0402-359 (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
Date - ''�l 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 bySection 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:
Carer OLD.,,R.Id;I UBLIC 1W,,j,U Policy No. C10MOD
J (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 •th'osg,prov sions.
Date: f_/ /� 61 V Applicant. ,i'I/.// ��f,�/)/`
s 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 restrictionsset 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 (hat the above information is*
° correct. I agree to comply with all City, and State jaws -relating to the building
construction, and hereby authorize representatives of,.fhis City to enter upon.;
the above- menti oned,propertfy-forr,inspection purposes
Signature (Owner/Agent) �!��'�/�r%� " I Date
BUILDING PERMIT PERMIT#
DATE VALUATIONLOT TRACT
y 8",U�u4Lj Z9 �,3
JOB SITEa. --- --� -�
ADDRESS E79: T , -
APN
M09-33 -24
OWNER
CONTRACTOR/DESIGNER/EN INEER
11KNNTA t HONES OF C4.41::iFORNTIA
1JERNAXs HOAr. S OF CAW- WAWA
78.401 : � 01IT IAA 11.1
78-4 01 C 10,311MAT'.' )1:1
f). -I lNTA CA K25'4
LA. QtW.YA CA 92253
(760)'177-0131 CAN 3434
USE OF PERMIT
n 0,014 SPA O DRIVEWAY A.PPRO.AC'H .
! RACT CO '!`RV0T!O'N I'D SF
POKCHIPATIO , 43.00 Sr
C. 1r1AA0,E/,V,ARPS74T' - 419,00 SF
H.71 AIMWD (1109r all, CONS"FRUCI €.0K
138.0 AO
PEMWIT 7 L`�:ON&JJAWY
C O Ia;`1'11,UCTIOfl1 FEE 101-000-418.000 +Otl
P A.H CHL+'C.K YFIZ 101.000-439-316; $539.13
itAECHANICAI, F ZT_? 101-000-421-000 $47,00
/ s
;t �3' .'t'fCtri.�.i?2, i1f.`.e. 101-000-42 -000 si,5.4).
P1,tTiltiiAMO FE 101-0„00.419-000 11643
SI �ACYN M07110iJ f'•O:F • 3:I!:.= 1.01 -0;10-74.1-000 V:l:la
Cid E`�C�11�C# l�fwl:. 101.000-423.000
0H%f9,, U. ",. IMPACT FBI ^�3,4Et�:fl0
•SS-."'C'i'.I'.A.l. CO3HMUCTIOX AITO PT” C'iiMIC
$4,186.13
'�'�,?TAL F +' 11 4? ]f+'P�'�v' ]0, U-914OW
APR 6 2004 r
CITY OF LA QU1,4TA
+•
.._...,__-DEPT. _
RECEIPT
DATE " �
By
DATE FI LE
INSPECT
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts—
Slab Grade
Return Air �—
Steel✓4/
_ S
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
Framing
_
_a
,
Compressor
Insulation
I ,�
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Vfith
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 APPR )VA S
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
IP84
Encapsulation
Gas Piping
-
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:
-�
1
In
HVAC INSTALLATION CERTIFICATE for Tested Duct Leakage & TXV Page 1 of 2 CF -6R
Site Address: 79-818 Viento Drive Permit Number:
Tract Number: 29323 Plan #: _ 3Y Phase: 5
Lot Number: 29 Project: Esplanade Builder: Lennar Homes
An installation certificate is required to be posted at the building site or made avalible for all appropriate inspections.
Atter completion of final inspection, a copy must be provided to the Building Department (upon request) and the building
owner at occupancy, per Section 10-103(b).
HVAC SYSTEMS:
Heating Equipment
o Iciency Duct
Equip. CEC Certifiedr Name Identicle (AFUE, etc.) Location Duct
Type and Model Name Systems (?!=CF -1R) (attic, etc.) R -value
___4.
Heating
Load
(BTU / Hr)
Heating
Capacity
(BTU / Hr)
FC US Ir 31 OJAV0661 10 AFU= attic
a is
4.
MINIMUM REQUIREMENTS FOR UCT LEAKAGE COMPLIANCE CREDIT
Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage).
r
CFA:
"
r
Indicate the maximum a owa le Duct Leakage and the calculation used:
0.7 x Floor Area x (0.06) for Climate Zone 8 through 15
0.5 x Floor Area x (0.06) for Climate Zones 1 through 7 & 16
Cooling Equipment
of Efficiency.
Equip. CEC CertifiedName Identicle . .(SEER, etc.)..
Type and Model Number , Systems (-CF -1 R)
Duct
Location
(attic, etc.)
Cooling Cooling
Dud Load Capacity
A -value '`(BTU / Hr) , (BTU / Hr)
HP USAir 5 ,.r
a is
4.
MINIMUM REQUIREMENTS FOR UCT LEAKAGE COMPLIANCE CREDIT
Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage).
r
CFA:
"
System of
Indicate the maximum a owa le Duct Leakage and the calculation used:
0.7 x Floor Area x (0.06) for Climate Zone 8 through 15
0.5 x Floor Area x (0.06) for Climate Zones 1 through 7 & 16
I, the undersigned, verity that equipme sted above is: 1) is the actual equipment installed, z) equivalent to or more 1.
efficient than that speed in the ce i e of com ian Form CF -1 R) submitted for compliance with the Energy
Efficiency Standards for residential uild� and ) q p ent that meets or exceeds the appropriate requirements for
manufactured devices (fromAp Iia icie c R ns or Part 6), where applicable.
6, 1 cb t-
Team Heating & Air
Signature, Date
Installing Subcontractor o.ame-
OR General Contractor (Co. Name) OR Owner
MINIMUM REQUIREMENTS FOR UCT LEAKAGE COMPLIANCE CREDIT
Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage).
r
CFA:
"
System of
Indicate the maximum a owa le Duct Leakage and the calculation used:
0.7 x Floor Area x (0.06) for Climate Zone 8 through 15
0.5 x Floor Area x (0.06) for Climate Zones 1 through 7 & 16
x
400 x (Cooling Capacity in Nominal Tons) x (0.06)
120 fan flow
21.7 x (Heating Capacity in Thousands of Output BTU per hour) x (0.06)
Measured Fan Flow x .06
uct Pressurization Test Results 5
87-
.100
100 x Test Leakage / Fan Flow = % Leakage
'
--Fail
Check Box for Pass or Fail (Pass = 6% or Less)
Pass x
T-24 Compliance Credit was Taken for TXV
TXV was installe
ystem of
Indicate the maximum a owa le Duct Leakage and the calculation used:
t4
0.7 x Floor Area x (0.06) for Climate Zone 8 through 15.
0.5 x Floor Area x (0.06) for Climate Zones 1 through 7 & 16
400 x (Cooling Capacity.in Nominal Tons) x (0.06)
fan flow r�
21.7 x (Heating Capacity in Thousands of Output BTU per hour) x (0.06).
Measured Fan Flow x .06
ud Pressurization Test Results
100 x Test Leakage / Fan Flow = % Leakage
Check Box for Pass or Fail (Pass = 6% or -Less)
Pass ai
QT -24 Compliance Credit was Taken for TXV
TXV was installed
PAGE 1
F2001-01 (4-02) Action Now T-24CF6-RTD&TXV macro
•G ,
HVAC INSTALLATION CERTIFICATE for Tested Duct Leakage & TXV
Page 2 of 2 CF -6R
Site Address: 79-818 Viento,Drive Permit Number:
0
Tract Number: 29323 Plan #: 3Y
Phase: 5
Lot Number: 29 Project:, Esplanade Builder;`-
Lennar Homes
System , of
Indicate the maximum allowable Duct Leakage and the calculation used:
0.7 x Floor Area x (0.06) for Climate Zone 8 through 15
0.5 x Floor Area x (0.06) for Climate Zones 1 through 7 & 16 .
400 x (Cooling Capacity in Nominal Tons) x (0.06) ."
fan flow 0
21.7 x (Heating Capacity in Thousands of Output BTU per hour) x (0.06)
Measured Fan Flow x .06
°
,
uct Pressurization Test Results
t
100 x Test Leakage / Fan Flow = %Leakage
Check Box for Pass or Fail (Pass ='6% or Less) Pass Fail
PT -24 Compliance Credit was Taken for TXV TXV was installed
system � of
y
,
Indicate the maximum allowable Duct Leakage and the calculation used: • - '
0-7 x Floor Area x (0.06) for Climate Zone 8 through 15
0.5 x Floor Area x (0.06) for Climate Zones 1 through 7 & 16 -
•
400 x (Cooling Capacity in Nominal Tons) x (0.06)
fan flow 0
'
21.7 x (Heating Capacity in Thousands of Output BTU per_hour) x (0.06)
Measured Fan Flow x .06
uct Pressurization Test Results 5
100 x Test Leakage / Fan Flow = % Leakage
Check Box for Pass or Fail (Pass = 6% or Less) Pass I Fai
T-24 Compliance Credit was Taken for TXV ; TXV was installed
ystem • � of � ,
Indicate the maximum allowable Duct Leakage and the calculation used: `
0.7 x Floor Area x (0.06) for Climate Zone 8 through 15, -
0.5.x Floor Area x (0.06) for Climate Zones 1 through 7 & 16
400 x (Cooling Capacity in Nominal Tons) x (0.06) - a
fan flow 0
21.7 x (Heating Capacity in Thousands of Output BTU per hour) x (0.06) -
Measured Fan Flow, x .06
uc
Pressurization Test Results ,
.100 x•Test Leakage /.Fan' Flow = % Leakage
Check Box for Pass or Fail (Pass = 6% or Less) Pass I Faill
�T-24 Compliance Credit was Taken for TXV TXV was installed
System E=3 of
Indicate the maximum allowable Duct Leakage and the calculation used:
0.7 x Floor Area x (0.06) for Climate Zone 8 through 15
-
0.5 x Floor Area x (0-06) for Climate Zones 1•through 7 & 16
400 x (Cooling Capacity in Nominal Tons) x (0-06)
fan flow 0
21-7 x (Heating Capacity in Thousands of Output BTU per hour) x (0.06)
Measured Fan Flow x .06
uct
Pressurization Test Results
100 x Test Leakage / Fan Flow = % Leakage -
Check Box for Pass or Fail (Pass = 6% or Less) Passl Faill
=T-24 Compliance Credit was Taken for TXV TXV was installed
I, the undersigned, verify that the above dia nostic test resufts and the work I performed associated with the test(s) is
`
'
in conformance with the requirements for pliance credit. (The builder shall provide the HERS provider a copy of the
CF -6R signed by the builder employees
rs tr rs i ng that diagnostic testing and installation meet the "'..
requirements for compliance credit.)
Team Heating & Air
esters — Signature, Da `- Installing Subcontractor (Go. Name
Performed OR General Contractor (Co. Name) OR Owner
COPY TO: Building Department
HERS.Provider (if applicable) ,
Building Owner at Occupancy * °
PAGE 2
' F2001-01 (4-02) Action Now,T-24CF6-RTD&TXV macro
LA
w-,lertifie'Ate 0 ion
f In's-ulad
r
Your Home has been insulated with CertainTeed Fiberglass Insulation products,_ hic>t are designed
fortoday's safety standaiel, and tomorrow's energy requirements. `.
CD
(Fiberglass is inorganic and therefore permanently noncombustible, so it does not have. to be treated ,
ri
urith fire-retard.•rrtt chemicals that will likely lose their elfectiveriess over time. It has not been treated
CD.
with chemicals that can corrode «siring or metal. Fiberglass will not absorb niaisture nor wi11 it
•
settle over time as may other insulation materials.
This also certifies that CertainTeed Fiber Glass insulation has been. profeasionally installed in this home '
•
to provide The followvng-thermal perfonnance:
Job Name: Tapestry n Esplanade T Tract: 29323 y lrbase: 5
Lot � Q Plan: _ 3YR Address: � 79 -,BLS �'ieato 1)r., La Quinua., Cal
Ceiling Area: R-38 Blo%-m , , " Garage Ceiling: - — Interior Walls:
.
With Liviog Above
`
Overhanga. Exterior Wails: R-13 Unfaced Batts -
F
Ceiling: Garage R'atl: Cantilevered
Ilnaccessible to Blow Floors WA, Above
Subconjr$actor.. OJInsulation o., Irl
600S. in Azusa 702 (62 01E-��p7 LiceaNe P465709
Signed
C®nchata Ortiz, Secretarj��/I'r'easure;r --or— 1? Scott Jenkins, President--or--
& . •
`Lora Merodna, (Director of Operations Officer
,
�i
R• means resistance Wheat flow. The higher the R- value, the greater the insulating power.
cr
Ask your builder for the fact sheen on. R- 'values. Keep this' ecrtifrcate hitlh your other
-
valued papers. If you ever Scu this home,' this certificate should be passed on to the buyer. '
..
Y
CERTIFICATE OF FIELD VERIFICATION AND DIA.CNUS HC TESTING (Page I of 7), CF -4R
TAPESTRY @ ESPLANADE PH 5 DATE TESTED 10-11-04
Project Title Date
79-818 VIENTO DRIVE LA QUINTA CA. 92253 L ENNIAR HOMES
-Proiect.Address Builder i\ame
T6NY PASCANITE 909-275-0204 PIAN 3V I UNIT
B Contact Telephone Pian Number
ALAN WEAVE 760-880-5504' _GROUP 1
HERS tE r Telephone Sample Group Number
#CCNAW183266 -1 Q4 LOT 29-5 1 OF 1
C ifying Signature Date Sample Lot Number
Firm: SERVICES LLC HERS Provider. CHEERS
Street Address: P.O. 130X 621 City/State/Zip: RARICi�O MIRAGE, CA. 92270
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, 1 certify that the houses identified on this form comply
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)
FXWhere 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 flow is measured enter measured value Isere
Leakage Percentage (100 x Test Leakage/Fan Flow)
Check Box for Pass or Fail (Pass=v% or less)
® THERMOSTATIC EXPANSION VALVE (TXV)
®
Yes'
❑ No Thermostatic Expansion Valve is installed and Access is
provided fir inspection
2000
®. ❑
Pass Fail
® ❑
E mER Y
CA5EC_I
�
arvices
.
t
Po: Box 621
Ph/Fax (760) 564-2044
Rancho Mirage, CA 92276
Ceil: (7601250-1852
Email: DESI\RG cr AO! .COI!'I
CERTIFICATE OF FIELD VERIFICATION AND DIA.CNUS HC TESTING (Page I of 7), CF -4R
TAPESTRY @ ESPLANADE PH 5 DATE TESTED 10-11-04
Project Title Date
79-818 VIENTO DRIVE LA QUINTA CA. 92253 L ENNIAR HOMES
-Proiect.Address Builder i\ame
T6NY PASCANITE 909-275-0204 PIAN 3V I UNIT
B Contact Telephone Pian Number
ALAN WEAVE 760-880-5504' _GROUP 1
HERS tE r Telephone Sample Group Number
#CCNAW183266 -1 Q4 LOT 29-5 1 OF 1
C ifying Signature Date Sample Lot Number
Firm: SERVICES LLC HERS Provider. CHEERS
Street Address: P.O. 130X 621 City/State/Zip: RARICi�O MIRAGE, CA. 92270
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, 1 certify that the houses identified on this form comply
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)
FXWhere 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 flow is measured enter measured value Isere
Leakage Percentage (100 x Test Leakage/Fan Flow)
Check Box for Pass or Fail (Pass=v% or less)
® THERMOSTATIC EXPANSION VALVE (TXV)
®
Yes'
❑ No Thermostatic Expansion Valve is installed and Access is
provided fir inspection
2000
®. ❑
Pass Fail
® ❑