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0402-292 (SFD)r LICENSED CONTRACTOR DECLARATION •1 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. Licenge # Lic. Class Exp. Date 69W5 :13 ITEC A � 6/30104 Date/4', -QU 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: Carver Policy No. STATE } UND i S6."sq�?6-41 (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, 1 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 thosg)proGisions. n Date: 14 2 -rf .1L.. Applicant C7t— '�,V2-ti {st aC 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 forinspection purposes. Signature (Owner/Agent ` Date /L BUILDING PERMIT PERMIT# !l� DATE / UATION LOT 0-292 TRACT 8199,734.90 16 2984-2 JOB SITE/AP N ADDRESS .CDA7�(11L\,G.Ca OWNER CONTRACTOR/DESIGNER/EN 1NEER PIC Hot". 'L JW Pif" INwiwwl—S, wea PO BOX 810 1425 L, UN.TMMTY DRIVE x.. 1~Tihri'A CA 92253 r1 CI1 � xV 8SO24 (602)257.1656 (,BL # 4990 USE OF PERMIT 'ELLE F'A1+e3MY I?i)<IE,I.,%.INO SFD . 1,OT 14, l')LAN P3A'ai;. PE12M1'I' DOES 140T INCLUDE POOL, SPA, BLOCK 1V,/ IGW, OR DMEWAY.APPIZOACH1 TRACT CONSTRWCVOIi A23 -U0 3F P011 HIPATIO 773.40 Sir 4%RI;AGWI:ARPORT $69,00 3' 'ESIMATM CIDST 011, COM. ICUM 199,734.90 :t'F: i'fr To SAWY1f:ARY C014STRIJCTION FAE 101.000418.000 $993.10 PLA14 CHECK "0 101-000-439-319 $513.37 Mp(:I- NNICAL FEE 101.000-421.000 173.00 XL ECTRI.C.Al, IF17, 101-00.0-42,0-000 $201.:30 P'l,L'AA. k3II40 PEI? . 101.000-419.000 $100,00 5T$ONO MOTION fr#& , RESI1.3 1312.0'110-241-000 $19.917 t3R1J13YNO F&.R 101-000-42.3-000 00-423.000 i15.00 laF,VJADPER. IMPACT ME $2,405.00 -�. ot7si°I to AND PL W C 1' $4,717.34 ;;kMt 1 3.' :�..F6 DUS NOW APR 0+�� $4,71-7.3 9 CITY OF 1QUENTA DEPT. FhiANCE /*��, `` ,f �• RECEIPT DATE I !% / BY / DATE FINALED INSPEC R INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR • BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings A Ducts Slab Grade —ti Return Air Steel S Combustion Air Roof Deck Exhaust Fans O.K to Wrap K ?i 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 42 Final Final POOLS - SPAS BLOCKWALL APPROVALS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Pibg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines 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: Final 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) .PO. Box 621 Rancho Mirage, CA 92270. E*mail:.,DESNRG.6A0UC0 Ph/Faix -(760) 5642044 Cell: (7601250-1852 CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7) PALMILLA PH -7 DATE TESTED 11-9-04 Project Title, Date 50-4'45.. 0445, VIA-AMANTE LA-QUINTA, CA. 92253 53 RJT HOMES rrpject Address . : . Builder Name CHAD MEYER 760-5646555 PALO BREA P -3X 2 UNITS Builder'Contact Telephone!. Plan -Number -RICHARD KROWN 760-250-1852 GROUP P 5 HERS Rater Telepbone Sample Group Number #CCNRK613292 1 LOT 16 1OF2 8:04, Certifying Signature Date Sample: Lot Number Firm: DESERT ENERGY SERVICES LLC HERS Provider: CHEERS StreetAdd(ess: P.O.,BOX621 City/State/Zip: RANCHO MIRAGE; CA. 92270 Copies to: Builder, HERS Provider HERS RATER COMPLIANCE STATEMENT The house was: R Tested, E].' Approved as part of sample testing but was not tested q As the HERS rater,providing diagnostic testing tasting and field verification, I certify'that the houses. Weritified.on this form comply With the diagnostictested compliance. requirements as checked on this form. The installer has provided a copy of CF -6R (Installation Certificate.. Distribution system is fully ducted(ke., 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 usedlin combination with -cloth backed, rubber- adhe'siVe, duct tapeAo seal -leaks at duct. connections, MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION. COMPLIANCE CREDIT Duct Diaignostic Leakage Testing Results.(Maximurn-6%Duct Leakage) Measured Duct Pressurization Test Results, (CFM. @ 25 Pa.) values Test Leakage Flow in CFM' 72- Iffan flow is calculated as'400cfm/tdn.x number of tons enteic'alculated value here 1606 If ran now is.measurcd enter measured value here Leakage4.5 Percentage ( 100 x Test Leakage/Fan Flow) Chqdk Box for Pass or Fail (Pass =6% or less) Pass Fail THERMOSTATIC EXPANSION -VALVE (TXV) Yes No Thermostat.ic:Expmion Valve islinstalled .and Access is provided -for inspection I . t7A D �-- L ENERGY ��� -- C A D E'......... C ' S M Boz 621 PWax• (760) 564-2044 Rancho Mirage, CA.92270 Cell: '(7601.250-1852, 'Email: DESNRG.PAOL:COM CERTIFICATE-OFFIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7) . CF -4R PALMILLA PH.7 Project Title -50445 V,'IA 'AMANTE LA QUINTA,-CA. 92253 Project Address CHAD MEYER 760264+-6555 Builder Contact Telephone RICHARD: KROMIN 760450-1852 HERS Rater —,�q - Telephone - Firm: DESERT'ENERGY SERVICES LLC Street Address: P:O. BOX 621. DATE TESTED 11-9-04 Date RJT HOMES Builder Name PALO BREA P -3X 2:UNITS Plan Number GROUP 5 Sample Group Number LOT 16 . 1 OF 2 Sample Lot Number HERSProvider: .CHEERS _ City/State/Zip: RANCHO 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 As the HERS rater providing, diagnostic testing. and field verification,.l certify that the houses identified on -this form comply with1he. diagnostic tested compliance.requirements as:checked on this form. 0 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) 9 : Where cloth backed, rubber:adhesive duct tape is installed, mastic and drawbands are used in combination with cloth backed, rubber adhesive duct fape'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 ResVis (CFM 6 25 Pa) Measured values Test Leakage Flow, in CFM 105 If fan flow is calculated as 400cfm/ton x number of tons enter calculated - value here 2000 If fan now is measured enter measured value here Leakage Pcrccntaae, (100 x Test Lcakagc/Fan Flow) = 5.25 Check Box for Pass or Pail (Pass =6% or less) 01 0 Pass Fail ® TFER.MOSTATIC EXPANSION'VALVE.(TXV) - ® Yes 0, No Thermostatic. Expansion Valve ivinstalled and Access is provided for inspection 4. ITi _ ;.� Via%.+,,'//a A .�, . 5t!2 Aj asu DUCT LBA L Gl 4:.1 DULaJOh' '.ns 1UJz_^ I!a a Ts: R:st:i:s (C-FM C a P?) if Fen Flaw is Calcula•^a s 430 e.•irdtcn x nur.. ,:r of w:s, cc s 21.7 x H=tiag Csaiy in Tho-isartcs of Btuthr, anter ealcalateti valua here ' ' if fan fiow Is measured, enter mersure� value here Uzxhgc Frnrion = Te.. L r�!(Mcasured or Cal:u)a:ad Fan Flow) Paes C leJ3g: ~scam < 0.06 ?ass Feil 0 For AE.r.OSOL ME SEALANTS 0.. _Y -The following diagnostic testing was cotnplettd: Duct Fan PrssarL�ion at rough-in r xsured leakage (CFhf) CHECK: AFTER FIMSEIG WALL: 0 Ycs: 0 No G Prcsst= pzn tat.or House pressurization -est o Y.-s, C1 No' Q Visual Iasp ction of DuctConneodoas ❑ Pass Fail ' TRERMOST TIC EXPANSION VALE Yes 0 No Thtrmstaiic ixpan:ion Valve is ire :lied zn : Ae:.ess'is - provided for ins cdon Y Ya is a pass - O O nirCT D IGN PW Fall RCCA Manuel D Design calculgdone have keen 1. rJ Yes ccmpl;ted, Duct Design Is on,the plans and duct Installation matches Plans. 2. C Yc6 G .No . ?XV is installed or Fen flow bas ben verified. if ao' Xv.° o vea5cd lac flow rnatch:s dwige iwo CF-UL Pan Fall H=ured Fan Flow Yes for both 1 zad 3 is a Pass D I, tbs irnddrsi.-ned, veri*y the: nc.- above diagnostic tcst re,ulla and iae wort [ ptxiamtrd associated tvtth the test(s) is b: coniem�.•ice %4tb dw requirernzats for complizooe credit. Fa builder W provide the FEZ provider a copy of the CF-6R signed'iy builder crnployeti.or sub-contnaors oerdfying.that diagnose kstiag a<►d instt lxdcn taex tfic cequirentents for corrgfience er lit ] the Tut: �' ,Date lumaing Subcontractor (Co. Wimc) OR Faiesmsd General Coarraeror (Co. Name) COPY TO: HuildingA:psttr nt K--PS ?rovidcr (if-:applicable) 8tcltlirg Owner= Osjpancy �cmpiianoe Po."s lv;gst' Ji ' t z6z88Z Sti : i p v©@• :'9 i , ; _STEL ATION `.CERTIFITCA E (�a,ae 3 of 13) Site Address Permit Number UCS' LEAK-WE A -D DESIGN DIAGNOSTICS DUCI.' LEALKAG REl)U4'1'1UN Pressuri=t Ion Test Results (CFN; @ 25 PA) 'rest Lcaks;c (CF4•19 Fit Flow If Fan Flow is Calculat:d, as 400 clir►hon x number of tots, eras.? 1.7 z Heating Cacciry In Thousands of Bkft, anter calculated value here If fan flow is measured, enter measured vElue here ,fib Leakage Fraction = Test L hj;e/(Meaautad or Calculated fan Flow) = ❑ Pass ifleilmge E-uctim <0.06 Pass ;Fan e For AEROSOL TYPE SEALANTS OlfLY -The following diagnostic testing was completedt Duct Fan Pressurization at rough-in measured leakage (CFM) CHECK AFTER FE]ISMNG WALL: 0 Yes 0 No 0 Pressure pea test or.Housc prrssurim6n. test 0 Yes ❑ No 0 Visual Lmpection of Duct Connections o ❑ ' 1 THBRMOST4TIC EXPAN4 01`4 VALVE fTXV) Yes ❑ No thermostatic Expansion Valve is iastalled and Access is = provided for inspection Yes is a passPass n ❑ DUCT DFS CN Fail RCCA Manual D Design calculations have been 1. 0 Yes ❑ NoDuct Design Is on the plans enc duct Installation maishes plans. 2. 0 Yes 0 No :TXV is installed or Fan flow has been vesifi6i if no TXV, Pass Fail verified fan flow matches design from CILUL Memured Fan Flow = Yes. for both 1 and 2 is a Pass ❑ b the undersigned, verify that the above dingnostic test results and the work 1 perionncd a6enciutt:d with the tests) is in confomta:cc with the rcquiserneuts for complittsce credit. ['The builder shall provide the HERS provider a copy of the CF-a npod by the builder . employees or sub-contractors certifying that diagnostic testing and installation rnti the rcgruiements for eerrrriliaaec credit- J Tuts '.S' ature, Date tastalling Subcontractor (Co. Name) OP. Perfonaed General Contractor (Co. Name) COPY TO: Building Department HERS Provider (ii appli6ble) . 'Building Owner at occupancy Compliance FormAugi st2001 a-25 ZO 3Jtid ttZ6Z88Z 8b:L0 1700Z/9T/TT'