0403-232 (SFD)v
' 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.
yLicense # Lic. Class Exp. Date
I t3b"�Q ?y A 13 / r MUM
Date ! !` J Signature of Contractor—k 7,
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.
(y�) 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 AMERICAN GWAIAL Policy No. WC"13820) IS1
(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, bshall forthwith comply with those,°provisions.
Date: � _(el �``2 Applicant
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) Date
BUILDING: PERMIT PERMIT#
DATE VALUATION LOT 0403-2M TRACT
61 30321
JOB SITE
ADDRESS ��+i��
i +max
APN
�-0•,�r
OWNER
CONTRACTOR/DESIGNER/EN (NEER
IM3i M CI.yJ!CSMU14-ITM
i lL�3J1JA'R. CO21dt`1idU IES"
24800 CIM-;1FIMAD'RIVE -#200
2A $00 IMMMANTADR1�'E 0200
)MS1014 V=01 CA. 92,691
MaSIC)N V'.I.R,J'03 CA 926QI
(949)598-8500 MIX 313
USE OF PERMIT
SII`iMr. F.11%dulyDi1vEIL- G
SPD, LOT61 PiA1: IYA.'MMI T 1 CIn- NOT IN r'LUVE 1FLOCK -11N LL,
F004 SPA OR RIVEMAY APPROACH.
TRACT CONSTRUCTKYN Z8?A,0,0 Sp
1POI:CHIF.A.TIO 35X,08 sp
CARAClIUCA1�.PORf. 404,00 3F
XM ATM COSI° OF CO.NRU13C:')1'�t.?A
169,933.60
PIERAM FE X- BRIVIKkUY
C0118'TRrX011011 FTZ 101.,000-•418.000 ISK50
PLAN CHI&CM YtiP' 101.000-439.3113 $19110
M:1?C1.1ANIC'ALM 101.000-421.000 $66150
ELMTRIC.AL ME 101-000-420-000 $14139
PLU16AUNO FI?I; 1011.000«419-000 S179,23
S F€LONO MOTION FPZ = RES)D 101-000-241-000 $16.99
LIRAD1140 FFA 101>000-423.000 VS.00
iil:.'ifLr1.%IT'a R IMPACT FEf:e�C1S.f10
SM -TOTAL COMMI a :W7TOi+ AND PUSS C"ID,=
13,8
a93."
DUF
MT,�LPERMUTFEES) NOW
$3,093,06
-T� 17.
RECEIPT
DATE
BY
DATEFINALED
INN5P.ECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVA S
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
ucts
Slab Grade
_
_ _
Return Air
—
Steel
_ _
Combustion Air
Roof Deck
i
Exhaust Fans
O.K to Wrap
_ _ _
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
Final
1 / 6
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 APPROVALS
_
Gas Test
Electric Final
Waste Lines
����
Heater Final
Water Piping
_
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Q _
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 d
Final ®J p
Utility Notice (Perm)
COMMENTS:
Ao
!o/27/2004 08:28 951686878E WESTERN; INSULAI IUN r'IrUE U4/ U
iNS"PLATION9
4211 Latham Street, Riverside, Califomla 92501'
Tei, (951) 685-8760 Fax (951) 586-6786
. 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:
TRACTIPHASE: LA QUINTA DEL ORO / PHASE" 2
LOT E31
SITE ADDRESS: ' 44-890 VIA MARABEL - LA 0UINTA, CA
-- -- - ---- - ;, -"--------------.--------------
CEILINGS Q PLANS 2 & 4: BLOWN INSULATION
MANUFACTURER: GREENFfBER.F THICKNESS: ' 10.3" R -VALUE: R-38
CEILLNRS &FLANS 2 S 4: ` BATTS
-MANUFACTURER: JOHNS MANVILLE , THICKNESS, 13" R -VALUE; R-38
CEILINGS: j BLOWN INSULATION
MANUFACTURER: GREENFIBER " ` .THICKNESS: 8.1" R- VALUE: R-30
' CE&INGS r BATTS
MANUFACTURER: JOHNS !MANVILLE THICKNESS: 11° R- VALUE: R-30
EJ(TERIQR W& LS' BATT,
MANUFACTURER: KNAUF p THICKNESS; 3 1/2" R- VALUE: R-13
GENERAL CONTRACTOR: LENNAR. HOMES '
SY — -{
TITLE`.
DATE: - -
INSULATION. CONTRACTOR: WESTERN'I'NSUL.ATION, L.P.
LICENSE UM
BY:
TITLE: PR0 C;IONMANAGER -
DATE: SEPTEMBER 30, 2004 -
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PO: Box 621 Ph/Fax (760)564-2044
Rancho Mirage, CA 92270'' Cell: (7601 250-1852
Email: DESNRG la•AOL,COM
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I.of 7) CF-4R
LA QUINTA DEL ORO
09-30=04
Project Title Date
FRED WARING CLINTON S'L, INDIn CA LENNAR HOMES
Project Address Builder Name
NACHO CASTENADA 760-578-6968 PLAN 2-Y 2 UNITS
Builder Contact Telephone Plan Number i
ALAN WEAVER 760-880-5504 GROUP' 1
HERS Rater 'Telephone - Sample Group Number
AL.'
rJA #CCNAW183226 09-29-04 61'2 . ,
Cert fy
i i..n9 Signature Date Sample Lot Number
9
Firm: DESERT ENERGY SERVICES LLC HERS Provider: CHEERS
N
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 tliat.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. .
E1 Distribution system is fully ducted(i.e.,Aoes 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
DuctDiagnostic Leakage Testing Results (Maximum 6% Duct Leakage)
Measured
Duct Pressurization Test Results (CFM @ 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% or less) ❑ ❑
Pass Fail
-
❑ THERMOSTATIC EXPANSION VALVE JXV)
No Thermostatic Expansion Valve is installed and'Access is
El Yes ❑ 0 El for inspection .