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0305-104 (SATT)LICENSED CONTRACTOR DECLARATION Cl) I hereby affirm under penalty of perjury that I am licensed under provisions of I— Chapter 9 (commencing with Section 7000) of Division 3 of the Business and cel LU Professionals Code, and my License is in full force and effect. O=)M License # Lic. Class 1. Exp. D;teA oZ r Date ��' ir—Signature of Contractor/ �= �'` -��-�► —� co g J U CID OWNER -BUILDER DECLARATION W W I hereby affirm. under penalty of perjury that I am exempt from the Contractor's ~ U) License Law for the following reason: Z_ ( ) 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 U') N Date Signature of Owner OC\I U Q 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: Carrier ST',A'!'l; I+I,`W D Policy No. 1.339116-1.4 (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,(he"workers' compensation provisions/of Section 3700.4 the Labor Code, I-shaW forthwith comply withthose provisions. Date:k-4 -i`(() ) Applicant F~.• 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 I certify that I have read this application and state thatAhe 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. r Signature (Owner/Agent)'Y (1 �'Date BUILDING PERMIT PERMIT DATE VALUATION .ItLOT TRACT Z:�iJ+S•I JOB SITE '79-910Ii.E• UM, A -50). ADDRESS APN ?72,4X)0 -(?18 OWNER CONTRACTOR / DESIGNER / EN &NEER lull .t C UIC RJB ]WvzW,11 qTS, -INC. PO 13OX $I0 LA QU,lt!l'PA c,92.,.,22 PTxc t: iix .t7t•Z Ss04 USE OF PERMIT Ra -TWX I WNM ; AarACMD —lT1 _•�A $?.%- UUTA laiq 727+_ p ;0411 b451:,.w d4V, l] Y..li .[94 S•f WA11141 POOL, 2,PA. OR ann TRACT CONSTRUCTION SF' ��rxl•�',� ���n� w JUN 09 2003 `.i.,+,3lZtaat�rf4.l�F+.t"-�St1` r57,d� Vii" CITY OF LA QUINTA FINAP ICE DEPT. E. i'fIVLATND C OR%t1 ' i:Ul ' itk tTG"T srknt I i"��,p3tzi� I GONS'Y'il.t,C"':�:�OB�li ].){-7�•�1)r-0()C1 �9Sq.�+ M1��`.ICI'dP<21,�IV-r� L _ Zei. ? 101-000-4121-000 !� SS11 t �}���//��� w�YAi•7. .t4JC�•..(iS-. .S' sii t 0!<-1.I00-4/ CL 000 $m!'.43 Pl,UMBI NO FEY 101-000-119T.009 MAD ST;! ONKS krti:)i'if:.::!11 PEA • RE, IS! 10 -(}(?{S !-000 $17.94 E4RADERO tPR�+' 116.00 DZIVJ ?:? 43MR LE :I PR.I-11 Pit)) ME8 $0.00 `'103' AL F' .NET 18 DUX.P W r y ' ➢..�sti RECEIPT DATE 7 BY f { DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings 7- 2 - Ducts zo Slab Grade Return Air tl Steel 3 Combustion Air Roof Deck % .-3 Exhaust Fans OX to Wrap 01 _ F.A.U. Framing _ -3 Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath r Drywall - Int. Lath Final G Final BLOCKWALL APP OVALS 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 7Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection 4/--:217- 3 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 2453 , Utility Notice (Perm) COMMENTS: ��/ '101/ - 0 ALLATION CERTIFICATE (Page 3 of 13) CF -6R G .a= Sat Sltd Address Permit Number. DUCT•EAKAGE AND DESIGN DIAGNOSTICS 'AKAGg RLDUCTJQN Pressurization Test Results (CFM 8 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 d-Sh mr, enter calculated value here If fan flow is measured, enter measured value here Leakage Fraction - Test L,eakagq(Measured or Calculated Fan Flow) a 0 Pass if leakage fraction <0.06 Pass . Fall 17 For AEROSOL TYPE SEALANTS -ONLY -The following diagnostic testing was completed: Duct Fan Pressurization at rough -in measured leakage (CFM) CHECK AFTERI:"SHINO WALL: O Yes .O No . d Pressure pan test.or Hotise pressurization test. 0 Yes O No U Visual Inspection of Duct Connections ° ° Pass Fall THERNTOMTIC EXPANSION VALVE T M ' Yes 0 No Thermostatic -Expansion Valve is installed and Access is - provided for. inspection Yes is a pass ° 0 DUCT DESTGN Pass Fail ACCA Manual D Design calculations have been L © Yes O No completed, Duct Design is on the plan's and duct installation matches pians., 2. 0 Yes i7 No 7XV Is installed or Fan flow has been verified. If no TXV, pass Fall verified fan flow matches design from CF -TR Measured Fan Flow m Yes for both I and 2 is a Pass 0 1, the undersigned, verify thatthe above diagnostic test resulti and the work [ performed associated with tire test(s) is in conformance with the requirements for compliance credit. rMc 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 requirements for compliance credit. i Tats i a ,Date I !ling bcontractor (Co. Name) OR Pedomud General Contractor (Co. Name) COPY f0: - Building Department .` HERS, Provider (if applicable} Building Owner at Occupancy TALLATI( CERTIFICATE 3 of CF -6R DUCT16KAGE AND DESIGN DIAGNOSTICS -:-DQCJ'LJK"AjjX REDUCUUN Pressurization Teit Results (CFM Q 25 PA) Test Leakage (CFM)_J&e Fan -Flow If Fan Flow Is Calculated as 400 of Wton X number of tons, or Qs. 21'.7 x Heating Capacity In Thousands of-Btu/hr, enter calculated value hore If f6h.flow Is measured, enter measured value- here Leakage Fraction Test Leakagq(Measured'or Calculated Fan Flow) C3 Pass if leakage fraction <0.06 Pass Fall 0 F6rAERO1SOrL TYPE SEALANTS ONLY -The'following diagnostic testing was completed: Duct Fan Presiprization at rough -in measured leakage (CFM) CHECK AFTER FPIISHING WALL: 0 Yes 13 Nd Cl' Pressure pan test.or House pressurization- test. 0 Yes 0 No .0- Visual Inspection of Duct Connections 0 0 Pass Fall ,WTHERMOLTATIC EXPANS1QN'VALVE'(TXV) T Ifyes O.No Thermostatic -Expantion Valve is Installed And Access is - provided. for. inspection Yes is a pass Pass Fail 0 DUCT DESIGN ACCA Manual D Design calculations have been 11, 13 Yes 0 No completed, mpleted, Duct Design Is on the plans and duct Installation matches plans., 2, 0 Yes 0 No TXV is Installed or Fan now has been verified. If no TXV, 0 C3Pass 'Fail verified fan flow matches design from CF -IR. Measured Fan Flow Yes for both I and 2 is a Pass 0 t the undersigned, verify that the above diagnostic test resulti and tfiow0ek I pirfbrmed associated with the tests) is in conformance with the requirements for compliance credit. [no builder shall provide the 1400 provider. a copy of the CF -61K signed by the builder .employeescompliance or sub -contractors certifying that diagnostic.testing and installation meet the �equirements for c Tab re, ate Ins FIling S contractor (Co. Name) OF, Performed General Contractor (Co,'Name) COPY -ft - Building Department HERS Provider (if applicable} Building Owner at Occupancy A eff4LLATION CERTIFICATE (Page 3 of els) CF -6R Site Address Permit Number. G DUCTIEAKAGE AND DESIGN DIAGNOSTICS -DUC1' LEAKAjjZ .REDUCb0N Pressurization Teit Results (CFM Q 25 PA) Test Leakage (CFM) - Pan -Flow If Fan Flow is Calculated as 400 cfm/ton x number of tons, or qs 21.7 x Heating Capacity In Thousands of•Stu/hr, enter calculated value here If fan flow Is measured, enter measured value here Leakage Fraction -Test Leakagq(Measured or Calculated Fan Flow) m li' o Pass if leaksge fraction <0-06 Pass . Fail 0 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 .O No . iS Pressure pan test.or House pressurization test. O Yes O No O Visual Inspection of Duct Connections o 0 Pass Fail �1HER1410STATIC EXPANSION VALVE 7TXV) ' 4'Yes O No Thermostatic -Expansion Valve is installed and Access is -provided. for. inspection Yes is a pass 0' O DUCT DESIGN Pass Fat! ACCA Manual D Design calculations have been 1. D Yes O No completed, Duct Design Is on the plans and duct installation matches plans., 0 0 2. O Yes O No TXV is installed or Fan flow has been verified. If no TXV, Pass Fall verified fan flow matches design from CF -T& Measured Fan Flow - Yes for both I and 2 is a Pass O 1, the undersigped, verify that the above diagnostic test results and the work I perforrned associated with the test(s) is in con fortnance with the requirements for compliance credit. F he builder shall provide the HERS provider, a copy ofthe CF -6R signed by the builder employees or sub -contractors certifying that diagnostic.testing and installation meet the iequirements for compliance credit. ) 4 Tests Si re, ate Installing ubcontractor (Co. Name) OR Perfomud General Con. tractor (Co . Name) COPY T0: - Building Department ` HERS Provider (if applicable} Building Owner at Occupancy INSULATION CERTIFICATE This is to certify that insulation has been installed in conformance with the current energy regulation, California Administrative Code, Title 24, State of California, in the building located at: 79-910 DE SOL A SOL ,LOT 106, LA QUINTA,CALIFORNIA CEILINGS: TYPE: BATTS MANUFACTURER: CERTAINTEED THICKNESS: R-38 WALLS: TYPE: BATTS MANUFACTURER: CERTAINTEED THICKNESS: R-21 LICENSE # b l� _ TITLE: Se�PCk'!'oVLG�U��\!C N SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072 ADMINISTRATIVE ASSISTANT DATE: 11/14/2003 9/17/03 4 _ ' Page 1 of 1 14712 SW SCHOLLS FERRY RD 1? # 328 ! �Q I N I BEAVERTON, OR 97007 L PHONE: 503-524-8268 FAX: 503-213-6222 John Hardwick 9-17-03 RJT Homes, LLC 79700 5e Ave LaQuinta, CA 92253 1\ �- P A r %w RE: Structural Observation - Lot 1066. John, Sample observations were made of the above house to ascertain whether the general intent of the construction documents is being followed. With respect to the structural items that remain uncovered and easily observable; this appears to be the case, with no remaining unresolved deficiencies that I am aware of. oR�FESSlav Mike Nelson, PE a