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0305-133 (RPL)to 04 tU �w O =) M rYLr) LLJ r o Z 0� r- l- O' W W I �a Z M N ON 0 °) a_ Q Cr `r Q0 LL M J Q UV O Z_ co 5 �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 69065 B HIM EA 00130121 Date .. ••_ Signature of Contractor , -- 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. 4( ) I have and will maintain workers' compensation insurance, as required by S t tion 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 OT.ATE FUNEj Policy No. 13$39013-02 (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 th se p ovisi ns. ,.Date:�kL jp_3 Applicant— Warning: pplicant Warning: Failure to secure Work 'rs'}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 Quinfa, 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 propert fo inspection purposes. ,-Signature (Owner/Agent) , Date BUILDING PERMIT PERMIT t/ DATE • VALUATION LOT TRACT 104 JOB SITE APN ADDRESS .50-180 %'iit471 O FM/'W OWNER gqryry fr/.�pJ�' �y�(�� 7��* �y CONTRACTOR // DESIGNER 7/EN I�NE1EyF{Tc P013OX 810 1425 E UNW—WiT:1'lt DplI 'L, LSA. QUINT' CA 97253 PHOWIX AZ 65034 (60B)257-1656 CBL-# 4990 USE OF PERMIT POtsLAM/t1� OP,A POOL, SPH B8(2 (01,0371,3020914) A.I.ARMS!)fSrt.RRIERS SHAX•L 13E IN PIACRA'A PM.. PLASTER 1NaPECTIO9, EQUIF'1dGn' T 9MLOSURENOT [NCLt DED POOL AND/OR SPA 151000100 LS ESTMA" 733 COS'' QV CONS1[RtTMOW PF,RWITEE 9MMAR3r' PLAN rHMCK FRE 101-000.439.318 COINS i'RU T ICYN FZE * 101-00" 18-000 WCHMICAL FIX -- POOL 1.01-000.421.000 ELZICTRIC.tAt, FEZ — POOL 101-000-.420-000 $4100 PLI1101NO FEE --POOL 101.000-419.000 $27.00 IPFMAY 14 2003 CITY Or RECEIPT DATE BY DATE FINALED 3��!l1711:OE'1 ] . $363.30 Fr. FIS MOi1 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 Exhaust Fans O.K to Wrap F.A.U. Framing Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final POOLS - SPAS BLOCKWALL APPROVALS steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric (p 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 62 - Gas Piping Gas Test Appliances Final - -� COMMENTS: 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) FF" 0 a IZ6j ..... . ....... - K) CN � a IZ6j INSTALLATION CERTIFICATE (Page 3 of 13) CF -6R �- Site.Address �w Permit Number DUCT LEAKAGE AND DESIGN DIAGNOSTICS DUCT LEAKAGE REDUCTION Pressurization Test Results (CFM c@ 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 i 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 ❑ Pass Fail 0 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 Q Pressure pan test or House pressurization test ❑ Yes ❑ No ❑ Visual Inspection of Duct Connections ❑ ❑ Pass Fail ❑- THERMOSTATIC EXPANSION VALVE (TXV) ❑ Yes ❑ No Thermostatic Expansion Valve is installed and Access is provided for inspection Yes is a pass ❑ 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 ❑ ❑ 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 St to 11 sta 1 R g Subcontractor (Co. Name)'011, Performed General Contractor (Co. Name) COPY T0: Building Department HERS Provider (if applicable) Building Owner at Occupancy y INSTALLATION CERTIFICATE Site.Address DUCT LEAKAGE AND DESIGN DIAGNOSTICS LEAKAGE R )n Test Results 25 PA) 3 of 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 ❑ 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 (TX CF -6R ❑ ❑ 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 13 -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 I 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 empl ees or sub -contractors certifying that diagnostic testing and. installation meet the requirements for compliance credit.] Tests Date nsta ing 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 13) CF -6R �ttann ►,1 �- � 1 y y SiteAddress Permit Number DUCT LEAKAGE AND DESIGN DIAGNOSTICS DUCT LEAKAGE REDUCTION Pressurization Test Results (CFM Q 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 Btuft, 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 Pass Fail fl 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 (TXV) ❑ Yes ❑ No Thermostatic Expansion Valve is installed and Access is provided for inspection Yes is a pass ❑ 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 M 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 ❑ ❑ 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.] IL4 1A 0 - Tests r ,Date 4istalling Subcontractor (Co. Name) OR Performed General Contractor (Co. Name) COPY T0: Building Department HERS Provider (if applicab)e) Building Owner at.Occupancy Dt - ENERGY CAVE Sw„i� - P.O. Box 621 Rancho Mirage. CA 92270 Email: RKrown62370aaol.com Ph/Fax (760)564-20" Cell: (760) a 250-1652 CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page 1 of 7) CF -411 PhZ^< < A tail. 3 �sIgP Projec Title &-0 T.T.T.7•7od / o,-- P Project &ddless -T ti HAedwitki7�oi ��s-�'3»_ wilder Na e PLALr P- I Builder Contact TelephonelaP n Number wMWZ5-0-1062 H R r 'GGI4RK(132°1;1+(f Telephone 1 Sample Group Number j l �0� l L)'1 enifying Signature Date Sample House Number Firm: pESE9T r-' L Edla Y 6sayl e -E3 HERS Provider. G.14 -I -E.Q.S. Street Address: P -0 46y. 621 City/State/Zip: taw OMO 41 ]JtASE Lfl Aft -10 Copies to: Builder. HERS Provider HERS RATER COMPLIANNCE STATEMENT 2 The house was: ❑ Tested Approved as part of sample testing but was not tested As the HERS rater providing diagnostic testing and field verification, 1 certify that the houses identified on this form comply with the diagnostic tested compliance requirements as checked on this form. ❑ The installer has provided a copy of CF -611 (installation Certificate. ❑ 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) 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 Measured values If fan flow is measured enter measured value here Leakage Percentage (100 x Test Leakage/Fan Flow) = Check Box for Pass or Fail (Pass=60/o or less) ❑ ❑ Pass Fail ❑ THERMOSTATIC EXPANSION VALVE (TXV) ❑ Yes ❑ No Thermostatic Expansion Valve is installed and Access is provided for inspection ❑ ❑ `i Yes is a pass Pass Fail 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: CEILINGS: TYPE:BATTS WALLS: TYPE:BATTS GE 19 50-180 CAMINO PRIVADO, LOT 104,11-A QUINTA ,CALIFORNIA MANUFACTURER:CERTAINTEED MANUFACTURER:CERTAINTEED THICKNESS: R-38 THICKNESS: R-21 HOM LICENSE # TITLE: �C�Ly►G�U��%U� SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072 ADMINISTRATIVE ASSISTANT DATE: 11/13/2003 Page 1 of 1 • 14712 SW SCROLLS FERRY ` # 328 BEAVERTON, OR 97007 a ' PHONE: 503-524.8268 FAX: 503-213-6222 E-MAIL: mjII.IS..0D..tthi.00M Y •e John Hardwick 2-27-03 rf RJT Homes, LLC 79700 500 Ave LaQuinta, CA 92253 RE: Structural Observation of: Lot 103 and Lot 104 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, there appears to be reasonable compliance with the general intent of the construction documents with no"unresolved deficiencies. Please call with any questions. Sincerely, AA...'es'm Mike Nelson, PE LW