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0306-204 (SATT)LICENSED CONTRACTOR DECLARATION 13Chapter I hereby affirm under penalty of perjury that I am licensed under provisions of ✓'l— 9 (commencing with Section 7000) of Division 3 of the Business and Ly Professionals Code, and my License is in full force and effect. O =) M License # Lic. Class Exp. Date r- v LO 6906M 1'i fiI(' A W30A4 LLI oZ � Date Signature of Contractor / (D O � / J U ' OWNER -BUILDER DECLARATION W WW I hereby affirm under penalty of perjury that I am exempt from the Contractor's 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 N Date Signature of Owner ON rn Q WORKER'S COMPENSATION DECLARATION o 2 Z I hereby affirm under penalty of perjury one of the following declarations: Lo O () 1 have and will maintain a certificate of consent to self -insure for workers' X W !-�: compensation, as provided for by Section 3700 of the Labor Code, for the m� Q performance of the work for which this permit is issued. Q U ( ) I have and will maintain workers' compensation insurance, as required by O U Q Section 3700 of the Labor Code, for the performance of the work for which this H permit is issued. My workers' compensation insurance carrier & policy no. are: Z Carrier 1' SAT E N4I°NJ Policy No. Cb O J (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: Applicant . P Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 116 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his %* application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is • correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. Signature (Owner/Agent) Date BUILDING PERMIT PERM.To � DATE �y VALUATION S191,170.50 LOT 1,10 TRACT 2)45,3"1 C JOB SITE 79.9.1$ IT SOLA SOL APN 172-�fk➢t)-ft ; ADDRESS OWNER CONTRACTOR/DESIGNER/EN INEER RIT HOU,I LLC }:tea• 11;1tr>F: alptknt, W(�. FO BOX $.0 142. X '. NINTIMIT x I AIA L&QpXfoi CA 9223 PI(`iI', DC .AZ 85634 (64)2i� 37 - i GSG G°Blti 4 990 USE OF PERMIT •.L'.{'1 ''' ..AJ I Y I {h L iw�Y � .�f.'. i- L .+ii Y'Y ... �. .. a. .,w.l 1✓� wv+YF-+-"aAa IVAt.4.A P0014 SPA C� ? VREVE�iIAY APPW11 ii TRhCT 0011 ) ki CTIOx 1119IYRfI SF KCIRCi:"}PPA', � t -. 368.041 SR OARAISK.lOV. ',,u•1"iRT 33alm ulz RN IMdAM fCOS I' OF fi.OMURU.M.40N k.93 ,:i 70-fo CONSTF(JM014 ('r.'"".e: 101.000 -M -OV, PLiN>„HXCK: FEE 101-40"39-M%P2144 .MZCHRA24;CAL RE !01-iXXJ•421..W' 10s,00 F_LWTP.}CAf✓ FUr 1 C1)-tJfX?-ti20-00 1 UW.0 P1.1;M91110 PER 101-000-419 00i, 4,34'I S71 C1Nf3 00'1 RYR FP;r 11,01D 1 C;} _000-241.0(h) $19.14 C}4t r D A O IM, 101.0170.4:1,00{I 10.00 DEV Eu3pzraIMPA1.11 If,?:t: SUB-!: ' "'tl. CCtAWRITCMON ' ,M f;'F"T 'K V , {59.05 ►; _ _ . ^11"?').'.f5�'ti $4,1.W.05 RECEIPT DATE l~ " BY: . •� ' DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings - ^ - Ducts ' Slab Grade Return Air Steel Roof Deck _ 3 _ Combustion Air Exhaust Fans O.K to Wrap - - cz F.A.U. Framing —/ _ 3 Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans 8 Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath ., -93 14> Final _2 Final BLOCKWALL APPRO ALS steel POOLS - SPAS 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- inalWater WaterPiping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans OX for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: Final 4S Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole i Low Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power 11/5/03 Pace I of 1 x6 DF ST60 (3) } " DIA. EXPANSION BOLTS w/ 5" MIN. EMBED, ALTERNATE HOLDDOWN STHD10 or STHD14 14712 SW SCHOLLS FERRY RD # 328 BEAVERTON, OR 97007 PHONE: 503-524-8268 FAX: 503-213-6222 E-MAIL: SlPenglneering@comcast.net ST48 (2) Y2" DIA. EXPANSION BOLTS w/ 5" MIN, EMBED. ALTERNATE HOLDDOWN LSTHD8 or STHD8 ALL METAL TO BE GALVANIZED From: Mike Nelson 503-213-6222 To: John Hardwick Date: 11117/2003 Time: 3:33:16 AM Page 1 of 1 14712 SW Scholls Ferry Rd # 328 Beaverton, OR 97007 503-524-8268 503-213-6222 (fax) 11-17-03 John Hardwick RJT Homes, LLC 79700 50th Ave LaQuinta, CA 92253 RE: Structural Observation - Lot 110 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 now appears to be the case, with no more unresolved deficiencies remaining that I am aware of. Mike Nelson, PE 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: 79-915 DE SOL A SOL, LOT 110, LA QUINTA,CALIFORNIA CEILINGS: TYPE: BATTS MANUFA CTURER: CERTAINTEED THICKNESS: R-38 WALLS: TYPE : BATTS MANUFACTURER: CERTAINTEED THICKNESS: R-21 =S LICENSE # 6 TITLE:S C,Q��( r✓� SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072 TITLE: ADMINISTRATIVE ASSISTANT DATE: 11/13/2003 INSTALLATION CERTIFICATE (Page s.ot 13 DUCT-JCEAKAGE AND DESIGN DIAGNOSTICS RUCT LEAKAG& MDUCTION Pressurization Teit Results (CFM Q 25 PA) Test Leakage (CFM) CF -6R Fan -Flow If Fan Flow Is Calculated as 400 cfrdton x number of tons, or es 21.7 x Hcating Capacity In Thousands o(-Btumr, enter calculated value here If fan flow Is measured, enter measured value here Leakage Fraction - Test Lcakage/(Measured or Calculated Fan Flow) a 0 Pass if lcakage fraction <0.06 Pass Fall 0 For AEROSOL TYPE SEALANTS ONLY-The'following diagnostic testing was completed: Duct Fan Pressurization at rough -in measured leakage (CFM) CHECK AFTER FINISHINO WALL: 0 Yes .O No . Cl Pressure pan test.or House pressurization test. 0 Yes 0 No 0 Visual Inspection of Duct Connections 0 0 Pass Fall ERMOSTATIC EXPANSION VALVE )'Yes 0 No Thermostatic Expansion Valve is Installed and Access is - provided for. inspection Yes is a pass 3_110 Pass Fail O DUCI DESIGN RCCA Manual D Design calculations have, been L 0 Yes 0 No completed, Duct Design is on the plans and duct Installation matches plans., 0 0 2, 0 Yes O No TXV is Installed or Fan flow has been verified. If no TXV, Pass Fall verified fan flow matches design from CF -IR Measured Fan Flow m Yes for both I and 2 is a Pass O I, the undersigned, Verify that the above diagnostic test results and the work I'performed associated with We test(s) is in conformancc with the requirements for compliance credlt. [The builder shall provide the HERS provider. a copy'of the CF -6R signed by the builder employees or sub -contractors certlfying that diagnosec.testing and installation meet the requirements for compliancc credit. ] L Taste—T re, Date Installing S bcontractor (Co. Nainc) OR Performed Oeneral Con ctor (Co. Name) COPY -TO: - Building Department ` HERS Provider (if appucabley Building Owner at Occupancy A-•25 CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7) CF -411 PAMILLA 02-24-04 Pro ect Title �ppSRTH& JEFFERSON D yrR�R&NbRGAN Builder Contact Telephone GRANT RICH 760-250-2084 Date R J T BUILDERS Builder Name ACACIA P-2 3 UNITS Plan Number GROUP I 1 OF 3 H Rater QyTelephone # CNNGR2074391 j . U Y LOT # 110 Certifying Signature Date Sample House Number Firm:DESERT ENERGY SERVICES HERS Provider: CHEERS Street Address: P.O. BOX 621 Copies to: Builder, HERS Provider 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 tae 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 44 If fan flow is calculated as 400cfrn/ton x number of tons enter calculated value here 800 If fan flow is measured enter measured value here Leakage Percentage (I 00 x Test Leakage/Fan Flow) = 5.5 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 Yes is a pass Pass Fail • CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7) CF -4R PAMILLA Project Title 50TH & JEFFERSON w'6 �AA�d A IA'-NbRGAN Builder Contact Telephone GRANT RICH 760-250-2084 H RaterTelephone CNNGR2074391 3 - / 8_ D If Certifying Signature Date Firm: DESERT ENERGY SERVICES Street Address: P.O. BOX 621 Copies to: Builder, HERS Provider 02-24-04 Date R J T BUILDERS Builder Name ACACIA P-2 3 UNITS Plan Number GROUP 1 2 OF 3 LOT # 110 Sample House Number HERS Provider: CHEERS City/State/Zip: RANCHO MIRAGE CA. 92270 HERS RATER COMPLIANCE STATEMENT The house was: I ® Tested ❑ Approved as part of sample testing. but was not tested As the HERS ra{er 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 96 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 (I 00 x Test Leakage/Fan Flow) = 6.0 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 ® ❑ Yes is a pass Pass Fail L 0 CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7) CF -4R PAMILLA Project Title ` 50IT��tH& JEFFERSON ' * R&NbRGAN Builder Contact Telephone GRANT RICH760-250-2084 a wJI 02-24-04 Date R J T BUILDERS Builder Name ACACIA P-2 3 UNITS Plan Number GROUP 1 3 OF 3 HW Rater L7Telephone I� # CNNGR2074391 y -/ LOT # 110 Certifying Signature Date Sample House Number Firm: HERS ENERGY SERVICES HERS Provider: CHEERS Street Address: P.O. BOX 621 Copies to: Builder, HERS Provider 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 72 If fan flow is calculated as 400cfin/ton x number of tons enter calculated value here 1200 If fan flow is measured enter measured value here Leakage Percentage (I 00 x Test Leakage/Fan Flow) = 6.0 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 Yes is a pass Pass Fail L �i Certificate of Occupanc Y 4'4 0 jINcas�nm4� G OF'L'1 BuBdin g & 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: 79-915 De sol a sol Use classification: S.F.D. Building Permit No.: 0306-204 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 Date: 05/25/04 'r Building Official: POST IN A CONSPICUOUS PLACE L