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0210-225 (SATT)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. Date FS'Ju45 N, I - 9C A Dated Signature of Contractor P r OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason: ( ) 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). ( ) 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. SeN) ) I have and will maintain workers' compensation insurance, as required by ction 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 5TATE I`'ts3• D Policy No. W3006-02 (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: 171 ,,.,..�.,_ Applicant'.. (k3;ria , t '•,� M r y w 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 SErciion 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 `'fortli, on his application. A. 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) ..y . ,1. 0 f Date r � BUILDING PERMIT PERMIT# DATE VALUATION LOT �''TRACT , E I 7:. - r ? S 41t?,,fiti ? 16 '45,858-; JOB SITE ADDRESS 79-975 DIr SOL. A Nif7. APN 772400-" OWNER CONTRACTOR / DESIGNER / ENGINEER RUT ROW LLC . XIr ,I3,JVr.€S'S P EWS,1'!v C. AQCAMA CA 92233 i -AI CMAX AZ 950-14 (602)757,1.656 MIA 49903 USE OF PERMIT ,3r.A .1�!_,T 1,14, %``i,r' N P38. PPt?ly IT OOE-i NOT 1NCI:t,1► E BLDC K WA:1.€.fi, PIXA., SPA OR DRIVEWAY APPROACH `F§I.AZT CONSTRUCTION 3J84100 S.17 Pt;)AMPAT.10y� 860.00 SP 0.A1Al�.t.�EjCA�['U[jf;, RT 562,00 O PRUMIr FrAT IMA WHY CONI RUCTIc- N FEE � 1X11.000 -418 -WO $993,00 MAN 0irric VICE iol_000_439_13119 $836.617 ItiECH�'1�t7C AL PEI& 101.000.421.000 MOO ZIAI,C',$'RICAL 111 !11F' P4.,kf't B171140 179F. 101.000-419-000 T-190100 S`1'1iONG MOTION FE -H- RESID 101-000-2.41-000 20.09 ORAI71.11.40FEL ,' tl 101.000,423-000 WIN >`l IK:t.tup3+�>f3. Imp'P.0 T at%t fFflS:11D A..f T IN PUBLIV 111AV-01 • RE'SIr 770-000.445-000 320.60 f y r . e3li i�'`�Ei..ti'l.�u iv LJ�`V►�,414.41 \.. J.lid.LV .t'k �.t.7 '�� `.Yi.C'aC�'V.rSR. !,-&4,3.1.9.46 ------�e ;t�`l0 1�Cr'1t�1'�:EU I�t4 $0.00 V 2 U �+��� E - 1 EINAA jCc�•� /YheY RECEIPT Di. E—� BY' DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms 8 Footings _ r — Ducts Slab Grade Return Air Steel 7 Combustion Air Roof Deck Exhaust Fans 0. K. to Wrap F.A.U. Izz 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 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 Water Piping Plumbingfinal Plumbing Top Out _7> Equipment Enclosure Shower Pans / O.K. for Finish Plaster Sewer Lateral / Pool Cover Sewer Connection / L� q, Encapsulation Gas Piping Gas Test Appliances Final Final 7 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: 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: 79-975 DE SOL A SOL, LOT 116, LA QUINTA, California CEILINGS: TYPE: BATTS MANUFACTURER: Certainteed Thickness: R-38 WALLS: TYPE: BATTS MANUFACTURER: Certainteed Thickness: R-21 GEN CONT C R: RJT H ES LICENSE # t� Y. TITLE: -5&t 4��SctlJ � A ON SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072 Al TITLE: ADMINISTRATIVE ASSISTANT DATE: 11/13/2003 INSTALLATION CERTIFICATE " _JA � -4'h eI.I la _ �1—II(4 Site.Address 7Q— 9 � see', see--- DUCT LEAKAGE AND DESIGN DIAGNOSTICS VDUCT LEAKAGE Rl Test Results 3ofI Permit Number 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 Leakaget(Measured or Calculated Fan Flow) a Pass if leakage fraction 5 0.06 CF -6R r13 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 ❑ 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 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 l 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 emp yees or sub -contractors 'certifying that diagnostic testing and. installation meet the requirements for compliance credit.]'];Lf fez_ Tests , Date Ang Subcontractor (Co. Name)"OR d General Contractor (Co. Name) Performe COPY TO: Building Department HERS Provider (if applicable) Building Owner at Occupancy INSTALLATION CERTIFICATE 3 of 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 0.06 ❑ Pass Fail {3 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 (TX ❑ Yes ❑ No Thermostatic Expansion Valve is installed and Access is . provided for inspection ❑ 0 .: 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 ❑ No TXV is installed or Fan flow has been verified. If no TXV, verified fan flow matches design from CF -1R. Measured Fan Flow ❑ C7 Yes for both 1 and 2. is a Pass Pass Fait ❑ 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 empi yees or sub -contractors certifying that diagnostic testing and. installation meet the requirements for compliance credit.] Tests a , Date 7 stall g Subcontractor (Co. Name)'OR Performed General Contractor (Co. Name) COPY T0: Building Department HERS Provider (if applicable) Building Owner at .Occupancy Desert ENERGY CADEC Sic — Copies to: Builder, HERS Provider HERS RATER COMPLIA.,�NNCE 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. 1 certify that the houses identified on this form complp with the diagnostic tested compliance requirements as checked on this form. ❑ The installer has provided a copy of CF -611 (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 seat 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 Qa 25 Pa) 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 (100 x Test Leakage/Fan Flow) = Check Box for Pass or Fail (Pass=60/o or less) ❑ THERMOSTATIC EXPANSION VALVE (TXV) ❑ ❑ Pass Fail ❑ Yes ❑ No Thermostatic Expansion Valve is installed and Access is provided for inspection. ❑ ❑ Yes is a pass Pass Fail P.D. Box 621 Rancho Mirage. [A 92270 Ph/Fax (760) 5642044 Cell: (760) 90570M 250-1657. Email: RKrown62370baol.comQ 7-5 CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page 1 of 7) CF -411 Projec Title 7��7 ad %iyp,y u� 50 Da l- u/,%-vt P Project &ddless N yAlPc�wiclC ( PLA P-3 Builder Contact Telephone Plan Number # Kepw4 Mo o 2 50- 11 r-01.10 / H ' S ey • / #�GGNRK Telephone Sample Group Number � ��` � N �sl 132°12 �� 1 a L..O''(- U I Cenifying Signature Date Sample House Number Firm: pose ff E,1,kW 6E2V1 e -Es HERS Provider. G.ti•�E-Q.S. Street Address: P.D . Bot( (0,21 City/State/Zip: 690 -HO M ICA4E .0222-70 Copies to: Builder, HERS Provider HERS RATER COMPLIA.,�NNCE 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. 1 certify that the houses identified on this form complp with the diagnostic tested compliance requirements as checked on this form. ❑ The installer has provided a copy of CF -611 (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 seat 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 Qa 25 Pa) 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 (100 x Test Leakage/Fan Flow) = Check Box for Pass or Fail (Pass=60/o or less) ❑ THERMOSTATIC EXPANSION VALVE (TXV) ❑ ❑ Pass Fail ❑ Yes ❑ No Thermostatic Expansion Valve is installed and Access is provided for inspection. ❑ ❑ Yes is a pass Pass Fail