0306-205 (SATT)D
► 1 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. Daatte q
11 HIC
5 WID
/'Date ` 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:
Carrier 8'4'A : )i MR) Policy No. I.A119t, 412
(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:.' �r .� 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) Date
PERMIT #
BUILDING PERMIT
DATE ! !„ J f VALUATION B, I i�J{ LOT l TRACT;}
JOB SITE w�4,? YJiI JY+. R S�.�iz
ADDRESS
APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
RJR H M1'::N UC
TUN, I7"TP CR14115,1NC.
PO Rr.)X F 10
; r.Z5 1';, 'pMM3.1TT'DRfVZ
L.P. Q1wt: k V27IS 3
A ;S-5034
USE OF PERMIT
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•
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t.A.NrIHkCli �!11 J(A_010ll••=4 3'•31r �,>,7 0 ,
'/,K34ANI`.'ALM 101•-000.42.1,000 TriIN.
P-11wrRI)CAL Mrk. 101-000,420-00"' 320.13V
PLUMBING K 01, •000.4 , 59-111MU
9°i.'a0i," --000-241.•000 fi:i0.tiy
0 f ?A D DID FU l \11 -coo -4"14.0v i 'd' i he
US:Vk1.1�fs r :T1�1`rC)'i�ItGl.So.
Ak"T IN PUBLIC P? A4TZ1. 1*f::'M M-000.445-00 520110
~ £STs'F,.TM".AA.,
34,'3946
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a � IT r ` VRIS'?. Ux NGaflh"
JUN 2 0 2003
CITY OF LA QUIN TA
FINANCE DEPT.r / f A'
RECEIPT7r!_1
ATE'
. /'.
BY
�l
DATE FI LED
INSPECTO
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
- Z 3
Ducts
Slab Grade
Return Air
Steel
- 3
Combustion Air
Roof Deck
_1/3 3
Exhaust Fans
O.K. to Wrap
- 5_ 5,
F.A.U.
Framing
- -3
Compressor
Insulation
//- ' ~
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wail Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
-
Final -
Final
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
ZL
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
44ZO.K.
for Finish Plaster
Sewer Lateral
Pool Cover .
Sewer Connection
-
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:
6 < /f%-�'� t5
-
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:
79-925 DE SOL A SOL, LOT 111, LA QUINTA, California
CEILINGS:
TYPE: BATTS MANUFACTURER: Certainteed Thickness: R-38
WALLS:
TYPE: BATTS MANUFACTURER: Certainteed Thickness: R-21
rE CON R: RJ OMES LICENSE #-1660604
TITLE: -5 Q
PAWPN SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072
TITLE: ADMINISTRATIVE ASSISTANT DATE: 11/13/2003
11,NSTALLATION CER•:._:FICATE (page 3 0_ J) CF4R
Slte nddress Permit Number
D)1: 71EAKAGE AND DESIGN DIAGNOSTICS
L'
DUCT LEAKAGE REDUCTION
Pressurization Test Results (CFM @ 25 PA)
Test Leakage (CFM) l05
Fan Flow
If Fan Flow is Calculated as 400 cfm/ton x number of tons, or as 21.7 x Heating Capacity
in Thousands of Btu/hr, 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 5 0.06 �' ❑
Pass Fail
❑ For AEROSOL TYPE SEALANTS ONLY - The following diagnostic testing was completed:
Duct Fan Pressurization at rough -in measured leakage (CFM)
CHECK AFTER FINISHING WALL:
❑. Yes ❑ No ❑ Pressure pan test or House pressurization test
❑ Yes ❑ No ❑ Visual Inspection of Duct Connections ❑ ❑
Pass Fail
I THERMOSTATIC EXPANSION VALVE (TXV)
AYes ❑ No Thermostatic Expansion Valve is installed and Access is
provided for inspection ❑
Yes is a pass Pass Fail
❑ DUCT DESIGN
1- ❑ Yes ❑ No ACCA Manual D Design calculations hate been
completed, Duct Design is on the plans and duct installation
matches plans.
2. ❑ Yes ❑ No TXV is installed or Fan flow has been verified. If no TXV,
verified fan flow matches design from CF -1R.
Measured Fan Flow
Yes for both I and 2 is a Pass
❑ ❑
Pass ' Fail
❑ 1, the undersigned, verify that the above diagnostic test results and the work I performed associated with the 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 requirements
for compliance credit.]
Ll - - I , L84
Tests St re, Date nstall g Subcontractor (Co. Name) OR
Performed General Contractor (Co. Name)
COPY TO: Building Department
HERS Provider (if applicable)
Building Owner at Occupancy
INSTALLATION ,:FRTIFICATE (Page 3 of 13) CF -61Z
Site Address Permit Number
DUCT LEAKAGE AND DESIGN DIAGNOSTICS
bUC T LEAKAGE REDUCTION
Pressurization Test Results (CFM Q 25 PA) Test Leakage (CFM)�5ty
Fan Flow
If Fan Flow is Calculated as 400 cfm/ton x number of tons, or as 21.7 x Heating Capacity
In Thousands of Btu/hr, 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 Fail
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:
❑ Yes .O No . ❑ Pressure pan test or House pressurization test
O Yes ❑ No O Visual Inspection of Duct Connections 0 0
Pass Fail
THERMOSTATIC EXPANSION VALVE (TX
Yes ❑ No Thermostatic Expansion Valve is installed and Access is - provided for. inspection
Yes is a pass0
O DUCT DESIGN � ss Fail
ACCA Manual D Design calculations have been
1. O Yes ❑ No completed, Duct -Design Is on the plans and duct installation
matches plans.,
2. ❑ Yes ❑ No TXV is installed or Fan flow has been verified. If no TXV,
verified fan flow matches design from CF -IR.
Measured Fan Flow =
Yes for both I and 2 is a Pass
0 0
Pass Fail
O 1, the undersigned, verify that the above diagnostic test results and the work 1 performed associated with the 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 requirements for compliance credit. )
tA-L _A
Tests tgn Date Inst Iling ubcontractor (Co. Name) OR,
Performed General Contractor (Co. Name)
COPY TO: Building Department
HERS Provider (if applicable}
Building Owner at Occupancy
Compliance Forms August 2001
A-25
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7)
PALMILLA
Project Title
Q1
5TH & JEFFERSON
DAWNbRGAN 760-275-0230
Builder Contact
# CNNRK613292
Certifying Signature
Firm: DESERT ENERGY SERVICES
Street Address: P.O. BOX 621
Copies to: Builder, HERS Provider
Telephone
760-250-2084
Telephone
03-27-04 ,
CF=4R
Date
R J T BUILDERS
Builder Name
PALO BREA P-3 2 UNITS
Plan Number
GROUP 2
03-27-04 LOT # III
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 -
El MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT
Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage)
Duct Pressurization Test Results (CFM @ 25 Pa)
Measured
values
Test Leakage Flow in CFM
If fan flow is calculated as 400cfm/ton x number of tons enter calculated
value here
If fan flow is measured enter measured value here
Leakage Percentage (I 00 x Test Leakage/Fan Flow) =
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
0
INSTALLATIO
7-925
C) 50C_A So Z_
CERTIFICATE (Page 3 of 13) CF -6R
DUCT EAKAGE AND DESIGN DIAGNOSTICS
DUCT LEAKAGE REDUC110N
Pressurization Teat Results (CFM ® 25 PA) Test Leakage (CFM)ftL-
Fan-Flow
If Fan Flow Is Calculated as 400 cfm/ton x number of tons, or as 21.7 x Heating Capacity
In Thousands of-Btu/hr, enter calculated value here
It fan flow Is measured, enter measured value here
Leakage Fraction a Test Leakage/(Measured or Calculated Fan Flow) _ it 0
Pass if leakage fraction <'0,06 Pass Fall
0 For AEROSOL TYPE SEALANTS ONLY following diagnostic testing was completed:
Duct Fan Pressurization at rough -in measured leakage (CFM)
CHECK AFTER FINISHING WALL:
0 Yes .O No . O Pressure pan test.or House pressurization test.
0 Yes 0 No 0 Visual Inspection of Duct Connections o 0
Pasi Fail
V THERMOSTATIC EXPANSION VALVE (TXV)
C$ Yes 0 No Thermostatic Expansion Valve is installed and Access is - provided for. inspection
Yes is a'pass0
0 DUCT DESIGN Pass Fall
ACCA Manual D Design calculations have. been
L 0 Yes 0 No completed, Duct Design Js on the plans and duct Installation
matches plans.,
2. 0 Yes O No TXV is installed or Fan flow has been verified. If no TXV, 0 0
verified fan flow matches design from CF -IR Pass Fall
Measured Fan Flow=
Yes for both 1 and 2 is a Pass
0 1, the undersigped, verify that theabove diagnostic test results and the work 1 performed associated with the 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 diegnostic.testing and installation meet the requirements for compliance credit. j
NO . DIA 4
TWn -Ainstalling Subc tractor (Co. Name) OR.
Performed General Contra or (Co. Name)
COPY TO: - Building Department
` HERS Provider (if applicabley
Building Owner at Occupancy
AWust 2001 a A-25
Comajanw Form9
TION CERTIFICATE
3.of 13) . CF -6R
DUCT]MAKAGE AND DESIGN DIAGNOSTICS
DUMLEAKAGE REDUCTION
Pressurization Te4 Results (CFM @ 25 PA) Test Leakage (CFM)_a!�
Fan -Flow
It Fan Flow is Calculated as 400 of Wton x number of tons, or 45 2 L7 x Heating Capacity
In Thousands of Stui/hr, enter calculated value here
If f6h.flow is measured, enter measured value here
Leakage Fraction - Test Leakagd(Measured or Calculated Fan Flow) a a
Pam if leakage fraction <0.06 Pass Fail
0 For AEROSOL TYPE SEALANTS ONLY -The following diagnostic testing was completed:
Duct Fan Presivrizati.on at rough -in measured -leakage (CFM) -
CHECK AFTER. FINISHING WALL:
0 Yes - .O No . lj'- Pressure , pan test.or House, pressurization. test.
0 Yes 0 No .0- Visual Inspection of Duct Connections
Cr_ THERMOSTATIC EXPANSION VALVE (Tm 6.
P'Yes Q.No Thermostatic Expansion Valve is. installed And Access is -provided. for. inspection
Yes4s; a pass 0.
Pass Fall
13 -DUCT DESIGN
ACCA Manual D Design calculations have. been
1. C3 Yes El No completed,
mpleted, Duct Design Is on the plans and duct Installation
matches plans.,
2. 0 Yes 0 No TXV Is Installed or Fan flow has been verified. If no TXV, Pass Pall
verified fan flow matches design from CF -11L
Measured Fan Flow
Yes for both I and 2 is a Pass
O 1, the undersigned, verify that'
the above diagnostic test resulti and the 'work UpirforTned us6ciated-Mth.the test(s) is in man
h-the requirements for compliance . credit. [The builder shall provide the HERS providcr.a copy of the CF -6R signed by the builder
employees or sub -contractors certifying that dis'postic,testing and installation meet the 'requirements for compliance credit.. I
4
ri
Tots Wturj-Datc ins, Iling tmcior (Co. Name) OR
Sl
performedGeneral Contractor(Co. Name)
COPY TO: Building Department
HERSProvider (it applicable)
-
Building Owner at Occupancy
A-25
2001
August
,- Certificate of Occupancy
IvcaeouTrn ��
G� OFBuilding & 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: 79-925 DE19 SOL A SOL
Use classification: S.F.D. Building Permit No.: 0306-205
Occupancy Group: R-3 Type of Construction: V -N Land Use Zone: R -L
Owner of Building: RJT HOMES LLC Address: PO- BOSS 810
City, ST, ZIP: LA QUINTA CA 92253
By: G SHOWALTER
�dj L
Date: 04/13/04
Building Official -
POST IN A CONSPICUOUS PLACE
•
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:
79-935 DE SOL A SOL, LOT 112, LA QUINTA, California
CEILINGS:
TYPE: BATTS MANUFACTURER: Certainteed Thickness: R-38
WALLS:
TYPE: BATTS MANUFACTURER: Certainteed Thickness: R-21
GENE COIs�fRA� R: DOMES LICENSE #61063i/
TITLE: -5 Q p&K I /l) I &A- MLT
N SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072
TITLE: ADMINISTRATIVE ASSISTANT DATE: 11/13/2003