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0402-295 (SFD)s 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 690645 B STC A. 6130/04 s -Date f4�� � JSignature of Contractors a �> > � % OWNER -BUILDER DECLARATION) I hereby affirm under penalty of perjury that Iaam 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 STATL:. FilA1D Policy No. 154"o-01 J (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. -.t " Date: > i - /� n7 }' Applicant �-a Pi E r o • 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. r 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)-I k b'o Date14-1 Fr;7 4, V - BUILDING PERMIT ` PERMITk�� _ DATE / VALUATION LOT TRACT 8,187,979.00 9. 298-,) 2 JOB SITE/ v / APN ADDRESS eri -ori C�:�1 y 772450-00111 OWNER - CONTRACTOR /DESIGNER /EN 1NEER R .1t©d=3 11C R V MYdmAam, Tl :. PO BOX 810 142 S L UNMT.M1TY1D1tWTs, LA QL11;1'.I"A CA 922S.1 PH0.# lgMr .AZ 85034 (602)257-1656 03V# 4990 USE OF PERMIT SFA , LO f1, PLAN P3A- PERAUT DOHS NOT IMCLUDE POOL, SPA, BLOCK WA.1:..U% OR DCc.[VEBd°r`1Y:t PPI3.tJACH, "% RF-DUC1171ON TO PLAN CHECK IEEE INTI%' TO MULTIPLE r4SU 1,1C Z OF S&VIE PLAN TYPP, TRACT CrJOSTRUCTION 3,199.00 OF POIRCKIPAT'IO 313100 SF CARAWC-apowf 530,00 SES ES711ANDE-t} COAX' OF CON611MC°° ON IS 7,979.£ PY+AMrl'ffri � SUMMARY CONSTRUCTIONFEE, 101-000-418-000 S947,50 50 PL kN CHECK FEE 10'!-000-439-318 $203.11 VIEC ANICALFEE 101 -NO -421-000 $105.00 .EfLECTiZIC..AL FEE 101 -000420 -WO gFfs2,43 PLL>1b9UMO .F99 101.000.419-000 5230.00 S'Tki3NC't AliOVON P.EE - RESIO 101-000-241-000 $l&80 G BADINO FEE 101.000-423.000 $15,06 . nEVE1.10M t MPaAC►' FEE ��,If1il:0U SUB -.70TAL. C0NMT.UC.`°f10X ANMD PLA'h3 (,41 EM, 6 $3;725.36 LESS ME-PAU) 1EM $Q1 00 lrzl IJ APR 01 2�004JI CITY OF LA TA K FfRANC ^- . . t' t / RECEIPT , 1 DAT E. 111C BY DATE FINALED INSPECTOR - INSPECTION RECORD ='OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings - p _ Ducts Slab Grade - Q _ 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 BLOCKWALL APPROVALS POOLS - SPAS steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final I Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines $- TZ- - Neater Final Water Piping J Plumbing Final Plumbing Top Out l Equipment Enclosure Shower Pans O.K for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances Final 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) — COMMENTS: 10 AdAGL e9 f 4 ;� r • } +ENERGY A D E C rServims ' PO. Box.621. Ph/Fax (760) 564-2044• -Rancho, Rancho Mirage,•CA 92270 Cell: (7601 250-1952 Email: DESNRG.0AOLCOht CERTIFICATE OF'FIE'LD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7) CF -4R PALMILLA PH 7 DATE TESTED 11-9-04 Project Title Date 50-420 VIA-AMANTE LA QUINTA; CA. 92-253 RJTL HOMES _Project cess Builder Name CHADMEYER 760-564-6655 ACACIA- P-2 3 UNITS . Builder Contact Telephone Plan Number RICHARD:KROWN ,760-250-1852• GROUP 5,_ HERS Rater Telephone Sample Grou Number G #CCNRK613292 11-184 LOT^9 ' Certifying Signature Date Sample Lot. Number Firm: DESERT ENERGY SERVICES LLC HERS Provider: CHEERS Street Address: P.O. BOX 621 City/State/Zip: RANCHO MIRAGE, CA. 92270 Copies to: Builder; HERS Provider HERS RATER COMPLIANCE STATEMENT rt , The house was: ❑ Tested Approved as, part of sample testing but was not tested. w #j As the HERS rater providing diagnostic testing and field.verificabon, 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 -6R (Installation Certificate. ; ❑ Distribution system is'fully ducted(i.e., does not.use building cavities as plenums or platform retums in lieu of ducts) - El 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. El MINIMUM REQUIREMENTS, FOR DUCT LEAKAGE REDUCTION COMPLIANCE -CREDIT , Duct Diagnostic Leakage TestingResults (Maximum 6% Duct Leakage) Measured Duct Pressurization Test Results (CFM @•25 Pa) values Test Leakage Flow in CFM If fan,flow is calculated as 400cfryVton x number of ton's enter calculated value here If -fan flow is measured enter measured value here Leakage Percentage (100 x Tesi Leakage/Fan Flow) _ ) Check Box for Pass or Fail (Pass =6% or less) ❑ ❑ Pass Fail ❑ THERMOSTATIC EXPANSION VALVE (TXV) ❑ Ycs El No Thermostatic Expansion'Valve is installed and Access is provided for inspection _01E] �i�� :.=� � ' OOT CEC RTIF��e�� - (Page 3 of 1:} SI;e:At:dress Mmit Numbor DUCT LEAKAGEAND DESIGN DL4G OS'I'ICS 12UCTJ' EAKa GE waiUC'1'101 Pre uurizatiou Tast Retttlti.(CFM Ga' 25 FA) Tea i.caf enc. (CFM) -7-9 . . Fan Flow I: Fan flow u Cali istd t s'400 cfrr✓u n x nttrrha'of togs, or as? 1.7 x Heating Captcity in i housands of SLOv, enter grated value here If fan flow is melstued, atter measured value here ' I eaizac Fraction = Text I2akagdiaiezraed or Calculated Fats Flow) Pats if lealmse 5aetion < 0.66 Pass Fall d For AEItOSOI: Z'YpE SEAI.AIVTS ONLY -Ile folln ing diagnosdc testing was completed: Duct Fart Pressurization at rough -in t'aeosurW Icakage (CFIvf) CHECKAFTER FIIv75HING WAU; ' O Yes ❑ No ❑ Pressure pan test or House pressurization test .O Yes O. No. ❑ Visual Inspection of Duct Coanecdors o o . Pass Flu ' THERMOSTATIC EXPANSION VALVE (T7M - - A Yes t7.No l a=stadc Expansion Valve. is installed and Access is - provided for.inspection Yes is a pan Pass Fail o nMST" . ACCA Maoual D Design oalwlatiom have bew } . 1..c Yes . E3 -No completed; Duct Design Is on the plans and duct Instellation matches pians. ' 3. 0 Yes ❑ No TXV b fnstollod or Fun flow bat beat verified. if no TXV. Pass Fail reified hn flow matches design from CT -M Mta cured Fan Flow . Yes far both 1 and 3 is a Pass ❑ L the undersigned, verify that die, above diagnostic W9 malts,and @te work I pcfmm "ami -ad with the tats) k in crmfercnnee With die rsgtanntents for compliaoco ptdiL [The bwlda than provide the HERS pmvidcr a copy of the CF -6R sighed by this btn'ldcr employers or sub -connectors certifying that dta8noado =ting and installation n= the regtti exrtcrtla for cotrtpltanca crWit ) �. �D= Tin S' lnttalliog Subcaavactor (Co. Narnc) OR p General Conaacmr (Co. Ntunc) CCFYTO: Butid'atgDepartment ;RS Provider (if. applicable) . Bundtng Owtta 31 O=up>ncy INSTULATION CERTI YCiTE • (Pagel of 13) . C—F-R, rA/M; ILL PA -7' c,f .> q Site Address Permit N7gibcr DUCT LEG., AND DESIGN DjACirNOSTECS DUL'1' LLrAKAUM, 12EllUL"I'IUN ? • Pressurizatloa Test Resclu (CFy2 � 2: PA) , .. Tat Lea}ag: (CFbI),ZD .-at Flew If Fan Flow is Cal»:atod as 400, cfitAon x numbx of tont, cr as 21. i x Heating Cgm.-ity In Thousands of Bzwhr, •enter calculated value here if inn Now Is measured, enter measured value here 74�: Lr'akap Fraction = Tat Lealtagd(Messured or Calculeted Fap Flow) _ X a Pass if lmsgc fraction < 0.06 P ass Fall o For AEROSOL TYPE SEALANTS O.."MY -The fcWwing diagnostic testing was completed: Duct Fen Pon a rough -in r= urtd leakage (UNO CHECK AFM MUSEVO WALL: ; D Yes 0 No 0 Pressure pan test or House prem urtzetian test �0 Yes O No 0 Visual Inspection of Duct Conuacti I - o Pass Fall TfMrRMO RTIC EXPANSION V ti ' A Y�s O:No. Thermostatic Expansion Valve is itutallod and Access is - provided foi inspecdoa Yes it a pass 7� o O DUCT DESXGY . I PAW Fair 1. D Yes 0 No RCCA Mamihl D Design ealculatim$ pave been completed, Duct Design is on the p ans anc duct Installation mattes plans 2.' 0 Yea 0 No 7XV is ipsosllcd or Frrt flow has been pcifial. If no TXT/, verified fan flow matches design froro CRI Pass F:W Mcaarad Fan Flow i Yea for both I and 2 is s Pass O . L tmdctsisoed, vetti>y that the above diagnostic teat rrsut� Mad the work 1 perfom od aaaaeWM with the tats) is iti C=fwn=ee With the r qub'erneats for ebrnpGt� Medic. [TU bMI shall ptpvide the HERS provider a coo of the CF -6R aigtted by the builds anployco or sab-etmtr,uars mrtif'ing dw diagnostic untie: iattaAatian meet the rtigidiancnts for eomptianx ardli ] � /�- /-off � • d '.r ; TWO 5 Date hrtalliog Subeornraemr (Co. Name) OR Permed CxnaslContr;:= (Co. Nave) COPY TO: But7din; Depattmmt HIM Provider (if ajpliceble) Btalding Owner at Ocoupsncy C=Ofe ce Forms Fitt 2001 A-15 . LO 3SVd tIZ6Z88Z 80t10 b00Z/9T/TT C . : CAfifq Sr"ALLAnoN CRTIFICAhZ, age3 f .{t -7 Slie Vic: azz ?ermli.Yumber DIi -LEAKAGE AND DESIGN DL4GN0S77CS lll,cr.�>;_4KAGi+: E2M'•l)uc�•i !Y - P. esrur=:loo Test Results (CFM 25 PA) Test.L•ilas;: (CFMl) . an r:Jw - If Fat Fow s C41.vL:cd n 400 dnkrh x nUMba of tors, W as;l1 x Haadr:g Capedty In Thousands of ahUhr; enter calculated value here If fan lbw is measured, eriter neasumd value.here _JM LealmS. Faodon = Tett &21m;e/Wwu:ed or Wculated Fan Flow) _ e Pan iflcabecfrucdonc0.06 pass Fall O For AEROSOL TYPE SEALANTS ONLY -The following dtagaostic ttsting.was completed: Duct Fan Presraizzlipn at rough -in measured Ieekage (GFA0 CHECK ATTER FINISii CT WALL' D Yes O No 0 Piesstm pan test or House preozi�on test •0 Yes 0 No 0 Vtsual k pccdon of DuctCo=cztioas �• ' PUS flail 'l TMOS7'ATiC EXPANSION VAiVE fT7M , )l Yes • L7 No 'Ibennostatic Expansion Valve is installed and Access is -Provided for inspection Yes is a pass a Pass Fall O DUCT DESIGN ACOA Manual D Desip ratcaladm bane been 1. 0 Yes ..0 No completed; Duct Deslgn is on the plans and duct Installation matches plans. 0 Yq 0 No ' M iu irst0ed or Fan flow bas bees vetifiad, if no IXv. p� Fall veacd faa'flow is wlws design from CF -M Mensual Fart Flow - Yes far both I and 3 is a Pass 0 L the vndmiped. vet* that the above diagnostic test retuhs ad the wm8 I pesfotmed usoeiatad with the Uxt(s) is in eonforuamec ; with the tequim=m for wmpUw= cradiL [iiia buildrr shall ymvidc ft HERS p widcr a copy of the CF -R elped by the builder easployeat or sub-=trsetws w ifymg drat diugaostie tinting and iastallat M meet t}tc requiirments for cora timee Lredit ) Tau S6whvr, Date famlling Subcontra= (Co. Nauta) OR ut>formsd General Conaaetor (Co Name) COPY70- 9uildingDgwtn=t ' -'ERS Provider Gf apptieable) Ulding Owner at Occupancy . Eorrt_lfa*tCa Fon s Altgust_'G01 A -a5 80 39tid t7Z6188z at, :L0 t,00Z/9T/TT -. � -, • y �� r Cs. .� . - � - .{ � ..;,.. �. . • ti':� y '• _ _..7 . �^' - , �' , •�, u n' _~ ter, .. - ' cu ertifo fO:cY �f h;�T,. its i -S - "] 7 • • \ -w ,� +• Td` ...' r ��I�'1j� �l � t • , N, .r3 `j�✓ .. ' Idca nTm Mi' c^j s ..ji ,r i '_ "+•j Fc - " r 9� ��` Y. -'�Buildin Safet Departmentt�A ��� 1,50 �S _ OF C`�` T ,.-^ A { *, - ��7 .: _•�-, n.• 2fi n r.r 3 . Mr - -■" - ,tie ,P '� �r r �; G i 'e , •L?. { •J] ` Y * M �` " ,<; ..k - .f - • f `„ +;' '� ,� ` • i , - r ' ,ra, �} r• , F L� � A, �] . 4 ti Y � .c• � r. i. T r s,... �a „ � � 4" a -�' a ,3�,• � r (� r •�k- � � � ^ r � �r .'� Y+ 1 � �+, R 4 *f 3..r L r - �- + �}.:f r r. ! "C � Y i r: ! •, a 7 ..? �X. jy 1�- ''Y Y � . a . _i _, • `• .jam •: A : - �'" L .: 5• ..� - r �.,_.'. y r `This Ceyrtficate is �ssuedpursuant to`•the requirementsl of Section 109}of fhei California Budding a - Code, cerfi in thaf; at�;'the 'time of issuance, this.�structure was m-, compliance with,t a ,: fY_,. gt _ �, , ` of, the -Building .Code; and -the various ,, ordinances ofMthe C ty7regulating building. . provisions f Y , - h" -��;• - •construct'- nd/or`us tM1 r� a a.• k, ��+• :7�� •T.rrir Ti_" 4•t� a,.ft 'C '•t,, k S - •G' *mow �1"�,f.. vii may".,, 3� y j.,. -_ �`�� yf rn k +- w +_.,' -;,,i `a n � f"•a i7J �" r� t1.�. � 4�a .r',a .�_. '� ;.!-a 't xa'}',yPM a �. .k..{�r a �,a]*' y •+ /- x$`�Y I.J. ` r - i '.C� v �• y� - -fir _ � ; 7 f i _ p r ..x ' f50=420 4 i - x BUILDING•ADDRESS:� 'Via'Amante .. �� .� r , C�_. y- �.• �, ^ .. � r.. a.- .?''��Z,1 �� };;",� � �+ a ;• C K..}- ,'f. +�?.�� -„-�: � ,,+1 �_..[[..r .^ ? r r i •;i• �� '�/ 'i `•i] s �'_ - S .r a'�� .. t;. u` ,'4 -� .. � �� .�rr0. �+,,� ar w ... ��. r;�'��f,� •r+ a .� •� `¢� „,�'ti .. �'�. ....�f ,rim � - sr..s„r f . -` - � ,U+� •� �• ,�. '�. � .yt. #-:. •r, �+ n.. 'yti. •, E '�w: `���r a �� y p= _ �• i ,r fan ; 'r' . �. '- � r,��-. _T�" O Y� � - � � � h� �-nli r ,} ° /,. L.1. r tt "�.` .. •y, .S .1 {, 4 C .3' 7 , (,"x�, ;A' y,Y _ � V"' W �• • i' �_ r y ;,g�•'' ,yU•!• .J t -ern � _ S - � r'�Building:.Permit No.: `0402-295 'Use classification: S:F.D. 4, F r ', h ,�'• ' fir% .,•. w - ,! , a.: ',f ' r4 -a . 'f .+L.''. r t f,, ,. • '} ^F .`�-„ t y` �,. {+'L � S • {'•'� cOccupancy,Group" R-3` C `-;:`j �Typesof.Construction ne Land Use,' R L �t r !y�-r -� j ti ,�, r� . sr`+ '>' ,n.lw. � , f t �'�Yi �Ji . Y✓t 'ifi'` '� x a. r �� .� a'!� � "" ';M� r� y . _ J w .� ..y^ _. _ a 4 ` 'ia .-I�q` �' ; � • J'�h .!�'u• T �'� 7 r. r � I ,' -t� S J ^ r � _., •�'!�y' N'' a''Y�._'�' t.r - 'uy..- ..� �y{„ '." y. p rsl�r��-F'�r. C `� ,y�y.•M�.+ri ,�.� ,:M,,,.'f'V.+:� .Y - a „iJ.,-if'rG; L. �1 r _ : {., V t .•' C _ '�- 'roti - ,' ••i�`" '.1 _ L,j 'S "' r y .•G-� ' y .Y r'; L'v f:��• ! '+"wr _ -., k ;. + ,� r1 � • r�, �.�c y ..��' 1.4. . �.,� . \� � . ' 4 '�`ni w. •�C+,'�C, �i•CY^♦'., V '��� � � �.� - r� _ �..,Sa � •'r''" V„�.. `G �S� 1�`"•1 Y�.. ruRJT HOMES LLC`�Y f4rw Q�� t; Address: 'P.O. BOX 6wn6rbf Building: L ��� � ;a _,,,:, - •� -'44 C ty,-ST, ZIP: ,LrA QUINTA . CA ,,92253 s G.SHOWATER•, y- V �• � _, r j4 :fns ;j: .. •y,; � :�� ' ��: y,_. -'. � Tt./ t t•��V K �(+:e;• `�'• � ",��•(.e; By� � A --� ,� � ,�"��►` '•• V�•�'�`7 ' �"-, j� aq ,. . +tl �.- .� - -�. i'� a •' f„-33` '-..+�" � !'i >. t:;, .. � t r',�, r•• �• •::,;- ; a `�" {'� `! fir. �•. . Tjj -,• Date. _ 02/15/05 r Building Official �' u. , � � r - •3a + µ tc�t .�7 .+: -+ t.� �� :i• . �'�'a .r' Y7 , v` y �iqJ "M�� A � , ;. •4 « k t � r +'3 _ . � '� - i7 tl �3�� � � r.,� �` �..�a i � � �'* a ` =pct,. °� w.�5 r�.�' � � � � .• . _}!'� rr�, - .. y -t'�a � � ` !, .POST IN A"CONSPICUOUS PLACE �. {; t_. � J [[``�w- L .5, F' ,•3' 1 :JrJ 'a' � �-� ter-+ �a � ] 7 '- .e { L� � '�� ` a - 1 --r �ra� J .{ "r'Y f j ..°` b .�. J'�� .! 'JJ - •cit �',� •'"'-.+ S