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0210-226 (SATT)LICENSED CONTRACTOR DECLARATION J� I hereby affirm under penalty of perjury that I am licensed under provisions of P'JJ Chapter 9 (commencing with Section 7000) of Division 3 of the Business and CV W Professionals Code, and my License is in full force and effect. O M License # Lic. Class Exp. Date a 690645 B 111C A 6!30'104 Z r-_ Date f " - ^ Signature of Contractor r r-- Hc - OWNER -BUILDER DECLARATION H C-) � I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason: Cl) ( ) 1, 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). ( ) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business & Professionals Code). . 1h () I am exempt under Section , B&P.C. for this reason LO N Date Signature of Owner O N rn d Q WORKER'S COMPENSATION DECLARATION It Z CE 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 !L compensation, as provided for by Section 3700 of the Labor Code, for the O Q performance of the work for which this permit is issued. m Q L) ( ) I have and will maintain workers' compensation insurance, as required by Q U Q Section 3700 of the Labor Code, for the performance of the work for which this cl: rn H permit is issued. My workers' compensation insurance carrier & policy no. are: co. Z Carrier STATE FrUNI. Policy No. M34IC1&W 1!_a (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 3 subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. ate: Applicant— Warning: pplicant 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) -D a l!. / �""-�•-d Date I+—t j �. _• BUILDING PERMIT PERMIT#0210-2126 DATE VALUATION $1,.q;470,+3Lf LOT Ili TRACT 219858_1 V JOB SITE ADDRESS 79-965 DIE SOL A SU o APN 7124M." OWNER CONTRACTOR / DESIGNER / ENGINEER Tt.,s l`%tC>ww T= Rrr nomTw, tvs, WC. PO 110X,S10, 1425 %'t1NCV�iZl`TryDERTti , LA QI:TT1;t'-A CA, 92253 RHOEM AZ 85034 (602)257-1656 C 14 4"0 USE OF PERMIT [ �J � ► (�� I p�} (y p} ry 6R9's.isS.1Cr..%'1"►LA'.i.1.Ls.E A , 6YCau�.l..L•+3� SFA r LXIT I I MAll IM. PRIMIT D09S NOT INC.,LUr)F Mi.00K MAC`s CU&STMICTION 3,8€l oo 3F P ORCi P.l.'sTIO 569.00 SF CLAR.t MFUCfiRi ORT 538,60 si E9..ITfV.ti{l,dXD COST OF CONS"T'1aUCIIJON 191-i70150 1X'`��MTr IME 117l MARY CONOTI UCTION FrM 101-000.418.000 4964.50 Pi..V1 C,HIECK PUT': 401 $822.46 ME"RKNICAL FESE 101-000-421-000 S10100 IN,.W T.R1CA1,, FEE 101-000-420-000 $22,9 ; i�rux��ftr�� l�� aZ ��-� I �•cls:f� ��.a0 :"sTROhB"9MOT1019F%Z-T2.1*IZ1V 401-004-.w41- 100 $19.14 t"iM}.,OPER !MPAC T 1178 ,OQi.i;tt x 9° IUB-' 1; C;)!'AL C't`)$�,"t' ..kT�''�'IONY AND 14-4\14 MEC.R. $4,339.05 IF IMS PRE -PAID FEW "T0,00 NOV 20 2H12 _ 4 CITY OF LA gi, o A FINA��C:ie C_��T. E i . RECEIPT DATE B1' DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings - l' - Ducts Slab Grade -t - 3 Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K. to Wrap - ,Z- 3 F.A.U. Framing Compressor Insulation 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 � - _ BLOCKWALL APPROVALS POOLS - SPAS steel Set Backs Electric Bond Footings t��l.4il �-� z ., g 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 Top Out Plumbing Final Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection _2 -- a s Encapsulation Gas Piping Gas Test Appliances _ Final Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit _ Rough Wiring Low Voltage Wiring Fbdures _ Main Service Sub Panels Exterior Receptacles G. F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: 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: CEILINGS: TYPE:BATTS WALLS: TYPE:BATTS GE 79-965 bE SOL A SOL, LOT 115,11-A QUINTA ,CALIFORNIA MANUFACTURER:CERTAINTEED MANUFACTURER:CERTAINTEED THICKNESS: R-38 THICKNESS: R-21 RJ T H ES LICENSE # 6 L.® TITLE: SGi I.IJliU1FA N SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072 TITLE: ADMINISTRATIVE ASSISTANT DATE: 11/13/2003 :o;) - - INSTALLATION CERTIFICATE (Page 3 of 13) CF -6R She.Address 79 - 9(:S /t -C Q 56-e— Permit Number DUCT LEAKAGE AND DESIGN DIAGNOSTICS DUCT LEAKAGE REDUCTION Pressurization Test Results (CFM Q 25 PA) Test Leakage (CFM) Fan Flow If Fan Flow is Calculated as 400 cfin/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 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: 0 - yes ❑ No 13 Pressure pan test or House pressurization test ❑ Yes ❑ No ❑ Visual Inspection of Duct Connections ❑ ❑ Pass Fail Cl- THERMOSTATIC EXPANSION VALVE (TX ❑ Yes ❑ No Thermostatic Expansion Valve is installed and Access is . provided for inspection ❑ ❑ Yes is a pass Pass Fail ❑ DUCT DESIGN I- ❑ Yes ❑ 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 flow has been verified. If no TXV, verified fan flow matches design from CF -1 R. Measured Fan Flow .❑ ❑ Yes for both 1 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.] l �3 Tests —S -17 a ate n' 11" ubcontractor (Co. Name) OR ' General Contractor (Co. Name) Performed COPY TO: Building Department HERS Provider (if applicable) Building Owner at .Occupancy INSTALLATION CERTIFICATE t\ 3of13 Site Address Permit Number DUCT LEAKAGE AND DESIGN DIAGNOSTICS DUCT LEAKAGE REDUCTION CF -6R Pressurization Test Results (CFM @ 25 PA) Test Leakage (CFM) l 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 13 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 13 Pressure pan test or House pressurization test ❑ Yes ❑ No ❑ Visual Inspection of Duct Connections ❑ ❑ Pass Fail ❑- THERMOSTATIC EXPANSION VALVE (TXM ❑ Yes ❑ No Thermostatic Expansion Valve is installed and Access is provided for inspection Yes is a pass ❑ DUCT DESIGN 1 ❑ Yes ❑ No RCCA 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 flow has been verified. If no TXV, verified fan flow matches design from CF -1R Measured Fan Flow = Yes for both 1 and 2. is a Pass ❑ ❑ Pass Fail ❑ ❑ 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.] ro A, 1 0 M-1, Tests S4 , Date 'Installing Subcontractor (Co. Name) OR Performed General Contractor (Co. Name) COPY TO: Building Department HERS Provider (if applicable) Building Owner at Occupancy INSTALLATION CERTIFICATE (page 3 of 13) CF -CR Site Address Permit Number DUCT LEAKAGE AND DESIGN DIAGNOSTICS DUCT LEAKAGE REDUCTION Pressurization Test Results (CFM cQ 25 PA) Test Leakage (CFM) "3�_ Fan Flow If Fan Flow is Calculated as 400 cfin/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 O 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 ❑ Yes ❑ No RCCA Manual D Design calculations have been completed, Duct Design is on the plans and duct installation inatches 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 1 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, (Ilse 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.] A. I. /14 Tests ,Date J stallfig Subcontractor (Co. Name) OR Performed General Contractor (Co. Name) COPY TO: Building Department HERS Provider (if applicable) Building Owner at .O.ccupancy 50- Q° Certificato of OccupancyLa, U I" w5 Building& Safety Department Y p �oF�9 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: 79-965 DE SOL A SOL Use classification: S.F.D. Building Permit No.: 0210-226 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 a Date: 7/22/03 Building Offi lal POST IN A CONSPICUOUS PLACE