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0203-142 (BLCK)H N C/) W Ouch d r W oZr- 0� F- LUO co r` F-Wa fn Z co LO N 0 .� dQ Lo Qcc 0 0 JJ M<0 O a L0 Z co 5 r- O F1 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 Vate +�wi - Signature of Cont a tort J /9 , t` 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. 'y I have and will maintain workers' compensation insurance, as required by Seci'ion 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 EE`WTH INSURANCE Policy No. ZM,2062506 (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 orthwith comply with t ,ose•6rovisioris. Date: --�"� Applicant $ � „ - wA Warning: Failure to secure Workers' Com ensation 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 prope y fo'r, inspection purposes. Signature (Owner/Agent)%? V Date.',1 r 1 BUILDING PERMIT PERMIT# f DATE VALUATION LOT 02(M-142 TRACT " ! y �j« 4312 -0c $775100 9 lei JOB SITE ADDRESS «M751 D AMEVID IUM APN OWNER CONTRACTOR / DESIGNER / EN (NEER 1I"[ RPIN Coyflcllrplucllow Co, 'L'URPIN CONDI Vit% CIMON CO. 7E-120 CALLEF ` ADO#206 78.120 GAUXMADO #206 (760)777-7611 CI3;` i 31151 USE OF PERMIT (ANU L. $T,3Ia9.,T."11140 . SLt1-%R :e411 XTA)... PERMITTO #0005.205.61.L F, SIN tA'et,C k1q °i7+'AU, k Z^TAJ3dN0 WAL6) E'ER WON MR!) STANDARD, 6 Ff. WALI, 31,09 Lit ESI' :A'L':1 C O,'f'Fr OF C'ONS117-113 UfLON 711 t0) COITS'f!'t'C1CT1014 Pk% ' 101.000-418�000 3 C1Ty0FLA01jaKj. °� F61!,!u1r��- „3, SUB -16' AL CON MMU =011 AWD P lid C^I i�t';X $21.M 1X3,05 PR9-�PAID TW 3 MOO 'TOTAL L"ET;id IT FENS DWE NOW $21.00 RECEIPT DATE/ BY -� D FINW-ED,. INSP R V INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms 8 Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K. to Wrap F.A.U. Framing Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans 8 Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath 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 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 Sewer Lateral Pool Cover Sewer Connection 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: CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTINCF-4R //JG � Project Title Dater Project Address Builder Namb Builder Contact Tele hone Plan Number � Cc yrwa�Vl 2I I b--7aL 3 HERS Rater _ Tele hon Sample Group Number ertifying Signaturey� ate Sample House Number Firm: ��� r755� HERS Provider: Street Address: 7V City/State/Zip: Gr Q12)nr Gbg -�53 Copies to: Builder, HERS Provider HERS RATER COMPLIANCE STATEMENT The house was: JZ 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. 2 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 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 /� 3 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 Flow) =, �5;y 2, 7b Check Box for Pass or Fail (Pass=6% or less) ❑ Pass Fail THERMOSTATIC EXPANSION VALVE (TXV) or Commission approved equivalent Z -Yes ❑ No Thermostatic Expansion Valve (or Commission approved ❑ equivalent) is installed and Access is provided for inspection Yes is a pass Pass Fail ❑ MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT 1. ❑ Yes ❑ No ACCA Manual D Design requirements have been met (rater has verified that actual installation matches values in 1 nCF-1 R and design on plan. NI /{f,//2. ❑ Yes ❑ 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 Pass Fail CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING Project Title Project Address keii1 Builder Contact Telephone IL_//.,.L� .�.. `LIQ -C-77 HERS Rater S ftifying Signature j/ Date Firm: Street Address: 7`�F,7 Copies to: Builder, HERS Provider Builder dame Plan Number Sample Group Number Sample House Number HERS Provider: CF -4R City/State/Zip: 2-1a z54; 9;�-,r3 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, I certify that the houses identified on this form co m I with the diagnostic tested compliance requirements as checked on this form. 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 drawbands are used in combination with cloth backed, rubber adhesive duct tape to seal leaks at duct connections. INIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage) Measured Duct Pressurization Test Results (CFM @ 25 Pa) -96 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 l� Leakage Percentage (100 x Test Leakage/Fan Flow) _, S '7 Check Box for Pass or Fail (Pass=6% or less) ❑ Pass Fail THERMOSTATIC EXPANSION VALVE (TXV) or Commission approved equivalent Yes ❑ No Thermostatic Expansion Valve (or Commission approved equivalent) is installed and Access is provided for inspection ❑ Yes is a pass Pass Fail ❑ MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT 1. ❑ Yes ❑ No ACCA Manual D Design requirements have been met (rater has verified that actual installation matches values in CF -1 R and design on plan. 2. ❑ Yes ❑ 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 Pass Fail CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING CF -4R Project Title Project ddress Zl Builder Contact Telephone HERS Rater _ / Telephone Q7 ftifying Signature Date Firm: -(J-Z �- A-!�' Street Address: Z7i Copies to: Builder, HERS Provider d Date Builder Namdd Plan Number Sample Group Number Sample House Number HERS Provider: /���7 SS�'�I City/State/Zip: !//�A 4,Mift Gam/ 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, I certify that the houses identified on this form comply with the diagnostic tested compliance requirements as checked on this form. ❑ 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 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 here Leakage Percentage (100 x Test Leakage/Fan Flow) Check Box for Pass or Fail (Pass=6% or less) ❑ Pass Fail LgJ THERMOSTATIC EXPANSION VALVE (-TXV) or Commission approved equivalent eyes ❑ No Thermostatic Expansion Valve (or Commission approved equivalent) is installed and Access is provided for inspection' ❑ Yes is a pass Pass Fail ❑ MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT 1. ❑ Yes ❑ No ACCA Manual D Design requirements have been met (rater has verified that actual installation matches values in CF -1 R and design on plan. 2. ❑ Yes ❑ 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 Pass Fail CERTIFICATE OF FIELD CATION AND DIAGNOSTIC TESTING Project Title Date ' 751 Project Address , Builder Narnfi Builcon/t-�ct i eiepnone )NL 1i1v�D o2%% �70�J HERS Rater _ Telephone CO(ifying Signature / Bate Firm: Street Address: Copies to: Builder, HERS Provider Plan Number Sample Group Number CF -4R Sample House Number HERS Provider: '3G �-- &G� U Z City/State/Zip: 441/Pi 2AT G� % HERS RATER COMPLIANCE STATEMENT The house was: wrTested ❑ 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. 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 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) 'h� -g 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 q Leakage Percentage (100 x Test Leakage/Fan Flow) Check Box for Pass or Fail (Pass=6% or less) ❑ ❑ Pass Fail THERMOSTATIC EXPANSION VALVE (TXV) or Commission approved equivalent 9rYes ❑ No Thermostatic Expansion Valve (or Commission approved equivalent) is installed and Access is provided for inspection ❑ Yes is a pass Pass Fail ❑ MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT 1. ❑ Yes ❑ No ACCA Manual D Design requirements have been met (rater has verified that actual installation matches values in CF -1 R and design on plan. 2. ❑ Yes ❑ 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 Pass Fail ♦' CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING I Project Title' 11 J Dates �' 6m5-�, Proiect Address Builder Name BuilOr Cont tTelephone Plan Number C. d-t'ISSU� 2l;' -57,? -3 Sample Group Number C0&ying Signature / Ddte Sample House Number Firm: �C-� ���UG HERS Provider: `l iii �- 00SSUZ Street Address: �%�vb�y /3�"/2Gf��Y'C City/State/Zip: G4 y'IJ)k& Copies to: Builder, HERS Provider CF -4R 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, I certify that the houses identified on this form comply with the diagnostic tested compliance requirements as checked on this form. 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 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 I Duct Pressurization Test Results (CFM @ 25 Pa) iJ 1, �� values L7/ 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 Flow) Check Box for Pass or Fail (Pass=6% or less) JET— ❑ Pass Fail THERMOSTATIC EXPANSION VALVE (TXV) or Commission approved equivalent IYes ❑ No Thermostatic Expansion Valve (or Commission approved equivalent) is installed and Access is provided for inspection ❑ Yes is a pass Pass Fail ❑ MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT 1. ❑ Yes ❑ No ACCA Manual D Design requirements have been met (rater has verified that actual installation matches values in CF -1 R and design on plan. 2. - ❑ Yes ❑ 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 Pass Fail