0403-220 (SFD)LICENSED CONTRACTOR DECLARATION
I herebyaffirm 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 AD 71.31103.
lit
LI��
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:
( ) . 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 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 WHO this permit is issued.
V 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 AMFfUC..A14 C ASUAI; Policy No. wei30`01131
(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`: U r?�%Applicant !/l/rf ezzz :/
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.
Signafiire\' (Owner/Agent) �" i(�� ��� sC Date -
4' "�✓
BUILDING PERMIT PERMIT#
"W-1120
DATE VALUATION LOT 49 TRACT
JOB SITE Yt •6V�,a
ADDRESS
APN
OWNER
CONTRACTOR/DESIGNER/EN (NEER
LE.m.pa commmI1.lz8
' i3OINAR COIbltvlUWUfr-9
24800 CHiRISAMADRAT-1020
24 �►f� t i3 t7 1+11 1� tV►< Zai
IATSHION`VIRTO " CA 92691
WISSCCrNW-U0 CSL 92691
.
`949)598.8500 0131.4 ��Ar34
USE OF PERMIT
.14M, UIT 49 F'1A74 211, ' i�%1.°M1^T DO MI 1'��.`,'i.fJ.l]Z 8Lo K VJ;t�u,
71����a�.c;°s�I: .
TRACT CONS'PI;UCTION ����,,00 SF
PORC;HPATIO 359,00 RV
0AR.AWWARPORT 462:00 SF
vs-imAnD G63n oir C i7mmuiC:nom
1.54,725.19
1t'KNU'J,'1° lily;, f' S7 MMAIN
CCiNS'MUCTIONFEE I0i--000.4.11.000 1832.00
MAW GHIA11.1:: FEE '301-000-439-318 $683.09
MMI ANIC:AL FFE 101.000-421.000 3MOO
PILECTRIC&L13EE 101-000-4M000 $133.57
PI,UM91110 FFF. 101.0010.419.000 $167,25
STRICYNO MCITi0I4 FEE - R.&SIP, 101-000-241-000 $15.47
O1•a.ADMO FES 101-000-47,. 3.000 015.00
DXV?-1XPEk IMPACT PER $a,4Cu.00
MMI • fO TAL, c OYiSTP,'U,--"riOI4 AMD ;t;�LAK CHEM
06 2004
rAPR
LA G^UE TC.
44i r; FINANiCE DEPT.
RECEIPT
w.{
DATE
BY
L
DAO E FINA411
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
Roof Deck_
O.K. to Wrap
_
_ _
_
,,
Combustion Air
Exhaust Fans
F.A.U.
Framing
. ' i «
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
BLOCKWALL AP ROVALS
Final
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 APPROV
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
.o J
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
Utility Notice (Perm) %— _
COMMENTS:
a IIVI�
o� O
s CITY OF LA QUINTA
BUILDING & SAFETY DEPARTMENT
F^' OF n'� ° 777-7012
INSPECTION REQUEST LINE
777-7153
Owner i FNNAR rxnivr>la c OF CAC iFORNIA
Contractor I :pNN A IR ,TQUE9 64Z CA r IFORNIA
Permit Number 0403-770
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS T7�=VlW
TU ' N—V=9
SFD, LOT 49 PLAN 2RC. PERMIT DOES NOT
INCLUDE BLOCK WALL, POOL, SPA OR
TYPE OF INSPECTION DATE INSP.
TEMPORARY POWER
SETBACKS
U/G PLUMBING/ WASTE
! U/G ELECTRICAL / GROUNDING
FOOTINGS / STEEL
CONCRETE SLAB
I
DO NOT POUR CO7Wk
ROOF NAIL / PRE-ROOF
I OKAY TO WRAP Al
FRAMING COMBINATION
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH MECHANICAL _
INSULATION
COVER NO WORK UNT"ABOVESIG•INTERIOR GYP. BD. DRYWALLEXTERIOR LATH
GAS TEST' =SEPTIC ABANDONMENT
SEWER CONNECTION ��
SEPTIC / GREASE INTERCEPTOR
MASONRY INSPECTIONS
FOOTINGS / STEEL
BOND BEAM
POOL/ SPA /WATER FEATURE. INSPECTIONS
PRE-GUNITE / SETBACKS
U/G PLUMBING
U/G GAS
U/G ELECTRICAL
PRE-PLASTER (ALARMS/ BARRIERS
FINAL INSPECTIONS
TEMP USE OF PERMAN=POWER.ELECTRICAL
PLUMBING
MECHANICALPUBLIC WORKS DEPACOMMUNITY DEVELOP
FINAL / JOB COMPLETED
mmrNr%X I A 1 0 nn MnT Ik1r.1 I In RICHT TO
07!12/04 16:12 CDFARIFACOSTAMESA 7607777011 N0.159 D02
X`CU— I I11Qut LC',a, r X'ICU1eCt
NotUlcaton a,f, !lite -,It to f• i���r�: �,rf=,_ .f";r��n a•r.'1*rithin Quavant-i.ned
Areas of 0mae
R.[vetside, and LOS An-geb S CauatzeS
WA Comptiemct k;rP_=eacg 595V36�0(0D 11?a�t#r
• I-L—mas CitylCmIaty
Agcocy
n
Name of CorriA�Y Rc�ucsci;ag Approve!: • � .,� .
Coo�act Person: j�,4,., �j e Iyer (7(epi• �75� //�% �� !� �� II Q D
(address. �pOx l g� Ci
TcicAonc: Fex- L
EXCEVIdon I.ocagon: 1.41 4- ZI. 5CAAIV TB`
tar &f 7
Dcslinatian Leceec•p:
4
E56rftCd 1t?.AU. of C
Q �' oil (c:e. CLb;cYErds): G.. zr C�.t__
f,t6cipttcd Detc of Movernenr. -711-314
UrgcocY Levcl for Lmmediate jttspcctioe sad Relece: (Circle One F3E• �2�e�a� ��
--- --
'.�iovcment of Soil is PC7.jwacd
D
Hold Mev'e oco.atUael �«c - • �'� W71_ I CALL AS SOON � FOSSIDL110
C�:•cked
SCL RULE NS?ECnON DATt o -ID TD,.C. ;
1)21c Trapped:
Sot! Mok•emcel is SLTictly for LIhcyc.Ii0 %clr;C Rc �-kon(S)
Ntmc of FZ,4 Pro iccI
T'±
r
5 -lock! bIFJJOJI"IdD Wdz,-:T tWZ'8 -Inn.
. I T - 9
4211 Latham Stroct, Rivcryidc, Califorrnia 9501 `
Tel. (951) 686.8760 Fax (9511686-8786
CF6R INSULATION CERTIFICATE
THIS I$ TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WIT!
THE CURRENT ENERGY REGULATION, CALIFORNIA ADMINISTRATIVE CODE, TITLE 24, ,
STATE OF CALIFORNIA, IN THE BUILDING LOCATED AT:
TRACTIPHASE: LA CIUINTA DEL ORO I PHASE 2
LOT 49
SITE ADDRESS: 78-370 TUSCANY -- LA QUINTA, CA
CEILINGS I§ PLANS 2 &4:, BLOWN INSULATION
MANUFACTURER: GREENFIBER THICKNESS: 10.3" R- VALUE: R-38'
CEILINGS M PLANS 2 & 4: BATT S
MANUFACTURER: JOHN$ MANVILLE THICKNESS: 13" R• VALUE_ R-38
CEILINGS: BLOWN INSULATION
MANUFACTURER: GREENFIBER THICKNESS: 8.1"- R- VALUE: R730
CEIL� INGS:, BATTS
MANUFACTURER; JOHNS MANVILLE THICKNESS: 1 1" R -VALUE: R-,10
EXTERIOR WALLS: BATTS
- MANUFACTURER: KNAUF THICKNESS: 3 1/2" R- VALUE: R-13
GENERAL CONTRACTOR: LENNAR HOMES
BY:
TITLE,
DATE: _
INSULATION CONTRACTOR: WESTERN INSULATION, LP.
LICENS UM R: 704464
BY;
TITLE: P]RffUtlnON MANAGER
DATE: SE EMBER 30, 2004
t
i,
De", - -
ENERGY
A o E
Se`�
P0. Box 621
Rancho Mirage, CA 92270
Email: DESNRG (a)AOL.COM
Ph/Faz (760) 564-2044
Cell: (7601,250-1852
CERTIFICATE OF FIELD VERIFICATIONAND DIAGNOSTIC TESTING (Page I of 7) CF -4R
LA QUINTA DEL ORO 09-30=04'
Project Title Date
FRED WARING & CLINTON ST, INnin CA LENNAR unMCc
Project Address Builder Name
NACHO CASTENADA 760-578-6968 PLAN 2 2 UNITS
Builder Contact Telephone Plan Number
ALAN WEAVER 760-880-5504 GROUP 1
HERS (fir Telephone Sample Group Number
-` #CCNAW183226 09-29-04 49-2 1 OF 2
Certifying Signature Date Sample Lot Number
Firm: DESERT ENERGY SERVICES LLC HERS Provider: CHEERS
city/state/Zip: RANCHO MIRAGE, CA. 92270
78 —.37 0 `i/ A ZOs c -46t"I
Street Address: P.O. BOX 621
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.
(R'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) values
Test Leakage Flow in CFM' 60
If fan flow is calculated as 400cfm/ton x number of tons enter calculated
value here 1600
If fan flow is measured enter measured value here
Leakage Percentage (100 x Test Leakage/Fan Flow) _ 3.75 ® ❑
Check Box for Pass or Fail (Pass=6% or less) Pass Fail
® THERMOSTATIC EXPANSION VALVE (TXV)
® Yes ❑ No The Expansion Valve is installed and Access is ®, ❑
provided for inspection
Millen
ENERGY S,, '- ADE C
PO. Box 621 Ph/Fax (760) 564-2044
Rancho Mirage, CA 92270_ Cell: (7601250-1852
Email: DESNRG MAOL.COM
`CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7) ' CF=4R
. • '. r
LA QUINTA DEL ORO
Project Title Date
FRED WARING & CLINTON ST, INDIO GA LENNAR HOMES
Project Address-678-6968Builder Name
NACHO CASTENADA 760PLAN 2 2 UNITS
Builder Contact Telephone Plan Number `
ALAN WEAVER 760-880-5504 GROUP 1
HERS r Telephone Sample Group Number
_ #CCNAW183226 : 09-29-04 49-2 2 OF 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, £A. 92270 -
- ' • - 78-37o J�A.•t�scq�
Copies to: Builder, HERS Provider L
HERS RATER COMPLIANCE STATEMENT
The house was: ® Tested EJApproved as part of sample testing but was not tested t
As the HERS rater providing diagnostic testing and field verification, I certify that the houses identified orf 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 v
Duct Pressurization Test Results (CFM .@ 25 Pa) values
Test Leakage Flow in CFM 45
If fan flow is calculated as 400cfm/ton x number.of tons enter calculated
value here 800
'If fan -flow is measured enter measured value here
Leakage Percentage (100 x Test Leakage/Fan Flow) = 5.625
-Check Box for'Pass or Fail (Pass=6% or less) `
Pass Fail
® THERMOSTATIC EXPANSION VALVE (TXV)
® Yes El No Thermostatic Expansion Valve is installed and Access is ® Elprovided for inspection - ,