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0109-024 (SFD)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 Professionals Code, and my License is in full force and effect. License # Lic. Class Exp. Date 01 Date .�.,1 Signature of Contractor--Z-� 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. (.4r 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 Z Policy No. S�'3t TE 1d ?`f1� 1 �4D6.gp (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: v s' ' Applicant �� . arn. i _.,a_... Warning: Failure to secure Workers' Compensatid 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) -� , ,�✓�.�� [ ', �' '� Datl BUILDING PERMIT PERMIT# DATE VALUATION LOT 01094Y24 TRACT JOB SITE APN ADDRESS 50 '375 VIA WXYrA DV411 5011 OWNER CONTRACTOR/DESIGNER/EN INEER 1MTOWS 1 TIC PJT x 's-kUm, we 1110 :- X ;S10 14251;, 'UMM-2,TI PRiVE, :tA f U1MA CA 922513 PROOF= J'yZ 93034 (602)25`-1-,656 x^01411 4990 USE OF PERMIT 5Itil3 � 3:.L�T 6"� �'1.,.�3T8 �k�L3dJ6. �`�RItR4T F.iO�"x 3Q�?'P 1'9iT:I.i1I�� Ii;,C;S�K WALLA 11001,LAPA OR DRIVEWAY APPRX').ACH TRACT C NTSTRUCTION 11,364-A OR izt;IltCHlP,l AIG gig. 00 SR UARAsf (CA"- ORT 70,00 SF XI.S'Y 'A I%D C001 OF W-RUMM1100 PIMMIT bw";IS'. 91INawl7 CONIMI iC` IONF' 101-W-0-41. Pv-0.00 $1,210.00 aVLA.N CHECK I'SEI 01-0W.439-318 $1,07.39 14 all-HANICAL ME 101.000.421.000 $110,00 MLF,1 C TI2lLW., FM 101-000420-000 $?A9. la PI.1,i.laABINO M 101.000.419-000 MOM STRtr 140 MOTION FER • 13PSM 101 -WO -241-000 $26,26 GR.A1atM FER 101-000-423-000 001..00 S, 3"�MLOPL,R IfARA.O'T "Y' $1997.00 ARX 04 PUBLIC PLACE6 - it;MIL 7,70 -NO -445-t' 00 $011,45 SLJ14—Tt TAY 4rQS4S i7 14F5.r ,i��©.M .►V.'i.bf .6�1.c11. Y 4Y�.ifw4SW.. Jr ,�``.A /S� IMS FRU-PAIDITT,11 $0,00 PD ° .�,I,:4".Y� :1f VnS 1`3ITC HOW SEP 0 6 2001 I CITY OF LA QUINTA1 RE EIPT FINAN UAD�RT. i/ % ! BY DATE FINALED INSPECTO P INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Forms & Footings Slab Grade (s_�� �( ice' v v G— Underground Ducts Ducts Return Air / Steel Combustion Air Roof Deck Exhaust Fans O.K. to Wrap Framing j. Z2 -UZ Insulation �/ ' r, _ G � F.A.U. Compressor Vents / �JJ( Fireplace P.L. .Fireplace T.O. _ Grills Fans & Controls Party Wall Insulation — / Condensate Lines Party Wall Firewall Exterior Lath • Z 2, G (,17^S Drywall - Int. Lath Final —3 — 7 Final I POOLS - SPAS BLOCKWALL APPROVALS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Pibg. Test Final I I Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines /6-)� Heater Final Water Piping Plumbing Top Out Shower Pans �% Plumbing Final Equipment Enclosure O.K. for Finish Plaster Sewer Lateral Sewer Connection Gas Piping ? _ 3�/�-�-� Pool Cover Encapsulation Gas Test _ Appliances Final COMMENTS: Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring /- Z Z - 3 Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G. F.I. Smoke Detectors 'Temp. Use of Power Final Utility Notice (Perm) (f 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: 50-375 VIA PUESTA DEL SOL, LOT 67, LA QUINTA, California CEILINGS: TYPE: BATTS MANUFACTURER: Certainteed Thickness: R-38 WALLS: TYPE: BATTS MANUFACTURER: Certainteed Thickness: R-21 LICENSE #(��V TITLE: 5(A` �fV.I��CIy1J�5� TS, A MASCO COMPANY LICENSE # 632072 TITLE: ADMINISTRATIVE ASSISTANT DATE: 11/13/2003 EfVERGYe- CERTIFICATE CABEC SE P.D. Box 621 Ph/Fax (760) 564 2044 Rancho Mirage. CA 92270 Cell: (760) et3:s 250- I�SZ Email: RKrown6237@aol.com r vz', OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page 1 of 7) CF -4R Projec Title / Da AvINuG J5 -v A4 QUI Poen P Project d ss NHAdwick �%(o0) ot?7S-s377 Telephone Builder Contact Tele _ P HERS Telephone '�L�1�RKto1320-1.'t. Certifying Signature Date Firm: DES�e Rl,Y �dEONI etES Street Address: �� • Bo�C G� Copies to: Builder, HERS Provider Builder Ne PLAT'S .�S E3 -e- 3 Ian Number G "tip # / - Sample Group Number 1 O—T-* 52 143 Sample House Number HERS Provider: C.ti•E-E-Q•S. City/State/Zip:IRJi4jT1 •&)2270 - HERS RA.TER�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 compip with a 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 If fan flow is calculated as 400cfm/ton x number of tons enter calculated 2000value here If fan flow is measured enter measured value here Leakage Percentage (100 x Test Leakage/Fan Flow) = 4 - SS ° o 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 Yes is a pass Pass Fail Dt - ENERGY CABEC S�"ic - P.D. Box 621 Ph/Fax (760) 564-2044 Rancho Mirage. CA 92270 Cell: (760) 885 08 2 50-1657- Email: RKrom[32370aol.com CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7) CF -411 _/�Al/rn 7 y3 Projec Title /wWae— Jv /A Qui P � J ��-70o /� �C ti/ unti, P Proje]%Q' d PA&dwick X7(00) P?7S-027- Builder Contact Telephone T Telephone #ruNRK6y13292 Certifying Signature Date Farm: 612ry :SE2Vi &E-5 HERS Provider. C•ti-�-E-Q►S. Street Address: R0 • E6y. 621 wilder Na e P LAZ 5F.3- & 3 lan Number e-" 2vi110 # Sample Group Number �-T-* 5 4 1../3 Sample House Number Copies to: Builder, HERS Provider City/State/Zip:gL'No f'i11���jG •0)J! 7-0 HERS RATEROMPLIANCE STATEMENT The house was: 90 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. 9f The installer has provided a copy of CF -611 (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 Q 25 Pa) values Test Leakage Flow in CFM If fan flow is calculated as 400cfm/ton x number of tons enter calculated 2600value here �4 If fan flow is measured enter measured value here Leakage Percentage (100 x Test Leakage/Fan Flow) = 5• Z v o ❑ Check Box for Pass or Fail (Pass% or less) Pass Fail ❑ THERMOSTATIC EXPANSION VALVE (TXV) ❑ Yes ❑ No Thermostatic Expansion Valve is installed and Access is ❑ ❑ provided for inspection Pass Fail Yes is a pass Desert == ENERGYeC A i3 E C P.o. Box 621 F%/Fax (760)564-2044 Rancho MrraQ 2 W. CA 92270 Cell: (760) BBQ Ir$SZ Email: RKrovm6237@ao1.com CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page 1 of 7) CF -411 PriDa g 5 Projec Title �v'� uC :!5, yj ll,U1 d S r l�V�ypt P S 7�'%Od . C- k f7& 0 ilder Contact HERS Telephone Telephone ##G"(o 13 tam Certifying Signature Date Firm: DESEeT �% I &Es HERS Provider: C.ti-EE-Q•S. i Street Address: P.0 Bot( (i2i Copies to: Builder. HERS Provider utlder Na' e P l..pl.� Ian Number G� 2Dli� Sample Group Number L,v* sz 3 3 Sample House Number City/State/Zip: twun tJyc lit •g227o 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 complN- 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 If fan flow is calculated as 400cfm/ton x number of tons enter calculated value here If fan now is measured enter measured value here Leakage Percentage (100 x Test Leakage/Fan Flow) = ❑ ❑ Check Box for Pass or Fail (pass --60% or less) Pass Fail ❑ THERMOSTATIC EXPANSION VALVE (TXV) ❑ Yes ❑ No Thermostatic Expansion Valve is installed and Access is ❑ provided for inspection Yes is a pass Pass Fail