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0210-232 (SFD)U) F - CV to W O d � 'w� OZI� CCDD 0. H CD J Awa C0 Z co N ON U °' dQ Z cc Q O LL Q J J mUU O aML Z_ co0 r-0 J 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 6510645 TJ HIC A. 6P301W. Date,/I' `7 Signature of Contractor G �. Q C71 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. k(.) 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 STATE FUND Policy No. J58310.3 -0u Y - (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 hall forthwith comply with those provis)ons. R, Date: /,..,,h�,� Applicant— Warning: 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/Agent) ._ J� +� �' z 4 ? rt" -,4*A/ Date,/A�. i f. �a BUILDING PERMIT PERMIT# 0216.213 TRACT 2,98,58-1 DATE VALUATION LOT 91 JOB SITE ADDRESS 50-175 CNAWi>t,i'RMADO APN 772-400-024 OWNER CONTRACTOR/DESIGNER/ENGINEER 140T HO. FIS TLC WT PO BOX 810 1425N., i NIiV01.M M -M-1.. LA.QUW`.I,'A OZ'S 92253 1aHl`1BIM AG SS 034 (602 ):d w Y 0 656 MN 4990 USE OF PERMIT SPA - LIDT 01 PLAN P2& .PER -MIT DOXS NOT 114Cl.,UD11. KOOK WAW P004 SPA OR :DRiEIWAY APPt,`,i.A.C34, %% RD' 1, UCT11rJ9 TO E'IATA L.KI~.. K ISL DUE TO I UTa TIPL ISSUI fyNCE OF SAJd N €'T.. N'N TYPO: TRACT C ONSTRUCTIM A191,00 3F FOR.CFiMATIO 3110014 0A,d't.AGWCA't;PORT 00 SY k �T�i` 4~4�n or CC7��s:�'#x�!•��'�'ion 3.i��P19119,4V �7;rryp•��/�3�r�,�4Q �('!�7(�' _gyp � .P:i�Al.a1P.� TrU A9'A?�r7C.A�"b.�AFI.+Y. f:0135TRtJt.'.'TION FES 103-00011418-.000 594U0 VLAH CHFX g FIS 101-000-439.318; $203.11 MW-HAWC1`wLFEE 101-000-421-000 $1.0,00 Mi'A;TRI A; , i'1A 1011-000-420-000 !$204.95 PLU MB1NOb FEE 101.000.419-000 $330M S'TROT40 MOTION FEE M910 101-000-241-000 $19.80 CRAD1910FRE 1 101=000-423.000 $15,60 IrlEVELOklZeR IMPACT FEE � ��ittaf.pU n �5t I -TO AL CO3lRT 1'R tit'TI", 4 1: 9 k'7,d�u>T C° 3 C $3,7 uS.'6 TO 7002 111.! IMM NOV 20 CITY OF LA QUINTA FINANCE DEPT. :RECEIPT DATE B1 DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings e< Ducts Slab Grade —/Q Return Air Steel ? Combustion Air Roof Deck Exhaust Fans O.K. to Wrap ,� F.A.U. Framing — — Compressor Insulation — 94 — 3 Vents Fireplace P.L. Grills UV Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath - �? Drywall - Int. Lath dA 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 Electric Final Waste Lines Heater Final Water Piping Plumbing Top Out % Plumbing Final Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection 77—,7 Encapsulation Gas Piping Gas Test �— Appliances L Final COMMENTS: P,zr/ 41)A1As Dw.Aj f jrsd��,z� 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) LT yi INSTALLATION CERTIFICATE (page 3 of 13) CF -6R Site.Address .. 75 &4/44ermitftmber _..__. DUCT LEAKAGE AND DESIGN DIAGNOSTICS f DUCT LEAKAGE REDUCTION Pressurization Test Results (CFM @ 25 PA) Test Leakage (CFM) -� Fan Flow If Fan Flow is Calculated as 400 cfm/ton x number of tons, or as 21.7 x Heating Capacity in Thousands of Btu/hr, enter calculated value here If fan flow is measured, enter measured value here Leakage Fraction. = Test Leakage/(Measured or Calculated Fan Flow) Pass if leakage fraction 5 0.06 {� 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 13Pressure pan test or House pressurization test E3Yes . ❑ No ❑ Visual Inspection of Duct Connections ❑- THERMOSTATIC EXPANSION VALVE (TX Pass Fail ❑ ❑ Pass Fail ❑ Yes ❑ No Thermostatic Expansion Valve is installed and Access is . provided for inspection ❑ D 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 -1R 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.] ' [q Tests 4Stre, 4'Date In tall' Subcontractor (Co. Name) OR Performed General Contractor (Co. Name) COPY T0: Building Department HERS Provider (if applicable) Btiilding Owner at Occupancy INSTALLATION CERTIFICATE 3 of SIte.Address Permit Number DUCT LEAKAGE AND DESIGN DIAGNOSTICS DUCT LEAKAGE REDUCTION CF -bit Pressurization Test Results (CFM @ 25 PA) Test Leakage (CFM) _12— Fan Flow If Fan Flow is Calculated as 400 cfin/ton x number of tons, or as 21.7 x Heating Capacity in 'thousands of Btu/hr, enter calculated value here If fan flow is measured, enter measured value here _ Leakage Fraction_ = Test Leakage/(Measured or Calculated Fan Flow) Pass if leakage fraction 5 0.06 (� [] P s 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 Fait ❑- THERMOSTATIC EXPANSION VALVE (TXV) ❑ Yes ❑ No Thermostatic Expansion Valve is installed and Access is provided for inspection Yes is a pass ❑ DUCT DESIGN ❑ ❑ Pass Fail 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 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.] Tests re, Date instalffig Subcontractor (Co. Name) OR Performed General Contractor (Co. Name) COPY T0: Building Department HERS Provider (if applicable) Building Owner at Occupancy INSTALLATION CERTIFICATE ___(Page 3 of I3) CF -6R Site.Address DUCT LEAKAGE AND DESIGN DIAGNOSTICS DUCT LEAKAGE surization Test Resu Permit Number Test Leakage (CFM) Fan Flow If Fan Flow is Calculated as 400 cfm/ton x number of tons, or as 21.7 x Heating Capacity in Thousands of Btu/hr, enter calculated value here If fan flow is measured, enter measured value here Leakage Fraction_ = Test Leakage/(Measured or Calculated Fan Flow) Pass if leakage fraction 5 0.06 C3 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 0 Pressure pan test or House pressurization test ❑ Yes . ❑ No ❑ Visual Inspection of Duct Connections ❑ THERMOSTATIC EXPANSION VALVE (TXV) A 13 Pass Fail ❑ ❑ Pass Fail ❑ 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 inatches plans. 2' Cl 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 -611. signed by the builder employees or sub -contractors certifying that diagnostic testing and. installation meet the requirements for compliance credit.] Tests to I I' g Subcontractor (Co. Name) OR Performed General Contractor (Co. Name) COPY T0: Building Department HERS Provider (if applicable) Building Owner at .O.ccupancy Page I ofii t 14712 SW SCHOLLS FERRY # 328 r S IENGINEBEAVERTON,OR 97007 P S NIGY PHONE: 503-524-8268 CONSULTANTSLLC FAX: 503-213-6222 JG� E -MMOL: minelson(a@aUbi.com a . 1,44" John Hardwick 2-26-03 a RJT Homes, LLC l J' 79700 50" Ave -f LaQuinta; CA 92253 A� Via010010" ',. RE: Structural Observation of: Lot 90 and Lot 91 John, Sample observations were made of the above house to ascertain whether the intent of the construction documents is being followed. Of the structural items that remain uncovered and easily observable, it appears that, in general, there is reasonable compliance with the intent of the construction documents with no unresolved deficiencies. Please call with any questions. Sincerely, Mike Nelson, PE z I ze INSULATION CERTIFICATE This is to certify that insulation has been installed in conformance with the current energy regulation, California Administrative Code, Title 24, State of California, in the building located at: 50-175 CAMINO PRIVADO, LOT 91, LA QUINTA, California CEILINGS: TYPE: BATTS MANUFACTURER: Certainteed Thickness: R-38 WALLS: TYPE: BATTS MANUFACTURER: Certainteed Thickness: R-21 GEtELON C : fRJ LICENSE # b .� TITLE:,9ip/5 o �lLy SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072 fi�� TITLE: ADMINISTRATIVE ASSISTANT DATE: 11/13/2003