0402-293 (SFD)(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
X690645 B TQC A n 6/301014
Date / .��Ei Signature of Contractor t.✓
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).,
( )
1, -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
r ,
WORKER'S COMPENSATION DECLARATION
I• hereby affirm under penalty of perjury one of the following declarations:
(Y) 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 STATE PUN D Policy No. 1$93906.01
(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
Code, I shall forthwith comply with those. provisions.
Date:jl_ r -<irl Applicant • 1 r 4-4 f ' •�.z
v --
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. I
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)_'p fl j' DateZ/%-/- /74
/l
PERMIT # .
BUILDING PERMIT T_. - 1-11
1
DATE VALUATION LOT 0402-293TRACT e `'
JOB SITE /
APN
A
ADDRESS 5&44M `V'.�A. I�INWi'T'E V .
. 772,050.007
OWNER
coNTRACTOR/ ENe3INEER
RN 110 :S 1
;err 3%1`1;ESM&NTS, ,INC.
PO BOX e1"0
1425 I'.."UN1'SM01TY DMS
LAQUINTA CA 92253
PROMOX AZ 85034
(602)p57-1656 MIA 4990
USE OF'PERMIT
(m� �yq��jp pig pp��'q�y/
a T1J�147�,C.l.L' 1: d']dYJ.Y,L Y A A6��d.:AS:wD
SPA.- IAT h, PLAN P7,Et.. PERMIT DOES NOT IM77LUI)E POCI,A SPIE;
BLDCV71rll LSk OR D9t14J:K0AY APPR0.APH i
1
f
°1'I'AC`1' CONSTRUCTION 3;141,90 SF
PMC H/PATIO 313.00 SP
KTP.,.MO ARPORT S:r4.f:0 SF
E"u>m,wirm Con Or CC91b"m'diC'.& on-
1.97,970104)
I'1• -R15 `FE' r`
CONSTRUCT1011 FEE 101.000.4.143.000
PLA.I+IOI'9.W-K.FEE 101-00"0-3143' $81AAS
MECHANICAL FEEZ 101-000-421-000 $105.00
9LECTRICA1, 'VB9 101-00&.420-000 $204.9
PLUMDT'N 3 VER 101.000.419=000 $230.00
S'PROHO tAO TION FEE - R.ESID 101-000-241-000 $1310
GRADING FEE 1.01-.000.423-000
f)EV'.ELOPER.IMPACT PEP p,00I.0.0
Y
_ YYt PS1101:T AVID PLAN C'}3TCK
$4,334.70
LUS I -IM -PAID MOS
$0,00
APR 0 l 2004
1'mmn, ms :Dut-v NNW
CITY,OF LA QUINTA
FINANCE DEPT..
RECEIPT
�QjNT/Er w} f
BY '``
DATE FINALED1
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
61— y
Ducts '
Slab Grade
6—
Return Air
Steel
4—
Combustion Air
Roof Deck
Exhaust Fans
O.K. to WrapQ
_ /p
F.A.U.
Framing
_ rJ —
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
-y
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
7
Equipment Enclosure
Shower Pans
z
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
w R11
-
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) =�
Deseft=
s�
ENERGY
__ C A d E C
S"�
— ,
Po: Box 621
Ph/Fax (760) 564=2044
Rencho Mirage, CA 92270
Cell: (7601250-1852.
Email: OESNRG O)AOL.COM,
,y
.
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7) CF -4R
PALMILLA PH 7
DATE TESTED: 11-9-04
Project Title
Date
50-460 VIA-AMANTE LA QUINTA, CA. 92253 RJT HOMES
Project res&
CHAD MEYER
Builder Name
760-564-0555 ACACIA P-2 3 UNITS
Builder Contact
Telephone, Plan Number
RICHARD. KROWN .
760-250-1852 GROUP 5
HERS Rater jj_, ,
Telephone, Sample Group Number
Certifying Signature
Firm: DESERT ENERGY SERVICES LLC
Street Address: P:O. BOX 621
Copies to: Builder, HERS -Provider.
11-18-04 LOT I1
Date Sample Lot Number
HERS Provider: :CHEERS
C41St1te2ip: RANCHO MIRAGE, CA. 92270
HERS RATER COMPLIANCE STATEMENT
The house was: ❑ Tested. ® 'Approved as part of sample testing: but was not tested
As the HERS rater providing.d.iagnostic testing and -field verification, I certify that the houses:identified on this form comply
with the diagnostic.tested compliance -requirements as.che.eked 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: returns in.lieu of ducts)
❑ Where cloth backed,, rubber adhesive duct -tape is,installed, mastic and drewbands 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,(g 25 Pa)'
Test Leakage Flow. in CFM
If1an flow is calculated as 400cfmiton x numberof tons enter calculated
value here
M
easured
values
If fan flow is measured enter measured value here
Leakage Percentage ('100 s Test Leakagc/Fan Flow) _
Check Bos for Pass or Fail (Pass =6% or lets) ❑ ❑
Pass Fail
❑ THERMOSTATIC EXPANSION.VALVE;(TXV)
❑ Yes ❑ No Thermostatic Expansion Valve is nstalled.and.Access is
provided:for inspection ❑ ❑
n
NS Y AlL:'�iTSON CERTIFI : AlrE (Page 3 Of 13) x' —
�' a/:►, // a P /+ .7
Site Address • P=r.mit Number
DUCT LE.A.K4GEALND DESIGN DIAGNOSTICS
• Ul'ii:T L,L41ACrLr it11))UG"1'lQ..)t�! t
piouurisatlon Tesf Results (CFirI C 25 PA) Trst Leakage (CFtvi) '? 3
Fan F:ow
If Fan Flow is CO.-Azted as 400 drWton x ntznbr oft= or zs 213 x FImtir_g Capacity,
In Thousands of ehnfnr, enier calculated value here
if fan tlow,is measured, enter measured value here W9'
Lana;. Fraction = Test Leak vlNeastr;cd or Calculates Fez Flow) _
Pau iflealage tiacdon <0.05 Pass - Fag
t For AEROSOL ME SEALANTS.ONLY -The following diagnostic testlag was completed:
Duct ];an Pressu�ion at rough -in measured leakage (CF?v1)
Cf= AFTER FIMSHIKG WALL.
0 Yes ❑ No 0 Pressure pan test or House pressurization test
Dyes ❑ No 0 Visual Inspection ofDuctConnecdons o D
Pass Fail
` I THERMOSTATIC F. &SIOIV YALY.F TXV1
PI Yes 0 No Thermostatic Expansion Valve is installed and, Access is -provided for inspection. '
Yes is a pass
Pass Fall
o DELT DESJGN
ACCA Manual D Design calculi ions have btsn
1. ❑ Yes. 0 No completed, Duct Design Is on the plans and dud Installation
matches plans.
Q o
2. O Yes 0. X10 TXv is instaflcd or Fan now bas ben varifia If oo TXV, ?AM Fall
verified fan flow matches d--dp from CRIB.
Measured Fat Flow
Yes for. both I and 2 is a Pass
t] L.tbe undcrsIS4 verily that the tbove diognostic test resutC sad the work I pe: farmed associated, with the tests) is in conformance
with dw requiretneats for eompGsactr credit. (The builder shall provide the HMS provider a copy of the CF -631 signed by the builder
employees or sub-aontraators txrafying that diagaosdc testing and k5tallation inert the tegtdi rents for eorrg lianas credit. )
c-
T,;= -' . 5 Date Installing subcontractor (Co. Name) OR
Pafatmad Ommil Contractor (Co. Nemo)
COPY To: aiind'tngDcpwmiertt'
-MRS Provider (if: applicable)
Building Owncr at OccuyatuY
t L • L_ f TON CErR �� : E Game sick is) i;L
PA/tet;//a PA ,7 Lof
She Addre"ss Permit Nurr:ner
DUCT4�E DESIGN �iIAGNOS'7CS
1)it(••'I'LEAKAGE EQU(l'1()N
Pessuri:atioa Test Results�'(0MaC :> PA) 7-rLzamsc
F:n x7ow -
U Fin F1ow'is CaliW- ted a 400 cWtcn x numbs of trs, or rs 11.7,x licadnL Capaciiy
in Thousands of elulht, enter calctaated value here
-If ffmn fIs measured, anter measured value here _]2,
tcloulgc Fracaor. = Test or Calculated Fns Flow) _ D
Pus iflefl7mge-11oti <0.9ti Pass Pafl
For.4EROSOL TYPE SEALANTS ONTY -The fonowing diagnostic tasting was completed;
Duct Fan Pressurizadon et rough -in maustsred leakage (Cirlvt7 r
CHEM AFTER FL'MSMNIG WALL:. ,
t7 Yes. O No D Pes=opan test or House pressurt�mdan rest
I Yes, o. No O Visual Inspection of Due: Conaeeuoas o o s
Pass Fill
g
TMMM0STATICMANSILDN VALVE MM
Yes 0 No -Thumotuatie Expansion Valve is instellc-d and 4is - provided for kspetxicm
• 'Yee is a past � p '
Pass FkU - .
O D_UCT DESIGN --
AOCA Manual D. Design wlciriedow have bxv
1, a. Yes o No . aomplated. Duct Design is on tho plans and duct tnstallailon
mat:tm plans.
?. ❑YesG Isio rxV is installed or Fan flow bss bees 19ABed If no TXV, Pass Fal)
verified fan flow tna�ehes drf P from CF -M
Yes i 6r both 1 and 3 is a Pass `
O I, the undasipm. verity that the abovo diagnostic test rsalts Rod 1130 work I padet3sed sweooiated with the tmi(s) is in confor=ce
with themuirerorata for compSRme credit [rho bald:r sball provide the BEERS provide a copy of the CF -6R signed by tho builder
t:nployas tv sub cbntiacuui cer*ip.- that diagaostie ms* and itt Wilson m;d the reg3dremcats for cott�li0aee asdit j
Teta S' D= Installing SUb=12 naor (Co. Nemo) OR
Pafort0cd GmtW Contra= (Co. Name)
CQ°Y 70:. Hug&g De utrruat
QRS Provide (if ; applicable)
Building Owncr"at Occup-oY
C=plit nce Form. Auguzet3001
00 39Cd bZ6Z88Z 817:L0.'1700Z/9T/TT
b
Site Address ?=rani. NurbEr
DUCT LEA-YAGE AND DESIGN DI LINOS T+CS
Preucri=ftn Test Rmmlts (CFM aQ ":--PA) GR L_- J ge (CFM4
Fsa i-iow
LrFa•i Flow a Caiarlat•a :; 4Q0 eftnhon x number of oris, ores?:.7 x Hca d czpaziy
in Thousands of WWI enter' c_IatlEted value here
If fan Pow Is measured, enter measured value here.?
Iia;c Fraction = 7ert L:aeegc((Meu;ned or Calculated Fan Flow) _ � D _
Pew ifl=IMge cra don <0.06 Psss Fait
0 For:gF.iZOSOL TYPE SEALANTS ONLY -The following diagnostic testing was completed;
Duct Fan Ptn:amization at rough -in measured leakage (CENT),
cHECIC AFTER FINISENG WALL:
Dyes o No Ei Pressure pan test or House presswization teat
D Yes 0 No 0 Visual Inspection of DuctConneetions o 0
Pass 'Fail
TWLMOST4TIC EXPANS)<ON VALW t'fXVI
Yes 0 No `Thermostatic Expansion Valve is inaOrd and Access is - provided for inspe;t5on
Yts is a peas :P= Fail
0 DUfaLi 9G—N
ACCA Manual D D;siga calcuMOM have b• -en
1. l7 Yes ❑ No completed; purl Design Is on the P13M and dud lhstaliation
matches PIUnL +
3. 0 Yrs 0 No' TXV is buWlcd or Fan Cow bas baa var&4 If no TXV, Pas Fail "
varificd f= flow matches dmiga from CRIB
M=urcd Fan Plow -
Yes for both I and 3 is a Pass
D L the imdasigned. verify that the above diabroostic test raubs and the work I paKottA !assn. -Toted with the tcst(a) is. in coniotmanca
witbdiG rrquirer=a � compliance credit l' U bmlder shall provide the mini S provider a copy of the CF6R signed by the bvilda
cmployeta or czti"g that diagnostic testing cod insWklon m* @r rcq*ennats for corrrpiiante ottit. ]
Tun Data iaaWbg Subcaataaor (Co. )hme) OR
p�yngad General Ccntraemr (Co. Name) "
=vY"TD: 9m'Iding DepwUnent
HERS Piavidar Cif appacabie)
Bidlding Owner at Occupancy.
Compiianes i-orns August 2001
S0 39tid VzGz88Z `80:40 V00Z/9T/TL
a r• _T j,c� `�~'� .4. w fr.� r. •7 �. .• � �" tii '. `} •.",J
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Vo
��� as J"'Certi•flca'te•-of�Occu ancICyv..�
D ' U _ G '•s-' •.. r '. tris • - `+`' ��I���7 r �' l . 1' r r•
(�7 .,.� i R ` y7 . ^' `r r.Sr � { � ,74 f .~ ,� 3rn tiJ t'�, .?. �� s •� r' `•�
l �� ��' �L�j ; � 3. a 'j y'�+� .'dr' �'' r'J '=L fit'. ^�.• � �' i �. ` � * +�� y� �j �• '�•'� 4' 4 _' i
- 4Bu�ld�n &StSafety:Department s:�:: t
~- X50 �.�. T' •� -, �•y �, .'/' �.. - _ r-r�.. • fi �- is �r� - n• • :i ` M- '! ;s ,;1,: .` }K ��'`":« '
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f• �y" =.r�.t- t- -"#•. - ,,..1 ; _ .j ,�Y a• ai� l iL4 •A,4 :Gu,�„ c, 'i- c '• „�y ,. • i v: _ �. -5.: _ .,i, , ti•::p u z , �* *• �.
This_Cerrificate �s=issued pursuant to the requirementsrof Section :109of the; California Building
�Code,� cerci �ng� liaf;ti at.�the� time�`of issuance; _'this structure was' in .compliance with- the
,. _ r }regulating building
; ° provisionsof the, 'Building" ;Code and tlie`,
various. ,ordinances of `;the. City
construction and/orFuse.
tf+" " • � 'tel »� .y . , ..� ' �� �i .'CF r ��i•� '
•r�•.Y ' 1 � �, - _ ¢ 'r' '1.; i..�i.,
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- < v Y�-.., u �, '• �. . y .i,� . !!`_ ; . �-� ; 4 •' t.f t rte,'"•
=� BUILDING'ADDRESS : 50-460`Via`-Amante�
M . _ � ' � ` '* � , T•,,.A;a C'.f •. o - ,-rt•.;' 'a, ,rt �-+ � �'�.- � ''F i- _' ,; �' ' ^s t.. .r , G , '� r „ n ..: � �-`� "``'� .
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,.°>�p ., zya ; �;.� r�s�' a "� ��y�Bu (ding Permit No:: 0402-293 «.
�-,Use,,classiflcation: •S.F D ,• `�,.� :' '� ,
.: . Fcf ,� �,, . • � �i .,.7 .• 'r ,y.t : '.-- ;W � a 'tF - ` ,. �>ti, :.:r �- � ,�, .i. W r Ci.1
' R 3` ,�` {-. Type'of Construction V=N';. ' �, Land Use ZoneR L y
Occupancy Group; ; =
_ Y r . _ rJ '4 � . �+". - •`s �. c , i r�• Y: +�'i - �- J'.ti, h -a.. y - ... �_ � rr; ~ " w.. � •• �� - a �,.; r r { � d S, � . �'� q' �� ,-.
j ?i gS;yt t. ..- : ."a• +¢� -, t `1 . r� •. `'..-} 1{.^ it '`M,4 Y. Z- a r ` r a �' �y��,
,awl', _ �� .`. mac] . _ .. T"'a. "� ..- y 1�'% �• ,� �y ..• . � i, � p? `u .'• � ,�N P! S� �� .Yj t �''` r `A" i
C n 3 ri� e `• , F . " , s?'.. i% C'- rC `Or "„r` .�_ y w y i... �, C t,7' ti-�y ;y� ,i -41
�'. -r 1 4r J
Owner of,Build ng: -RJT HOMES LLC t= ` ` '{Address: P.O .BOX, 81 r 4�3
CA
Cit ST' ZIP.: LAQUINTA*'t,92253.
fi.4r .+'• -'.. i� i9 Ciet"_'. -';:'' �-' -` ��*Yr- ",•' •� _� ,w -
s, ,�� 3' a = ' '�=� x• ':mp ' ''` _,;'c
By G.SHOWATER
l ' ^ � F �� iJ V. 4-. JY • - iMY v C 'y J • rr � R�.• v 1.r "•., 'S [�, � .f'+-. i � ' n 1 .. „� V . -w t f �i• ,f
., `!V_tr•` _ :� b. . r
�,' -`h �.tw ti°u�. r �'r •"r•',- �-Date , 02/15/05' '
w Building0ffi I �- "- .,��`�, _ ,`�
r-• ;'Z.�}^"` t� ,' i•*. tY�� • „Y .-� r• ` + -t �., �Y • u V _. !
j':-` {i 7� `"i-': ..,••c•�-�• �w t, 1' �t'•' .,' „� .�, -'�r� ?t -i ;y°�th�.�+`�
cap'P ST IN A CONSPICUOUS PLACE Ye *k ' tr'
koa• 3
ry\
�r ?�, y •r t..; s ,.Y v z-,?�„'' q,, •C'ir tT 3"� x.�'�+'�✓� f a'i"Y',y�l}' r_3- L +
way _ _ ;y.. .� -:ice '� • f.,. f.J .,r tl'�j?,.'�,:. Js`_ -•s +. .�"�,•- s'r.. .ti. kS . ,i -