0403-234 (SFD)t1 LICENSED CONTRACTOR DECLARATION
Thereby 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
766241 ,A 13 1103
Date' 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:
( ) 1, 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
DateSignature 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.
Sec)' I have and will maintain workers' compensation insurance, as required by
iion 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' -AMERIC-AN VASUAr, Policy No. WC11$20 SJ '
(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 those, provisions.
Date: / �- �! %Applicant %/�.f�` �/! •��
rf- e ,
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 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 enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) 11f /f'. Date t✓:f�r'r�b`f�f
PERMIT #
BUILDING PERMIT
040344M.
DATE VALUATION F�%1�LOT TRACT ��aa
JOB SITE
ADDRESSrrS'c�`!?r ..�a�I�,+s-
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OWNER.
CONTRACTOR / DESIGNER / EN (NEER
IZ, ,rRKrR. C01, 4GINTIM, 9
co w-v-nn'Es
24,800 C11MANTPaMl 000
NaSIMi;1k3 VMJ0 C- 92691
_inDo
e M fdi . CIA�y��j1'2691
ryqq:39!0..W
$434 �!11q
USE OF PERMIT ( p7r,6
SFD,. LOT 3 PLAN 3XZC. IMPIVAIT'DOZZ ATOP 11110"LID9 BI.:t7CK WALL,,
Paul, SPA OR DRIVi4•WAY AP3'.IOACH.
r '
�'i'�,E40 G.�7 +fL T Ut:'.T,f 00 OF
taORCIIiPATIc '�6.a3f) Si
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COiNSTRUCTICN:EE•, 101-,000418-000 $012.59
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Iji.A1� Ct�i�C;Yv F:r� 191�;3t�-�•SS►-3�€S $t�4.��5
ME011AAXW, VELP
103-000-420-000
1-l'umoIl<FC1 FIDE 101-000-419-000 $185M
ST]9w: OT�a'g�YI:iWPLPE - MID 101-0(10..,g241? 0�11�iy 8AU
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$2,961,40
tors PRR- - ATaD FEES
$0.00
APR 0 6 2604
c';; Y DF LA @�°NTA
. i 9::f CE DEPT.
RECEIPT
DATE!
BY
fr'
DATE FINALED
`
INS�CT R
�..t l
/{/
1// 3 O
/ G
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
_ BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
_ _r
Forms & Footings _
Ducts
Slab Grade
_
_
Return Air
Steel
_
Combustion Air
_ _ _
Roof Deck ✓ _ 10 r _
O.K. to Wrap _4
Exhaust Fans
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath / 3 G
Final
Final
BLOCKWALL APPROVALS
Steel
POOLS -SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING LAPP OVALS
Gas Test
Electric Final
Waste Lines _� _
Water Piping
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connectionp 7 t4S % A? �'
Encapsulation
Gas Piping
Gas Test
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 f p d
Utility Notice (Perm)
COMMENTS:
f :0/27112004 08:28 9516568786 WESTERN INSULATION PAGE Ub/U!
WIEDSTLUMNI , r
4211 Latham Street, Riverside, California 92501
Tei, (951) 686.8760 Fax (9511686-8786,' ,
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.DLL ORO l PHASE.2 ,
LOT 63~
SITE ADDRESS' 44-860 VIA. MARABEL - LA QUINTA, CA
CEILINGS A PLANS 2 &,4:. BLOWN INSULATION
MANUFACTURER: GREENFIBER THICKNESS: 10.3" � R- VALUE: R-38
,
CEILINGS -0- PLANS 2 & 4: BATTS �
MANUFACTURER: JOHNS MANVILLE THICKNESS: 13" ! R- VALUE: R-38
CEILINGS: BLOWN INSULATION
MANUFACTURER: GREENFIBER THICKNESS: 8,1 R -VALUE: R-30
CEILYbIGS; BATTS .
MANUFACTURER' JOHNS MANVILLE ` 'THICKNESS; 11" R -.VALUE: R-30
UTERI®R tA�ALLS:-?' x :.•BATTS r
MANUFACTURER: KNAUF THICKNESS: 3 112" R- VALUE: R-13
• .
GENERAL CONT ACTOR- LENNAR HOMES
BY. y t
TITLE: +'
DATE: r ,
INSULAT-10N.CONTFACTOR: WESTERN INSULATION, L.P.
LICENS N -
TITLE:. PRO TI NAGER
DATE: SE E BER 30, 2004 -
it •+• ., ,. ' ' ..
Dit
ENERGY s.1-- o E
I�ceB
S .
P0. Box 621 Ph/Fax (760) 564-2044
Rancho Mirage, CA 92270 Cell: (760) 250-1852
Email: DESNRG @AOL.COM
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page 1 of 7) CF -4R
LA QUINTA DEL ORO 09-30 -04
Project Title Date
FRED WARING & CLINTON ST iNn 10 C -A LENNAR HOMES
Project Address Builder Name
NACHO CASTENADA 760-578-6968 PLAN 3 2 UNITS
Builder Contact Telephone Plan Number
ALAN WEAVER 760-880-5504 GROUP 1
HERS F3,qter Telephone Sample Group Number
#CCNAW183226 09-29-04 63-2
Certifying Signature Date Sample Lot Number
Firm: DESERT ENERGY SERVICES LLC HERS Provider: CHEERS
Street Address: P.O. BOX 621 City/State/Zip: RANCHO MIRAGE, CA. 92270
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, I 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
Duct Pressurization Test Results. (CFM (0 25 Pa) values
Test Leakage Flow in CFM
If fan flow is calculated as 400cfm/ton x number of tons enter calculated .
value here
If fan flow is measured enter measured value here
Leakage Percentage (100 x Test Leakage/Fan Flow)
Check Box for Pass or Fail (Pass=6%o or less)` ❑ ❑
Pass Fail
❑THERMOSTATIC EXPANSION VALVE (TXV)
❑ Yes ❑ No Thermostatic Expansion Valve is installed and Access is a ❑
provided for inspection
ENERGY C A C E C ,
ervces
P0. Box 621 Ph/Fax (760) 564-2044
Rancho Mirage, CA 92270 Cell: (760) 250-1852
Email: DESNRG (WAOL.COM
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7) CF -4R
LA QUINTA DEL ORO 09-30mO4
Project Title Date
FRED WARING & CLINTON ST, INDIO GA LENNAR HOMES
Project AddressBuilder Name
NACHO CASTENADA 760-678-6968 CASITA 1 UNITS
.Builder Contact Telephone Plan Number
ALAN WEAVER 760-880-5504 GROUP 1
HERS Rp ' Telephone :Sample Group Number
#CCNAW183226 09-29-04 63-2
Certifying Signature Date Sample Lot Number
Firm: DESERT ENERGY SERVICES- LLC HERS Provider: CHEERS
Street Address: P.O. BOX 621 x City/State/Zip:
RANCHO MIRAGE, CA. 92270
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,. I 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, masticarid 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) r
Measured -
Duct Pressurization Test Results (CFM '@ 25 Pa) values
Test Leakage Flo% in CFM
If fan flow is calculated as' 400cfm/ton x number of tons enter calculated
value here ,
If fan flow is measured enter measured value here
Leakage Percentage (100 x Test Leakage/Fan Flow)
Check Boz for Pass or Fail (Pass=6% or less), : El El{ Pass Fail
❑ THERMOSTATIC EXPANSION VALVE(TXV)
❑
Yes No,
Thermostatic Expansion Vale is installed and Access is ❑
provided for inspection _ li' 1:1,. El
'Y,
FROM :PD—EP PALM DESERT FAX NO: :1-760-674-574' Jul: 28 2004 03:59PM P2
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