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0401-113 (SATT)LICENSED CONTRACTOR DECLARATION y I,hareby affirm tinder penalty -6f 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#- Liic.. ��pCyylassExp. Date 690645 B�F Date' /i (•I Signature. of Contractor r=' � ' r 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). ( ) 1, 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 p1A"pE 1—,01gjDPolicy No. 23�3��b Al (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: I - IV -30- Applicant "•"'e u."", 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 fora 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. �y ,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� = Date• ,V aoafi.ri': l+ BUILDING PERMIT PERMIT# ` �+��'•-g�,,�i TRACT DATE .VALUATION , LOT 129 / C, JOB SITE ADDRESS 50-2M VIA �S'°.id% ',NIIMC APN 7Z__10.9_( ? OWNER CONTRACTOR/ DESIGNER / ENd INEER .0 110MES 1:1Z lu — unw—A 1's, r o, ' BOX 810 1425' �i,,rytsl�� 11V.ii.C'�`�I:ff �DR3NT, YyPO e�. y�� ✓�y9,g, LA QO,µ�V AA CA ?.+22 3 c 8 �u P1�>�}.�}.riv.l. Z .?1Z Ci.7 14 (602)257.1656 CD 4 41" USE OF PERMIT STA - LDT 129, .#3U„ N P2A_ PKAMIZ• DLJ.fPl4'NO-1 1NCLUD.L POOL, SPA BLOCK WALLA,. Oil DRIVEWAY AY APPROACH TRCTC; T CONSTRUCTION : 1Iol o ww PC3RCHIPATIO 314,00 SC 0ARAMICARPORT SAW OF FSTMArED COST f:31i'CONSMUMIONT 16719 Mon, COMSTRUC.`-TION FEE 101.000-4,18-000 5947,50 PLAN CH.WX FEE MECTI 6N1£WL PEP,i til �rt00a�d�1 �.00� �tU�.l1�t ELW,TRICAL FEE 1 D B -000-420-000 PLUMBING Fpm 101-000-419-01130 MOM STRONG MOTION FEE • r.20D 1011-000-2,41 -WO $1.3,90 ORADING .r'F" 101.000-423—O 0 915.01) DEVEI.OP EER 11 -11ACT r, F-2, r7,r1A).f1Q 1.17:5 ',PRE�PAU> rOES $0.00 ISMAUT 1� -tea DUEMOW $4, 01, M JAN 28 2004 CITY Ov TA imLs6NTA FINANCE P.1cF•r, RECEIPT DATE BY DATE FINALED I NSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings 3 - Ducts Slab Grade - Return Air Steel Combustion Air Roof Deck - - y S Exhaust Fans O.K. to Wrap Tj - N/ F.A.U. Framing —3 - Compressor Insulation Vents Fireplace P.L. 17Grills Fireplace T.O. z Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath - sT I- Final Zz Final -- " BLOCKWALL APPROVALS steel POOLS - SPAS Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location - Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS _ Waste Lines C Q - /6_ 7 Gas Test Electric Final Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K for Finish Plaster Sewer Lateral Pool Cover Sewer Connection +y, y Encapsulation Gas Piping _ Gas Test Appliances Final COMMENTS: 9�� .�/� a3 Final I ELECTRICAL APPROVALS I Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fb(tures Main Service Sub Panels Exterior Receptacles G. F.1. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) INSTALLATION CERTIFICATE(Page 3 of 13) `CF -6R 507 Q . WLSk.p.C+w SIte.Address Permit Number DUCT LEAKAGE AND DESIGN DIAGNOSTICS DUCTLEAKAGE REDUCTION Pressurization Test Results (CFM ® 25 PA) Test Leakage (CFM) Fan Flow If Fan Flow is Calculated as 400 cfndton x number of tons, or as 21.7 x Heating Capacity , In Thousands of Btulhr, enter calculated value here If fan flow is measured, enter measured value here Leakage Fraction = Test Leakage/(Measured or Calculated Fan Flow) Pass if leakage fraction < 0.06 Pass Fall ❑ For AEROSOL TYPE SEALANTS ONLY -The following diagnostic testing was completed; Duct Fan Pressurization at rough -in measured leakage (CFM) CHECK AFTER FINISHING WALL: ❑ Yes ❑ No 17 Pressure pan zest or House pressurization test ❑ Yes O No ❑ Visual Inspection of Duct Connections Pass Fail ' a THERMOSTATIC EXPANSION VALVE (TXvl Yes 11 No Thermostatic Expansion Valve is installed and Access is - provided for inspection Yes is a pass - ❑'DUCT DESIGN Pass Fail 1. ❑Yes 13 No ACCA Manual D Design calculations have been completed, Duct Design is on the plans.and duct installation matches plans. , 2. ❑ Yes ❑ No TXV is installed or Fan flow has been verified. If no TXV, 0 lT verified fan flow matches design from CF -IR Pass Fail Measured Fan Flow = Yes for.both 1 and 2 is a Pass , ❑ I, the undersigned, verify that the above diagnostic test results and the work I performed associated with the test(s) is in conformance with the requirements for compliance credit. [The builder shall provide the HERS provider a copy of the CF -6R signed by the builder employees or sub -contractors certifying.that diagnostic testing and installation meet the requirements for compliance credit: j ` Tests ignature, Date ,nsuiumg subcontractor (Co. Name) OR' Performed , General Contractor (Co. Name) COPY TO: Building Department HERS Provider (if applicable) Building Owner at Occupancy ' Compliance Forms Atigust20011 F A-25 1 INSTALLATION CERTIFICATE (Page 3 of 13) CF-6R .,�,i�9 56 - as5 vim,lru Pa Site Address Permit Number ' DUCT' LEAKAGE AND DESIGN DIAGNOSTICS DUCT LEAKAGE REDUCTION Pressurization Test Results (CFM @ 25 PA) Test Leakage (CFM) ' Fan Flow If Fan Flow is Calculated as 400 cfm/ton x number of tons, or as 21.7 x Heating Capacity In Thousands of Btu/hr, enter calculated value here If fan flow Is measured, enter measured value here Leakage Fraction = Test Leakage/(Measured or Calculated Fan Flow) _ p Pass if leakage fraction < 0.06 Pass Fail ❑ For AEROSOL TYPE SEALANTS ONLY -The following diagnostic testing was completed: Duct Fan Pressurization at rough-in measured leakage (CFM) - CHECK AFTER FINISHING WALL: ❑ Yes ❑ No ❑ Pressure pan test or House pressurization test ❑ Yes ❑ No ❑ Visual Inspection of Duct Connections0. o Pass Fail 0' THERMOSTATIC EXPANSION VALVE (TXV) Yes ❑ No Thermostatic Expansion Valve is installed and Access is - provided for inspection, Yes is a pass '�' • 0. ❑ DUCT DESIGN Pass Fail ACCA Manual D Design calculations have been 1. ❑ Yes ❑ No completed, Duct Design is on the plans and duct installation matches plans. a 2. ❑ Yes ❑ No TXV is installed or Fan flow has been verified. If no TXV, r ' o O' ' verified fan flow matches design from CF-IP, Pass Fail Measured Fan Flow= Yes for both I and 2 is a Pass ❑ 1, the undersigned, verify that the above diagnostic test results and the work I performed associated with the test(s) is in conformance ' with the requirements for compliance credit. [The builder shall provide the HERS provider a copy of the CF-6R signed by the builder employees or. subcontractors certifying that diagnostic testing and installation meet the requirements for compliance credit. ] ly r9 Q� Tests Signature,,Date Installing Subcontractor (Co. Name) OR Performed General Contractor (Co. Name) COPY TO: Building Department a HERS Provider (if applicable) Building Owner at Occupancy Compliance Forms Au9ust2Q01 i A-25 Comptianod Forms. August2001 A-25 i INSTALLATION CERTIFICATE 3 of 13) CF-6RTM -(Page Site Address Permit Number' , DUCT LEAKAGE AND DESIGN DIAGNOSTICS DUCT LEAKA(;E REDUCTION ' Pressurization Test Results (CFM @ 25 PA) Test Leakage (CFM)_Z5_ Fan Flow If Fan Flow is Calculated as 400 cfrrdton x number of tons, or as 21.7 x Heating Capacity In Thousands of Btu/hr, enter calculated value here If fan flow is measured, enter measured value here Leakage Fraction = Test Leakagel(Measured or Calculated Fan Flow) _ ❑ Pass if leakage fraction < 0.06 pass F8T1 0 For AEROSOL TYPE SEALANTS ONLY -The following diagnostic testing was completed: Duct Fan Pressurization at rough -in measured leakage (CFM) CHECK AFTER FINISHING WALL: 0 Yes No O Pressure pan test or House pressurization test O Yes O No O Visual Inspection of Duct Connections ❑ ❑ Pass Fail THERMOSTATIC EXPANSION VALVE (TXV) 00%s ❑ No • 'Thermostatic Expansion Valve is installed and Access is - provided for inspection Yes is a pass ❑ 0 DUCT DESIGN Pass Fail ACCA Manual D Design calculations have been L O Yes O No , completed, Duct Design ison the plans and duct installation matches plans. 2. ❑ Yes D No TXV is installed or -Fan flow has been verified. If no TXV, ❑ ❑ verified'fan flow matches design from CF -IR Pass Fail Measured Fan Flow= Yes for both 1 and 2 is a Pass ° O I, the undersigned, verify that the:above diagnostic test results and the work I performed associated with the test(s) is in conformance ' with the requirements for compliance credit [The builder shall provide the HERS -provider a copy of the CF -6R signed by the builder employees or sub -contractors certifying that diagnostic testing and installation meet the requirements for compliance credit. ] a D 'TestsSiLad,- Installing Subcontractor (Co. Name) Pdfonned General Contractor (Co. Name) COPY TO: Building Department , ' HERS Provider (if applicable) Building Owner at Occupancy s Comptianod Forms. August2001 A-25 • 1 '� .x...� h _ .. � '.f! Cil C ".l j • �� n .. _ _` �- 4 tinan Cert�f ca to of OCcti anC . o .h,� t1 � '• �. •��.... .. .. V .� - y +^i` k + ' � ' if .. - � _I 'YCp60iA7ED �� ,� .�. rn r «1!. � � - ti- i - OF, Building&�Safety'Depart e, t { r: _ „ _ r - '• . f* •' - •�y, - ,. -,q., r_ - ire +s ? C .. 5: � l4 This ,Certificate is issuedpursuantwto_the 'requiretnents�of Secti6n.109.of the California Building, Code, `certifying_ ythat, a-t``the'- time` of,-issuance;,,this�structure .vvas��'m compliance.swith the _ c. i �• provisions of -the' Building• Coale:, and-' the various, ordinances, of the City, regulating building construction. and/or =use: •'BUILDING ADDRESS: 50 -255 -VIA SIMPATICO.- f k ,,.Building rPermit No. 0401-113 Use'classification• S.F.D. {, ' = , . ,. ,. Occupancy Group: R-3x� { r ' , c - Type, of Construction V=N `f ., �h"� J ;'L"and Uk,Zone R L -�, z � -. ...•��-• _. C _•- ��,• ` ,�, `� cry • d�-.c � a'� t.. � ^,� < � a' � s dress Owner1. �PO.BOX810ung TA CA 92253 ZIP. LACity, STLA-0 By: G'SHOWALTER ' Date: 09/01/041 .. �. Building Offici A• 7 ' # POST IN A CONSPICUOUS PLACE ; 3 • 1 '� .x...� h _ .. � '.f! Cil C ".l j • �� n .. _ _`