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0208-144 (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 i8a50�a X31 � � �,3f0?, ,bate � Signature of Contractor/,✓r 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 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 i�t�hi ? 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 Section 3700 of the Labor Code, I shall forthwith comply with tFiose,provision 'Date:'"• r"�«.�,: :�. APPlicant.^,�r.;rrt'r�.:�,^rl,,:<•'.i ' �..- 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 pef!son at whose request and for whose benefit work is performed under or pursuanlito any permit issued as a result of this applicaton agrees to, & shall, inde & hold harmless the City of La Quinta, its officers, agents and emplo 2. Any permit issued as a result of this application becomes null and work is not commenced within 180 days from date of issuance of c permit, or cessation of work for 180 days will subject permit to cance a to . I certify that I have read this application and state that the above inform tion correct. I agree to comply with all City, and State laws relating to the gilding C1 construction, and hereby authorize representatives of this City to enter up the above-mentioned property for inspection purposes. Signature (Owner/Agent 20 Date`- L2i�4-1 BUILDING PERMIT PERMIT# y�_144 DATE VALUATION LOT TRACT 7.x€1 ;�`5�14'7.1. 71 JOB SITE ADDRESS'i C it JAMOM }� ���� APN w 76.1-86 _00.91 OWNER CONTRACTOR/DESIGNER/EN INFER "vtlr;tl'`.KCim'DA1�'.1` , Ra I, ILC 1GA UI3. L A CONS` RUCTION 1IC 51.1 til S©'VIRERN 1f"3 PO I3l7X 366 1A Q NI i A CA, 92253 1'.A QTWIT-°A CA, 92253 (7£(1)i&"- 48832 CBLO, 3237 USE OF PERMIT MGM r'iMMY 1J'` .t.,1; R40 SFD , 1,0 55 PLAN 39. HERMIT EDGES NO.r.' INCLUDE BLOCK' VirALL4 P0`ka f1rP : Oft DRNtINAN APPROACH. 75% PLAN CI-T.eCY FEE S�i�UC�'SCai"3 itiCt �;'Ti3 ISaIxAl�lru�'fir'' SJ�t� I�1:.�hi5 Ti'Pii: CUSTOM C0148TRUCT1014 4,6-5% DO OF Fit' ACHI A; IO 99.00 :Yip (4AR.°a00CAIt.PORT 9.1 L D g.F tff'#'rZQrCO.V 01" COINS .8�4.fC':i::1ON 407 059,10 :FEIRM11 #1W uS+�l'ih�i.0:RY CO 1,111YRUCTIOIwI V21 101.000-418.000 S1, 7li:S� PLAN CHECY' .Fggl�P�ZY7 110011-00o0-43-91318 fY�{ Lil.iaisnA�b''ny[e(JA`�/.+r`i.U[�617y:. te'i.iV"^i.d.1"b�V0 ZIAEC'3't�1f�.t1t 1'h.'Il1 A�Iffi'{607ti^�i2F./ LJIJV � y aYbJ.t7s Pi:0Idj.9rN0'I?11; 101.00041 9-000 V33X S RONO MOTIM- Fes, • R,S1t) 101-000-2,41.000 $40:71 O!tADINO F I'. 101-000.423,000 fl.5100 s.0v DSIV;I,OPXA 1V5P.A.Gr FJM baa e*05.00 ART 1`N PUBLIC PLACES - I FSK 270>000.445.000 *317.6s �17�3••�`�'�.Al.. C`.�^�,1'�'�'�`t�:fJ'4a°?F�C:t'�':P�k1.a ;��1'..,�1i� u1:'�.�s�'°� �'."a��,"� 1.",3 U,'� S P..P Eg­ P.P0.D :FtE33 X0.00 TC3:�'.A:C,FKk?bm!1`FY11v IJUL'' HOW -5,Is* 71 5 �3 ��NTq� AG9N ED RECEIPTDAT BY DA �� INSP T INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs A Onderground Ducts Forms & Footings ucts Slab Grade tum Air Steel Combustion Air Roof Deck Exhaust Fans O.K. to Wrap 7Q F.A.U. Framing Compressor Insulation- $ITTVents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath ` Drywall - Int. Lath Final Final POOL - 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 Electric Final Waste Lines t�-1-`—� I fiy 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 Encapsulation Gas Piping Gas Test �2y� Appliances Final COMMENTS: Final Utility Notice (Gas) Lf�jl/ ELECTRICAL Temp. Power Pole APPROVALS AX, Underground Conduit Rough Wiring Low Voltage Wiring y Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power ?f 3 Final Utility Notice (Perm) Desert ". )• - ENERGY Services — P.O. Box 621 Ph/Fax (760) 564.2044 Rancho Mirage, CA 92270 Cell: (760) 835.7939 Email: RKrown6237@aol.com CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page 1 of 7) CF -4R Ct15�o"1 �0ME , THE6LHHIT OlQ: 4/NO3 _ Project Title Date 57.64:6 13Loca IL Di ArN o W D, L.A- &WT 6U'wfll g i W D EY E I.. Proiect Address Builder Name L Builder Contact 'oddfl!2i� #e_d-W R 4 l 32 �j2• '2 ertifyl g Signature Firm:DESERT EO -f SER\/IdZ r Street Address: P a BOX t 21 Copies to: Builder, HERS Provider 17(- 314-0 P LA Q - C_U S:To r4 Telephone Plan Number ;�3 155r71 ) G KOy P I Telephone Sample Group Number 4LJZ s �14-r 5 5 1043 Date Sample House Number HERS Provider: C • N .R.S City/State/Zip: �Ak1Cgotj IRA<E. C k- °12210 HERS RATE�R.�,/COMPLIANCE STATEMENT The house was: lJ 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. 500'i -he 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) YWhere 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 aj$ If fan flow is calculated as 400cfm/ton x number of tons enter calculated value here If fan now is measured enter measured value here Leakage Percentage (100 x Test Leakage/Fan Flow) _ e Check Box for Pass or Fail (Pass=6% or less) Z' ❑ Pass Fail d TH ERMOSTATIC EXPANSION VALVE (TXV) Yes ❑ No Thermostatic Expansion Valve is installed and Access is 1 CD for inspection E Yes is a pass Pass Fail Desert L ENERGYS''- r CAGE Services — P.O. Box 621 Rancho Mirage, CA 92270 Email: RKrown6237@aol.com Ph/Fax (760) 564-2044 Cell: (760) 835-7939 CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7) CF -4R C�lS'(oM Dome E'giuMM11 Project Title 57.845 Blick DlAmo -lb,LA QuibiT Proiect Address Builder Contact Telephone 0 3 Hat Telephone Ee wv #e- Certifyin Signature Date Firm: DESERT E0�Ktt//'( 5EIZVILE5 Street Address: . Q BOX t 2 Copies to: Builder, HERS Provider 0 `(es=c OQ: 4/I4%03 Date 6Umt-wWiLL-5 DEYEL Builder Name P LA N - CIJ $To ry Plan Number Gt ft tJ P Sample Group Number l,V -I- 41= 5 5 2 043 Sample House Number HERS Provider: C • fi •�-•� •K.S City/State/Zip: CFidtl IRA4E. Coil• 012272 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. 3, The installer has provided a copy of CF -6R (Installation Certificate. CVDistribution system is fully ducted (i.e., does not use building cavities as plenums or platform returns in lieu of ducts) LD 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 31 If fan flow is calculated as 400cfm/ton x number of tons enter calculated value here If fan now is measured enter measured value here --� Leakage Percentage (100 x Test Leakage/Fan Flow) = • is "/ v Check Box for Pass or Fail (Pass=6% or less) ❑ Pass Fail LJ THERMOSTATIC EXPANSION VALVE (TXV) 4ye5 ❑ No Thermostatic Expansion Valve is installed and Access is 1 for inspection E CD Yes is a pass Pass Fail Deser� �� ENERGY 1''- r CA°E Services — P.O. Box 621 Ph/Fox (760) 564-2044 Rancho Mirage. CA 92270 Cell: (760) 835-7939 Email: RKrown6237@aol.com CERTI FICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page 1 of 7) CF -4R J5'(o M � o M E , 'rH E "Sum MI's" sim P N: 4/14/an Project Title Date 57.845 BL*ey- DIAtM010, W QuiwT 6u iReu14iLL-> DEVEL. ect 9ddress Builder Name M /lvW�le.L. (7l Prou) `77J- 31 • PLA Q - CIJs'To►"A Builder Contact r Telephone HEE3r�/R r Telephone R to Certifying Signature Date Firm: DESERT EIJa-r,4-(5E7pwiCE5 Street Address: P a BOX (PZ 1 Copies to: Builder, HERS Provider Plan Number G K0 LJ P I Sample Group Number l o-i✓4t= 55 .3043 Sample House Number HERS Provider: d . H -a-E�- City/State/Zip: &kgotj IRASE. CA• 0)2210 HERS RATER COMPLIANCE STATEMENT R/ 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. 91"The installer has provided a copy of CF -6k (Installation Certificate. O,/Disiribution system is fully ducted (i.e., does not use building cavities as plenums or platform returns in lieu of ducts) l( 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 SS If fan flow is calculated as 400cfm/ton x number of tons enter calculated value here ytaap If fan now 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 4THERMOSTATIC EXPANSION VALVE (TXV) dyes ❑ No Thermostatic Expansion Valve is installed and Access is 1 ❑ provided for inspection �J Yes is a pass Pass Fail INSTALLATION CERTIFICATE (Page 3 of 13) CF -6R' Site Address Permit Number DUCT LEAKAGE AND DESIGN DIAGNOSTICS DUCT LEAKAGE REDUCTION Pressurization Test Results (CFM rt 25 PA)TestLeakage (CFM) Fan Flow If Fan Flow is Calculated as 400 cfm/ton x number of tons, enter calculated value here goo If fan flow is measured, enter measured value here - ---- Leakage Fraction = Test Leakage/(Measured or Calculated Fan Flow) = 0.0+4 Pass if leakage fraction 5 0.06 cir ❑ Pass Fail ❑ For AEROSOL TYPE SEALANTS ONLY - The following diagnostic testing was completed: Duct Fan Pressurization at rough -in measured leakage (CFM) CHECK AFTER FINISHING WALL: ❑ Yes ❑ No ❑, Pressure pan test or House pressurization test ❑ Yes ❑ No ❑ Visual Inspection of Duct Connections ❑ ❑ Pass Fail 9?/THERMOSTATIC, EXPANSION VALVE (TXV) 000y' e s ❑ No Thermostatic Expansion Valve is installed and Access is ❑ provided for inspection 210, Yes is a pass Pass Fail ❑ DUCT DESIGN ❑ Yes ❑ No ACCA Manual D Design calculations have been completed, Duct Design is on the plans and duct installation matches plans. 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 ❑ I, the undersigned, verify that the above diagnostic test results and the work I performed associated with the 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 ifying that diagnostic testing and installation meet the requirements for compliance credit.) I Tests ignat e, ate Performed COPY TO: Buildi a Depart t HERS Provider if applicable) Building Owner at Occupancy Installing Subcontractor (Co. Name) OR General Contractor (Co. Name) Compliance Forms August 2001 A-25 INSTALLATION CERTIFICATE (Page 3 of 13) CF -6R' 51-845 13(An4 Di-AmoNo 3-W-3 La Quigirij Site Address Permit Number rte._ DUCT LEAKAGE AND DESIGN DIAGNOSTICS ❑ DUCT LEAKAGE REDUCTION Pressurization Test Results (CFM @ 25 PA) Test Leakage (CFM) E3�� Fan Flow If Fan Flow is Calculated as 400 cfm/ton x number of tons, o i enter calculated value here A000 If fan flow is measured, enter measured value here Leakage Fraction = Test Leakage/(Measured or Calculated Fan Flow) = 6,0it Pass if leakage fraction <_ 0.06 ❑ ❑ Pass Fail ❑ For AEROSOL TYPE SEALANTS ONLY - The following diagnostic testing was completed: Duct Fan Pressurization at rough -in measured leakage (CFM) CHECK AFTER FINISHING WALL: ❑ Yes ❑ No ❑ Pressure pan test or House pressurization test ❑ Yes ❑ No ❑ Visual Inspection of Duct Connections ❑ ❑ Pass Fail ❑ THERMOSTATIC EXPANSION VALVE (TX ❑ Yes ❑ No Thermostatic Expansion Valve is installed and Access is provided for inspection ❑ ❑ Yes is a pass Pass Fail ❑ DUCT DESIGN I ❑ Yes ❑ No ACCA Manual D Design calculations have been completed, Duct Design is on the plans and duct installation matches plans. 2. ❑ Yes ❑ No TXV is installed or Fan flow has been verified. If no TXV, verified fan flow matches design from CF - IR. Measured Fan Flow = Yes for both 1 and 2 is a Pass Pass Fail ❑ 1, the undersigned, verify that the above diagnostic test results and the work I performed associated with the test(s) is in conformance with the requirements for compliance credit. [The builder shall provide the HE provider a copy of the CF -6R signed by the builder employees or su �contractgrs certifying that diagnostic testing and installation meet the requirements for compliance credit.] i -, 0 Tests �gg_D�epaent Performed COPY TO: Buildi HERS Provider (if applic le) Building Owner at Occ ancy Installing Subcontractor (Co. Name) OR General Contractor (Co. Name) Compliance Forms August 2001 A-25 INSTALLATION CERTIFICATE (Page 3 of 13) CF -6R 57- U- B lumy. ISt *mu ID el 3 La tier fid Site Address Permit -Number r" DUCT LEAKAGE AND DESIGN DIAGNOSTICS L7 DUCT LEAKAGE REDUCTION Pressurization Test Results (CFM en 25 PA) Test Leakage (CFM) Fan Flow If Fan Flow is Calculated as 400 cfm/ton x number of tons, enter calculated value here 2OCIp If fan flow is measured, enter measured value here Leakage Fraction = Test Leakage/(Measured or Calculated Fan Flow) Pass if leakage fraction <_ 0.06 [� ❑ Pass Fail ❑ For AEROSOL TYPE SEALANTS ONLY - The following diagnostic testing was completed: Duct Fan Pressurization at rough -in measured leakage (CFM) CHECK AFTER FINISHING WALL: ❑ Yes ❑ No ❑ Pressure pan test or House pressurization test ❑ Yes ❑ No ❑ Visual Inspection of Duct Connections ❑ ❑ Pass Fail R'THERMOSTATIC EXPANSION VALVE (TXV) Yes El No Thermostatic Expansion Valve is installed and Access is - provided for inspection ❑ Yes is a pass Pass Fail ❑ DUCT DESIGN 1 ❑ Yes ❑ No ACCA Manual D Design calculations have been completed, Duct Design is on the plans and duct installation matches plans. 2. ❑ Yes ❑ No TXV is installed or Fan flow has been verified. If no TXV, verified fan flow matches design from CF -I R. Measured Fan Flow = Yes for both 1 and 2 is a Pass Pass Fail ❑ 1, the undersigned, verify that the above diagnostic test results and the work I performed associated with the 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 requirements for compliance credit.) / !jj1V*-5G Teststgnatur D to Performed COPY TO: Buildi Department HERS Provider (if applicable) Building Owner at Occupancy Compliance Forms August 2001 Installing Subcontractor (Co. Name) OR General Contractor (Co. Name) A-25 Certificate of Occupancy City of La Quinta Building and Safety Department This Certificate issued pursuant to the requirements of Section 909 of the Uniform Building Code, certifying that, at the time of issuance, this structure was in compliance with the various ordinances of the City regulating building construction or use. For the following; BUILDING ADDRESS: 57-845 BLACK DIAMOND Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0208-144 Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL Owner of Building: WEISKOPF PARTNERS Building Official Address: 51-161 SOUTHERN HILLS City: LA QUINTA, CA 92253 By: DANIEL P. CRAWFORD JR. Date: 4/23/03 POST IN A CONSPICUOUS PLACE