0403-229 (SFD)LICENSED CONTRACTOR DECLARATION
�Hheretiy.affirm under penalty ofperjury that I am licensed under provisions of
•.:�ghapter 9 (commencingrwith 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
760241 AB
/Date 4 k')G/ 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).
( ) 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 r 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:
Carriers M1!f?ICA�d Gs'�s 0AIt, Policy No. wC!3?mis1
(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 thosejj�Iovisions`.
Date: Y'tf 2�� •4 Applicant '/� RX`://
Warning: Failure to secure Workers' 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`afforney'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 issuarice 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 above-mentioned property.for inspection purposes.
Signature (Owner/Agent)J Date f
BUILDING PERMIT PERMIT#
1b403•-22-9
DATE VALUATION LOT TRACT
JOB SITEAPN
ADDRESS 44.SVMJjIDZHn
611Ati-032-4
OWNER
CONTRACTOR / DESIGNER / EN (NEER
LMW.AR COM2vTC3N! a
LENIPTAR i;OMMtMM.ES • .
24800 C TMAN ADMVE #2290
24800 CYfl0A MDPJVB##200
1VL'1,ciON Wao CA '92691
1mfr0m V.W0 CA 92691
{949)598.8500 CV -0 3 434
USE OFF PERMIT "
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SIFL?, LOf 59 RLAN iZIi.E3 'PFZRHIT f10F..S NOT 114= 102? ffL:�CK -WALL,
P001, SPA OR fMVEWAYAPPROACH,
t
TR4CT Ct N0T,R0CT1UN VallilOA SP
PGR WPAVJO
489.00 Sri,s'1J�•�R
�p``11pp
Ai3) MA1^1F ORT 461100 U7
Fa3'n",1XD CWC OF COMMUMON
01.4 s`i'Td'.116.'f 1011 RRE 1.0)_000-41811000 $800,5f1
PLA14 CHECK VEZ 101-000-439-318 ' X165.92
? .4>11,EiR4IG�.LfrkR iLf.000�4%2-tD�10 P3.00
ELECTPLICA1w FEE 10'1-000-42i!-000 $136.32
PlIUMBF00 FEE 101.000.419.000 0166.00
v
S` POND MOT1014 FZ S , h:lS3.D 1021-000-241-000
4`iRADD10 FEE 101.000-423.000 WIN
DLVf:1.0'P 1'e:1%1PACT F'Z.L:
f� A\ �`• dti' m`zTfc'I7:("iAa.€#hlyi7'������T.AyL+�,'''(p��arE����':f('� �q+�q '�'[�� �[�1
$3,76}& 113
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APR 0 6 2004 PxtvA r rs D� wow
CITY OF LA QUINTA
FIVAN(;E DEPT.
$3,xc s
RECEIPT-,
DATE
'r
By
r
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVAL S
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Slab Grade
_—�
Ducts } _
Return Air es_
Steel
Combustion Air
Roof Deck
_
Exhaust Fans
O.K to Wrap
_ _ _
i
F.A.U.
Framing
_
Compressor
Insulation
_
Vents
Fireplace P.L.
Coe
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
—
Drywall - Int. Lath 15Q —
Final
Final
POOLS - SPAS
BLOCKWALL
APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALe
Gas Test
Electric Final
Waste Linespir
ra.
Heater Final
Water Piping
.
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
v �-
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring 11 Ktr
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) O r O
07412/04
a
16:12 CDFARIFACOSTAMESA -> 7607777011 NO.159 D03
�v�jcit• tIV r,E?Q _1.U;° ! __;, a"r �. + . t K'uIeCt
Noffleadon Q Latent to J'Ylove S, .jU f = or vlitbin Quarantined
Areas of Ors;na.e, Fsver' ide, nid Los Angele,; Co4ades
Complia�e4
ee�neat�1.4
permit >~
Laao.ing CicylCo�n7�
14 of aaioekyr Rc .UtSL og Approvel:
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a��sS. 0 Sox 280 C, zip: gz236 .
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Lors� `1A ;AZA_
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Estin:su'd euzAvy of Soil (t.z. Cub'CY.Lf6):
,�,r:ec(p;.tcdDeu of,�✓,ovcrocor. _ � /� .
Urxcocy Lin-cl for Lntacdi,atc lnsp't600 ud Relecsq: (Circle One_F; f
y j Movcoeoi os Soil
Bold M�yccaF�tUnei aitc Cyr:ked u -T ` 2ALL AS SOON r,5 TOSSIBLF TO
SU D'ULE L-SPEMON DATi kb') TL'C.
D2tc7 rapped: k of laps: Tmpa -Ed b)•:
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p2ic Pickcd TJy C00%mmt:_____,:_
SoU M ve eetis S��ict] v P,-Cbbi cd for tLc Ec,1'0'#kZ^ C RCc'�•o-i(s')
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woes
WESTERN INSULATIONv o dp
4211 Latham Street, Riveruide. California 92501
Tel. (951) 686-8760 Fax (951) 686-8796
CF6R 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: LA.QUINTA DEL ORO 1 PHASE 2
LOT 58
SITE ADDRESS. "4�t-83fi ViA MARABEL , tsA'.QUIN7A.'GA
C�LII NGSPLANS 2 & 4: BLOWN INSULATION
MANUFACTURER: GREENFIBER THICKNESS: 10.3" R- VALUE: R-38
CEILIIV(S ;�
ANS'2 a& 4: BAITS .,
MANUFACTURER: JOHNS MANVILLE THICKNESS. 13 R- VALUE: R-38
BLOWN INSULATION
MANUFACTURER: GREENFIBER THICKNESS: 8.1 R—VALUE: R-30
CEILINGS: i BATTS .
MANUFACTURER: JOHNS MANVILLE THICKNESS: 11 R- VALUE: R-:30
EXTERIOR WALLS::' BAITS
MANUFACTURER: KNAUF - * . THICKNESS. 31/" R-= VALUE: R-13
GENERAL C®NT'RACIOR. LENNAR HOMES
TITLE. — A
DATE:
INSoUL`XN CONTRACTOR: WESTERN INSULATION, L.'P.
LICENSE UM
BY: _c ,
TITLE: ..PROD T! N NykNAGER
DATE: SEPT EWBER 30, 2004 —
w
QC,uoQoTCG TQ :7A bnA7..TP/AT
MOM..
ENERGY s�1=- ' A a E
s�,ce$ --
P0. Box 621 Ph/Fax (760) 564-2044
Rancho Mirage, CA 92270 Cell: (760] 250-1852 .
Email: DESNRG 0808 COM
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7)
C F-4 R
LA QUINTA DEL ORO u9-�
30 — -
Date
Project Title
FRED WARING 8� GLINTON ST, INDIO I FN AR HOMES
Builder Name
Project Address
NACHO CASTENADA 760-b78-6968 CASITA I UNITS
Builder Contact Telephone - Plan.Number
ALAN WEAVER 760-880-5504 GROUP 1
HERS Rat�jn Telephone Sample Group Number
��' #CCNAW183226 09-29-04 58-2
Certifying Signature Date Sample Lot Number
Firm: DESERT ENERGY SERVICES LLC HERS Provider:.' CHEERS
Street Address: P.O. BOX 621 GE, CA. 92270
City/State/Zip: RANCHO MIRA
Copies to: Builder, HERS Provider
HERS RATER COMPLIANCE STATEMENT
The house was: ❑ Tested ® Approved as part of sample testing but was not tested
As the HERS rater providing diagnostic testing and field Verification, l certify that the houses identified on this form comply
with the diagnostic tested compliance requirements as checked on this form.
❑ The installer has provided a copy of CF -6R (Installation Certificate.
❑ 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
values
Duct Pressurization Test. Results (CFM @ 25, Pa)
Test Leakage Flow in CFM'
If fan flow is calculated as 400cfm/ton x number of tons enter calculated
value here
If far- flow is measured enter measured value here
Leakage Percentage (100 x Test Leakage/Fan Flow)El = ❑
Check" Box for Pass or Fail (Pass=6% or less) pass Fail
❑ THERMOSTATIC EXPANSION VALVE (TXV)
❑ Yes No Thermostatic Expansion Valve is installed and Access is ❑ ❑
provided for inspection