0306-449 (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 # Lie. Class Exp. Date
t
DateSignature of Contractor I`+� k
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.
(,) I have and will maintain workers' compensation insurance, as required by
Sei:tion 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 STA' , :''w's..D Policy No. 0.0;114, .
(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,J shall forthwith comply with those provisions: ,
Erate: ' �' Applicant.
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 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/AgeraDate ='
BUILDING PERMIT PERMIfX-4A,
449.
DATE VALUATION ?j kCDQ_tt,,! 3. 70 LOT � TRACT 2911214
JOB SITE
ADDRESS Si• 903 1%TN'MI;D i ��OT
APN 'i 75 3 0-�'.'1J
OWNER
CONTRACTOR / DESIGNER / ENGINEER
UROERA.1, B ANN
1e 4.20 Lf VA,?: id s.`.[
USE OF PERMIT
i]{ ii r V�7. sti ,2'i r'i 3� ,7 i'1K, YF.4CSv1i1 i`liiu:� ik {.>:.I ly [: a,.Ui.•/L'e f1l,.O.7, rV7.1.1My
POOL, 10R& OR Cat':1 EIh+AY AP.f'F.0A 0,H, s' 1A IiF:Jyi, CITiON TO PL Ah9
CHECK Wl; DUL'.';' MULTIPLE .1.' a'UAVCt 011 S4r9M1:', .4j.L bit! '1'TPR
Cit131"31M, 2,0(13F
PORCH" —' a Fto :ei F.ori ST
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�p LAI-4 ("HECK l�iti 'V1,71�t•'fF�: i�F39-S1P
' '{;t'-Ff.PSNICALfef.F, i.0i-000-421.000 $}16,itil
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i#W); I10 fc? +. 101-10010_t 3.,000 !r3.Eyil
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J1,}L,.1 ••l, tJl.t'�i.J L1 �11i L)l..lr�iLpi .l.��t'Y �R�,L..� F'l.+l?1�� �rA^i/{h,.l♦-
J� ��� -�I ,�i.
- Ii}'CAR_ E t?1V,'E "€'?I�.�:�� DU.�' i°iCJ�W
RECEIPT
DATE ;
BY
DATE FI D
INSPECTOR}—
INSPECTION RECORD
OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR
BUILDING APPROVALS MECHANICAL APPROVALS
Set Backs Underground Ducts
Forms & Footings Ducts
Roof Deck 23 d K I IExhaust Fans
O.K. to Wrap '' Z7 .10 V 1,6 _ F.A.U.
Insulation ` Vents
Fireplace P.L. Grills
Fireplace T.O. Fans & Controls
Party Wall Insulation Condensate Lines
Party Wall Firewall
Exterior Lath
nru"11 _ Int lath i t rJ Id
Final
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVA
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
, - v
Ati
Encapsulation
Final
COMMENTS:
Final 43
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underaround Conduit
Fixtures /
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
JON TANDY
78-194 Elenbrook Ct.
Palm Desert, CA 92211
Office (760) 772-7192
Fax (760) 772-7193
Pager (760) 776-3338
REGISTERED INSPECTOR'S WEEKLY REPORT
TYPE OF ❑ REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLY C �0--"K�
INSPECTION -3f3p, ❑ POST TENSIONED CONCRETE ❑ ASPHALT ❑ OTHER
PERFORMED ❑ REINFORCED MASONRY ❑ FIRE PROOFING
JOB LOCATI N
��~ ��
+
W
�t
REPORT SEQUENCE NO
TV OF TRUCTURE
`.0.V S
PERMIT NO.
DATE
DAV F WEEK
(
4 0-
TER AL DESCRIPTION
ARCHITECT
INS ECT R
HRS. CHARGED
ENGINE R
ASSISTAN75
HRS CHARGED
INSPECTION
DATE
GENERAL
CONTRACTOR
`
SUB
CONTRACTOR o'
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COPY SENT TO CLIENT CI
CONTINUED ON NEXT PAGE D
PAGE
OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MY
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE
NOTED I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED
PLANS. SPECIFICATIONS, AND APPLICABLE SECT5ONS OF THE
GOVERNING BUILDING LAWS
G � }
SIGN E OF REGEST ED IN/I 1 SPECTOR
11--S-Cj7-11
DjfE OF REPORT REGISTER NUMBER
474
INSTALLATION CERTIFICATE (PAGE 1 OF 8) CF-6R
Laurels pl. 3
SITE ADDRESS PERMIT NUMBER
AN INSTALLATION CERTIFICATE IS REQUIRED TO BE POSTED AT THE BUILDING SITE OR MADE AVAILABLE FOR ALL APPROPRIATE
INSPECTIONS. (THE INFORMATION PROVIDED ON THIS FORM IS REQUIRED; HOWEVER USE OF THIS FORM TO PROVIDE THE
INFORMATION IS OPTIONAL.) AFTER 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 CEC CERTIFIED MFG. #OF EFFICIENCY DUCT DUCT OR HEATING HEATING EQUIP
NAME IDENTICAL (AFAU ETC.) LOCATION PIPING LOAD CAPACITY
TYPE AND SYSTEMS CF-1R VALUES (ATTIC ETC.) (R-VALUE) (BTU/HR) (BTU/HR)
HEAT PUMP MODEL #
FAU CARRIER 58STX070112 I 80% ATTIC 4.2 87K 70K
FAU CARRIER 58STX090116 1 80°/n ATTIC 4.2 112K 90K
COOLING EQUIPMENT
EQUIP CEC CERTIFIED COMPRESSOR # OF EFFICIENCY DUCT DUCT COOLING COOLING
TYPE PKG UNIT MFG NAME AND IDENTICAL (SEER ETC.) LOCATION R VALUE LOAD CAPACITY
HEAT PUMP MODEL NUMBER SYSTEMS (CF-1R VALUE) (ATTIC) (BTU/HR) (BTU/HR)
A/C CARRIER 38HDC0303 1
A/C CARRIER 3 8HDC 1483 I
12 SEER ATTIC 4.2 30K 29.2K
12 SEER ATTIC 4.2 48K 47.7 K
I, THE UNDERSIGNED, VERIFY THAT EQUIPMENT LISTED ABOVE IS (1) IS THE ACTUAL EQUIPMENT INSTALLED (2)
EQUIVALENT TO OR MORE EFFICIENT THAN THAT SPECIFIED IN THE CERTIFICATE OF COMPLIANCE FORM (CF-IR) SUBMITTED FOR
COMPLIANCE WITH THE ENERGY EFFICIENCY STANDARDS FOR RESIDENTIAL BUILDINGS, AND (3) EQUIPMENT THAT MEETS OR
EXCEEDS THE APPROPRIATE REQUIREMENTS FOR MANUFACTURED DEVICES (FROM THE APPLIANCES EFFICIENCY REGULATIONS ON
PART 6), WHERE APPLICABLE.
T
SIGNATURE, DATE
WILLIAMS HEATING CO.
INSTALLING SUBCONTRACTOR (CO NAME)
OR GENERAL CONTRACTOR (CO NAME) OR OWNER
THERMOSTATIC EXPANSION VALVE (TX'Y)
`AYES THERMOSTATIC EXPANSION VALVE (OR COMMISSION APPROVED EQUIVALENT) IS INSTALLED AND ACCESS IS PROVIDED FOR INSPECTION.
❑ NO
YES IS A PASS PASS ->< FAIL
COPY TO: BUILDING DEPARTMENT
HERS PROVIDER (IF APPLICABLE)
BUILDING OWNER AT OCCUPANCY
Deo 16 04 11146a EnergB Calo Servioes Ino. 780•-0558 p.3
INSTALLATIOXCERTUICA TE (!'age 3. uf.13) C F-6R.
Silo Addrem
10•rutit Number
DUCT LEAKAGE AND DESIGN DIAGNOSTICS
ti1(I;i)li('1'1(>N
r;r.. vrlcal+on Test Results (CFM @ 25 PA)
I'ust l.wrkap! (CHA)
but I:Inu
It Fan Flow is Calculated n Aoo chV[on x number of tons, or or. 2 1. 7 x Hooting CoppCIty
Ift ThOugar-ft Of Atulttr, }r+tar talarulalo0 Wuo hero
If fan flow Its measured. enter measured Value here '
Leakage FraCtiW = Test Leukager(Meimured or Calculated Fan Flow) 5
Paco If loalcagc fractIOn -1- 0.06 C]
�stixi Fi;II
JACMI(VION
Nrossi,eviltron Tust Results (CFhA Ih; 25 VA)
Tust Leakapu (L'I'M)
I•un low
II FaFn Flow it. Calculatod or. 400 cfrnitcn x numbor of tons, or as 21.7 x HcotaY4 CapAcity
In Thous.+ahas of $tw/hr, antra c:Ilculakid vatuw hero
If fan flow is measured, enter measured value horn
Leakage Fraction = Test Leak.agt:!(Measwed or Calculated Fan Flow) r
Para If loakngo traction • !• 0 00 ❑
pas!; Feu
I(J For AVROSUl. '11'111,: `EAIANTS Uxl.'Y-• Tho following alogroclie tooting was comptotod:
\ Duct Fan Preasurizatlon of rougn-in measurod leakage (GFIM) '
CHECK AFTER FINISHING WALL
Yes ❑ No ❑ Prossuro pan toot or Houso proocunzotton tend
Yes ❑ No ❑ Visual Inspection of Duct Connor:tiuns �� ❑
Y ❑ No Thormostatic Expansion Valvo is mstallnd and A=.,s:a Is
provtdod for inspection
Ysr, is $1 ry:awx Foil
YC-m. ❑ No ACCA hilenuarl C Design calcul:atlons have been
cornpfotod Duct DoalpA lu on t'ru plane and duct inrt illabon
l rnatchus plans,
Z Yon ❑ No TXV it,, Inrtitllod or Fan flow ha, boon vonrlod, If no T!(V,
verdKad fan flow matchob design•. from CF-1R
Wasuraa Fan Flow =
i Yo, for moth 1 and 2 is, a Puss
con.1hd unoefslgnad, vRfrfy that thk aboVf! du4pnpaW 0 t rilMitB 6160 tarn work I per(pTned 31s3QCi3t&d with 1hg LBS[(5) +5 n
e noo with tho rogvrrar%onto for compliance.) crotllL M10 bulldOr Aill provZo tan MI;HS provraor :I rcipy w tho CF-613
s-9noo ay tno builder omploy000 or cub-conuacto(a c nrtying that dlagnoctrG tasting and Inat:aW,bgr, Mmit the ntqurromi!nt:;
for complianco Crodll.)
Tonto oIgnatuec. Dalo
Porformed
COPY TO: Sulldlnq Dopartmnnt
HERS Nrcvld+ur (d appllcablu)
Building Omer at O(xup2ncy
In tilling 4vbco0*;iotOr (Co. Name) OR _...-
General t'ontroctor (Co. Nome)
Compllanco Forms Snptumber 2.W2
� ........_w..'�r _». - A?
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Part 1) CF-4R
THE LAURELS
Project Title
q"
54963 Winged Foot, La Quinta, CA.
Project Address
Dave (909) 841-1942
Builder Contact Telephone
1-27-05
Date
First Pacifica Dev. Corp.
Builder Name
3-R
Plan Number
Tim Topham (951)_780-7265 1
HERS Rater Telephone Sample Group Number
T-1-- - Z 7 12005 12 Sys. 1 Track 29121 _
Certifying Signature Date Sample House Number
Firm: Energy Cale Services, Inc HERS Provider: CHEERS
Street Address: 16551 Mockingbird Cyn. Rd. City/State/Zip: Riverside, CA 92504-9638 _
Copies to: Builder, HERS Provider
HERS RATER COMPLIANCE STATEMENT
The house was: 0 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
comply with the diagnostic tested compliance requirements as checked on this form.
0 The installer has provided a copy of CF-6R ( Installation Certificate)
0 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 draw bands are used in
combination with cloth backed, rubber adhesive duct tape to seal leaks at duct connections.
0 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 29
If fan flow is calculated as 400cfin/ton x number of tons enter
calculated value here 1000
If fan flow is measured enter measured value here
Leakage Percentage (100 x Test Leakage/Fan Flow = 2.9%
Check Box for Pass or Fail (Pass=6% or less) 0 ❑
Pass Fail
0 THERMOSTATIC EXPANSION VALVE tTXVI or Commission aoproved equivalent _
Yes ❑ No Thermostatic Expansion Valve (or Commission approved
equivalent) is installed and Access is provided for inspection 0 ❑
Yes is a pass Pass Fail
January 5, 2001
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Part 1) CF-4R
THE LAURELS
Project Title
q03
5496fl Winged Foot, La Quinta, CA.
Project Address
Dave (909) 841-1942
Builder Contact Telephone
1-27-05
Date
First Pacifica Dev. Corp.
Builder Name
3-R
Plan Number
Tim Topham (951) 780-7265 1
HERS Rater Telephone Sample Group Number
�--+ � �—^ -'Z7 12005 12 Sys. 2 Track 29121
Certifying Signature Date Sample House Number
Firm: Energy Calc Services, Inc HERS Provider: CHEERS
Street Address: 16551 Mockinabird Cyn. Rd. City/State/Zip: Riverside. GA 92504-9638
Copies to: Builder. HERS Provider
HERS RATER COMPLIANCE STATEMENT
The house was: 0 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
comply with the diagnostic tested compliance requirements as checked on this form.
0 The installer has provided a copy of CF-6R ( Installation Certificate)
0 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 draw bands are used in
combination with cloth backed, rubber adhesive duct tape to seal leaks at duct connections.
X❑ 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 23
If fan flow is calculated as 400cfin/ton x number of tons enter
calculated value here 1600
If fan flow is measured enter measured value here
Leakage Percentage (100 x Test Leakage/Fan Flow = 1.42%
Check Box for Pass or Fail (Pass=6% or less) 0 ❑
Pass Fail
0 THERMOSTATIC EXPANSION VALVE TX or Commission aggroved a uivalent
0 Yes ❑ No Thermostatic Expansion Valve (or Commission approved
equivalent) is installed and Access is provided for inspection 0 ❑
Yes is a pass Pass Fail
January 5, 2001
uesten
RSSIDBN3"IAL
GNTRACTING
4211 Latham Street - Riverside, California 92501 • Phone: (909) 686.8760 • Fax: (909) 686-8786
License # 794484
CF6R INSULATION CERTIFICATE
THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH
THE CURRENT ENERGY REGULATION, CAUFORNIA ADMINISTRATIVE CODE, TITLE 24,
STATE OF CALIFORNIA, IN THE BUILDING LOCATED AT:
TRACT/PHASE: THE LAURELS/ PHASE 1
LOT 12
SITE ADDRESS: 54-983 WINGED FOOT LA QUINTA, CA
CEILINGS:
BATTS
MANUFACTURER:
J01INS MANVILLE
THICKNESS:
13"
I- VALUE: R-38
CEILING&
BLOWN INSULATION
MANUFACTURER:
GREENFISER
THICKNESS:
8.1"
R VALUE: R-30
CEILINQ&
BATTS
MANUFACTURER:
KNAUF
THICKNESS:
10"
R- VALUE: R 30
CEILINGS,
BATTS
MANUFACTURER:
KNAUF
THICKNESS:
6 "/"
R- VALUE: R-19
EK19919R WALL..&
BATTS
MANUFACTURER:
KNAUF
THICKNESS:
3 W
R VALUE: R-13
INTERIOR WALLS:
BATTS
MANUFACTURER:
KNAUF
THICKNESS:
3 W'
R — VALUE: R-11
RAL CONTRACTOR: THE BREHM COMPANIES
BY:
TITLE:
DATE:
WESTERN INSULATION, L.P.
BY: -11-1
TITLE: P UCTION MANAGER
DATE: JANUARY 11, 2005
01/90 39Vd N0I1d-lf1SNI NH3153M 98LB989I96 L9:80 900Z/L1/10
Certificate of Occupancy
I `G�
OFF Building & 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: 54-983 WINGED FOOT
Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0306-449
1
Occupancy Group: R3 Type of Construction: V-N Land Use Zone: RL
Owner of Building: GENERAL BANK Address: 1420 E. VALLEY BLVD
City, ST, ZIP: ALHAMBRA, CA 91801
By: GARY HARTMAN
_
a' Date: MARCH 14 2005
Building Official
POST IN A CONSPICUOUS PLACE
i