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0307-340 (SFD)LICENSED CONTRACTOR DECLARATION IIS `t hareby 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;,,. • t (1 yy YYpy����•• /' + � F Jar/��� �/� /�/�,. ,C7 ��'S 13 ��t V"' Signature of Contractor•% -� ' OWNER -BUILDER DECLARATION Lhereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason: 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",pfoject (Sec: 7044', Business & Professionals Code). () I am exempt under Section'-, B&P.0 for this reason Date `` Signature of Owner WORKER'S COMPENSATION DECLARATION I hereby affirm under penaltyrof perjury one pf the following declarations: () I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for l y 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 S7ection 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.. (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'permitis issued, I shall not employ any person in -any manner so as to become subject to the workers' compensation laws'O`f California, 4nd°agree".that..if,l should become subject to the workers' compensation provislonS of�Section-37•_ 00 of the Labor Code, I shall forthwith comply with th* provision's. ✓` Date: 2, x Applicant,,JJ.!�' ---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. I 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 a+ d yvoid if r work is not commenced within 180 -days from date of issuancq 0'such permit, or cessation of,:work'for 180 days will subject permit to cancellatio Selo I certify that I have'read this application and state that the above int correct. I agree to comply with all City; and State lawsjelating to i construction, and hereby��a'uthonze �eo� sentatives-of this City to the above :mentioned -of oDertv:for.InsoecLon:ourooses. I Signature upon;ir Date/' -� BUILDING PERMIT: PERM T.#.. DATE VALUATION LOT µ k. m TRACT JOB SITE APN ADDRESS 80,9.15A ' . ITK A X77f, OWNER CONTRACTOR / DESIGNER / ENGINEER M 3F'?.t�Li✓?Y21!''';��.ppIl...i+!L�,C!tt�++�.g1'A9��.y4a-W �� d ip{ i��9.�}.�y^� J%A_VTF , 7 00NWgy:} mw.wC I 'h �7:"a:y5�'6�:}�. �. 105 J�V,.'�`Y � 1Y\D .,a '1424 'f aa7'01ngA` CA 9402 USE OF PERMIT i,'[� % i.xk � ,:11?l.:h�l 4,fi �?>Ax:MIl l' ,C?0�5 2dta'f.l`I.dt.".WJt7?? Z;LC'►C:'x oi�frl.f:�T.�, ' TRACT C;t7N;YITIUC1ION 1,11740,0 S 617.0:. ' M0 SIF �s�/.6.fS.l E,D i.c*r o �N U•�`tl�wdL:G4L1�6F•3 h��•pJ�� AI�f�N(?e]�.�� GOId€ M()CT1014 FEE 101-000- 48-00100 x¢1,5 PI:Ml tat XC:.K FRE, Y U9 (3Ci'Q-r93S'-'s k $;i6z1.4 ; '�i��C?�l,�l+dic:�. X17 1 Cf t �Utitl�y�� 2 •(itJfa �R6,0� PLUMBINQ ITTE 101 -000-419-000 S'i'Ai.OM MGT ON ! ISM'' ,• 12., It . 101 --D00-141 -000�l341.`➢b G -PA 1INGrES 313.0 ,C3MEL.CJPFR9A1ukCI ' PES $4j01-1.34. i{�I p ' '� •t'b�''� 1�'�'�'I' a�1v' 3�'� �1?: y�c�'�;t;• - - �S,43i.:1 R 3�! V 24 2003 1:,OF LA C UINTA �9Amr i; nr- . -RECEIPT'” �- DATE' BY' F INSPE TO �{ALED 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 OX to Wrap Z F.A.U. Framing G Compressor Insulation z 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 APPROVALS Gas Test Electric Final Waste Lines Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans J/ O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Z 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: CERTIFICATE OF FIELD VERIFICATION AND DIAG IOSTIC TESTING Project Titl // j uate 1 J - �S 75lrfr Proiect Address Builder Name Builder Cont ct I elephone / 5 3 HER Rater Tel phone Plan Number CF -4R Sample Group Number rtifying Signature Oat6 Sample House Number Firm: SC. HERS Provider: J76 -•f A,--a6/iZ5S Street Address: %Z,:(0 X"d-Fa 4 Clr'G6, _- City/State/Zip: L9 0(41ni6 C69 9�2; 3 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 co?Iy with the diagnostic tested compliance requirements as checked on this form. Q� 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 105 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) _. ✓' J Check Box for Pass or Fail (Pass=6% or less) ❑ Pass Fail THERMOSTATIC EXPANSION VALVE (TXV) or Commission approved equivalent ,RTI-Y'es ❑ No Thermostatic Expansion Valve (or Commission approved equivalent) is installed and Access is provided for inspection Yes is a pass . ❑ 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 ras D Fail N)W ❑ ❑ Pass Fail it !•9 `4 ,- Certificate of Occupancy Loo�oew7rn �.� G� OF 1Building & Safety Department This Certificate is issued pursuant to the requirements of Section 109 of the California Building Code, certifying that, at the time of issuance, this structure was in compliance with the provisions of the Building Code and the various ordinances of the City regulating building construction and/or use. BUILDING ADDRESS: 80-956 VIA PUERTA AZUL Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0307-340 Occupancy Group: R3 Type of Construction: VN Land Use Zone: RL Owner of Building: PUERTA AZUEL PARTNERS Address: 17700 SW UPPER BOONES FERRY City, ST, ZIP: PORTLAND OR 97224 By: GARY HARTMAN Date: OCT 6, 2004 Building Official 7 POST IN A CONSPICUOUS PLACE