0106-398 (SATT)LICENSED CONTRACTOR DECLARATION
1"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
i
'13 Inc A
u Date4 Signature of Contractor
I.hereby affirm under_penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
(.) I,as ownerof the property, or my employees with wages as their sole
compensation •will do the ,work, and thestructure 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). 1. '
() 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 m6'�tain 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.
(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 SectsoR 3700 of the Labor
Code, I shallorthwith comply with those provisiogs=
Date: .%Applicants, •--'
-�..,�.,w..
Warning: Failure to secure 1N WT-9°''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.purposs .
rte,,- _
Signature (Owner/Agent)' Date
BUILDING PERMIT PERMIT#
VALUATION LOT L��7dV uuV TRACT
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JOB SITE
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ADDRESS7'9-7�SIA. Off CMAD
-7,n-Q�t.0M
OWNER
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MYNS.rRUCTIONFEE 101-000-418•000
YLIA i4 CHECK ter', 101-000-439-.318
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$3,907.10
.TOTAL IMEMW IT ,ti DUE JR0
XMA)
RECEIPT/
DATE /_ .
BY
DATE FINALED
INSPECTOR
�0
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
TINSPECTOR
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
/x_22 {> j ,�(,L(
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath /C. -LI Q
Drywall - Int. Lath
V6 • , f/( _
Final
Final
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
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
ISewer Lateral
� Sewer Connection
/ `/fZ2
Pool Cover
Encapsulation
Gas Piping
Gas Test
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"l.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
e.,. P.O.' Box 1504
J� 78=495 CALLE TAM'PICO (760)
777-7000
' SjningBrighterThanEve, LA QUIN.TA; CALIFORNIA. 92253 FAX (760)
.777-71.0;1 '
April 11, 2002
.,.RIVERSIDE`COUNTY ASSESSOR
Attn: Mapping Department
P.O. Box' 1.2004
Riverside,. CA 92502=2204
.-Dear Mr. Hargis:
Please be advised of a correction't o a`street name for the following structures.
Tle; structures formerly addressed as -79-710 79-730, 79-750, 79 7,.70�and 79-835
Via'Sin Cuidad'the construction for'which building permits #0106-407, 0106-404,
0106-402;'Q106-'398 and 0109-019 were issued, will now -have a street name of
VIA SIN CUIDADQ.
Please note this change and contact me directly at (760) 777-701.9 if 1 may be of further
assistance:
Thank you.
_ Sincerely, .
Diane Aaker
;
Building & Safety Department
_
.. u�•Y..a r
'IN
ST;
---....._ 70 X11 �N eu.roAaa
L'LATION C -ATE (Page 3.of 13) 61.CF-6R
f
:Site Address
DUCT•EAKAGE AND DESIGN DIAGNOSTICS
DUCT LEAKA(t REDUCA10N
Pressurization Test Results (CFM ® 25 PA) Test Leakage (CFM) ,
Fan -Flow
If Fan Flow Is Calculated as 400 cfmfton x number of tons, or @s 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 Leakaget(Measured or Calculated Fan Flow)
0
Pass if leakage fraction <0.06
Fall
0 For AEROS0L TYPE SEALANTS ONLY -The following diagnostic testing was completed:
Duct Fan Pressurization at rough -in measured leakage (CFM)
CHECK AFTER FINISHING WALL:
b Yes • .t7 No .. 0 Pressure pan test or House pressurization test.
0 Yes 0 No O Visual Inspection of Duct Connections .
0 0
Pass . .Fail
jaERM0 TI PAN I V
Yes 0 No Thermostatic Expansion Valve is Installed and Access is - provided for. inspection
Yes is a pass
0
p s Fail
0-DUCT0-DUCT DE TGN
ACCA Manual D Design calculations have. been
L O Yes O No completed, Duct Design is on the plans and duct Installation
matches plans., ,
2. 0 Yes 0 No TXV is installed or Fan flow has been verified. If no TXV,
0 0
Pass ' " Fall
verified fan flow matches design from CF -IR
Measured Fan Flow a �_
Yes for both 1 and 2 is a Pass
O I, the undersigped, verity that the above diagnostic test results and the work I performed associated with tlt'e test(s) is in conformance
with.ft requirements for compliance credit. [The builder shall provide the HERS provider. a copy of the. CF 41k signed by the builder
employees or sub -contractors certifying that diagnostic.testing and installation meet the requirements for -compliance credit. ]
Tests ; ate '
"�4tllingSutor (Co. Name) OR
Qeneral Contractor (Co. Name)
Performed
COPY TO: - Building Department
• HERS Provider (if applicabley
Building Owner at Occupancy
INS ALhATION CERTIFICATE (Page 3.of 13) CF -6R
.: - 6
: Sit dress Permit Number.
DUCT EAKAGE AND DESIGN DIAGNOSTICS
DUCT LEA"gZ ALQUCTIQN
Pressurization Teit Results (CFM ® 25 PA) Test Leakage (CFM)
Fan -Flow
If Fan Flow is Calculated as 400 cfmfton x number of tons, or @s 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 Leakaget(Measured or Calculated Fan Plow) a 0"
Pass if leakage fraction .<0.06 ' pass Fail
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: .
O Yes .O No .. O Pressure pan tesfor House. pressurization- test.
0 Yes 0 No .O Visual Inspection of Duct Connections o 0
Pass Fall
jK jffERM0 T PAN I V '
'i Yes 0 No Thermostatic Expansion Valve is installed and Access is - provided for. ihspection
*1EP o.
Yes is a pass Pass Fail
a -DUCT DE i
ACCA Manual D Design calculations have. been
L O Yes 0 No completed, Duct DesIgn.is on the plan's and duct installation
matches plans.,
0 0
2. 0 Yes O No TXV is installed or Fan flow has been verifled. if no TXV. Pass Fall
verified fan flow matches design from CF -IR.
Measured Fan Flow
Yes for both I and 2 is a Pass
O 1, the understgped, verity that the above diagnostic test results and the work I performed associated with.ttt'e 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 iregutrements for compliance credit. l
3 o
Tats i re; ate Installing S contractor (Co. Name) OR
General Contractor (Co. Name)
Performed
COPY TO: - Building Department
• HERS Provider (if applicable)
Building Owner at Occupancy
a ., A-25
August 2001
Coma" Forms o
-STALLATION CERTIFICATE (Pages .of 13)
CF -6R
:Site -Address Permit Number.
DUCT•AKAGE AND DESIGN DIAGNOSI`ICS
DUCTLLAKAGA RK CTION
Pressurization Test Results (CFM ® 25 PA) Test Leakage (CFM) _�3
Fan -Flow
If Fan Flow is Calculated as 400 cf n/ton x number of tons, or @s 21'J x Heating Capacity
In Thousands of•Btumr,,enter calculated value here
If fan flow is measured, enter measured value here
Leakage Fraction Test Leakaget(Measured or Calculated Fan Flow)a
0
Pass if leakage fraction <0.06 pass
Fail
0 For AEROSOL TYPE SEALANTS' ONLY-Thelollowing diagnostic testing was completed:
Duct Fan Pressurization at rough -in measured leakage (CFM)
CHECK AFTER FINISHING WALL:
O Yes '.O -Nd . l7 Pressure pan test.or House pressurization -test.
O Yes O No O Visual Inspection of Duct Connections . a
o
Pass
Fail
IHER14OSTATIC EXPANSION VALVE '(T= '
' `Yes O No Thermostatic'ExpanSion Valve is installed and Access is -provided for. inspection
„Yes,is a passPase
Fail
DUCF DESIGN
ACCA Manual D Design calculations have, been
1. 0 Yes O No, completed, Duct Design is on the plans and duct installation
matches plans.,
O
2. O Yes 0 No TXV is installed or Fan flow has been verified. If no TXV, Pass
D
Fall
verified fan now matches design from CF-IIL
Measured Fan Flow
Yes for both 1 and 2 is a Pass
O I, the undersigned, verity that the above diagnostic test results and the'work ['performed associated with.ttre test(s) is in conformance
the CF -6R signed by the builder•
with the requirements for compliance credit.'IThe builder shall provide the HERS providcr•a copy of
orsub-contractors certifying that diegnostic.testing and Ins lation meet the requiremenu forcompliance credit. ]
employes
L.Da
Installing Sulico clot (Co. Name) OR
Tests
General Contractor (Co. Name)
Performed`
COPY To: - Building Department
• HERS Provider (if applicabley
Building Owner at Occupancy
o
A-25
August 2001
Comdr Form9
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i �/fe�iv�fdfcv�iuninnuin�uiiii�isuviiaiiisva' •
INSULATION CERTIFICATE
y
_ -
ormance located at: ox
i that insulation has been in
in conn of California, in the building the current energy
% This is to certify Title 24,
reguox
lation, California Administrative Code, LOT 81,LA QUINTA,CALIFORNIA
j y 79-770 VIA SIN CUIDADO,
'r
1 % THICKNESS: R-38
CEIL� MANUFACTURER: CERTAINTEED
y
TYPE:. BATTS
THICKNESS: R-21'
WALLS: MANUFACTURER: CERTAINTEED r
TYPE: BATTS
j51
T ; RJT H S LICENSE # p6
GEN L 0 C G DAN
TITLE: Sud
B
1G PRODUCTS, A
P MASCO COMPANY LICENSE # 632072
ON SCHMID BUILDING
TITLE... ADMINISTRATIVE ASSISTANT
DATE: 11/1312003
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