0403-221 (SFD)l LICENSED CONTRACTOR DECLARATION
I he'reby;affirm under penalty of perjury that I am licensed under provisions of.
^°Lhapter 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 l Exp. Date
7.66241.. AB -2 / 7i3Ii4?3
,,Datew� '�� '�� Signature of Contractor�����( �r
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that l 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 z& Professionals
Code).
O . I am exempt under Section' B&P.C, for this reason
Date Signature Iof Owner
WORKER'S COMPENSATION DECLARATIONt, r,• ' .
I "hereby affirm under penalty., of perjury one of the following declarations:
() I have"and will maintain a certificate of consent to self-irisure 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:
Carrier Amr..,va(xw w.; au AC ' Policy No. WC11pJ201131
,
(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'p,ovisioris.
Date:. Applicantv//,
//%�����1
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) ,�<�rr'=fi/0`x` Date
,.r
r�
./
BUILDING PERMIT PERMIT
DATE VALUATIONLOT TRACT
11..x,8_97.60 50 3r5 3
f
JOB SITE _......�.�._y�.-.-.-
ADDRESS
APN "
OWNER
CONTRACTOR / DESIGNER / EN INEER
LYWAR �°,CAAMU I
24800USAM DRI VEsft20K)
2,41300 CHRIS 'ARRVE, 9,200
. ,
, t.RST(iR X17 3O C' S3i6 'i '
MS;fUAI VX .ICJ }, "C'A 92691 -
(94a)s98•,8500 tSVt -3434
r+
USE OF PERMIT ,
- S.1?V, !PDT M PLAN i1''l1,..1PEX ITDOES NOT i' CIAJDE H.I.00IC WALL -
F CK111,, Sig: OP, DRIVEWAY AP'.P..ROAMt
s -
TRAZY COOEIa'RUCTIOW .2,16.40.001 3F
PC.tRr WPATII3 41x OCt 0
r . " OAWWLdi, PORT 462,00 €1? .
•
cos r copy.
Y
kT9 101 -000-A. 18-000 $840,00
PLAN CHMK .FEE'i 101.000-•4.39_318 ?172.93
" MIECI MNICAL FEE 101.-0004211 -000 3,00
Z.LlCTRIC.e'S,L:F'EEI '101`000t 420-000 $13114
P.LLIMBINO FIFE 101410Cl- 41 Vi -000 1x84::00
Sk'RO140 NOTICYN PEE-PESID 101-0004A 1-p00 $1509
fRA►DMWKE 3f9'i.a()CJC1-4� ACCO $P .Of)
lDEV13WPER 114PACT AL?R•
(A"%°A.C.. C"41ATw"f, 1 C:iA T" AND Pit X aM,CY,
LESS PRE -PAM )KRUS
APR 06 2�6
CtFINANCE
DEP .
RECEIPT
DATE
By
DA7E FINALEP,
INSPECTOR
4
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Gradeetum
_
Air
Steel
Combustion Air
Roof Deck
_
i
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
-Y
Compressor
Insulation1
Ag
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
_
Final 42 1 Y,4
BLOC LL AFVPROVALS
Final
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROV A S
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
.p
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Kk.
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) _
q
I
4211 Latham $trCat, Pavrrside,1Califarnis 92541
-Tel. (951) 686.8760 Fax (9511686-8786
CF6R INSULATION CERTIFICATE
THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH
THE CURRENT ENERGIE REGULATION, CALIFORNIA ADMINISTRATIVE CODE, TITLE 24,'.
STATE OF CALIFORNIA, IN THE BUILDING LOCATED AT-
TRACT/PHASE: LA QUINTA `DEL ORO /PHASE 2
SO
SITE ADDRESS: 78-380 TUSCANY -.LA QUINTA, CA
---------------
;.CEIILIugs aPLA F�2 d��: BLOWN INSULATION,
MANUFACTURER: GREENFIBER THICKNESS: 10.3" R- VALUE: R-38
CEILINGS I- PLANS 2 & 4: BATTS
r MANUFACTURER: JOHNS MANVILLE_ THICKNESS:' 13" R- VALUE: R-38
CEILIfdCS: ? BLOWN INSULATION
MANUFACTURER: GREENFI BER THICKNESS: 8.1" R-`JAI_UE: R-;0.
CEILINGS: ti BATTS
MANUFACTURER: JOHNS MANVILLE THICKNESS: 1 V! R- VALUE: R-SO
EXTERIOR 1NALLS: t' BATTS .
MANUFACTURER: KNAUF THICKNESS: 3 112° R- VALUE: R-13'
i GENE L CONTS6PTOR LENNAR HOMES
BY:
TITLE,-
DATE:
ITLE:DATE:
INSULATIQN gQbjT 9T0R:.vESTERN INSULATION, L.P.
LICENS UMBER: 794489
BY:
' TITLE: PR .TION ANAG"ER
DATE: SENTAMBER 30, 2004
I,
ENERGY s,� `- AD E
amcas
P0Box 621 Ph/Fax (760) 564-2044
Rancho Mirage, CA 92270 Cell: (7601250-1852
Email: DESNRG (a AOL.COM
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7)
LA QUINTA DEL ORO
Project Title
FRED WARINIG R CLINTON ST, irinin CA
Project Address 76078-6968
NACHO CASTENADA
Builder Contact Telephone
ALAN WEAVER 760-880-5504
HERS Rater Telephone
#CCN4W183226 09-29-04
CF -4R
09-30=04
Date
LENNAR HOMES
Builder Name
PLAN 1-V 2 UNITS
Plan Number
GROUP 1
Sample Group Number
41111-2 1 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, CA. 92270
Copies to: Builder, HERS Provider 78- 38o \((k 'TJS c ray
HERS RATER COMPLIANCE STATEMENT
The house was: N Tested ❑ Approved as part of sample testing but was not tested
As the HERS rater providing diagnostic testing and field verification,'1 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 retums 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 FOP. 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 64
If fan flow is calculated as 400cfm/ton x number of tons enter calculated
value here 1400'
If fan flaw is measured enter measured. value here
Leakage Perentage (100 x Test Leakage/Fan Flow) = 4.571
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 El
�i
e
ENERGY
S�1 - C A D E Cr
P0. Box 621
Ph/Fax (760) 564-2044
Cell: (7601250-1852
Rancho Mirage, CA 92270
Email: DESNRG O..AOL.COM
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7)
LA QUINTA DEL ORO 09-30=04
Project Title Date
FRED WARING g_Cl INTON ST, INDIO CA II cwNwn HOMES
Project Address -Builder Name
NACHO CASTENADA 760-5786968 PLAN 1-Y 2 UNITS
Builder Contact Telephone - Plan. Number
ALAN WEAVER 760-880-5504 GROUP r 1
HERS Bater Telephone Sample Group Number
#CCNAW183226 . 09-29-04 50-2 2 OF 2
Certifying Signature Date Sample Lot Number
Firm: DESERT ENERGY SERVICES LLC HERS Provider: CHEERS
Cit /State/Zi
Street Address: P.O. BOX 621 Y P: RANCHO MIRAGE, CA. 92270
-7 � '� 0 %A A TJS GAel7eQ
Copies to: Builder, HERS Provider j
HERS RATER COMPLIANCE STATEMENT.
h 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 @ 25 Pa) values
Test Leakage Flow in CFM 51
If fan flow is calculated as 400cfm/ton x number of tons enter caluel here 1000
If fan flow is measured enter measured value here
Leakage Percentage (100 x Test Leakage/Fan Flow) = 5.1 ® ❑
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
CITY OF LA QUINTA°
BUILDING & SAFETY DEPARTMENT
CFM OF'Ct�`'� 777-7012 - ..
INSPECTION REQUEST LINE '
777-7153
Owner x FNNAR F 0AI nF CALIFORNIA
Contractor LE qN A Al
Permit Number nano 2�t
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS
78=380. V-tk TUSCANY
SFD, LOT 50 PLAN. IYA. PERMIT DOES NOT.
INCLUDE BLOCK WALL, POOL, SPA OR
TYPE OF INSPECTION DATE P.
TEMPORARY POWER n
SETBACKS '
U/G PLUMBING/•WASTE
U/G ELECTRICAL/ GROUNDING
FOOTINGS /.STEEL
CONCRETE SLAB
DO NOT POUR CONCRETE U ILA OV G
t ROOF NAIL / PRE -ROOF
OKAY TO WRAP
FRAMING COMBINATION
ROUGH ELECTRIC
ROUGH PLUMBING..
ROUGH MECHANICAL
INSULATION t
COVER NO WORK UNTIL ABOVE SIG .ED
INTERIOR GYP. BD. DRYWALL
EXTERIOR LATH `
GAS TEST C - �f
SEPTIC ABANDONMENT
SEWER CONNECTION 2.13o
SEPTIC )'GREASE INTERCEPTOR ti
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 F, ,
TEMP. USE OF PERMANENT POWER '
ELECTRICAL -
PLUMBING
MECHANICAL
PUBLIC WORKS DEPARTMENT
COMMUNITY DEVELOPMENT DEPT. r
FINAL! JOB COMPLETED
inc RIr,WT Tn