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0311-057 (SFD)U) H _N C0 w O =) M t Q �n W o Z O O WWF Z ch N ON (.5 °) � Q Lo aCr 0 X W W — m U U O d M H Zt Z_ co 5 �O Q J 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 Profesr,:pnals Code, and my License4s-in`full`f6rce and effect. License # �''' Lic. Class� �495,Exp`Date Date Signature of Conlraetor,T". !J 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. ( )' 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: Cartier Policy No. ZURICH Ah.10VC-AH (This section need not be completed if the permit valuation.is.for $100.00 or less). () I certify that in the performance of thework fog which this permit is issued, I shall not employ any person in any,rm, annner. so as tooXec6me subject to the workers' compensation laws of California/ and agr$)5 that fl should become subject to th !workers' compensation proVlslons,:of�Seetion.3700,of the Labor .�._. Code; I shall forthwith comply°withthose-provisions fate: &2& Applicant Warni g: Failure to secure Workers' Co pensation 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 & eacF eFserrat whose request and for whose benefit work is performed under or ursuant to any permit issued as a result of this applicaton agrees to, & shall, Ir,demnif & hold harmless the City of La Quinta, its officers, agents and a p iyees. 1 2. Any permit issued as a result of this application becomes null d oid �f�o work is not commenced within 180 days from date of issuanc LofCuch permit, or cessation of work for _180 days will subject permit to ca cell tic CITY I certify that I have read.this application and state that the above info tmation is Fti correct. I agree to, comply with all City, and' State laws relating to the -ti 1 Ing construction, and hereby authorize rgpresen atives,,of'this City to enter upon r r � the above-mentioned property for inspectioli"pdrposes. ', Signature (Owner�Ag i) .�'' `� Date 'f BUILDING PERMIT PERMIT# DATE VALUATION LOT j_ t TRACT JOB SITE ' APN ADDRESS Art -7,454 eft 6 T'41. rA. tVTT, Y�i�-�9fJ••tn3�3 OWNER CONTRACTOR / DESIGNER / EN (NEER iduCrA tzUT, P.r n1r.r.'ns, T)Av1S itERD :'X'300 %WUPPER IJiO i@ MS MURRY 1 C917AX0.N Y' RC1AD, = 105 KXKMAND CR 9772 111W0MTM CA 92024 (760j534.2310 C l,0 420 USE OF PERMIT , 'VO3Y.T+.rk 'hTTr.. .iPE3 • WT 4 .PkuIN TAR, Pk;RAUT k OOS'NOT INCA.; D.* 81DC X:'WA;"..T<< POO 1, VA RTL D 33VYW.,-..,Y atPPRO.y.CR 3% REDU --r WN TO :'LFI V CH11 'r: FER, DUZ TO P.Rr_fLT EPLE,, "S310 -AME OF AME s Ukw TYPE: TR CI, CON;S REED`? ON 1,°,a"Am SE F'0RCiJ.PATK,', 451.00 1131,11 �,��fz� a,�r�,r���.�:���•s zs�s.a� �r 1w;9'l;3ld&TED 'C or OF (:0! iUMITMID l:''.ke bfi'r 19'1•;;x; SIMEE'NAR`(' CGHSTIRUCTION YN11 l V) -MO-41 8-000 $42.,30 PLAW CHECK r"My 101-000-439,3 19 �13i.id MVKIE^.Jtz. IC A L 'Fu 101.000»42 i • 0001 t92.54 FIX.MMAL M L t01 -000-42U-000 $115,'.47 PLU MBIW) PER, 10100()-41 0V,' Si 143.9R9 STRO ID':O'T1:' N FEE •,f1&MM, 101 0Ck,-241 0C;O $x°.31 ` C}RA1..11"'10KF 10 -000.423.0 ' Dom: L�i.i�PX"�e-. lAHrl`•.f:, 1��):: ��4GS.G0 11u' IrOrr L OCAT;?lWI rU1''IOWMIA'St�PsEIppAI5tq9ICY] EdA� K :C ,93.i.51� 1g gq� T 2t2003 OF LA QUINTA 9ANCE DEPT. RECEIPT DATE BY DATEGF�IN ED/ INSPECT R INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR L 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 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 Final BLOCKWALL APPROVALS POOLS - SPAS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPROVAL 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 Encapsulation Gas Piping Gas Test Appliances Final Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voftage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: , H N U) 04 W O co r- W r— Z f` coo 0. O H( J D W CL N Z co LO N ON U (3) CLa �QO J J nUU D i 0) ,It Z_ CS Z) �O Q J 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 DATE Professionals Code, and my License is in full force and effect. License # Lic. Class Exp. Date 813480 B HIG 10131;0' 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). ( ) 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. ( ) 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 Policy No. ZURICH AMERICAN WC298892003 (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 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 JOB SITE ADDRESS OWNER BUILDING PERMIT VALUATION $95.10' 80- 764 WA PUERTA A= LOT 0311-057 PUERTA AZUL PARTNERS, LLC 17700 SW UPPER BOONES FERRY PORTLAND' OR 97224 USE OF PERMIT FAA/IILY DWELLING APN CONTRACTOR/DESIGNER/ TRACT 30091 762-240-003 EER DAVIS REED 169 SAXONY ROAD, STE, 105 ENCINITAS CA 92024 (760)634-2350 CBL# 420 SFD - LOT 21 PLAN 2AR PERMIT DOES NOT INCLUDE BLOCK WALLS, POOL, SPA OR DRIVEWAY APPROACH, 75% REDUCTION TO PLAN CHECK FEE DUE TO MULTIPLE ISSUANCE OF SAME PLAN TYPE TRACT CONSTRUCTION 1,549.00 SF PORCH/PATIO 451.00 SF OARAGE/CARPORT 255.00 SF E.YnmATED COST OF CONSTRUCTION PER= FEE SUA4A&ARY CONSTRUCTION FEE PLAN CHECK FEE MECHANICAL FEE ELECTRICAL FEE PLUMBtN4 FEE STRONO MOTION FEE - RESID GRADINC3 FEE DEVELOPER IMPACT FEE 101-000-418-000 $621.50 101-000-439-318 $133.15 101-000-.421=000 $92.50 101-000-420-000 $115.32 101-000-419-000 $145.50 101-000-241-000 $9.51 101-000-423-000 $15.00 $2,405.00 SUB -TOTAL CONSTRUCTION AND PLAN CIIEC''K LE -33 PRE -PAID FEES TOTAL PERMIT FEES DUE NOW RECEIPT I DATE I BY I DATE FINALED INSPECTOR 95,107.00 $3,537.51 $0.00 $3,537-551 • • 0 CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING CF -4R Firm: '376 Buil�er,h1ame Plan Number -�ampie house Number HERS Provider: C HE IC S Street Address: -M', 6 ffK4,1Loy� /YL �� City/State/Zip: u �tl )r) jk Copies to: Builder, HERS Provider HERS RATER COMPLIANCE STATEMENT The house was: ❑ Tested 7Approved 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 com with the diagnostic tested compliance requirements as checked on this form. Distribution system is fully ducted (i.e., does not use building cavities as plenums or platform returns in lieu ducts) ZJ 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. �NIMUM 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 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) (THERMOSTATIC EXPANSION VALVE (TXV) or Commission approved equivalent ❑ ass Fail 'Yes ❑ No Thermostatic Expansion Valve (or Commission approved l/ equivalent) is installed and Access is provided for inspection ❑ Yes is a pass Pass Fail ❑ MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT 1. ❑ Yes ❑ No ACCA Manual D Design requirements have been met (rater has verified that actual installation matches values in CF -1 R and design on plan. �� 2. ❑ Yes ❑ No TXV is installed or Fan flow has been verified. If no TXV, verified fan flow matches design from CF -1 R. Measured Fan Flow = ❑ ❑ Yes for both 1 and 2 is a Pass Pass Fail