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0402-296 (SFD)LICENSED CONTRACTOR DECLARATION U) I hereby affirm under penalty of perjury that I am licensed under provisions of H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and v W Professionals Code, and my License is in full force and effect. j =) cv) License # Lic. Class Exp. Date CY 690645 B IRC A 6/30/04 Z r-- Date Signature of Contractor D 0. r U C> OWNER -BUILDER DECLARATION L W ~ I hereby affirm under penalty of perjury that. I am exempt from the Contractor's . n License Law for the following reason: cn Z_ ( ) 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). M () I am exempt under Section , B&P.C. for this reason LID N Date Signature of Owner ON 0)4 Q WORKER'S COMPENSATION DECLARATION Zcr I hereby affirm under penalty of perjury one of the following declarations: Fa. p. () 1 have and will maintain a certificate of consent to self -insure for workers' C LU LL compensation, as provided for by Section 3700 of the Labor Code, for the J Zi performance of the work for which this permit is issued. Q () ( ) I have and will maintain workers' compensation insurance, as required by j o Q Section 3700 of the Labor Code, for the performance of the work for which this rn H permit is issued. My workers' compensation insurance carrier & policy no. are: � Z Carrier Policy No. co. 5 STATE FUND 1583906-01 CJ g (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 3 subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date: Applicant 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._ i 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 ka -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."ragree 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) Date BUILDING PERMIT PERMIT# DATE VALUATION LOT 0402-296- TRACT $179,361:56 8 29858.2 JOB SITE APN ADDRESS 50-410 VIA AMANTE 772-050-007 OWNER CONTRACTOR/DESIGNER/EN (NEER " RJT HOMES LLC RJT INVESTMENTS, INC. PO BOX 810 142511, UNIVERSITY DRIVE LAQUINTA CA 92253 PHO=. AZ 55034 (602)257-1656 CBL# 4990 USE OF PERMIT MNGLE FAMII,Y ATTACHED SFA - LOT 8, PLAN PIA. PERMIT DOES NOT INCLUDE POOL, SPA, BLOCK WALLS, OR DRIVEWAY APPROACH, 75% REDUCTION TO PLAN CHECK FEE DUE TO MULTIPLE ISSUANCE OF SAME PLAN TYPE TRACT CONSTRUCTION 2,894.00 SF PORCH/PATIO 997.00 SF GARAGEICARPORT 457,00" SF ESTIMATED COST OF CONSTRUCTION 179,361.50 PFJUvHT FEE SUMMARY CONSTRUCTION FEE 101.000-418-000 $919.50 PLAN CHECK FEE 101-000-439-318 $193.92 MECHANICAL FEE 101-000.421.000 M.50 ELECTRICAL FEE 101-000-420-000 $185.43 PLUMBING FEE 101-000-419.000 $208.00 STRONG MOTION FEE - RESID 101-000-241-000 $17.94 GRADI O FEE 101-000.423-000 • $15.00 DEVELOPER IMPACT FEE $2,001.00 SUB -TOTAL CONSTRUCTION AND PLAN CHECK $3,620.29 LESS PRE -PAID FEES $0.00 TOTAL PERMIT FEES DUE NOW $3,620.29 RECEIPT DATE BY DATE FINALED INSPECTOR 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 Date"/' GjN —� 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 las 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). O 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: 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: CarrierSTATEFUply Policy No. Ig��gO�„AI (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 those provisions. Date: �s.. Gr Iter Applicant— Warning: pplicant Warning: Failure to secure - Workers' Compensa on 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 isrperformed. under or pursuant to any, permit issued as a result of this applicators -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 propertyfor inspection purposes. Signature (Owner/Agent) `� -�/'�' �= j' Dater��� v BUILDING PERMIT PERMIT # DATE �f VALUATION LOT 04M'2 TRACT JOB SITE' APN ADDRESS MA1,.0 VIA AMAIN D. . MAW -007 OWNER CONTRACTOR/DESIGNER/EN (NEER 1Z.1” T 1101VEZ 1:1C UrDWE+ar)". is, ANTIC. PID)BC1 : 810 1425 iw'Lfid1VERMTT D-WI'tt•E CA 92253 1-1�1,05TW 'a 8303 (602)217-1656 CBLA 4990 USE OF PERMIT SFA - WTS, PLAN PIA. PERMIT DOE4 NOT ENCLUI)E .POO4 EPA BLOCK WALI..f3, OR DPVVFWAY APPROACH..13%.63EDUCY1014 TO PUN CliEV.K FEro. rJUE TO MULTIPLE ISSIJA14CE (,PSR MP. PL.t'►1s TYPE TkACT CONOTRUC:'piON SP PORMPATIO 99100 S 0.AtiR,At3F'1CARPORT 457.00 $C U1 rel.. A'ZND COW 0:F CONS`.PIiUC'MN L`'lrPMUT F'EE W1I I ihRY CO]MI.I fRUCTI01d FEE 101.000-418-000 SPI?, PL&W CHECK FEE, $193.92 WIXTI RAN15-V.0 FES: 101.000.421-,000 $'il.30 9LRC"TRId'AI,FEE '101-000-420-006 ` $10.43 PLUM{11T146IuE 101-000.419;0013 $ t10.tlo STRONG idOTION FEE o RESID 101=000-2A8 -0100 V-7.94 C'Iii:il:lJING FEE 161 000-423.003 $15.00 DEVELOPER IMA.C'T 112L+ X4,001.00 SUB -:'MAL CClM—TI UCMW.E AND PLAN CH3?.C.K $3,620.29 p - LESS P FAM TW_ $0100 a APR 01 CITY OF LA QUIN'rA FMA CEDE r RECEIPT DATE/ BY�r� DATE FINALED INSPECT F., INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings - Ducts i Slab Grade - Q - y Return Air - Steel -- /Q - S/ Combustion Air Roof Deck -, - Exhaust Fans O.K. to Wrap -Zp - 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 PLUMBING APPROVALS Gas Test Electric Final Waste Lines —1- Al _ 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 Gas Piping Gas Test Appliances Final COMMENTS:. �, 1�. T y *J,+ Final of Utility Notice (Gas) - ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring - - Low Voltage Wiring Fbdures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) M r 14 �NERG_Y CABEC - i P0. Box a21 Ph/Fax (760),564-2044 RanchoWirage, CX92270 Cell: (760) 250-1852 Email: DESNRG, MAOL.com �t CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I..of 7) CF -4R PALMILLA. PH 7 DATE TESTED 11-9-04 Project Title Date f 50-410. VIA AMANTE .LA QUINTA, CA. 92253 RJT HOMES' 'Project Address 1 �• Builder -Name 760-564556 OCOTILLO. P-1 3 -UNITS. Builder Contact Telephone Plan Number RICHARD KROWN 76D-256-1852 GROUP 5 HERS Rater . _ - _ —'.Telephone` ` Sample Group Number f - • #CCNRI<613292. 11- 18-04 LOT g Certifying Signature Date Sample Lot Number Firm: DESERT ENERGY SERVICES LLC, HERSRrovider: CHEERS r - . +. Street Address: P.O. BOX 621 City/State/Zip: RAPICHO MIRAGE, CA..92270 _ Copies to: Builder, HERS Provider HERS RATER COMPLIANCE STATEMENT The house was: ❑ Tested ® Approved as part of sample. testing but was :not tested jr AS..the.HERS rater providing diagnostic testing and field verification, I certify that the houses identified on this form comply I with the diagnostic tested compliance requirements as checked on this form. r ❑ The installer has provided a copy of CF -61R (Installation Certificate. 0 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 (x,,25 Pa) 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 FIo%V) Check Box for Pass.or.Fail (Pass =6% or less) ❑ THERMOSTATIC,EXPANSION.VALVE (TXV) ❑ ❑ Pass Fail 0 Yes ❑ No.Thermostatic. Expansion Valve is.installed and.Access is provided for inspection ❑ ❑ 0 L'�STAILMON. CERTIFICATE(Page 3 of 13) I CF-6R T'TaI P -7' /off= i Slue Address - : Parmit{Number ' DliCT'LEAKkGE A_ND DESIGN DLAG\'OSTICS DUCT, Lr a1CAG1C 1tEllUC'I'lU_� Pressurization. Test Resulrs (CFM. 25 PA) Test L:akage (CFM) Fan Flow rf Fan Flow is Calculated as 400 of ration x number of tons, or as 21.7 x Heating:Capaeiry, in Thousanda'a(BLUbr, enter calculated value here If tan flow is measured, enter measured value We Lcaka;: Fraction --Test LaslgeJ(Meuurod or Cplcul.red Fan Flow) p Pass if leakage t}nction <0.06 Pius • Fail . ❑ For AEROSOL TYPE SEALANTS ONLY -Tbe following diagnostic testin; was completed: Duct Fan Pressurization at rough-in measw-ed leakage (C`Fq) CHECK AFTER FIMSHING WALL . ❑ Yes ^_ No D Pressure pan test or House pressurization test t O Yes ;❑ No 17 Visual Inspection of Duct Connections o Pass Fall Li T13LT2D•foSTA•1'TC EXPANS16N VALVE (TXV) E3 Yes ❑ No Tbertnostatic Expansion Valve is installed and A" is provided for inspection Yes is a put .. o ❑ DTJCT DESIGN ?a s. Fail ACCA Manual D Design calculations have been- 1. C) Yes 0 No completed, Duct Design is.oh the plans and tuct installation, matches plans : 2. o Yes O No M is interned or Fan flow utas been verified. If no TXV, O p verified fan flow matches design from CRIB Fess tail Measured Fan Flow- Yes for both 1 and 2 is a Pass . Q 4 the undersigned. verify that the above diagnostic test results rad the work i performed associated with the tcst(s) is in catubr>r=e with the requiremeets for compliance audit [•nuc builder shall provide the H`RS provider a copy of the CF-6R signed by the bvilda employees orsub-contractors certifying that diagnostic testing and installation meet the requirements for compliance &edit j r //' r­ey� Tans Stgtature, Date tnstalting 5ubcoenvetor. (Co. Name) OR Perla:mrd G=cml Contractor (Co. Name) : : COPY TO: Building Deparo wit HERS •Provide (if applicable) Building Owner at Occupancy— Compliance Forms August 2001 TO 3!DVd VZ6Z887. OZ:L© r00Z/8T; Ti. INSTALLATION CERTIFICATE. (Page 3 of 13) CF -6R Site Address Permit Number DUCT LEAK4GE AND DESIGN DIAGNOSnCS J]UCI' LEAKAGE !t1''•DUC'1ION PressurizaUoo Tat Results (CF.Ma(j 25 PA) Tat Lge (CFM) ..& Fan Flow • if Fan Flow is Calculated as 400 cfm/ton x number of trans, or its 21.7 x heating Capacity in Thousands'o(SWAir, enter calculated value here :If fan flow Is measured, enter measured value here Leahge Fraction= Test Leskao(Measured or Calculated Fat Flow) _ p Pau if leakage fraction < 0.06 Pass Fail I7 For AEROSOL TYPE.SEALANTS ONLY -The following diagnostic testing was completed: . Duct Fan PressuAzation It rough -in measured leakage (CFK CHECK AFTER MSHING WALL 0 Yc6 0 -No ❑ Prmwe pan test or House pressurii ion test ❑'Yes 0 No 0 Visual Inspection of Duct Connections ' q Paz Fall O THERMOSTATIC EXPANSION VALVE fCRV) x Cl Yes ❑ No Thermostatic Expansion Valve is insi fled i and Access is - provided for inspectionpr Yes is a pass 0. o DUCT DEGN Pass SI Fall ACOA Manual D Design calculations have bevo 1. 13 Yes ❑ No completed, Duct Design Is on the plans and duct Installation matches plans ' 2. O Yes O No TXV is installed or Fan flow hss been verified. If no TXV. vai$ed fat flow matches desip.f i;m CILUL Pass Fail Measured Fan Flow= Yes for Loth 1 and 2 is a Pass ❑ L the tmdasiSud, verify lith the above diagnostic teat mutts and the wodc l performed usocWed with the tests) is in confumra C with tic requirements for compliance Credit. [Tbe builder shall provide the kUM provider a oopy of the CF -6R signed by the builder ernployers or sub-contraetoo'ctatifyin; Owt dissnoatic twtins and Wtallation meet the requirefmts for coriphartee credit. J, TCSG 5' Date' landing subeoatraetm (Co. Name) OR . Pedar ued General Contra= (Co. Name) , COPY TO:Buildms Depattmerit HERS Provider (f applicable) Bwldios f?wner at Oceupancy Compliance Forms August2001 A-25 Z0 39Vd bZ6Z88Z 0Z:L0 p00Z/81/LT d. INSTA LLATIO CERTIFICATE (Pave 3 413) CFr6R �tMi 1 Q VA-'7 Site Address Permit Number DUCT LEAKALGE RIND DESIGN DIAGNOSTICS DUCT' L9A.KAGLr REDW110N Q Pressuriiuieo Test "Results (CFM @ 25 PA) Test L-4k3ge (CFJvi) ✓ Fan Flow If Fan Flow is C alculr!ed as 400 cWto_ n x number of tons, or as 21.7 x Heating CapWty In Thousands of Stuff, enter calculated value here If fan flow Is measured, enter measured value here + ' Leakage Frizion o. Test Leal=0Ncssmd or Calculated Fan Flaw) _ G Pass if lerlctge fraction < 0.06 Yass Eau C ForAEROSOL TYPE SEAL\T5 ONLY -The following diagnostic testing was corppleted: . Duct Fan Prt=suri2ztion at rough-in tar==-cd leakage (CFS CHECK AFTER FWLM NG WALL ❑ Yes ❑ No ❑ Pressure pan test or House pressuriiation test 1.3Ydi ❑ No D V liW 1avpectian of Duct Cdrtnecpons Pass Fall ❑ THERMOSTATIC E-XP 4NSION VALVE rrXV) ❑ Yes ❑ No TherntostadC Expansion Valve is installed and Access is - provided for inspection Yes is a pass �e Pass o Eau ❑ DU96E DESTGN ACCA Manual D Design calculnRoab have been 1. [3 Yes Q No . completed, Duct Design Is on. the plans and "duct Installation matches plans 2. D Yes D No •TXV is installed or Fan flow has been verifitid If no TXV, t7 Pass 0 Fail vaificd fa Bow'rnatches design from CI+-IR • Measured Fan Flow= Ycs for both land 2 is a Pass 0 L the undenigaed, vcity that the ebov,; diugnosdc tar results aad the work I peribrmed tsssociatcd with the orst(s) is in confota== with the requirements for eoniplia = e mdir. (ne builder shall provide the HM provides a copy of the CF-6R signed by. the builder employees or sub-coaCactois oottifying that diagnostic testing and installation mezt the rogtrirenrxts for w0=61iaacc credit. ] Te= `7Sigaature, Dam installing Subcontractor (Co. Name) OR Pab=d Gencrul Contractor (Co. Name) r COPY TO: Building Dcpmtaicnt HERS Provider (if applicable) Buldin; Owner :.t Occupancy Compliance ForAugust2001 A-25 E0 39Vd t;1Z6Z88Z 0Z:G0 000Z/8T/T1