0303-197 (SFD)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,
6015A 86 B
,/Date ' v Signature of Contractor
OWNER -BUILDER CLARATION
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).
O I am exempt under Section B&P.C. for this reason'
Date Signature of Owner' "
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty oYperjury one of the following declarations:
( ) I have and will maintain a certificate of consent toself-insure for workers''
compensation, as provided for by Section 3700 of the Labor Code,. for ttie
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,.Ifor the performance of the work for which this
permit is issued. My workers' compensation insurance carrier & policy no: are:
Carrier STATEFUNDPolicy No. I70 �2a-Q13
(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, 1, shall forthwith comply with those provOions.
,.,-Date: v Applicant-
Warning:
pplicant Warning: Failure to secure Wor ers' Com ensation coverage is unlawful.and
shall subject an employer to cAinal 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 eriter upon
the above-mentioned property for inspection purposes.
r�--x �..
�Signature (Owner/Agent)'�i -�Q---'`-L-�•-- Date L --
McDEI
Ix .. PERMIT # -
PERMIT
1B_UILDING' �.,
DATE VALUATION *rJ"A,() LOT : TRACT 4052L
JOB SITE
.ADDRESS 441-910 VU CATALIKA!,
APN 604-•052-:iiD?I' r
OWNER "`��
CONTRACTOR / DESIGNER / EN INEER �r
LA Qt7N'i`.A DM ORO I47; LP.
C0R),TM93'0X. DF _V.=P R.S, ,WC.
005 CALi.t1`':51 4Rd331'L AEL •
.5005 C••P%�: - SAW, RAMAN, Ym .B1
PATIA I ?1'-T GIS CA 92 264
PALM, SPRR-TI33 CA 92164
(760)325;-4289 M0 6867
USE OF PERMIT
SWI CroLE, FA1AI[ Y DWF:;J1;I. NO .
5 TU+ L -u1 .4 F-T-d.3.1li .N.. iir Z.Ra I Ie- Fa4ml A fJUZ5 FiCAT L 4 F, .
BLOCK WALIA POO4, SPA OR DYLrV9 WA'Y'AT,0P_0AC.H
TRACI11 CONSTRUCTION ZM00 OF
r PORC:kilg''AXI0 %315.00 SW
' OARAGE'f-ARI+'UII T 426.0003F
X STWAIED CC��"ir' f�Y+' �C)i�S'CI~tL�4:"�'1tiON
rr3,M.,f&0
PERMr rt F,: SiTMANky'
CONSTRUCTION FG', 101-00041%-000
PLAN CHEC' K FRIE .. '-101"000.439-318 $744.9Y
MECHANICAL FER 101-000-421-000''.SSt roo
Euarpuc.AL• IFFE 101:••000-420-0.00 $146.67
• PLUKOINO F.FF 1Q.1<000-419.000
STRC?Y1'CI I+ROTICeTI 'tre'L� RE wiD I0'1-000-241.00.0
ORADI'sNO FEE '101-000 423a00 : sts,03
DMllaf)3?T.RIMPAC'f
I+':aTsDEPOSIT '1C1`1aS1fJ0°ei��-�I� •$ra0b.40
—� RLTe` hoi A1>11i' RLh W. c –rhac$.4,490.71
(41 '' f I1 ' -PAID FRIG:
4500,00
APR .16 203 . �,�yRlx�r'Is DUE NO
CITY OF'LA QUINTA •.
r-imANCE DEPT.
RECEIPT'
DATEBY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
-
Ducts
Slab Grade
Return Air
Steel -
Combustion Air
Roof Deck
.-
Exhaust Fans
OX to Wrap
F.A.U.
Framing
Compressor
Insulation
Fireplace P.L.
Vents
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
.
Drywall - Int. Lath
Final /Pr
Final 1G !�
BLOCKWALL APPROVALS
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
Gas Test
Electric Final
Waste Lines
.p
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
— fj
Encapsulation
Gas'Piping
Gas Test 2
i S .
Appliances
Final
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 S / '7
Utility Notice (Perm) _ G —
COMMENTS:
- Cedificafa ofInsulation
Your home has been insulated with John Mansville Fiberglas: insulation products, which are designed
x for today's safety standards and tomorrow's energy requirements. '
' Fiberglass, is inorganic and therefore permanently noncombustible, so it does not have to be treated
- with fire -retardant chemicals that will likely lose their effectiveness over time. It has not been treated _ - . • - '
with chemicals that can corrode wiring or metal. Fiberglass will not absorb moisture nor will it
settle over time as may other insulation materials. `
This also certifies that insulation have been professionally installed in this home to provide the
- following thermal performance. -
. Job Name:. LA Qufa A UL. g20 Tract:'3a62jj Plan# 3y Phase:'
hase •. MCUIPC * • ,
{ 25 _
Lot No: ob Address: ,y 910 - VtA C�tr01UNA, f
_ e Ceiling Area: Rap Garage Ceiling:Fi# - -Non-Access.
With Living Above • ' & Sloping Areas ,
Exterior Walls* 7-13 %(&Sp4 n Overhangs: Access Attic: '
': ~z �. f _ ♦ With Living Above.
_ Between Floors: F :# Interior Walls: ,.
- Subcontractor.:.
Signed: le
R -means resistance to heat flow. The higher the R -value, the greater the insulating power. -
' Ask your builder for the fact sheet on R -values. Keep this certificate with your other
valued papers. If you ever sell this home, this certificate should be passed on to the buyer. .
CERTW,,ICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page 1 of 7 CF -4R
y LA QUINTA DEL ORO -.PHASE= MODELS
. Project Title ; • ' Date
a. (4491 n Via to `na La Ouinta CA LENNAR '
Project Address— -" -. y Builder Name
Dave l�tchell R t 760' 75-0887. Plan 3 (pg. 1'd 1) `
Builder Contact 'Telephone - Plan Number
'3 _ • . William Henson (CCN #CC2004076) 760-250-7022 Group 13•
HERS Rater. Telephone Sample Group Number • '
28 (MODEL)
Certifying': -'Signature Date „ Sample House Number
r Finn: "BCI Testing HERS Provider:' CALCERTS ,
_ _
Street Aadress: PO Box 50575 city/State/zip: -Phoenix, AZ 85076. ,
Copies to: Builder, HERS Provider
HERS RATER COMPLIANCE- STATEMENT r'
The house was: Tested ❑ Approved as part of sample testing, but was not tested F
As the HERS rater providing diagnostic testing and field verification, I certify that the houses identified on this form comply
th the diagnostic tested compliance requirements as checked on this form:
The installer has provided a copy of CF -6R (Installation Certificate. y
Distribution system is fully ducted (i.e., does not use building cavities as plenums or platform returns in lieu of ducts)
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 duct connections.
MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT
Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage)
Measured «
Duct Pressurization Test Results (CFM @ 25 Pa) 1 ; values `
Test Leakage Flow in CFM a
If fan flow is calculated as 400cfin/ton x number of tons enter calculated
r value here 0O
If fan flow is measured enter measured value here
* f. Leakage Percentage (100 x Test Leakage/Fin Flow) _ b
• Rr„+
Check Box for Pass or Fail (Pass=6%or less).. , ❑
•• _ • as Fail
t
' RMOSTATIC EXPANSION VALVE (TXV) ' r
Yes ❑
No. . Thermostatic Expansion Valve is installed and Access is . •" p� a ❑ -
✓✓✓����\\ provided for inspection
Yes is a pass Pass Fail
❑ MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT
1' ❑ Yes ❑ No ACCA Manual D Design requirements have been met (rater has
- t verified that actual installation matches 'values in CF -1R and
design on plan.
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 =
13 11
Yes for both 1 and 2 is'a Pass Pass Fail -
Compliance Forms August 2001 ti A-16,
. , � is , ' - •. � ,. t' .. i ,
SEP -07-2005 WED 02"40 PM TEAM HEATING & A/C i
FAX .NO. 95169438U3
r., u l
HVAC INSTALLATION CERTIFICATE for Tested Duct Leakage & TXV Page 2 of 2 CF -6R " F
Site Address:f 44910 la Ce line Permit Number
Phase. Models
Tract Number. 30521 Plan alt: 3Z
Project• La Quinta Del Oro Builder. Lennar Homes .
Lot Number: 28
system M 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 7 816 ,
400 x (Cooling Capacity in Nominal Tons) x (0.06)
21.7 x (Heating Ca city in Thousands of output BTU per hour) x (0.08).
Measured Fan Flow x.06
Vu -a Pressurization Test Results
100 x Test Leakage I Fan Flow = % Leakage
Check Box for Pass or Fail (Pass = 6% or Less) TXV wa
Ir -)A Com li--e Credit was Taken for TW .
System [ : of
Indicate the maxnnum 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 Capaci In Thousands of Output BTU W hour) x (0-08)
Measured Fan Fla X.06
Pressurization Test Results FM (W WAS_. '
look Test Leakage/ Fan Flow = % Leakage ,
Check Box for Pass or Fail (Pass = 6% or Less)
. ' TXV wa+
'r'Mt�liance Credit was Taken for TXV.. -
'$ystefn of
Indicate the maximum 0110"ble Dud Leakage and the`k uletian ur ed.
0.7 x Floor Area x (0.08) for Climate Zone 8 through 15
0.5 x Floor Area x (0.08) for Climate Zones 1 through 7 816
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 ob
Pressurization Test a 25 -PA)
100 x Test Leakage I Fan Flow = % Leakage ,
Check Box for Pass or Feil (Pass = 6% or Less) `
Ir 13A Co luno& Credit was Taken for TXV Ticv wa:
'system of
Indicate the maximum allowebie Duct LeakaU-
0.7
e and the calculation used: w
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 7 816
400 x (Cooling Capacity in Nominal Tons) x (0.06)
21.7 x (Heating Capa ' in Thousands of Output BTU per hour) x (0.06) t
Measured Fan Flow X.06
Pressurization Test Results
100 x Test Leakage I Fan Flow = % Leakage
Check Box for Pass or Fail (Pass = 6% or Less)
QT -24 Compliance Credit was Taken for TXV TXV wa:
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 emp M
certifying that diagnostic testing and installation meet the
requirements for compliance creel• )
Team Healkg'a Air Condift tt
esf is gesture, to Iasi I* g Subountractor (Co. Name) OR
Performedr General Contractor (Co. Name)
V
COPY TO: Building Department
HERS Provider (if applicable)
Building Owner at Occupancy
PAGE 2
r F2001-01 (4-02) Action Naw T-24CF6.RTD8TXV macro
SEP -07-2005 WED 02:39 PM TEAM HEATING & A/C FAX N0, 9516943803
P. Ub
HVAC INSTALLATION CERTIFICATE for Tested Duct Leakage &l TXV Page 1012 CF -611
0110 rwul000. -..v ,.. ...-----....-
er. 30521 Plan #. 3Z Phase Models
Trail Numb
Lot Number: 328
0 Project La Quinta Del Oro Builder. Lennar Homes
An installation c ardficate is required to be posted at the building:site or made 8valible for all appropriate inspections.
After completion of final Inspection, a copy must be provided to the Building Department (upon request) and the building
owner at occupancy, per Section 10-103(b).
HVAC SYSTEMS:
ligating lr_qutpunerR %ANnik7n1FM1kG' - oEfficiency - Duct Heating Heating
Equip. UIX-Certifted mtrwame Idendcle AFUE, etc.)' Location Dud Load Capacity
Type and Model Name S stems >= CF -1R attic, etc. R -value Q3TU / lir BTU / Hr
60%c
c
c
6mling cquipmurlt
o EfIriciencyDuct"
ng
Equip. Gftc; GOWN Mfr Name Idendcle (SEER, etc Location Dud Load Capacity
Type and Model Number S tems >=CF-IR)attic, etc.. R -value BTU / H BTU / Hr
NAUZ49 1z AMC M-42 -
WC035 -7 AMC ffz.r— 35.mMKID 1zcH-4.2 JG,UUU
�w�..11..d 9\ w r�lnnf 4n nr rrnro
I, the unuarsigne% venry Alec equipment 1-Jau duWF 1'. Ir 10 uro a\.wa.1 -.. �•-••. -- �• ••.�•_
efficient than that specIftfilti the certffica to of complance (Form CF -1 R) submitted for compliance with the Energy
Efficiency Standards for( end 3) equipment that meets or exceeds the appropriate requirements for
manufactured devioes ( e I E Is
Regulations or Part 6), where applicabie.
011ri1005 Team Heating & Arc. Inc.
ns ng con r o. ame
OR General Contractor (Co. Name) OR Owner
MINIMUM REQUIREMENTS FOR DUCT LEAKAGE= COMPLIANCE CREDIT
Duct Diagnostic Leakage Testing Results (Maximum 6°% Duct Leakage)
CFA:
System CE of 33
Indicate the maximum a 16wrd le Dud Leakage and the calculation used:
0.7 x Floor Area x (0.06) for Climate Zone B 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 (0.08) ►
21.7 x (Heating Caps ' " in'Thousands of Out ut BTUper hour) x (0.06)
Measured Fan Fb vi I X.05
Vu—c Pressurization Tesl Results
100 xTest l eakege /Fan Flow = 96 !°eakagd i
Check Box for Pass or Fag (Pass = 6% or Less)
MmT-24 Compliance Credit was Taken for TXV TXV wa
Ty—stain of 33
Indicate the maximum allowable Duct Leakage and the calculation used.
0.7 x Flow 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
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 a .ofi
Pressurization Test Results 5 PA)
100 x Test Leakage / Fan Flow = % Leakage
Check Box for Pass or Fail (Pass - 6% or Less)
OT -24 Compliance Credit was Taken for TXV TXV wa
PAGE 1
F2001-01 (4-02) Acfion Now T-24CF6-RTO&TXV macro
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