SFD (0302-008)54425 Avenida Martinez
0302-008
s `• 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
5igmAture-6f•Contractorr/
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:
(J 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
S 3bon 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 aF:MPT P6li6y 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 Section 3700.of-the,Labor
Code, I shall forthwith comply with those'ro Iv sions.
ate .'rte - LrAij plicantVID
— ' ti •,
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on .his
application.
1. Each person upon whose behalf this application is made & each person at -
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposesf
,Signature (Owner/Agent l' ' !w Date _
BUILDINGrPERMIT PERMIT#
DATE' VALUATION LOT 2-C TRACT `
.s j qp @g yg,pp ry y
• . 05,3!*. d0 91110 . ••
JOB SITE
ADDRESS -42' r! aA !fKN` A A WMTP,7.4a
APN
774-253--W47._.
OWNER
CONTRACTOR / I ESgI GNyER, / E)N (NEER
w y
RA,')STD F. LU.1. la7
d I:.` AC Y, T4LJ.LVIL S
54- 4;3 s E00H I
47„750 ADAMS STREEr#Ng;
.u`+,.C4►U] 'J CA 02253
LA QLr. 1'.rA CA 92253
ziUj i6y7ff1C3"Fi° 02063
USE OF PERMIT
7% }7P 9I1 Y D IT-11AN #
-3?48Sal': SPI). Pc'F.'t 2MfT IJOk " NOY i NCf,ifDE BID=%V.P.ul, Pool, OR .
a. fth"E.' v►.Q`a E APPI+s ACH,
/
'1`RAC:i C ONSTRUC1'tO,N 3,304,001 JY
1F`C?4'..C€'i/PA'1110 •- '747.00 iF
0ARAWC ARPORT 00,00 OF
A.Si'd JVfJV..D CWD,IA 'O1, SrLdd Y1'.: U L C$n
.A 0513.W. S0
pry+y Y 6Y 1YNR ,* ,'
.0 MKA.0 J,A :.G 90XIW t R ].
CONS"`Y'FtiT :`I'JCt+101_(Y1)04)8_000 ShO14154
A'pIN .XPFEE
•PI,AN 0110K0110K_ 101 430-439 8 $Wil.t!A
,
14'91; DEPOSIT 101-000-439-318 42ftop
MECHANICAL PEP, 101-000.411-000 00.00
r
ELECTRICAL Y9.9 101-000.420-000 81'i0i62
PLIUMBLNO Y99 101.000-419.000. $222.50
STRONG t' ,,0110lq 1+E -'RUID 101«000►241-000 m2.1D..
ORADO?* PEE '101 m000-42'-000 W.011)
131:"ti'%'LOPEA IMPACT 1(x'sF.,F
PRWM1S1 Ptd 101.000-441 -345 $100.00
.Aw+ ix PUBI'le P1ACES - M. U TIG -000.4445.000 $13.0'
Lr:1:Z3 P.RF,-PP,1T3WES
425 aoo
IRERMilllr DIKES DO F NOW
u, W-1.8
MAY 16 1003 .4
CITY f— L A
REC P AIDATE'` '
NSPE Ri
ti
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
3
Exhaust Fans
O.K. to Wrap
0 _
F.A.U.
Framing
Compressor
Insulation
+Q
Vents
Fireplace P.L.
_
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
05
Final
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 APPROVALS
Gas Test
Waste Lines
• 7
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
% 63
Encapsulation
Gas Piping
Gas Test
Appliances
1
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS,
Temp. Power Pole
S Q3 c
Underground Conduit
Raugh Wiring
Low Voltage Wiring
Fixtufes
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
_
Final
Utility Notice (Perm)
Date
5/15/03
No.
24427
Owner
Randy Bills
Address
54-865 Obregon
City
La Quinta Zip 92253
Tract #
Type
Single Family Residence
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
47950 Dune Palms Road
La Quinta, CA 92253
(760) 771-8515
APN #
Jurisdiction
Permit #
Study Area
No. of Units
z o
Q BERMUDA DUNES
V) RANCHO MIRAGE
INDIAN WELLS
PALM DESERT y
f? LA GUINTA
4 INDIO
® v
774-253-027
La Quinta
0302-008
1
Lot # No. Street S.F. Lot # No. Street S.F.
Unit 1 9/10 54425 Avenida Martinez 3348 Unit 6
Unit 2 Unit 7
Unit 3 Unit 8
Unit 4 Unit 9
Unit 5 Unit 10
Comments
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions under
500 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile
homes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to
Education Code Section 17620 and Government Code 65995 Et Seq.
in the amount of $2.14 X 3,348 S.F. or $7,164.72 have been paid for the property listed above and that
building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued.
Fees Paid By CC/Provident - Sharon Bills Check No. 95952
Name on the check Telephone 760/880-3446
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Sharon MCGi`vrey $7,164.72 $0.00
Payment Recd Over/Under
b " —
Signature f
NOTICE: Pursuant to Government Code Section 66020(d)(1), this will serve to notify you that the 90 -day approval period in which you may protest the fees or
other payment identified above will begin to run from the date on which the building or installation permit for this project is issued, or from the date on which
those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting
THE ESCROW CONNECTION
1111 East Tahquitz Canyon Way, Suite 107
? palm Springs, California 92262=6789
Phone: (760) 327-8566
Fax: (760) 327-1812
LOAN ESCROW INSTRUCTIONS
TO: The Escrow Connection Date: April 16, 2003
Escrow omcer: LEANNE ZJAZIER
Escrow Numtxr: 29995 -LZ
The undersigned Borrower(s) is obtaining a .oan on the property hereinafter described and will cause Lender to hand you the
proceeds of a new First Trust Deed in the ar]ount of $360,000.00, less Lender's normal costs and charges, which you are
authorized to use on or before May 1, 2003, providing upon recordation of the securing Deed of Trust, you obtain an ALTA
Lender's Policy of title insurance, per Lend(r's requirements covering real property in the County of RIVERSIDE, State of
California, as follows:
LOTS 9 AND 10, BLOCK 300, UNIT NO 27, SANTA CARMELITA AT VALE LA QUINTA, COUNTY OF
RIVERSIDE, STATE OF CALIFORNIA, AS PER MAP RECORDED IN BOOK 19, PAGE 82, INCLUSIVE OF MAPS,
IN THE OFFICE OF THE COUNTY RE(:ORDER OF SAID COUNTY.
COMMONLY KNOWN AS: VAC -.UW 774-253-027, LA QUINTA, CA
The title policy is to show the tit a to the pro .crty to be vested in:
RANDY C. BILLS and SHARON S. BILLS, HUSBAND AND WIFE AS JOINT TENANTS
The policy is to be free of encumbrances except as follows:
(1) Any General and Special Taxes and Special District Levies not due or delinquent; this will include the lien of supplemental
taxes, if any, assessed pursuant to Chapu:r 498, 1983 Statutes of the State of California.
(2) All Taxes, Bonds and Assessments levier or assessed subsequent to the date of these instructions.
(3) Covenants, conditions, reservations (incl ]ding exceptions of oil, gas, minerals, hydrocarbons, and/or lease without right
of surface entry), restrictions, rights of u ay, and easements for public utilities, districts, water companies, alleys, and
streets.
(4) First Trust Decd to file, securing a note in the principal amount of $360,000.00 in favor of PROVIDENT SAVINGS
BANK at the best prevailing rate and tet ms per lenders instructions to be deposited into escrow.
Escrow Holder is instructed to draw and reco.'d concurrently with other documents through this escrow, a quitclaim Deed
executed by Legacy Home California, LLC, is favor of Randy C. Bills and Sharon S. Bills, covering subject property.
CONDITION OF TITLE: Escrow Holder i:: authorized and instructed to pay any encumbrance necessary to place title in the
condition called for herein and Borrower will hand you any instruments and/or funds as required for such purpose.
OBTAIN DEMAND: Escrow holder is hereby authorized and instructed to obtain demand from lender(s) of record and to pay
for same from Borrower's proceeds at the elate of escrow, including prepayment penalties, interest and such other costs, if
applicable.
FIRE INSURANCE: Secure for Lender an e tdorsement on existing insurance policy naming lender as First Trust Deed
Holder and providing for replacement cost guarantee, as required by Lender. Charge account of Borrower at close of escrow
and pay premiums as may be required for sam., per billing to be deposited herein prior to close of escrow.
CLOSING COSTS/CHARGES: Pay escrow charges and proper recording fees, also charges for evidence of title called for
above (whether or not this escrow is consummated) and you are authorized to pay off any bonds, assessments and/or taxes, also
any encumbrances of record, plus accrued interest, charges and bonus, if any, to show title as called for above and/or necessary
to comply with same. Instruct the title company to begin search of title at once.
ADVANCE RELEASE OF DEMAND FEE,,: In the event the Existing Lienholder(s) requires payment to demand statement
fees in advance of issuing their demand statem mt, Borrower shall deposit sufficient funds as called for by Escrow Holder for
Payment of same and authorizes Escrow Holder to release said funds' to Existing Lienholder(s) prior to close of escrow.
Borrower acknowledges and agrees that said finds are NON-REFUNDABLE in the event this escrow is not consummated.
EACH PARTY TO THIS ESCROW HAS RECEIVED A COPY OF THESE INSTRUCTIONS AND HAS READ THE
ADDITIONAL ESCROW CONDITIONS, GENERAL PROVISIONS AND INSTRUCTIONS ATTACHED HERETO
AS IF SAME APPEARED OVER THEIR Si:GNATURE5.
RANDY C. BILLS SHARON S. BILLS
Additional InsWictions Attached Hereto And Made A Part Hereof
By initialling below, UWe agree that !AVe have read, understand and acbtowlead the t o fined herein.
Borrower Initials: (('nollts• Y v Orl iflai.
COPY of ihE st:
IO 'd Iti£0 18L 606 'ON XdJ d3a ISNOO-XNVO INH4IAOHd Wd 901(0 nHi coon-SI-aw
The Escrow Connection Date: April 16, 2003
Escrow No.: 29995 -LZ
ADDITIONAL ESCROW INSTRUCTIONS
CLOSE OF ESCROW: The close of escrow shall be tie day documents deposited in this escrow are recorded pursuant to these instructions.
EXTENSION OF TIME FOR CLOSING: If the conditions of this escrow have not been compiled with at the time provided for in these instructions, you ire
nevertheless to complete this escrow as soon as the co: ididorus (except as to time) have been complied with, unless a written demand for the return of money
and/or instruments by a parry to this escrow Is receive I by you prior to the recording of any instrument provided for In these instructions.
NECESSITY FOR WRITTEN INSTRUCTIONS: No notice, demand or change or instructions shall be of any effect unless given to you in writing and
approved in writing by all parties affected by sauce.
DEPOSITS AND DISBURSEMENTS: All fitnda deli••cmd to you by the parties to this escrow shall be deposited in any non-interest hearing account
designated as a "Trust Account' with any bank or dept islory authorized by the Federal or State Government and may be transferred to, and co -mingled
with, other such trust accounts. You shall not be oblig ated to identify or to guarantee the signature of any payee on said checks.
SUB-FkROW AGENTS• As you deem reasonably n:ccssary to the closing of this escrow, you may deposit any funds or documents received by you
herein, with any bank; title imuraoce company, savingi and loan association, trust company, industrial loan company, credit union, admitted insurer or
licensed escrow agent and any such deposit shall be de :rued in accordance herewith. In this regard, you are authorized to utilize the services of one or more
sub -escrow agents as defined under the California Fina icfai Code and/or documents prior to close of escrow, if reasonable necessary in your discretion.
ADJUSTMENTS AND PRORATIONS• All adjusti mitts shall be made upon the basis of a thirty day month, including, but not necessarily !hailed to the
following: A. Taxes for the current year, based on out amounts disclosed on last available tax bill; B. Premiums on fire insurance pnticics as handed you; C.
Interest on loans of record, based on stammcnt from ti: lender.
RECORDING AND TRANSFER FEES: To facilitate he recording of any documents delivered into or through this escrow, you may pay all required fees;
all of the costs of which shall be deemed to constitute a t authorized expenditure to be paid or charged to the party responsible therefore.
EFFECT OF CONFLICT: If, before or after recoriinl; documents, you receive or become aware of any conflicting demands or claims (hereinafter
"conflicts") with respect to this escrow, the rights or obligations of any of the partes or any money or property deposited or affected, you shall have the right
to discontinue further performance on your part until th. conflict is resolved to your satisfaction. In addition, you shat have the right to commence or defend
any action or proceeding you deem necessary for the dt termination of the conflict. A conflict shall be deemed to include, but is not necessarily limited to,
your receipt of uniletcral instructions or instructions fro" some, but not all of the escrow. In the event of a conflict, you shall not be liable to take any action
of any kind, but may withhold all moneys, securities, d rumens or other things deposited into escrow, until such conflict has been determined by agreement
of the parties or by legal process.
In the event any action is commenced to determine a cc illict or otherwise to enforce or declare the provisions of these instructions or to rescind them,
including, but not limited to, a suit in inter pleader (wh _the/ or not the action is prosecuted to final judgment, voluntarily dismissed or settled, and
irrespective of whether you ere the prevailing party in a iy such action) and it becomes necessary or desirable for you to obtain legal advice with respect to a
conflict or on account of any matter or thing arising out of or in any way related to these instructions, whether or not suit is actually commenced, the parties
to Itis escrow jointly and severally agree to pay all of y or costs, damages, judgements and expenses, including attorney's fees, incurred by you in
connection with the same.
PAYMENT OF FEES AND CHARGES: It is understo hd that the fees agreed to be paid for your services are for ordinary and ustial services only, and
should there be any extraordinary or unusual services ttodered by you, the undersigned agree to pay reasonable compensation to you for such extraordivary
or unusual services, together with any costs and cxpenst s which may he incurred by you In connection with same. Upon the close of escrow, you may
retain, on your own behalf, your charges, costs and fee; and charge the same in your accounting against the person responsible therefore.
IT IS UNDERSTOOD THAT, IN THE EVENT THIS IiSCROW IS CANCELLED OR TERMINATED, YOU WILL RECEIVE COMPENSATION FOR
SUCH SERVICES AS YOU HAVE RENDERED IN C)NNECTION WITH THIS ESCROW.
LIMITATIONS ON DUTIES AND LIABILITIES, YO J SHALL NOT, IN ANY MANNER OR UNDER ANY THEORY OF LAW OR EQUITY, HAVE
ANY RESPONSIBILITY OR LIABILITY FOR ANY OR ALL OF THE FOLLOWING ACTS, EVENTS KNOWLEDGE OR CIRCUMSTANCES:
1. Determining the sufficiency, genuineness or validity A any document, instrument or writing deposited with you herein or the form of content, or the
identity or authority of the persons executing or depo: iting any of the same;
I. Ascertaining the terms, covenants or conditions of airy document. instrument or writing deposited with you, or to Investigate or examine the
circunstarces under which it was executed and/or delivered to you;
3. The failure to notify any person, including but not lirhited to the parries hereto, of any sale, resale, loan, exchange or other transaction involving the
property or rights that are the subject hereof or inelde, htal'thercto, or any profit or advantage to any person, firm or corporation, inpluding by not limited
to any broker or agent of any parry hereto, regardless of the fact that such other transaction(s) may be directly or Indirectly handled by you in
connection with the within escrow or any other escros ,, or come to your knowledge, In any form whatsoever;
4. The payment, examination as m amount, propriety, or validity of any in, including but not limited to personal property, corporate, business or license tax
or any description, assessed against, chargeable or pa: able by either of the parties hereto;
5. Your failure or refusal to comply with any amendmer is. supplements and/or notations hereof or hereto which are not signtd by all parties hereto and
actually delivered to you;
6. Your failure or refusal to terminate at cancel the with n escrow, without full and complete compliance, to your satisfaction, with the provisions of
paragraph "Necersiry for Written Instructions" herein;
7. For any liability predicted upon any relationship othet than that of an escrow holder, it being specifically irrevocably and conclusively understood,
agreed and deemed no other legal relationship Is hetet y created or shall be implied, assumed or come into being;
8. For failure of any party to this escrow to comply with any of the provisions of any agreement, contract, or other instrument rded or referred to in these
instructions:
9. Any duties beyond that of an escrow holder, which at: expressly limited to the safekeeping of money, instruments or other documents received by escrow
holder mid for the disposition of them In accordance with the written instructions accepted by you.
Additional Instr uctions Attached hereto And Made A Part Hereof
By initialling below, 1/We agree that 1/We have read, understand and acknowledge the text contained herein.
Borrower Initials:
M 'd Ib£0 I8L 606 'ON Xd.d d30 ISNO0108 INHIAONd Wd 90:£0 f1H,L EM-SI-AVW
fl.
The Escrow Connection Date: April 16, 2003
Escrow No.: 29995 -LZ
l 5''Your knowledge of [natters affecting the property which is the subject hereof shall not, and does not, create any liability or duty in addition to the
responsibility of escrow holder under these instruct ons:
11, You shall not be obligated to make any physical examination of any real or personal property describe in any document deposited Into this escrow, and
the parties agree that you have not made, and will not maki, any representations whatsoever regarding said property:
12. You shall not be concerned with, nor responsible ()r, the giving of any disclosures required by Federal or State law, including but not limited to, any
disclosures required under Regulation Z, pursuant in the Federal Consumer Credit Protection Act, the effect of any zoning laws, ordinances or
regulations affecting any other property described I h thls escrow. The undersigned jointly and severally agree to Indemnify and hold you harmless by
reason of any misrepresentation of omission by cith:r parry or their respective agents, or the failure of the parties to this escrow to comply with the rules
and/or regulations of any governmental agency, stare, federal, county, municipal or otherwise. Partiea to this escrow have satisfied themselves outside of
escrow that this transactor is not in violation of tht Subdivision Map Act or any other law relating to land division. and you are relieved of all
responsibility and/or liability in connection with sat hc, and are not to be concerned with the enforcement of said laws;
13. Any loss that may occur by reasons of (i) forgeries or false representations; (i) the exercise of your discretion in any particular manner, (iii) for any act,
duty requirement or obligation not expressly requb ed of you hereunder or specifically sate herein; or, (iv) for any reason whatsoever except your gross
neglect or w7lful misconduct.
AUTHORITY OF BUSINESS ENTITY: As to any copomtion, partnership or other entity which may be a parry hereto, it shall be conclusively presumed
that any document executed by an officer or general pa mer of such entity was made upon due, full, legal and complete authority of the goveming body of
such entity, and you shall have no responsibility to lmdt pendently investigate or verify such authority.
AUTHORITY TO RELEASE INFORMATION. You ,.re authorized and instructed to furnish information from this escrow to tender and/or brokers as may
be requested by them, including, but not limited to wp;cs of all instructions and closing satcment(s) in this escrow. You arc authorized to accept funds
deposited to a parry's account by such party's broker at agent without ftiithcr authorization.
SUCCESSORS AND ASSIGNS: The provisions herco. shall bind each party hereto and his respective heirs, administrators, executors, assigns, trustees,
guardians, conservators, receivers and successors in int:resL
DESTRUCTION OF DOCUMENTS: You ate authori:cd to destroy or otherwise dispose of any or all documents, instruments or writings received by you
herein and accounting or disbursement records perainit g hereto at the expiration of five (5) years from and after the initial date hereof, regardless of any
subsequent notations thereto or the date of close of escr hw, without liability or further notice to any parries herein.
EXECUTION IN COUNTERPARTS: These instructio is may be executed in counterparts, each sball be deemed an original regardless of the date executed
and delivered, and said counterparts shall constitute one and the same instrument. When necessary to the context hcrmf or the contents thereof, the singular
shalt include the plural, or vice -versa, and the gender u: cd shall include the We and proper gendl r -
EFFECT OF EXECUTION: The signatures of the and :rsigned hereon and on any dommcm(s) and instrument(s) pertaining to this escrow Indicates their
unconditional acceptance of the same and constitutes ac. mowledgment of their receipt of s copy of the same.
ESCROW COMPANIES ARE NOT AUTHORIZED r0 GWE LEGAL ADVICE, W YOU bESIRE LEGAL ADVICE, CONSULT YOUR
ATTORNEY BEFORE SIGNING.
EACH PARTY TO THIS ESCROW HAS 1ECEIVED A COPY OF THESE INSTRUCTIONS AND &1,S READ THE
ADDITIONAL ESCROW CONDTMONS, GENERAL PROVISIONS AND INSTRUCTIONS ATTACHED HERETO
AS IF SAME APPEARED OVER THEIR •31GNATURES.
RANDY C. BILLS SHARON S. BILLS
- END OFINSTRUCTIONS --
£0 'd Ib£0 I8L 606 'ON XdJ d30 ISNOO-XNVO INH4IA08d Wd LOU AHI £OOZ-SI-AdW
NOV-17-2003 07:09 AM
k
CERTIFICATE OF
P.02
CF -4R
Plan Number m
Sample Group Number
`-cua -
ffiifying Signature D e Sample House Number
Firm: , e. HERS Provider; G,vc/75S G/u7 S
StreetAdtlresS z I':s OY .lv` (q Clty/State/Zlp; ZN ulei
Copes to: Builder, HERS Provider
HERS RATER COMPLIANCE ST TEMENT
The house was; 2f Tested ❑ Approved as part of sample testing, but was not tested
As the HERS rater providing diegnostic testing and field verification, I certify that the houses identified on this form
coFly with the diagnostic tested compliance requirements as checked on this form,
Distribution system is fully ducted (La., does not use building cavities as plenums or platform returns ,n lieu
f ducts)
LVJ 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 a 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 here
Leakage Percentage (100 x Test Leakage/Fan Flaw) _
Check Box for Pass or Fall (Pass=6% or less) ❑
Kas Fail
4THERMOSTATIG EXPANSION VALVE (TXV) or Commission approved equivalent —
' Yes 13No Thermostatic Expansion Valve (or Commission approved
equivalent) is Installed and Access is provided for inspection Q
Yes is a pass pass F,9,1I
❑ MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT
1 0 Yes 0 No ACCA Manual D Design requirements have been met
(rater has verified that`actual lnstallation'matches values in
CF- 1R and design on plat).
2 Q Yes 0 No TXV is Installed or Fan flow has been verified. If no TXV,
verified fan flow matches design from CF -1 R.
Measured Fan Flow =
Yes for both 1 and 2 is a Pass
C C -
Pass Fal
\I WSIadden Engineering. 5 (4) 18 (00
6782 Stanton Ave., Suite A, Buena Park, CA 90621 (714) 523 - Fax (714) 523 -1369
39-725 Garard Ln., Suite G, Palm Desert, CA 92211 (760) 772-3893 Fax (760) 772-3895
Date
.Job No.
FIELD MEMO
Project Narr-e Client,
Site Address
Job Phone
Work Done
.rgxat caimmi%ru / Fetntinn-q In-qnprted
'res,Dry
Location
Elev.
Moist
% Relole
Ret. Max
Moist
CA,
Ida
Density
%
GO action
Oct
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429,
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Comments
Super. or Agont
Tech.
24 hour notice requested to schedule Field Technician. Thank you for the opportunity to be Of service.
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Skadden Engineering
6
6782 Stanton Ave., Suite A, Buena Park, CA 921 (714) 523-0952 Fax (714) 523-1369..
39-725 Garand Ln., Suite G, Palm Desert, CA 0 92211 (760) 772-3893 Fax (760) 772-3896
Date
Job No.
'
-.,FIELD MEMO
M Client:
Project Name
Site Address ...
./4.
Work Done
e:5
Test Summary / Footings Inspected
Test Location
No.
Comments
Dry
Moist
% Relative
Ref. Max Moist
.
Elev. Density
%
Compaction
Pcf %
Super. or. Agent
,.,f:(ield Tec
24 hour notice requested to schedule Field Technician. Thankyou for the oppoftunity""
to be of service.
Certificate of Occupancy
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: 54-425 AVENIDA MARTINEZ
Use classification: SFD Building Permit No.: 0302-008
Occupancy Group: R3 Type of Construction: VN Land Use Zone: RC
Owner of Building: RANDY BILLS Address: 54-865 AVENIDA OBREGON
City, ST, ZIP: LA QUINTA CA 92253
`. By: KIRK KIRKLAND
Date: 11-19-03
Building Official
POST IN A CONSPICUOUS PLACE