Cover Encapsulation Sewer Connection 9/ 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)/S�� 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: Use Classification: Occupancy Group: SINGLE FAMILY DWELLING R-3 Owner of Building: SRHI, LLC 81-290 GOLF VIEW DRIVE Type of Construction: VN Bldg. Permit No.: 0109-052 Land Use Zone: RL Address: 16940 VON KARMAN AVE STE 200 City: IRVINE, CA., 92606 Ak By: DANIEL P. CRAWFORD JR. Date: 6/18/02 Building Official POST IN A CONSPICUOUS PLACE INSTALLATION CERTIFICATE (Page 3 of 13) CF -6R Site Address $ !, 217,0 67 O (, F V I G w �>P_ • "T vE �?_LA Permit Number DUCT LEAKAGE AND DESIGN DIAGNOSTICS --r� �- 1 DUCT LEAKAGE REDUCTION Pressurization Test Results (CFM @ 25 PA) 6 Test Leakage (CFM) r7 Fan Flow If Fan Flow is Calculated as 400 cfm/ton x number of tons, or as 21.7 x Heating Capacity Q in Thousands of Btu/hr, enter calculated value here l If fan flow is measured; enter measured value here Leakage Fraction = Test Leakage/(Measured or Calculated Fan Flow) = Pass if leakage 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 test or House pressurization test ❑ Yes ❑ No ❑ Visual Inspection of Duct Connections ❑ ❑ Pass Fail ❑ TH R' MOSTATIC EXPANSION VALVE (TXV) Yes ❑ No Thermostatic Expansion Valve is installed and Access is provided for inspection ❑ Yes is a pas! 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 -1R. 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 sub -contractors certifying that diagnostic testing and installation meet the requirements for compliance credit.] Tests gnature, 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 August2001 —A-25 . INSTALLATION CERTIFICATE (Page 3 of 13) CF -6R Site Address 9.12-1,0 CIoLt-- V re-" J)P—• LIOT 4- � � Permit Number DUCT LEAKAGE AND DESIGN DIAGNOSTICS i2 DUCT LEAKAGE REDUCTION Pressurization Test Results (CFM @ 25 PA) n Test Leakage (CFM) i Fan Flow If Fan Flow is Calculated as 400 cfin/ton x number of tons, or as 21.7 x Heating Capacity n, "( in Thousands of Bmft, enter calculated value here If fan flow is measured; enter measured value here Leakage Fraction = Test 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 test or House pressurization test ❑ Yes ❑ No ❑ Visual Inspection o.f Duct Connections ❑ ❑ Pass Fail ❑ THERMOSTATIC EXPANSION VALVE Mv' ) 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 Far. 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 -611 signed by the builder employees or sub -contractors certifying that diagnostic testing and installation meet the requirements for compliance credit.) Tests Si ature, 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 Site Address . l 2d/p G'70JF_ /! iN LbTn L% Permit Number DUCT LEAKAGE AND DESIGN DIAGNOSTICS DUCT LEAKAGE REDUCTION Pressurization Test Results (CFM @ 25 PA) Test Leakage (CFM) 't !I 2 s zo tN Cit 5 �'C�R 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 Bmft, enter calculated value here 1eD If fan 116w'is measured, enter measured value here ' Leakage Fraction = Test Lcakagel(Measured or Calculated Fan Flow) = Pass if leakage fraction 5 0.06 ❑ 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 ❑ THERMOSTATIC EXPANSION VALVE =NO L� U Pass Fail ❑ ❑ Pass Fail ❑ 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 -1R. 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 sub -contractors certifying that diagnostic testing and installation meet the requirements for compliance credit.) Tests CylgnaZre, 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 . 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/-2, PHASE 2 LOT #: 2024 SITE ADDRESS: 81-290 GOLF VIEW 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: 794484 BY: TITLE: PRO UC ON MANAGER DATE: J N FRY 28, 2002 MP.Y.06.2002 09:52 176023340.0! MATER ROOFING Corporate Office: maw F.U. BOX 462890 Ewondido, CA 92046 WES'T'ERN PACIFIC HOUSING LA QUINTA 760-364-7022 (FAX) Attn: JOHN ¢2543 P.005/009 Roofing on "LEGENDS al },P. i -k WEST" Ph 2 LOT #24 Phone: (760) 737-9,"8 FAX; (761.1) 7:31.0350 05-6-02 Mayer Roofing has supplied and installed "15 " O'hagin cloaked roof dente, on lot #24 at 81-290 GOLF.VIEW DRIVE Tile vents have been installed per manufacturers specifications. Nate: Exact vent locations are determined by builder RESPECTFULLY SUBMITTED A2 SCOTT BEECRAM OPERATIONS MANAGER Mayes hoofing, Inc. Page I of t 558 I.ihrary Street . San Fcrnandu, ('A 91340 193 Orange Strcct . Rivet -side, CA 92.502 (8 18) 838-0064 . FAX (8 18) 8:38-4493 (909) 782-0601 . FAX (909) 782-004 I