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07846 (SFD)Building 78-660 Bradford Cimle Mailing Address City lZip ITel. Ot au�;�ccu P.O. BOX 1504 N Q . 418.4x8 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 Contractor I Omr Address Zip I Tel. State Lic. I City & Classif.��?� y Lic. # Arch., Engr., Designer Address Tel. CityI Zip I State I Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licen d under provisions of Chapter 9 (commencing with Section 7000) of D1visi--o�n//3 of the BB. s' ass� nd Profe/scions Code, and my license is infullforce and effect. �,r'/,�/�i�r„f> SIGNATURE Z DATE i OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason:0,(Sec. 7031.5,Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, or thathe is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). O 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, Buisness and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale.) ❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) ❑ 1 am exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Pol icy ,N 0. -Company Ck'Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) valuation or less.) I certify that in the performance of thg 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. Date Owner NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Lender's Name Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to .enter the above- mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip BUILDING: TYPE CONST. OCC. GRP. A.P. Number Acacia Hams Legal Description Traet 23M -P1an P_a Project Description Lot 76 REMARKS go ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR 5/4/90 Issued by: Date Permit Validated by: Validation: 4r Y .^" Sq. Ft. Size 1927 No. No. Dw. Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ i Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. 562:6"W Const. 6ORSO Mech. MOO Electrical 14.47. Plumbing S.M.I. Grading Driveway Enc. Infrastructure i TOTAL 3,917.88 1 9, REMARKS go ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR 5/4/90 Issued by: Date Permit Validated by: Validation: 4r Y .^" CCNSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL SO. FT. ® $ UNITS COLL. AREA SLAB GRADE YARD SPKLR SYSTEM 2ND FL SQ. FT. HEATING (ROUGH) STORAGE TANK POR. SQ. FT. ® MOBILEHOME SVC. BAR SINK GAR. SQ. FT. ® POWER OUTLET ROOF DRAINS CAR P. SQ. FT. ® DRAINAGE PIPING WALL SQ. FT. HEATING (FINAL) DRINKING FOUNTAIN. SQ FT ® URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES FINAL INSP. WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GRADING cu. yd. $ plus x$ GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED FINAL INSP. 1 'Q� LAUNDRYTRAY AIR HANDLING UNIT CFM ROOFING KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET' COMPRESSOR HP POLE, TEM/PERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER. B.T.U. SO. FT. ® c BATH TUB SQ. FT. ® c WATER HEATER MAX HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/e c SEWAGE DISPOSAL SPARK ARRESTOR SQ.FT.GAR ® V4c HOUSE SEWER GAP, FIREWALL GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE CK FE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR' SETBACK GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS 0 SEWER 9R-9EF e A 4 M= ROUGH WIRING. DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH)' 3 r7 Gl l! METER LOOP HEATING (FINAL) OTHER APPJEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ =$ LUMBER GR. FINAL INSP. 1 'Q� FRAMING / /„ v FINAL INSP. ROOFING REMARKS: VENTILATION FIRE ZONE,ROOFING FIREPLACE SPARK ARRESTOR GAP, FIREWALL 13 F -w THING 16 3 tNa L D MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION LYl 8 CERT. OCC, FENCE FINAL INSPECTOR'S SIGNATURESJINITIALS GARDEN WALL FINAL SEP -19-2005 11:07 PM 6�> CERTIFICATE OF FIELD VERIFICA - Project +tleXO , - DIAGNOSTIC TESTING •' Date Builder Name Plan Number Sample Group Number P. 01 CF � DS tying Signa urs at Sample House Number Irm: fe, o HERS Provider: c y'Elex S Street Address: ( l5 t�/YL �� + CIty/StatelZip; u 41'✓l/1 r4 I Copies to: Builder, HERS Provider UgRS RATER COMPLIANCE STATEMENT The house was Tested C3 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 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 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. )6--m—l" NIMU M 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 l Test Leakage Flow in CFM ✓ "I If fan flow Is calculated as 400cfm/ton x number of tons enter calculated value here Alrr j Vro If fan flow Is measured enter measured value here c� Leakage Percentage (100 x Test Leakage/Fan Flow) =/� Check Box for Pass or Fall (Pass=B% or less) Q Pass Fall THERMOSTATIC EXPANSION VALVE (TXV) or Commission approved equivalent jilyles ❑ No Thermostatic Expansion Valve (or Commission approved equivalent) is installed and Access is provided for inspection �❑ Yes Is a pass ass Fail ❑ 'MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT 1. ❑ Yes C] No ACCA Manual D Design requirements have been met (rater has verified that actual installation matches values in 'n CF -1 R and design on plan. A. 2. 0 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 = ❑ O Yes for both 1 and 2 is a Pass Pass Fall SEP -19-2005 11:07 PM C' C FIELD .vh P.02 DIAGNOSTIC TESTING r CF -4R d ��r Date //, Builder Name ephone Plan Number '-6772 31 ephgne Sample Group Number rifying- Signature Dat Sample House Number irm: J—`. �ssa(/a7Ls HERS Provider: / G H0, R✓ Street Addres r-1, 6/0 Aro saf d"dY� �/YG �P� City/State/Zip: L u epu/r� �'t 1 C 1 F ,�.,?-r Copies to: Builder, HERS Provider HERS RATER QOMP61ANCEMW The house was:Tested ❑ Approved as part of sample testing, but was not tested 49 As the HERS rater providing diagnostic testing and field verification, I certify that the houses identified on this form com 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 B% Duct Leakage) Measured Duct Pressurization Test Results (CFM @ 25 Pa) J,/,M 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 Fall (Pass=6% or less) ❑ ass Fall THERMOSTATIC EXPANSION VALVE (TXV) or Commission approved equivalent ❑ No Thermostatic Expansion Valve (or Commission approved ,g"Yes equivalent) is installed and Access Is provided for inspection ❑ Yes Is a pass 1 ass Fail ❑ MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT 1. CD 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. NM 2. C Yes O 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 = 0 ❑ Yes for both 1 and 2 is a Pass Pass Fail SEP -19-2005 11:08 PM CERTIFICATE OF FIELD VERIFIC Pr5�l/ 5 mg& ProJelj,t,dd l5 r Builder Cont ct Lor 55' ,7 Su.ilWName Plan Number Sample Group Number P.03 17 605 C �fying Signature ate Sample House Number irm: '4'C -e-0 HERS Provider: Street Address: r%���(A �r�a�9'ev� Cl�'L/Fr City/State/zip: Lw �✓M1� G� 92?- 3 Copies to: Builder, HERS Provider HERS RATER COMPLIANCE STA The house was: Tested ❑ Approved as part of sample testing, but was not tested As the HERS rater providin diagnostic testing and field verification, I certify that the houses identified on this form comp with the diagnosticested compliance requlrements as checked on this form. Distribution system Is fully ducted (i.e., does not use building cavities as plenums or platform returns in lieu �'0f ducts) S 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 leeks at duct connections, i MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT Duct Diagnostic Leakage Testing Results (Maximum 0% Duct Leakage) Duct Pressurization Test Results (CFM ® 25 Pa) 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) THERMOSTATIC EXPANSION VALVE -11 i or Commission a gZ Yes ❑ No Thermostatic Expansion Valve (or Commission approved equivalent) is installed and Access is provided for inspection Yes is a pass ❑ MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT 1. O Yes 0 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. o 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 = Measured values �.j 3 y0 , ass Fail uivalent M O Yes for both 1 and 2 is a Pass Pass Fail CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING CF -4R Nrotect i sue uaku Proiert Address Builder Name Builder Cont HERS Rater Telephone Plan Number -573 T,elephong Sample Group Number C Eying Signature Date Sample House Number Firm:HERS Provider: Street Address: 7y6,K0 A/ f,11:EYZ C r L-, _ City/State/Zip: Z,,' Copies to: Builder, HERS Provider HERS RATER COMPJLIANCE STATEMENT The house was: 9 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 6 If fan flow is measured enter measured value here Leakage Percentage (100 x Test Leakage/Fan Flow) _ 5,417 Check Box for Pass or Fail (Pass=6% or less) ❑ Pass Fail 1A THERMOSTATIC EXPANSION VALVE (TXV) or Commission approved equivalent 2 Yes ❑ No Thermostatic Expansion Valve (or Commission approved equivalent) is installed and Access is provided for inspection R ❑ 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. 41 / Measured Fan Flow .= ❑ ❑ Yes for both 1 and 2 is a Pass Pass Fail