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0402-290 (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 i tt (190 i45 B Inc A � � 6/30/04 Date YID ! ' "�� 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: Cartier Policy No. STATE FUND 1383906-01 (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, e 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 Ith .with comply with �th6'e.ousions �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. 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) s �4 L - Date 1 BUILDING PERMIT PERMIT# DATE �) f % j VALUATION LOT TRACT q�%ry'" ryy �t� 1�r4 na 7 t `!/ i•� / IDYJlO I�P.,3!d �4D •b�T�Ju�C�10.L ! JOB SITE t APN ADDRESS 50-40.5 VJA + M"11�, ' 77-W,00,i OWNER -- - - - _ - � " - -' - CONTRACTOR / DESIGNER / EN (NEER 4 FXf 110,YMS "LLC RJT 19V `1li�i,.NT9;, DIC:. PO BOX 010 14" r. UNArE � 'D .�s LAQL7W.C.A. CA 92253 Pxiomgw AZ 85034 . (600257.1656 CEL4 4990 USE OF PERMIT MIGLE F,"GLY AT ACM ' SPA, L4)T 11y, PL1A N P28, PURR., I Y' i)OLrS NOT INCI,t)DE POOL' SPA, i WCK WALIA Olt DRiSI1;61►'A.Y APPROACH TRACT CONSThf1G'T1014 31191,00 SF PORCHIPATIO 568.00 SF GARAUICA RPORT 3330 SF E1 171KATIM COST 61? ICONSMSfMON 19IXOM CONSTRUCTION FZR 101 X00 418r0©0 $5fi1,50 PLAN CHECK FEE 101-0)0-439-315 0=46 laily4H"AC:A.L FEE 101.000.421.000 $105.00 ELEC^I':C<JQkL I= 101-000-420-000 $2N.95 P.LUM40 IRE 101-000-119-000 $230.00 STRONG PAO T1014 ?EE >'RESID 101-000-241-000 $19.34 GUM() FEE, 101n000-423-000 $13.00 _- . _ ' - DEVEIX)PER. IMPACT FEE; !$2,001.00 1. ke SUD-TOTAL C01,T YRUC 09 A11D ;P1,M- CSFrX, $4,15.05 USS PRE -PAID F= AL 1E1W' IFFM DUE NOW APR 01, 2004 CITY OF LE! 0U4NTEA FINANCE DEPT. % \r jy RECEIPT DAfE/ j� / r/ I / �\ BY ` -. .> DATE FINALED 1`21' INSPECTO JI / /.� INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings-/ - Ducts Slab Grade -/ - ReturnAir Steel Combustion Air Roof Deck Exhaust Fans O.K. to Wrap Z 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 I C. Final -- — BLOCKWALL APPROVALS POOLS - SPAS 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 T �7/,7— I• Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K for Finish Plaster Sewer Lateral Pool Cover Sewer Connection is, V 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: •- r . NERGY, C. Al E- C �t�n►t�s: --- . R0. Box 621 Ph/Faz (760) 564-2044 RanchoMirage,-_CA 9227Q Cell: (7601.250-1852 Email: DESNRG JAOL.tom CERTIFICATE OFTIELD VERIFICATION AND: DINGNOSTIC.TESTTNG (Page I of 7) CF-4R PALMILLA PH 7 DATE TESTED 11-9-04 Project Title Date 504,05, VIA AMANTE LA .QUINTA, CA. 92253 RJT HOMES ,Project-Address":Builder Name CHAD MEYER 76046646555 ACACIA P-2 3 UNITS Builder Contact Telephone Plan Number RICHARD KROWN760-250-1852 GROUP 5 HERS Rater , Telephone Sample;Group Number #CCNRK613292 I1=18-04 LOT 18 3 OF 3 Certifying Signature Date Sample Lot Number Firm: DESERT ENERGY SERVICES LLC HERS:Provider:. CHEERS Street Address:PAO 113OX' 621 .. City/State/Zip: RANCHO MIRAGE; CA: 92270 Copies,to: Builder, HERS Provider . HERS RATER COMPLIANCE 'STATEMENT' The house was: 9 Tested ❑ Approved as part.of sample-testing but was not tested a+ As the,HERS rater providing diagnostic testing and field verification, I certifythat the, houses.identified on.this form comply b With'theAiagnostic tested compliance requirements.as checked on this form. The. installer "has.provided•a"copy' of CF-W (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 drawban_ ds are used in combination with cloth backed, rubber.adhesive duct tape to seal leaks at duct connections. MINIMUM.REQUIR.E,MENTS FOR DUCT LEAKAGE.REDUCTION COMPLIANCE. CREDIT Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage) Measured l: Duct Pressurization Test Results (CFM @-25 Pa) values Test Leakage Flow, in CFM 48 If fan. flow is calculated as 400cfm/ton.x number.of.tons.enter calculated value here 800 4 'If.fawflow is measured enter measured value here Leakage:: Percentage (100 x Tcst Leakage/Fan Flow) = 6 11 Check Box for Pass or. Fail (Pass=6% or less) ® ❑ +` Pass' Fail THERMOSTATIC EXPANSION VALVE (TXV) ® Yes []-,No,Thermostatic; Expansion Valve is installed and Access is' provided for inspection ® ❑ r D"af ENERGY C,A'D E C Sennces Ro. 86x.621 Ph/Fax (760) 5644044 Rancho Mirage, CA 92270 Cell: (760125.0-1852 + Email: DESNRG 6MOL COM CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of .7) CF -4R l PALMILLA PH 7 DATE TESTED 11-9-04 1 Project Title Date 50-405 VIA AMANTE LA QUINTA, CA. 92253 RJT HOMES iProject Address Builder Name CHAD' MEYER 760'564-6555 ACACIA P-2 3 UNITS Builder Contact Telephone Plan Number RICHARD KROWN 760-250-1852 GROUP 5 HERS Rater. Telephone Sample.Group Number #CCNRK613292 804 LOT Ig 2 OF 3. Certifying Signature Date Sample Lot Number Firm: DESERT ENERGY SERVICES LLC HERS Provider: CHEERS j Street Address: .P.O.,BOX 621 City/State/Zip: RANCHO MIRAGE, CA. 92270 Copies to: Builder, HERS Provider .HERS RATER COMPLIANCE STATEMENT The house was*.,. ® Tested ❑ Approved as partof sample testing but was not tested As. the HERS rater providing diagnostic testing,and field -verification, I.certiify 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) 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 72 If fan flow is calculated'as 400cfm/ton x number of tons enter calculated value here 1200 If finnow is measured enter measured value here Leakage Percentage (100 x Tesl Leakage/Fan"Flow.) = 6 Check Box for Pass or Fail (Pass =6% or less) ® ❑ Pass Fail THERMOSTATIC EXPANSION VALVE JXV) ® Yes ❑ No. Thermostatic. Expansion Valve is installed. and Access.is provided for inspection ®' ❑ P0. Boz 621Ph/Fax (760)564-2044 'Rancho Mirage, CA -92270 Cell: (76.01250-1852 Email: DESNRG Qi AOLCOiN CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7) CF -4R PALMILLA PH 7 DATE TESTED 11-9-04 Project Title Date 50-405 VIA AMANTE LA QUINTA, CA. 92253 RJT HOMES Project Address 76Q-564-6555 Builder Name CHAD MEYER ACACIA P-2 3 UNITS Builder Contact Telephone Plan Number -RICHARD. KROWN 760-250-1852 GROUP 5 HERS Rater Telephone Sample. Group Number #CCNRK613292 11=18-04 LOT 18 1 OF 3 Certifying Signature Date Sample Lot Number Firm: DESERT ENERGY SERVICES LLC HERS Provider: CHEERS Street Address: ,P.O. BOX 621 Copies to: Builder, HERS Provider City/State/Zip: RANCHO MIRAGE, CA. 92270 v HERS RATER COMPLIANCE STATEMENT The house was: ® Tested' 0 Approved as part.of sample testing butwas 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 (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 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 75 If fan flow is calculated as 400cfm/ton x number of.tons enter- calculated value -here 1600 I.f.fan now is measured enter measured value here Leakage Percentage (100 x Test Leaka-cfFan Flow) = 4.6875. Clicck Boa for Pass or.Fail (Pass =6% or less) Pass' Fail ® THERMOSTATIC EXPANSION_ VALVE (TXV) ® Yes - ❑ No Thermostatic, Expansion Valvc is.installcd and Access, is. ® a provided forinspcction Y 4 r LNTSTALLA-TION CERTIFICATE PrILM,1I f F _1 h CF -6R lumber DUCT LEAKAGEANND DESIGN DIAGNOSTICS QUCI' LEA1CAGX RY-DUCTION PressurLation Test Results (CFM ® 25 PA) Test Leaks;c (CFM) —91 Fan Flow If Fan Flow is C:lcuintrd as 400 cWton x numbtrof tons, or as 21.7 x Heathg Capscity in Thousands'o(Btumr, enter calculated value here 'if fan flo%v Is measured, enter measured Value here tip Ftsction =Test LrakajO(Mcaswd or Ua lated Fan Flow) _ a Paso iflcabge hution <0.06 Pass Fail 0 For AEROSOL TYPE SEALANTS O14LY -The following diagaosde testing was completed: Duct fan Prtwuriution at rough -in mcasta•ed leakage (CPW CHECK AFTER MASHING WALL: ❑ Yes ❑ No M Pressure pan test or House pressur=tion test ❑ Yes ❑ No 0 Visual Inspection of Duct Connections Pass Fat? 0 THERMOSTATIC EXPANSION VALVE fI'XV1 b Yes 0 No Thermostatic Expansion Valve is installed and Access is - provided for it specdon Yea is a pegs � O DUCT DESIGN Pass. Fall ACCA Manual D Design calculations have boots 1. O. Yes o No completK.Duet Design is on the plans and duct Installation matches plans, 2. 0 Yes CI No TXV is ctstalled or Fan flow sus been vend led. If. no TXV, t] t7 vcaod fan flow matcbca design Sem CF -11R. Pass Fail Measured Fan Flow= Yea for both I and 2 is a Pass O I, the Ueda -signed, verify that the above diaptostic test n sults and th6 work 1 paioiu associated with the togs) is in confommaoe with rite requirements for comptim= credit (the builder shell provide the H1�tS prOvider a copy of the CF -R signed by the budder employ= ortasb-eoatractms cerd&ng that diagto3dc tatatg ind dastslia O melt the tequirw=ts for comptitmr. asdiL ) Teats Si Date Installing Subcontractor (Co. Nam) OR Lateral Cantraetor (Co. Name) COPY TO. BuildingDepartavnt. HERS -Provider (if applicable), Building Own= at CcY 91 39Cd t7Z6ZBBZ Zb:SI D00Z/90/11 LNTSTALLA-TION CERTIFICATE PrILM,1I f F _1 h CF -6R lumber DUCT LEAKAGEANND DESIGN DIAGNOSTICS QUCI' LEA1CAGX RY-DUCTION PressurLation Test Results (CFM ® 25 PA) Test Leaks;c (CFM) —91 Fan Flow If Fan Flow is C:lcuintrd as 400 cWton x numbtrof tons, or as 21.7 x Heathg Capscity in Thousands'o(Btumr, enter calculated value here 'if fan flo%v Is measured, enter measured Value here tip Ftsction =Test LrakajO(Mcaswd or Ua lated Fan Flow) _ a Paso iflcabge hution <0.06 Pass Fail 0 For AEROSOL TYPE SEALANTS O14LY -The following diagaosde testing was completed: Duct fan Prtwuriution at rough -in mcasta•ed leakage (CPW CHECK AFTER MASHING WALL: ❑ Yes ❑ No M Pressure pan test or House pressur=tion test ❑ Yes ❑ No 0 Visual Inspection of Duct Connections Pass Fat? 0 THERMOSTATIC EXPANSION VALVE fI'XV1 b Yes 0 No Thermostatic Expansion Valve is installed and Access is - provided for it specdon Yea is a pegs � O DUCT DESIGN Pass. Fall ACCA Manual D Design calculations have boots 1. O. Yes o No completK.Duet Design is on the plans and duct Installation matches plans, 2. 0 Yes CI No TXV is ctstalled or Fan flow sus been vend led. If. no TXV, t] t7 vcaod fan flow matcbca design Sem CF -11R. Pass Fail Measured Fan Flow= Yea for both I and 2 is a Pass O I, the Ueda -signed, verify that the above diaptostic test n sults and th6 work 1 paioiu associated with the togs) is in confommaoe with rite requirements for comptim= credit (the builder shell provide the H1�tS prOvider a copy of the CF -R signed by the budder employ= ortasb-eoatractms cerd&ng that diagto3dc tatatg ind dastslia O melt the tequirw=ts for comptitmr. asdiL ) Teats Si Date Installing Subcontractor (Co. Nam) OR Lateral Cantraetor (Co. Name) COPY TO. BuildingDepartavnt. HERS -Provider (if applicable), Building Own= at CcY 91 39Cd t7Z6ZBBZ Zb:SI D00Z/90/11 5 INSTALL AMN CERTIFICATE (Page 3 of 13) CF-6I 7-�r' `A4 L41 Fri It I [A Site Address PermIt Number DUCT LEAKAGE IND DESIGN DIAGNOSTICS DU Ct' LEAKAGE' RED UCJ UN Pressurization Test Results (CF.M r�{. 25 PA) Test Leakage (CFM) Fan Flow . If Fan Flow is Calcul=ed as 400 ettrhon x n umber of cons, or to 21.7 z Headng Capacity In Thousands 'C(Sh lhr, enter calculatod value here If fan flow Is measured, enter measured value here _2-2 .. Icakige Fraction Tat Lakagef(Mtastmd or Cabseluod Fm Flow) a . }� ❑ Pass if hxkage fraction < 0.06 Pau Ings 0 For AEROSOL TYPE SEALANTS ONLY -The following diagnostic testing was coWpleted: Duct Fan Pressurization at rough-in measured lealmge (CPM) CHECK AFM FINISFl1TlG WALL O Yes O No O Pressure pan test or House prmuriza6on test D Yes 0 No O. Visual lnapaction of Duct Connections o a Pass Fail . Q TFfXRMQSTA r E)fpANS1ON VALVE MM O Yes 0. No Thermostatic Expansion Valve is"installed and Access is -provided for insptctioa: Yes is a pass Ir p 0 DUCE DF. GN pass. Fall ACCA M®ual"D Dasiga calculations havc.bom 1. ❑ Yes O No. completed, Duct Design Is on the plans and duct Installation matches pians 2. ❑ Yes O No TXV is inMae d or Fan tiow has been verified. Uno TXV, O past. o Fait verified fan flow matebea design hmn CILIX Ma=ured Fan Flow Yes fir both I and 2 is a Pass G L dtc utile Mpodi verify that the above diagnostic test results and the work I performed assexiated with the t_st(s) is in rnfnr =cr with ft regttireimm for cornpha m a credit (fie builder sball provide the HIM provides a copy of the CF4R signed by the bm'kkr eatpToyeea ortiub-con=tors artitying that diagnostic testing and installation meta the requin:mamants for comptimCa mdiL J Tan Si test, Date hwWlingSubtwntractor(Co.Nano)OR Pa Med Car=d Contractor (Co. Num) COFY I'l} Building Depurenont' HERS Providet Cif applicable) s tolding Oahe at Oocupanry „ Comp lame Forms August 2001 Li 39Vd 17Z6ZBBZ Z17:91 h00Z/90/11 INT'AL]LATION CERTIFICATE (Pa;e 3 of 13). CF-6R Site Addresse� rmit Number DUCT i.EAKA.GE AND DESIGI DIAGNOSTICS DUCT LZAKAGE PLEDUC1'IUN Premurindoa Test Results (CAM (a 25 PA) Test Leakage (CFw-12 Fan Flow If Fan Flow is Calcuwed' u 400 etis•Jton x nwiber of tons, or as 21.7 x Heating Capadry In Thousands'o( BtWhf, enter calculated value here If fan fltsw is measured, erlier measured value two Lcakayc Fraction a Test LeakaFJ(Mcawrsd or Calculatod Fan Flow) p Pass if lwkaga frutim <0.06. , . Pass Fail . O For AEROSOL TYPE SFUL• INTS ONLY -The following dlagnostic tesdng was completed: . ... .. Duct Fan Pcesutrizatidn at lou gh•in measlatd leakage (fes; . CHECK AFTER FIMSFANG WALT.: . 0. Yes 0 No 0 Pressure pan test or House pressurizat0a test: 0 Yes, 0 No ❑ Visual Inspection of Duct Coanw'dons o e . . Piss Fan ❑ THERMOSTATIC EXPANSION VALVE =VI O Yes O No Thermostatic Expansion Valve is instaBod and Access is - provided for inspection Yea is a psss tj ° b DUCT DESIGY Paso . Fa!! ACOA Manual D Design calculations have been 1. O Yes O No completed, Duct Design IS on the plans and duct Installation matches plans ' 2. O Yes 0 No -TXV isinsnilad or Fan flow has beta verified. If no TXV, o Pass ° Pall valLed fan flow matehrs design frm CFLIX - Mcwvred Fm Flow= Yes for both I end 2 is a Pass 0 L the tardctaigtted, verifythat the abevc diagnostic test results oad the work I perfatord associated with the tcat(s) is is ctmfa=ce with dse requircnraIs for wmpliatxc.crcdit (rbc builds"provide the i�RS Fx4da a copy of the Cl -6R signed by the builder etrployees or nub-eoetraetors certifying thu diagnostic thing and installation meet the requirements fnr compliance credit. J f Tau Si ,Date Installing Subcontractor (Co. Naw) Olt Pabnckcd Gentaal Contractor. (Co. Nsrnc) eoFY m- Bru7ding Department HERS Provi4er .(if applicable) Building Owner at Occupancy Compliance Forms Augus12001 ;L-25 . 81 39Vd bZGZBBZ Z17:91 1700Z/90/Li /P 7