0301-052 (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 r Exp. Date
date.2` �+ 1! ' 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.
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')'A. X V '-M Policy No. 21.70-1401-2003
(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;
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings.O
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
d
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
Underground Plbg. Test
Final
Gas Piping
i PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
U/107 0_31
OX for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
—
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
-
_ _ -
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fires
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
'Smoke Detectors
Temp: Use of Powerh _o
Final
Utility Notice (Perm)
Comments
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions under
500 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile
homes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to
Education Code Section 17620 and Government Code 65995 Et Seq.
in the amount of $2.14 X 2,799 S.F. or $5,989.86 have been paid for the property listed above and that
building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued.
Fees Paid By CC/Valley Independent Bank - Anna Gonzalez Check No. 287129
Name on the check Telephone
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Sharon MCGllvrey $5,989.86 So.00
Payment Recd Over/Under
Signature c
U V
NOTICE: Pursuant to Government Code Section 66020(d)(1), this will serve to notify you that the 90 -day approval period in which you may protest the fees or
other payment identified above will begin to run from the date on which the building or installation permit for this project is issued, or from the date on which
those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting
Construction Management. P.roject:Management Engineering •Development
August 5, 2003 �) `o �;1-7
Mr. Skip Lench
Ms. Taylor Bruce -
Landell Ventures
La.Quinta, CA
RE: 78-231 Calle CadrZ - La'QuiRla; CA - Sl►aetaral Ob;ermioe Reporl
Dear Skip and Taylor
Per my structural observation on 8/04/03, based on my observation the framing'and foundadon where in
accordance with the plans:and per general construction standards, There was one hold down that 1 request
be adjusted to the plate, which 1 pointed out to the job superintendent.
Please correct this one item listed above,.and if you stay have any questions, plewc feel free to call at
anytime. Look forward to.serving, you. again.
Sinc �.
arayanan
Vice - President
,Concorde Consulting Group,lnc.
Consditing Engineers
cc. K.M. Kripa, SE, PE
bl�
4511 E. Sunnydunes Road Ste. # E Palm Springs, Ca 92264 Ph: (760) 322-8626 Fax: (760) 416-1893
r, �..,.,. , �n.�nry ,man. !9nl+rq rn� �n nr •+> Pr+n> inn inn
Dec 01 06 07:46a
N.
909-389-9927 p-1
INSTALLER COMPLIANCE STATEMENT FOR DUCT LEAKAGE
INSTALLER COMP14ANCE STATEMENT
The building was: ✓ IffTested at Final ✓ ❑ Tested at Rough -in
IN 'ALLER VISUAL INSPECTION AT FINAL CONSTRUCTION STAGE:
V Remove at least one supply and one return register, and verify that the spaces between the register boot and the interior
finishing wall are properly sealed.
❑ if the house rough -in duct leakage test was conducted without an air handler installed, inspect the connection points
2reeen the air handler and the supply and return plenums to verify that the connection points are properly sealed.
Inspect all joints to ensure that no cloth backed rubber adhesive duct tape is used
✓ ❑ DUCT LEAKAGE REDUCTION
Prar>'"roe fnr Rold voritirawnn and dinnnnctir tectinp of air AcMhutian s stents are avallahle in RA CM. Anoendix RC4.3
NEW CONSTRUCTION:
Duct Pressurization Test Results (CFM @ 25 Pa)
Measured
Values
Signature: ( %
04r
1
Enter Tested Leakage Flow in CFM:
LJO
2
Fan Flow: Calculated (Nominal: ✓ ffCooling ✓ O Heating) or ✓ ❑ Measured
If Fan Flow is Calculated as 400 cfm/ton x number of tons or as 21.7 cfm//(kBtu/hr) x Heating
I Capacity in Thousands of Btu/br, enter total calculated or measured fan flow in CFM here:
1 , OoL
✓ ✓
3
Pass if Leakage Percentages 6% for Final or:5 4% at Rough -in:
100 xLine # 1 / 1 0o Line 42)11
oSa4ass
❑ Fail
ALTERATIONS:
Duct System and/or HVAC Equipment Change -Out
4
Enter Tested Leakage Flow in CFM from Pre -Test of Existing Duct System Prior to Duct
System Alteration and/or Equipment Change -Out.
5
Enter Tested Leakage Flow in CFM from Final Test ofNew Duct System or Altered Duct
System for Duct System Alteration and/or Equipment Change -Out
6
Enter Reduction in Leakage for Altered Duct System
Line # 4 Minus Line # 5 -(Only if Applicable)
7
Enter Tested Leakage Flow in CFM to Outside (Only if Applicable)
✓ ✓
8
Entire New Duct System - Pass if Leakage Percentage:5 6% for Final or:5 4% at Rough -in
100 x (Line # 5 f Line # 2)11
E3 Pass ❑Fail
TEST OR VERIFICATION STANDARDS: For Altered Duct System and/or HVAC Equipment Change-
Out Use one of the following four Test or Verification Standards for compliance:
✓ ✓
9
Pass if Leakage Percentage:5 15% [100 x [ (Line # 5) / (Line # 2)11
❑ Pass ❑ Fail
10
Pass if Leakage to Outside Percentage 5 10% [100 x [__(Line # 7) / (Line # 2)]]
❑ Pass ❑ Fail
I 1
Pass if Leakage Reduction Percentage z60% [100 x _(Line # 6) / (Line # 4)]]
and Verification Smoke Test and Visual Inspection
13 Pass 13 Fail
12
1 Pass if Sealing of all Accessible Leaks and Verification by Smoke Test and Visual Insection
❑ Pass ❑ Fail
Pass V One of Lines # 9 throw # 12 ass
El Pass ❑ Fai{
✓ Ql, the undersigned, verify that the above diagnostic test results were performed in conformance with the requirements for
compliance credit I, the undersigned, also certify that the newly installed or retrofit Air -Distribution System Ducts, Plenums and
Fans comply with Mandatory requirements specified in Section 150 (m) of the 2005 Building Energy Efficiency standards.
Installing Subcontractor (Co. Name) OR General
Contractor (Co. Name) OR Owner
'Deq,�T W I Lt& CorxTau -Tt OIJ
Signature: ( %
04r
Date:
Copies to: BUILDING DEPART.�NT, HERS RATER (IF APPLICABLE) BUILDING OWNER AT OCCUPANCY
Residential Compliance Forms April 2005
Dec 01 06 07:46a
909-389-9927 p.2
✓ O THERMOSTATIC EXPANSION VALVE (TXV)
Procedures for field verification of thermostatic expansion valves are available in RACM, Appendix RI.
✓ ✓
Access is provided for inspection. The procedure shall
consist of visual verification that the TXV is installed on
✓ Yes No the system and installation of the specific equipment cr ❑
shall be verified.
Yes is a sass I Pass I Fail
✓ ❑ REFRIGERANT CHARGE MEASUREMENT
Verification for Required Refrigerant Charge and Adequate Airflow for Split System Space Cooling Systems without
ThPrmnctntir. Frnancinn Valves
Outdoor Unit Serial #
Location
Outdoor Unit Make
Outdoor Unit Model
Cooling Capacity Btu/ly
Date of Verification
Date of Refrigerant Gauge Calibration (must be checked monthly)
Date of Thermocouple Calibration (must be checked monthly)
Standard Charge Measurement Procedure (outdoor air div -bulb 55°F and above):
Procedures for Determining Refrigerant Charge using the Standard Method are available in R,4 CM, Appendix RD2.
Note: The system should be installed and charged in accordance with the manufacturer's specifications before starting this
procedure.
Measured Temperatures
Supply (evaporator leaving) air dry-bulb temperature (Tsupply, db)
OF
Return (evaporator entering) air dry-bulb temperature (Treturn. db)
OF
Return (evaporator entering) air wet -bulb temperature (Tretum, wb)
OF
Evaporator saturation temperature (Tevaporator, sat)
OF
Suction line temperature (Tsuction, db)
OF
Condenser (entering) air dry-bulb temperature (Tcondenser, db)
°F
lunerheat Charge Method Calculations for Refrigerant Charge
Actual Superheat = Tsuction, db -Tevaporator, sat OF
Target Superheat (from Table RD -2) OF
Actual Superheat - Target Superheat (System passes if between -5 and +5°F) OF
Temperature Split Method Calculations for Adequate Airflow
'Wit Mnthnd C.ntrvintinn iv not nore.vcnry ifAdenvnto AirAnw rrodit is tntrnn
Actual Temperature Split = T return, db Tsupply, db
OF
Target Temperature Split (from Table RD3)
°F
Actual Temperature Split Target Temperature Split (System passes if between -
YF and +3°F or, upon remeasurement, if between -3°F and -100°F
Residential Compliance Forms April 2005
- Certificate of Occupancy
: o�
14
OF Building& Safety Department
This Certificate is issued pursuant to the requirements of Section 109 of the California Building
Code, certifying that, at the time of issuance, this structure was in compliance with the
provisions of the Building Code and the various ordinances of the City regulating building
construction and/or use.
BUILDING ADDRESS.: 78-231. CALLE CADIZ.
Use classification: SINGLE-FAMILY DWELLING Building Permit No.: 0301-052
Occupancy Group: R3 Type of Construction: VN Land Use Zone: VC
Owner of Building: RED STAR Address: P.O. BOX 450
City, ST, ZIP: LA QUINTA, CA 92253
By: KIRK KIRKLAND
► Date: April 19, 2004
Building Official
POST IN A CONSPICUOUS PLACE