0402-294 (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 Exp. Date
0906-43 B C A t ' W- 0104
Date� �� 12 0`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
i
WORKER'S COMPENSATION DECLARATION
_tl 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
tperformance 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 S•TATF FUND Policy No. 1583906.01
(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
1`C6de:I shall forthwith comply with those provisions
Date: Zi " � G' Applicant -,A 3.4 t ' .ely—
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 in,, purposes.
1.
t Q. P
Signature (Owner/Agent)(& ,-°'�?fsj t�t`Y Date' "�✓ '���- "
BUILDING PERMIT PERMIT#
6e'
DATE! tLOT " 'g
TRACT/\� `
10
JOB SITE , /
APN
ADDRESS 50- AO VIA AVIANTES
i i i-iJ D C�
OWNER - — - _
CONTRACTOR/ DESIGNER/ EN INEER'
PO DOX 810
1425 X UX % SITY D'-R!.'Vr ^ -
LkQUTNTA CA 92253
P110EN. M. AZ 83034
(602,1257-1656 :1CT311J 4990
,
USE OF PERMIT
R�+TCYL:�i6l�F:Y
SFA - LA) T' 1; PLAN P3A• ;PF'-FTTo! IT D08S NOT INCLUDE POOL, SPA,
BLOCK W,�:LLS, PR,DR1VZVAYA.PPR0AI.C`H
TRACT CONSTRUCTION 3,284.09 OF
PORCH/PATIO 773.60 SF
0ARAWC ARPORT.. $68.00 SF
ESIMA ED COZ'p i' 0Y, C✓03MM 7C`T10,M
IW.734MI
PARTC /l f bTE SLTMMARY
CONSTRUCTION M 101-01,10-418.000 SQBQ.wfl
PLAN CHECK FEL 101-000-4139-318
MECHANICAL PEE 10'.1-000-421-000 $r.00
ELECTRICAL PEE 11.01-000.420-000 $201,30
PLUMBINO FEE 103.0013.419.000 $190.00
STRO-N ? MOTION FEE - ii.iP.SID 101-000.241-000 $14.3"'!
ORADING VgXi 101-000-423-000 00.423.000 51.5.00
__ .. - _ _ , -
.Df VEWPERIMPAC:T FPZ
a
9U.B-TOTAL CON=lMMO.1E:3' —*n") Tar..11l�f C .
-
$A,313.34
[�1 o LESS PRE -PAID VM?111
D: I
510100
APR 01 2004t� EI IT ;S JWE NOW
S4,31 3„�a
(�
CITY OF LA QU:N'B�A
FINANCE D T.� h/
RECEIPT
DATE / // / / 1
/'//11
BY ( J
DATE FINALED _
INSPECTOR
,; V
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Z ^
Return Air
Steel
-Z —
Combustion Air
Roof Deck
_Zj_
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
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines 6;
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
Final(�-tea
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:
9,47',. 4,,4,E 4- -1,9 �s
CERTIFICATE OF FIEID VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7) CF -4R
PALMILLA PH 7 DATE TESTED 11-9-04
Project Title 'Date.
50-440 VIA AMANTE .LA QUIi`NTA, CA..92253 - RJT. HOMES.
Project,Address Builder Name
CHAD MEYER 760-564-6555 PALO BREA P-3 2 UNITS
-Builder Contact Telephone Plan Number
RICHARD KROWN 7602504852 GROUP ?
HERS Rater Telephone Sample Group Number
# CCNRK613292 11-18-04 LOT 10
Certifying Signature Date • Sample Lot Number
Firm: DESERT ENERGY SERVICES LLC HERSProvider: CHEERS
Street Address: P.O. BOX 621 City/State/Zip: RANCHO MIRAGE, CA. 92270 ,
Copies to: Builder,.HERS Provid''er
HERS RATER COMPLIANCE STATEMENT
The house was: ❑ Tested ® Approved as part ofsample testing but was not tested
As the HERS. rater providing diagnostic.testing and field verification, I 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 (in stallation.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)
Measured
Duct Pressurization -Test Results (CFM ,@ 25 Pa) values
Test Leakage Flow in CFM
If fan flow is calculated as 400cfm/ton x number oftons enter calculated
value licre
If!fan now is mcasurcd.enter measured value here
Leakage Percentage :(100 x Test Leakage/Fan Flow)
Check Box for Pass or Fail (Piss =6% or less) ❑ ❑
Pass Fail
❑ THERMOSTATIC EXPANSION VALVE (TXV)
❑ Yes ❑ No Thermostatic Expansion Valve is installed and Access is
provided for inspection ❑ ❑
3
D"e, t,
- - -
ENERGY
C A a.F
S emcm
PO_ BOX.621
Ph/Faz.(760) 564-2044
Rancho Mlrago, CA 92270
Celli (7601260-1852
Email`' DESNRG AAOL:COM
CERTIFICATE OF FIEID VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7) CF -4R
PALMILLA PH 7 DATE TESTED 11-9-04
Project Title 'Date.
50-440 VIA AMANTE .LA QUIi`NTA, CA..92253 - RJT. HOMES.
Project,Address Builder Name
CHAD MEYER 760-564-6555 PALO BREA P-3 2 UNITS
-Builder Contact Telephone Plan Number
RICHARD KROWN 7602504852 GROUP ?
HERS Rater Telephone Sample Group Number
# CCNRK613292 11-18-04 LOT 10
Certifying Signature Date • Sample Lot Number
Firm: DESERT ENERGY SERVICES LLC HERSProvider: CHEERS
Street Address: P.O. BOX 621 City/State/Zip: RANCHO MIRAGE, CA. 92270 ,
Copies to: Builder,.HERS Provid''er
HERS RATER COMPLIANCE STATEMENT
The house was: ❑ Tested ® Approved as part ofsample testing but was not tested
As the HERS. rater providing diagnostic.testing and field verification, I 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 (in stallation.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)
Measured
Duct Pressurization -Test Results (CFM ,@ 25 Pa) values
Test Leakage Flow in CFM
If fan flow is calculated as 400cfm/ton x number oftons enter calculated
value licre
If!fan now is mcasurcd.enter measured value here
Leakage Percentage :(100 x Test Leakage/Fan Flow)
Check Box for Pass or Fail (Piss =6% or less) ❑ ❑
Pass Fail
❑ THERMOSTATIC EXPANSION VALVE (TXV)
❑ Yes ❑ No Thermostatic Expansion Valve is installed and Access is
provided for inspection ❑ ❑
3
i
iSTALLATION CERTIFICATE (Page 3 of Li) CF -6R
i' i �4- 1o4-)0-
Address
o IOAddress Permit Number
DUCT LEAKAGE AND DESIGN DIAGNOSTICS
l)Ul r LEAKAGE !tl•;DUC- ION
Freasttrization Test Remits (CFM @ 25 PA) Test La kago (CFM)-
Fin Flow _
If Fan Flow is Calcuisted as 400 cfn✓ton x number of tons, or as 21.7'x Heating Capacity
In Thousands c( BhiAir, enter calculated value here
If fan Row Is measured, ender maasureo value here
Leakage Fraction = Test.Leakagd(Measured or Calculated Fan Flow) _ O
Pass if leakage faedotn .c 0.06 Pass Fail
O For AEROSOL TYPE SEAL&N- TS ONLY -The following dfagnostic testing was completed:
Duct Fan Presaurizstion at rough -in meamn ed leakage (CFI►
CHECK AFTER FINISHING WALL -
0 Yes O No O Pressure pan test of House pressurisation test
O Yes 0 N 1 O Visual Inspection of Duct Connections o a
Pass Fail
•D TEV"OSTATIC EXPANSION VALVE 0XV)
O Yes O No Thermostatic Expansion Valve is installed and Access is - provided for inspection
Yes is a pass Pass Fail
• DUCT DESIGN _ _
ACCA Manual D Design calculations have been
1. ❑ Yes O No completed, Dud Design Is on the plans and dud Installation
matches ptarts.
2. O Yes O No TXV is installed or Fan flow his been verified..If no TXV, t] a
verified fan flow tuatcbes design from CRIR Pass Fail
Measured Fan Flow -
Yes for both l and 2 is a Pass
O 1, the undersigned, verity that the above diagnostic test resuhs and the wont I perforated associated with the orst(s) is in conforamtcc .
with the requirements for cofivIJ tttoe credit (7he builder shall provide the HERS provider a copy of the CF4.& sighed by the builder
crmloyeca a sub -contractors ceafWg that diagnostic testing and iamilation mat tbo tsquirernents for compliance credit. j
Tram Si c, Dak Instaiting Subcontractor (Co. Name) OR
Performed General Contractor (Co, Name)
COPY TO: Btalding Deparment
HERS Provider Cf applicublc)
BmId'mg Owner at Occupancy
Compe't'ence Forms August 2001 a-25
EZ 39dd tPZ6ZBBZ Zb:ST h00Z/80/IT
lei TSTALLATYON CERTIFICATE (Page 3 of 13)
CF -6R
>' a P)-? :lof 1Q
Site Ad rens I Permit Number
DUCT LEAKAGE AND DESIGN DIAGNOSTICS
DUCT LF,"AGE REDUCTION
` Pressorin ion Test Results (CFA! Q 25 PA) •'fan Wkigc (CFM)•&
. Fan Flow
• If Fap Flow is Calculated as 400'efinhon x number of tons, or as 21.7 x Heating Capacity
In Thowands'ot Btulhi, enter calculated value here
If fan flow is measured, enter measured value here ICI
Leakage Fmcdon = Test LeaksO(Measund or Calculated Fan Flow) y
p
Pass if Wimp hudoo < 0.06 Pass
Fail
0 For AEROSOL TYPE SEALANTS ONLY -The follow(ug Magna testing was completed:
Duct Fan Pressutizstion at rough -in rncawed Ietiltage (CFI41).
CHECK AFTER FINISHING WALL:
O Yes 0 No ❑ Pressure pan test or House pressurization test
Oyes ❑ No O Visual Inspection of Duct Connections. ti
.
Wass
Fall
❑ THERMOSrATTt^ )C7CpAIVSION VALVE t"r v)
Q Yes .D No 71tm astaric Expansion Valve is installed mid Access is - piovided for inspection
Yes is a pass g'•
O
O DUCT DESIGN Pass
l+an .
ACCA Msmual D Design calculations have boat:
1. ❑ Yes ' O No
completed. Duct Design is on the plans and duct Installation
matches plans.
1 ❑ Yes d No TXV is insWied or Fan flow hat bees verifitl. If no TXV,
verified.faa iloiv matches dasigo from CML Pass
Fall
Maasurod Fan Flow=
Yes for both 1 and 2 is a Pass
0 I, the undersigned, verity that the above diagnostic tet results and the work I performed absoeiatcd with the tests) is in coofarmaace
with the requiremeers for compliance credit (The builder shall provide the HERS provider a copy of the CF -61k signed by the builder
employees or sub cottttactats catitjhttg that diagnostic, u3tir,g sad ;astalfudoo meet the rcqulm=ts for corr>sibw= cmdit. )
Tcsrs �9 gnaotre, Date histalling Subconowtor (Co. Nance) OR
Cental Ceausctor (Ca :same)
COPY TO: BuddingDeparut>imt
HERS Provider (if applicable)
Buildiag Owac at Occupancy;
Compliance Forms ,,. August 2001
a-z�
ZZ 39Vd 0W88L
Z17:91 000Z/S0/11
�fiCa to ' of YOcc,uJe,-1
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7
17
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w'` '
this Certificate' is issued_ pursuant to . the requirements of%Section 109 of the Cahforn�a� Budding
t r
�Coale,4 certifying.. that; at the time*:of--►ssuance;--°thisr}s'tructure;was, -in °compliance, with`�the�:-�-
° provisions#rof the Building Code• and , the various ;ordniances�the:.C�ty regulat►ng..bu�ldmg
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construction 'and/or use. ;.-` . = t,- • ' y " ' U y i ' °
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44
BUILDING ADDRESS:. 50440-l`
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Building Permit No ' 0402-294
;Use classification S:F.D.
rr i • ; r `
r =T e of Construction: V-NL"and Use Zone: R L 4;
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-Occupancy Group, R-3 .4 4� `}; �,fYf ° - a
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►: r -aAddress:. P.O: 60X'810
Owner-of,Bullding. �RJT-HOMES'LLC
City,`ST, ZIP: LXQUINTA, CA �92253�
z L Y f : ' t, • , By:'TER
� +, , [� . � d" •�.� � �� ,. �a:G.SHOWA
r = Y r �r. Date:: 02/15/05,
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POST IN A CONSPICUOUS'PLACE
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