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0210-229 (SATT)U) 1— (V t) w ouC) W I� tY oZ� O �CD J r` U) Z r) LO N ON U °) CL Q Z Cr r a 0 XW m< O Q.: �. Z_ CIS5 (1 ' J 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 (.TofessAals Code, and my License is in full force and effect. License # Lic. Class Exp. Date ta9t1d4S B i1TiC A �} 61 0104 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 licenTed 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 STATE FUNDI Policy No. (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 tho eprovisions. 067 Date: 11 ..Y ,.. Cr, Applicant—'.. tst C�c srs� Warning: Failure to secure Workers' Compensation n 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 �i%'-�?•7" - BUILDING PERMIT - PERMT# DATE VALUATION LOT TRACT I i ,'! --, Z �3Ei7, 7 112 29853_1 JOB SITE_ APN ADDRESS 79-.935—VE iJE 1+.0L A SOL I 772-400—M OWNER CONTRACTOR / DESIGNER / EN (NEER W HIC)bm L,LC r-rf INVEFlunro, RP8'C_ PO BpIOX, 61 0 1425 %t ..�' Y IRM lik QCiriiYnt C. 92'253 I�U��33,;V' PI -M t VAR . AZ 8SID34 (60n)257-1656 C:BIR 4490 USE OF PERMIT swa 1E F,ti,1+rS! f : t�i1`A`a1�1L�'r7 Sf+'.1�1 a LOT 1 1d PL.f14' P2A. PEWIT DOES' ;NOT ITI+C:1.L` )E.. DLOCK, WAT.IB, P001:, SPA O'R DRi1PW.A.` WAY `TRACT (XINSTRUC.'T1ON V1a;.'M SP POR.CJfiillysf:.TIO 31:1.00 SF' MAGM PORT S3tt,iDr3 3F E119_':Lilt N11..TD COW oir C0N8 i RUC•n0.N 111 7 r;P79.W PEaZM.n' F.0 SU'WVil RY CONSTRUCV00 FEE 1191-000.416.ON) $947,10 PLAN b Ht• CK: FEE 101.000^4.39.131,8 $812.115 1V1EG.11'1suy CAL PEP, 101-000 421-000 $105,00 1;LLECTR.t(WI FEE 101-000-420 -000 pfd ASi 1?L11MS11-40 !'FIX 101-000-41R-000 5230,00 S°1`flt3NO MK7r1OW .KZ d 3i ESI D 101-00 -,2.1.000 $18AD OYt.AD11110. RE 0i _000423-000 $11106 J.)V_ .L? DP2P. IMPACT ACT VTIIIPI �e,DD1.U0 A'lli.p:t"TMii` L Ilitdi`i67'21C.,,9tI.401Y ANY) PLA/.V 6+div-11r, $4,334 10 U to c (7'1<A1a FK#.�EW F'.�.EN DUE : 40w S4,3324.70 NOV CITY OF LAQSaitail+ FINANCE DEPT. RECEIPT DATE BY DATE FINALED INSPECTOR 2 I- INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR y. BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade - Z Return Air Steel y- Combustion Air Roof Deck -// - 3 Exhaust Fans O.K. to Wrap - -J F.A.U. Framing Compressor Insulation ents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath -�'- Drywall - Int. Lath Final Final BLOCKWALL APPROVALS POOLS - SPAS Steel Set Backs Electric Bond Footings �)j 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 - 2-- Heater Final Water Piping Plumbing Top Out Plumbing Final Equipment Enclosure Shower Pans Sewer Lateral O.K. for Finish Plaster 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) 45* COMMENTS: i - INSTALLATION CERTIFICATE (Page 3 of 13) CF -6R Site Address �9— 1�'3S �d� Permit Number DUCT LEAKAGE AND DESIGN DIAGNOSTICS 92UCT LEAKAGE 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 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 In ❑ Pass Fail .13 For AEROSOL TYPE SEALANTS ONLY -The following diagnostic testing was completed: Duct Fan Pressurization at tough -in measured leakage (CFM) CHECK AFTER FINISHING WALL: 0 - Yes ❑ No 11 Pressure pan test or House pressurization test ❑ Yes . ❑ No ❑ Visual Inspection of Duct Connections ❑ ❑ Pass Fail ❑- THERMOSTATIC EXPANSION VALVE (TX ❑ Yes ❑ No Thermostatic Expansion Valve is installed and Access is . provided for inspection ❑ 13 --: Yes is a pass Pass Fail ❑ DUCT DESIGN 1 ❑ Yes ❑ No ACCA Manual D Design calculations have been completed, Duct Design is on the plans and duct installation matches plans. 2•. ❑ Yes 13 -No TXV is installed or Fan flow has been verified. If no TXV, verified fan flow matches design from CF -1 R 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.] I L4 Tests Si ature, Date 16ta 1 g Subcontractor (Co. Name) OR • General Contractor (Co. Name) Performed COPY T0: Building Department HERS Provider (if applicable) Building Owner at .Occupancy IN- -S Site.Address Permit Number DUCT LEAKAGE AND DESIGN DIAGNOSTICS DUCT LEAKAGE REDUCTION CF -6R Pressurization Test Results (CFM Q 25 PA) Test Leakage (CFM) -� Fan Flow If Fan Flow is Calculated as 400 cf n/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 0.0613 '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 ❑- THERMOSTATIC EXPANSION VALVE (TXV) ❑ Yes ❑ No Thermostatic Expansion Valve is installed and Access is . provided for inspection ❑ ❑ Yes is a pass Pass Fail ❑ DUCT DESIGN I ❑ Yes (3 -No ACCA Manual D Design calculations have been completed, Duct Design is on the plans and duct installation matches plans. 2., ❑ Yes ❑ No TXV is installed or Fan now has been verified. If no TXV, verified fan flow matches design from CF -1 R. 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 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 empl s or sub -contractors certifying that diagnostic testing and, installation meet the requirements for compliance credit.] Tests i ate nstall g Subcontractor (Co. Name) OR' Performed General Contractor (Co. Name) COPY TO: Building Department HERS Provider (if applicable) Building Owner at Occupancy INSTALLATION CERTIFICATE (rage 3 of 13) CF -6R Site.Address DUCT LEAKAGE AND DESIGN DIAGNOSTICS Permit Number WDUCT LEAKAGE REDUCTION 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 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 IM -7 ❑ Pass Fail fl 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 ❑" THERMOSTATIC EXPANSION VALVE (TXV) ❑ Yes ❑ No Thermostatic Expansion Valve is installed and Access is provided for inspection Yes is a pass ❑ DUCT DESIGN ❑ ❑ Pass Fail 1 ❑ Yes ❑ No ACCA Manual D Design calculations have been _ - completed, Duct Design is on the plans and duct installation matches plans. 2• ❑ Yes ❑ No T;KV 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 1 and 2. is a Pass Pass Fail ❑ 1, the undersigned, verify that the move 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 -611. signed by the builder employ or sub -contractors certifying that diagnostic testing and. installation meet the requirements for compliance credit.] I'l 11W lb Tests Sign , Date stall g Subcontractor (Co. Name) OR Performed General Contractor (Co. Name) COPY TO: Building Department HERS Provider (if applicable) Building Owner at .Occupancy r: /.F/r. �. /'i i�i."1 '�.'i.'/,�/ /Jr/'. �./'i.✓% !% //,i-/': ,'1 !.'///, i:i/I... .�/.! J/f/ ,i/i.i i /�; �-//Ji%'i :,i /. i.� i, s,�ii. iii %i, i,::i','�i�.�//%% i.i%/:/r %V.%lY '/J/.'//rNi %J! rl!//J.V.+d� INSULATION CERTIFICATE i 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 i r r CEILINGS: r TYPE: BATTS MANUFACTURER: Certainteed Thickness: R-38 r i f r WALLS: TYPE: BATTS MANUFACTURER: Certainteed Thickness: R-21 r R: t ❑MES LICENSE # ,. GEN L CO RA pp r ,r TITLE: pek I � i E��?�� _5 ram'. SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072 r i r lo 4PGON TITLE: ADMINISTRATIVE ASSISTANT DATE: 11/13/2003 r r, r i r �iir ','u v,v.�. r r i, v,�/-• ,ry i,�ii iiri �i;i i �iii "iii�i iiiii�iiuii;r,i: �iniii, iiiiii��s;i(i i,ii.,viii�.iiwiiiiiii�i�ii;iii,r/iiiii/�ii�.%v,z•F i.rr�.I r,w%