0306-203 (SATT)U)
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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
B �I e l�n,t� ! �
Date Signature of Contractor
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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 issugP�{ Ally orkers' compensation insurance carrier & policy no. are:
Carrier I.ra'I'L Y fi 1^? Policy No. tv�:i''lftb-ti�;
(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' compensatiori provisions of Section 3700 of the Labor
,Code, I. shall forth Iwith comply with those provisions;
Date: % jL `f :Applicant t. f c` i
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.
M.
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,tcrthe building
construction, and hereby authorize representatives 'of this City to enter upon/
the .above- mentioned property for inspection purposes. r
Date
Signature (Owner/Agent)
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BUILDING PERMIT PERMI0306-2013 7
DATE VALUATION �:��/t.�,'� .E LOT it TRACT 19Ei0f•.`1
JOB SITE 79 -905 DF ROL rN, SOL
APN 772-490-011
.ADDRESS
OWNER
CONTRACTOR DJEESIyG/NEERp//!E�N761NyEERR�
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USE OF PERMIT
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2 b 20.03
CITY OF LA QUiNTA
FINANCE DEPT.
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RECEIPT
DATE r' j rJO
By_!S'^
DATE FINALED
INSPECTOFfe—
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
- i -
Return Air
Steel
Combustion Air
Roof Deck
p - / 5
Exhaust Fans
O.K. to Wrap
// / _
F.A.U.
Framing
%
Compressor
Insulation
- - p3
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 O
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
Heater Final..
Water Piping
Plumbing Final
Plumbing Top Out .
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
-y -
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) ,.
COMMENT : -r-e� C%; 9 :r>
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INST,
CER7'iFICATE
(Page 3.of 13) CF -61Z
Site Address �. -� . Permit Number.
DUCTIEAKAGE AND DESIGN DIAGNOSTICS
DUCT LEAKAGE RKDUCTION
Pressurization Test Results (CFM ® 25 PA) Test Leakage (CFM).
Fan -Flow
If Fan Flow is Calculated as 400 cfm/ton x number of tons, or @s 21.7 x Heating Capacity
In Thousands of •Stufnr, enter calculated value here
If fan flow Is measured, enter measured value here
Leakage Fraction -Test Leakage/(Measured or Calculated Fan Flow)
Pass if leakage fraction <6.06 Pass Fail
O For AEROSt7L TYPE SEALANTS' ONLY -The following diagnostic testing was completed:
Duct Fan Pres§urizad.on at rough -in measured leakage (CFM)
CHECK AFTER FINISHING WALL:
O Yes .O No O Pressure pan test.or Hot se. pressurization- test
O Yes O No 0 Visual Inspection of Duct Connections o Q
Pass Fail
V TFIERMOSTATIC EXPANSION VALVE ('FfCVI '
PYes O No Thermostatic -Expansion Valve is installed and Access is - provided for. inspection
Yes is a pass A . 0
q UCT DESIGN Pass Fall
D
ACCA Manual D Design calculations have. been
L O Yes O No completed, Duct Design Is on the plans and duct Installation
matches'plans.,
2. O Yes O No TXV is installed or Fen flow has been verified. If no TXV. O o
Pass Fall
verified fan flow matches design from CF -IR.
' Measured Fan Flow s
Yes for both 1 and 2 is a Pass
O I, the undersigned, verity that the above diagnostic test results end the work I performO associated with
.tire test(s) is in conformance
with the requirements for compliance credit. Me builder shall provide the HERS provider. a copy of the CF -6R signed by the builder
employees or sub -contractors certifying that dia' ostic.testing and Installation meet the iequirements for compliance credit. )
Tess Si ature;-Date "�Iru�talling6contractor (Co. Name) OR
Perforn�ed General Contractor (Co. Name)
COPY. TO: - Building Department
` HERS Provider (if applicable)
Building Owner at Occupancy
INSTALLATION CERTiFICA.TE (Page 3.of 13) CF -6R
DUCTALKAGE AND DESIGN DIAGNOSTICS
DUC'1' LEAKAG A REDUCTION
Pressurization Test Results (CFM Q 25 PA) Test Leakage (CFM)
Fan -Flow
If Fan Flow is Calculated as 400 cfm(ton x number of tons, or @s 21'.7 x Heating Capacity
In Thousands of •Btulhr, enter calculated value here
if fan flow is measured, enter measured value here
Leakage Fraction -Test Leakage/(Measured or Calculated Fan Flow) = -
0
" Pass if leakage fraction <'0.06 Pass
Fall
o For AEROSOL TYPE SEALANTS ONLY -The following diagnostic testing was completed:
Duct Fan Pressurization at rough -in measured leakage (CFM)
CHECK AFTER FINISHING WALL:
O Yes D No'. O Pressure pan test.or House pressurization test.
O Yes O No 0 Visual Inspection of Duct Connections o
0
Pass
Fall
•0I2THERM0S1ATICEXPANSI0NVALVE'(T2W _
a'Yes' O No Thermostatic Expansion Valve is installed and Access is -provided. for. inspection
Yes is a pass
Pass
o
Fail
O DUCT DESIGN
ACCA Manual D Design calculations have, been
1. O Yes ONO completed, Duct Design is on the plans and duct installation
matches plans.,
2. O Yes O No TXV is installed or Fan ftowAss been verified. If no TXV, 0
Pass
0
Fall
verified fan flow matches design from CF -IR.
_ Measured Fan Flow=
Yes for both I and 2 is a Pass
0 1, the undersigned, verify that the above diagnostic test results and the work J performed associated with.ttie test(s) is in conformance
with the requirements for compliance credit. [The builder shall provide the HERS provider.a copy of the CF -6R signed by the builder
employees or sub -contractors certifying that diagnostic.testing and installation meet the ivquirements for compliance credit. )
08
Tesa - re;- ate Insta Ing�SubW(Co. Name) OR
Performed General CName)
COPY TO: - Building Department
HERS Provider (if applieabley
Building Owner at Occupancy
A-.25
quyust 2001
comm Foffn 0
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INSULATION CERTIFICATE
This is to certify that insulation has been installed in conformance with the current energy
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regulation, California Administrative Code, Title 24, State of California, in the building at
79-905 De Sol A Sol, Lot 109, La Qulnta, Califomia
y'
CEILINGS:
TYPE: Batts MANUFACTURER: Certainteed THICKNESS: R-38
WALLS;
TYPE: Batts
MANUFACTURER: Certainteed
GENERAL CONTRACTOR: RJT Homes
THICKNESS: R-21
LICENSE#:
BY: TITLE:
PARAGON SCHMID BUILDING PRODUCTS, A Masco Company LICENSE # 221517
BY: bz.1TITLE: ACCOUNT REPRESENTATIVE DATE: 2/18/2004
fnw:a�swc r'r%�a!vw.9sro»•v:.m�s�r+�rsfvt4wbxWtr.:e!zna+xcavfara!arc»��wA,v.:a�:am...sev�+x+si!acae!�scsv�ntsiva!ssaca!cefre!;sv��wuet�ra+su2vcstw-:rs�w»'acax'x'v:uw.v�vr.�rrv:+;vtv:l..v: �x.:� �rs�
7
INSULATION CERTIFICATE
G
s This is to certify that insulatio has been installed in conformance.with the current energy
regulation, California Adminis ' e Code, Title 24, State of California, in the building located at
Y �
CEILINGS:
TYPE: Batts X�RE
teed THICKNESS:
WALLS: TYPE: Batts teed THICKNESS:GENERAL CONTRACTOR: LICENSE # Y
;r.
BY:
PARAGON SCHMID BUILDING PRQ(DUCTS A Masco Company., LICENSE # 221517
BY: rrITLE: ACCOUNT REPRESENTATIVE DATE: 2/18/2004
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CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7) CF=4R
.q
PALMILLA 03-27-04
Project Title
50TH & JEFFERSON
Drill► &de'MbRGAN
Builder Contact Telephone
RinwApn KRnwAI 760-250-2084
# CNNRK613292
Certifying Signature
Firm:DESERT ENERGY SERVICES
Street Address: P.O. BOX 621
Copies to: Builder, HERS Provider
Telephone
Date
R J T BUILDERS
Builder Name
PALO BREA P-3 2 UNITS
Plan Number
GROUP 2 2 OF 2
03-27-04 LOT # 109
Date Sample House Number
HERS Provider: CHEERS
City/State/Zip:
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 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 90
If fan flow is calculated as 400cfm/ton x number of tons enter calculated
value here 1600
If fan flow is measured enter measured value here
Leakage Percentage Q 00 x Test Leakage/Fan Flow) = 5.625
Check Box for Pass or Fail (Pass=6% or less) ® ❑
Pass Fail
N THERMOSTATIC EXPANSION VALVE (TXV)
® Yes ❑ No Thermostatic Expansion Valve is installed and Access is
provided for inspection ® ❑
Yes is a pass Pass Fail
•
•
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7) CF -4R
PALMILLA 03-27-04
Pro ect Title
05'TH BddJEFFERSON
&AR q&,�rMbRGAN
Builder Contact Telephone
RICHARD KROWN 760-250-2084
# CNNRK613292
Certifying Signature
Firm: DESERT ENERGY SERVICES
Street Address: P.O. BOX 621
Copies to: Builder, HERS Provider
Telephone
Date
R J T BUILDERS
Builder Name
PALO BREA P-3 2 UNITS
Plan Number
GROUP 2 1OF2
03-27-04 LOT # 109
Date Sample House Number
HERS Provider: CHEERS
City/State/Zip: 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 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 116
If fan flow is calculated as 400cfm/ton x number of tons enter calculated
value here 2000
If fan flow is measured enter measured value here
Leakage Percentage (I 00 x Test Leakage/Fan Flow) = 5.8
Check Box for Pass or Fail (Pass=6% or less) ® ❑
Pass Fail
® THERMOSTATIC EXPANSION VALVE
® Yes ❑ No Thermostatic Expansion Valve is installed and Access is
provided for inspection ® ❑
Yes is a pass Pass Fail
,- Certificate of Occupancy
Iurproanim
c OF'TBuilding & Safety Department
This Certificate is, issued pursuant to the requirements of. Section 109 of the California Building
Code, certifying that, at the time of issuance, this structure was in compliance with the
provisions of ' the Building Code and the various ordinances of the City regulating building
construction and/or use.
BUILDING ADDRESS: 79-905 De Sol a Sol
Use classification: S.F.D. Building Permit No.: 0306-203
Occupancy Group: R-3 Type of Construction: V-N Land Use Zone: R-L
Owner of Building: RJT HOMES LLC Address: PO BOX 810
City, ST, ZIP: LA QUINTA CA. 92253
By: G. SHOWALTER
tea' Date: 04/15/04
Building Officii4l
POST IN A CONSPICUOUS PLACE