0403-222 (SFD)J 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 AB M31/03
Date /� ^T�'�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),
() 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`wi(I maintain a certificate of consent to self -insure for workers'
compensation, asjprov'ided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
1 -have and willmaintain 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 AME ICA M C.A..3UA,L Policy No. WC1302I;1151
(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 prov Bions.
Date:-'// % .,� `t / Applicant i�//I ? �� t
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,Jt'S 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) !t�f-l�i�if Date /�i •/�!�
BUILDING PERMIT PERMIT# •:
DATE VALUATION `�{pvy 7 7 q f� LOT 0403-222 TRACT
JOB SITE mow,
APN
ADDRESS %9 yrtFti a CaC �Ai
4d��4-w e7r J
OWNER
CONTRACTOR / DESIGNER / EN (NEER
Untaki c c> t r7t l
:G t FAtz LQE t+11 .
24000 CHtt. AITrAiT%It PE #200
2-4300 C'Y3x2.iDAYFEAEURIU, #200
mirlf Poll VM0 CA 92691
ia=rov `i T_T0 'CA 92691
(949)59S3"35013 C"Z'Ul, 3434
USE OF PERMIT -
sla rte:. iAMI y 3_WELIJNG
sprio 1.C3P 51 PLAN 2RB.:0ERM.t'f 0085 NOT 114CLUTt;.BLOCK WALL,
P001 31PA OR DRIVEWAY APPR ACK
TITA T CGz3d'S'P.r ld1"Io'I'd5103.0 Sig
iPOP.C1iiP.A1°10 33R1W S!r'
IQARAOVCARPORT 462.011) FIF
MMNA".i.ED COST O3, C431.0-MUCTIS. N
;1.54,'7--2 10
,CONSTRUCTION, FEE 101-000-i 18000 $032109
PLAN CRECK ME 101-000.139-1318 $17127.
1511.taC;HANICALIr"M 101.000••421.000 $60,00
_17161tCTRICAL Pit&r 101-000-420-000
PZvOM13ow vez 101.000-4.19.000 $103.23
STRONG IdlOT1014 PEE • It ID 10 1 -{7W-241 •DODO $15.47
(1RlA0INCI FEE 101-000-423-000 515100
• t
SUR °ITCYi AT. d"(fMMtCXU90111 AM Pi AN C`'"UC'K
1.,63 Pll,�. -.PNM VN+,E$S
`�I1.l1tT
07f ,i-.rkA--L T'lJF':0..1I S ME .NOW
&3"799.5f, .
f,�
CITY OF E. `
FfCJAN F nan, A
RECEIPT
tea:: -
DATE
�./ . � • � �/
,r1 �,i : _
DATEFINA ED
D _ . o �/ -
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
_ _
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
_� _
. p
F.A.U.
Framingy
_
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 057-
Final
POOLS - SPAS
BLOCKWALL
AP ROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVP
Gas Test
Electric Final
Waste Lines
✓ Fj
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
S
Appliances
Final
COMMENTS:
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) _ _ y
CITY OF LA QUINTA
BUILDING & SAFETY DEPARTMENT
OF
'777 -7012 -
INSPECTION
777-7012INSPECTION REQUEST LINE
777-7153
Owner` 'LENNAR HOMES OF CALIFORNIA
Contractor LENNAR HOMES nF C -Ar Mop T A
Permit Number 0403-222
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
"-78 390 VIA>TUSCANI'�
JOB ADDRESS cam_ -=�
SFD, LOT 51 PLAN 2RB. PERMIT DOES NOT
' INCLUDE BLOCK WALL, POOL, SPA OR
_ DRIVEWAY APP
TYPE OF INSPECTION DATE IN SP.
TEMPORARY POWER .
SETBACKS
U/G PLUMBING /WASTE
U/G ELECTRICAL/ GROUNDING
FOOTINGS / STEEL
CONCRETE SLAB
DO NOT POUR CONCRETE U IL AB VES D
ROOF NAIL / PRE -ROOF .�
'OKAY TO WRAP
FRAMING COMBINATION
ROUGH ELECTRIC
ROUGH PLUMBING i
ROUGH MECHANICAL
INSULATION 4
COVER NO WORK UNTI BO SIGN
INTERIOR GYP. BD. DRYWALL
EXTERIOR LATH
GAS TEST C'14
•, _IF
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 PERMANENT POWER
ELECTRICAL - r
PLUMBING.
MECHANICAL
PUBLIC WORKS DEPARTMENT
COMMUNITY DEVELOPMENT DEPT.
FINAL / JOB COMPLETED
AQnVCC ADDonvAI C% nn aj^r l.or.o I-
.-,.... .� �,.
WEpTzo
4211 Latham Street, Riverside, California 92501
Tel. (951) 686-5760. Fax (951) 686-8780 '
CF 6R 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 URO ! PHASE 2
LOT 51
SITE ADDRESS: 78-390 TUSCANY — LA QUINTA, CA
--------------------- --................................ ---- - --
CEILINGS M PLANS 2 & 4: BLOWN INSULATION
MANUFACTURER: GREENFI®ER THICKNESS: 10.31' R- VALUE: R-38
CEILINGS t�. F'Lo4NS 2 & 4: BATTS
MANUFACTURER: JOHNS MANVILLE THICKNESS: 13" R- VALUE: R-38
CEILINGS: BLOWN INSULATION
MANUFACTURER: GREENFISER. THICKNESS: • 8.1" 'R= VALUE: R-30
CEILINGS: BATTS
MANUFACTURER: JOHNS MANVILLE THICKNESS: 11 R- VALUE: R-SO
EXTERl4R WAlf .L$: BATTS .
MANUFACTURER: KNAUF, .-THICKNESS: 3112" R- VALUE: R-13
GENERAL CONTRACTOR: LENNAR HOME
BY.
TITLE: -
DATE:
INSULATION CONTRACTOR:-WESTERN INSOt ATI®N, L.P.
' LICENSE ER7 84 ,
BY:
TITLE: PROD ON YANAGER
DATE; SEPTEMBER 30, 2004 -
ENERGY C ABE
S wvi
P0. Box 621 Ph/Fax (760) 564-2044
Rancho Mirage, CA 92270 Cell: (7601250-1852
Email: DESNRG 0AOL.COM
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7)
CF -4R
LA QUINTA DEL ORO A9-30 D4
Date
Project Title
venin CA LENNAo_ HOMES "
FRED WARING & CLINTON ST Builder Name
Project Address
NACHO CASTENADA 760-b78-6968, PLAN 2 2 UNITS
Builder Contact Telephone Plan Number
ALAN WEAVER,760-880-5504 GROUP " 1
HERSr Telephone Sample Group Number.
#CCNAW16226 09-29-04 51-2 1 OF 2
Certifying Signature Date Sample Lot Number
Firm: DESERT ENERGY SERVICES LLC HERS Provider: .CHEERS
Cit /State/Zip: RANCHO MIRAGE, CA -92270
Street Address: P.O. BOX 621 y 78 - 34o tice�T.�sc�an�y
Copies to: Builder, HERS Provider
HERS RATER COMPLIANCE" STATEMENT "
The house was: ®Tested 0 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 83
If fan flow is calculated as 400cfm/ton x number of tons enter calculated 1600
value here
If fan flow is measured enter measured value here
Leakage Percentage (100 x Test Leakage/Fan Flow) _ 5.1875
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
ft
Deseft= =
.ENERGYS'► C A 5,E C
ENERGY
PO. Box 621 Ph/Fax (760) 564-2044
Rancho Mirage, CA 92270 Cell: (760] 250-1852,
Email: DESNRG OAOL.COM
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC°TESTING (Page I of 7)
CF -4R
LA QUINTA DEL ORO Date
Project Title LENN"o unnnFc
FRED ::'ARINC 8. GLINTON ST; INDIA CA Builder Name
Project Address 760-578-6968 PLAN 2 2 UNITS
NACHO CASTENADA
Builder Contact .
Telephone Plan Number
ALAN WEAVER 760-880-5504 GROUP 1
HERS Telephone Sample Group Number
`"
It,
"� #CCNAW183226 09-29-04 51-2 2 OF 2
Certifying Signature Date Sample Lot Number
CHEERS
Firm: DESERT ENERGY SERVICES LLC HERS Provider: ,
City/State/Zip: RANCHO MIRAGE, CA. 92270
Street Address: P.O. BOX 621 78.3yo
Copies to: Builder, HERS Provider
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, I certify that the houses identified on this form comply
with the diagnostic tested compliance requirements as checked on this form.
LL N 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 48
If fan flow is calculated as 400cfm/ton x number, of tons enter calculated
value. here 1000
If fan flow is measured enter measured value here
Leakage Percentage (100 x Test Leakage/Fan Flow) = 4.8
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
• 4 0