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0305-102 (SFD)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 1 /' Exp. / Date !I r% J r r Date , '� � =� Signature of Contractor tA ,4�- 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 VT.A7F- KIND Policy No. 15�i3A(!16-02 (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 Cal omia, and agree .that if I shoul6'become Subject to the Workers' compensa�on provisions of Section 3700wof•the Labor Code, L,641 fdrth.with comply,wittrthd`se provisions.. i Date: i`f^/ -) ; >'� 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, indemnity & 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.% f ,.,Signature (Owner/Agent) .,L� / / Date �. BUILDING PERMIT PERMIT�M5-1.02 DATE VALUATION t2S. Fv 2_r TRACT g/3. I ,F. JOB SITE ADDRESS -La6�«N' APN '? OWNER CONTRACTOR / DESIGNER / EN (NEER r0 i" :I:►01AIRS LIC C ,:;z,C I mia-d -0, we. 110TCXD810 H. 0X11JL21HMr:01VF LA QUY A C.1S :4 "0_34 Q,51,ft 4x190 USE OF PERMIT ak0 • e.vi `!i5 , Y71 -N i,11+6J1iC4. f'V #At 1, 37 l7 � :i. ! lftl9rl +!4'CL YY CdJCeI+. ,iv !� c + $ ty x u t moi. �y t� i,. ..f'�t (� _....._ �fT�i�.J z,-P(xx,q �Tp/t t. R DR11 XYQyil�%��11'-.i'.� 111 . �.. D .... IT PORCHirVAT.10 S,VP100 EW 0AF#,diCl.S�.' CARPOlR'I' »i,:.aiY SV CITY OF' fA FINANC CXXT, 0r, p:(w.eVI IT M ITUMM ARY MgVITz;1TC' OW ME '01••0f0-418.000 ;Ytj:! z ti, 0V Clii`:S.'-Y 'fiat 101-000-141:12-311 k;'@1,w1 ,..3-, 1,99 ,YkNXAY, 1FE $1:1 0r► VXICTRILCpal ME $2032 Tt.'.i5:ii#i1•IClf�C�i?. 1{il.d�'rE)f}..d.;�'i.L1i^Ti R;?SwG;.t� _.ONO AH)TION MY, - 'RESID 101-000- cA i. -000 cf•., f 0RJADPI40 :FEZ 01 -000-4,23-000 SiIMV L?'"'✓ Y O>I�i?r iMPAC;T FY $7,40.0-+ APT M 1'"UIMAC PIACUj - R991 270.000.445.00' 1136.45 t?S 4tk!Pf!3LT a01-000­43,9-:31?-S`,00am tTt1P-,-4TTJU, J'T.AN C' $3,3:18.76 TG -TAI, 11MMIT.TEPS DUX'NOW S4,53&76 RECEIPT DATE .r' BY r r / 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 — C3 Combustion Air Roof Deck — — Exhaust Fans O.K. to Wrap F.A.U. Framing _ _ 5 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 c BLOCKWALL AP ROVALS POOLS - S AS 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 Heater Final Water Piping Plumbing Final Plumbing Top Out — Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances Final Final e 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:��� 9/3/03 Page 1 of 1 14712 SW'SCHOLLS FERRY RD # 328 BEAVERTON, OR 97007 PHONE: 503-524-8268 FAX: 503-213-6222 John Hardwick COLLA; puI/ RJT Homes, LLC J T 79700 501' Ave LaQuinta, CA 92253 �t j RE: Structural Observation - Lot 48 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 appears to be the case, with no ► remaining, unresolved deficiencies that I am aware of. AIA &X''L Mike Nelson, PE y7 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: 50-250 VIA PUENTE ,LOT 48, LA QUINTA,CALIFORNIA CEILINGS: TYPE: BATTS MANUFACTURER: CERTAINTEED THICKNESS: R-38 WALLS: TYPE: BATTS MANUFACTURER: CERTAINTEED THICKNESS: R-21 GENE L O T- R: RJT S LICENSE#-� TITLE: PARAWN SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072 1 11,64 dd.4191z4 TITLE: ADMINISTRATIVE ASSISTANT DATE: 11/14/2003 CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7) CF -4R b Project Title 7q- 7a o /ivfNvf ,10 Z,9 d, / 02-1/- 03 Date T. 7 • Pr ect Address /fn/ 7u1(/�� w/ Buil er Namme /^• 4 jg- 0Z Builder Contact / j � Telephone Plan Num er SAN 766-.3Y&-015 Z Telephone Sample Group Number Date Firm:%tel rff� Street Address: 21 iACY it � Copies to: Builder, HERS Provider 1-6,Lo 1/9 Sample/House Number HERS Provider: 'mb//f s-/ City/State/Zip: �A e % '6 , /dmrf (/j 0MfZ%v HERS RATER COMPLIANCE STATEMENT The house was: 5 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. L7 The installer has provided a copy of CF -6R (Installation Certificate. EVDistribution system is fully ducted (i.e., does not use building cavities as plenums or platform returns in lieu of ducts) 130'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 a, 25 Pa) values Test Leakage Flow in CFM I/ If fan flow is calculated as 400cfm/ton x number of tons enter calculated _ value here 1A V If fan flow is measured enter measured value here — Leakage Percentage (100 x Test Leakage/Fan Flow) = Check Box for Pass or Fail (Pass=6% or less) 80'— ❑ �,/ Pass Fail ld THERMOSTATIC EXPANSION VALVE (TXV) 2 Yes ❑ No Thermostatic Expansion Valve is installed and Access is provided for inspection �� ❑ Yes is a pass Pass Fail ❑ MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT 1. ❑ Yes ❑ No ACCA Manual D Design requirements have been met (rater has verified that actual installation matches values in CF -I R and design on plan. 2. ❑ Yes ❑ No TXV is installed or Fan flow has been verified. If no TXV, verified fan flow matches design from CF -I R. Measured Fan Flow = Yes for both I and 2 is a Pass Pass Fail CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page 1 of 7) CF -4R l4 aUA )-,a Project Title 79- Tao /9V f -N v Project Address cf 6 A If ?- (7G a) Ks7S yt9 Z Builder Contact Telephone 15A &-v955 Date . 7. Aom f Buil er Name ,5g -02c Y Plan Number tspvr ^ Telephone Sample Group Number Date Firm: /,/2 oEZE//L /1 • //L?H/C Street Address: Copies to: Builder. HERS Provider -o 1DJ Y& Sample House Number HERS Provider: y A!� 4:� �- City/State/Zip: �4—k,e4fj 6 „ //IArf HERS RATER COMPLIANCE STATEMENT The house was: LJ 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. R"The installer has provided a copy of CF -6R (Installation Certificate. 130"Distribution system is fully ducted (i.e., does not use building- cavities as plenums or platform returns in lieu of ducts) IT 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. EJI'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 U U V If fan flow is measured enter measured value here `"- Leakage Percentage (100 x Test Leakage/Fan Flow) Check Box for Pass or Fail (Pass=6% or less) ❑ Pass Fail THERMOSTATIC EXPANSION VALVE (TXV) 1J 1'es ❑ No Thermostatic Expansion Valve is installed and Access is provided for inspection Yes is a pass ❑ MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT 1 • ❑ Yes ❑ No ACCA Manual D Design requirements have been met (rater has verified that actual installation matches values in CF -I R and design on plan. 2. ❑ Yes ❑ No TXV is installed or Fan flow has been verified. If no TXV, verified fan flow matches design from CF- I R. Measured Fan Flow = Yes for both I and 2 is a Pass Pass Fail ❑ ❑ Pass Fail CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7) CF -4R bon 1'—UA La Y 11k / 22-k- 03 Project Title 4 O �V �N U V A �v, /� Date T. 7 . Am f79- M! Project Address Buil er Name c�ts.9•�t �S�o2C Y Builder Contact n _ Telephone Plan Num er 9 Certil Finn: Street Address: 212,N Copies to: Builder. HERS Provider -3y�-v95S Telephone Sample Group Number Sample House Number c HERS Provider: T/y City/State/Zip: /9%Aif*%10 Date 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 certifv that the houses identified on this form comply with the diagnostic tested compliance requirements as checked on this form. 0The 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. K 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 If fan flow is calculated as 400cfm/ton x number of tons enter calculated value here W If fan flow is measured enter measured value here Leakage Percentage (100 x Test Leakage/Fan Flow) _ �p • 0 Check Box for Pass or Fail (Pass=6% or less) ❑ Pass Fail U THERMOSTATIC EXPANSION VALVE (TXV) 1f Yes ❑ No Thermostatic Expansion Valve is installed and Access is ❑ provided for inspection Yes is a pass Pass Fail ❑ MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT ❑ Yes ❑ No ACCA Manual D Design requirements have been met (rater has verified that actual installation matches values in CF -I R and design on plan. 2. ❑ Yes ❑ No TXV is installed or Fan flow has been verified. If no TXV, verified fan flow matches desien from CF -I R. Measured Fan Flow = Yes for both I and 2 is a Pass ❑ ❑ Pass Fail LATION CERTIFICATE (Page 3 of 13) GF -6R INSTAL C Permit Number Site.Address DUCT LEAKAGE AND DESIGN DIAGNOSTICS DUCT LEAKAGE REDUCTION ssurization Test Results (CFM @ 25 PA) Test Leakage (CFM)_ Fan Flow If Fan Flow is Calculated as 400 cfm/tn,Thousands numberd of 8 stu/hr, enter calculatedvCapacity ie 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 ❑ ass 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 X yes ❑ No Thermostatic Expansion Valve is installed and Access is 13 provided for inspection yes is a pass Pass Fail ❑ DUCT DESIGN 1 ❑ Yes [3 No ACCA Manual D Design calculations have been completed, Duct Design is on the plans and duct installation matches plans. 2.❑ y ❑ No TXV is installed or Fan flow has been verified. If no TXV, verified fan flow matches design from CFe I R- d Fan Flow = .❑ ❑ Yes for both I and 2. is a Pass Pass Fail that the above diagnostic test results and the work I performed associated with the test(s) is.in ❑ 1, the undersigned, verify wrements conformance with the requirements for compliance credit. ['I7r�bu'ldea' sl lgd installation meet thereqf the CF -6R. signed by the builder employees or sub -contractors certrfymgdiagnostic for compliance credit) Lk 0 Insta Ing Subcontractor (Co. Narne) OR Tests tune, Date General Contractor (Co. Name) Performed. COPY TO: Building Department HERS Provider (if applicable) Building Owner at Occupancy INSTALLATION CERTIFICATE (Page 3 of I3) CF -6R Permit Number Site.Address DUCT LEAKAGE AND DESIGN DIAGNOSTICS DUCT LEAKAGE REDUCI'lviv Pressurization Test Results (CFM Q 25 PA) Test Leakage (CFM) (23 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 ❑ ass 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 M- THERMOSTATIC EXPANSION VALVE X Yes ❑ No Thermostatic Expansion Valve is installed and Access is provided for inspection Yes is a pass ❑ DUCT DESIGN Yes ❑ No 2: ❑ Yes ❑ No ACCA Manual D Design calculations have been completed, Duct Design is on the plans and duct installation matches plans. TXV is installed or Fan flow has been verified. if no TXV, verified fan flow matches design from CF -IR- d Fan Flow Yes for both 1 and 2. is a Pass Pass Fail ❑ ❑ Pass Fail with ❑ 1, the undersigned, verify that the above diagnostic test results and the work I performed associated ted copy a the(CFs -in conformance with the requirements for compliance credit. [The builder shall provided installation meet the requirements signed a the builder employees or sub -contractors certifying that diagnostic testing for compliance credit.] �-' LSj4n3gi:Subcontnmctor(Co. Narne),OR Tests 4Siaw9mLDate General Contractor (Co. Name) Performed COPY TO: Building Department 1, able) HERS Provider (if app is Building Owner at Occupancy INSTALLATION CERTIFICATE Site Address DUCT LEAKAGE AND DESIGN DIAGNOSTICS 3 of Permit Number CF -6R ❑ DUCT LEAKAGE REDUCTION Pressurization Test Results (CFM @ 25 PA) Test Leakage (CFM) I IL Fan Flow If Fan Flow is Calculated as 400 cfm/ i Th nend of B er of stu/hr, enter calculated v aluuee here if fan flow is measured, enter measured value here Leakage Fraction. = Test Leakage/(Measured or Calculated Fan Flow) • Pass if leakage fraction S 0.06 ❑ Pass Fail fl For AEROSOL TYPE SEALANTS ONLY - The following diagnostic testing was completed: Duct Fan Pressurization at rough•n 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 X yes ❑ No Thermostatic Expansion Valve is installed and Access is . provided for inspection Yes is a pass ❑ DUCT DESIGN 1. 13 Yes ❑ No 2. ❑ Yes ❑ No ACCA Manual D Design calculations have been completed, Duct Design is on the plans and duct installation matches plans. TXV is installed or Fan flow has been verified. If no TXV, verified fan flow matches design (Measured Fan Flow = Yes for both I and 2. is a Pass Z ❑ Pass Fail ❑ ❑ Pass Fail verify that the above diagnostic test results and the work I performed associated with the test(s) i-6 ❑ 1, the undersigned, fyHERS conformance with the requiremR. ents for compliance credit. [The builder shall providetesting and installation meet thepy of the CF requiremen 6 signed by the builder employees or sub -contractors certifying that diagnostic testing for compliance credit.] 11 1• 11finstalfnitubcontractor (Co. Narne) OR Tests Sign ate General Contractor (Co. Name) Performed COPY TO: Building Department HERS Provider (if applicable) Building Owner at occupancy IN$-TALLATION CERTIFICATE (Page 3 of 13) CF -6R Site Address / Permit Number DUCT LEAKAGE AND DESIGN DIAGNOSTICS? � so - '50 P '`r DUCT LEAKAGE REDUCTION Pressurization Test Results (CFM ® 25 PA) Test Leakage (CFM) Fan Flow If Fan Flow is Calculated as 400 cfrn/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 Leakagc/(Measured or Calculated Fan Flow) =a 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 O Pressure pan test or House pressurization test O Yes O No O Visual Inspection of Duct Connections THERMOSTATIC EXPANSION VALVE (TX a a Pass Fail 'TfYes O No Thermostatic Expansion Valve is installed and Access is - provided for inspection Yes is a pass a O DUCT DESIGN Pass Fail ACCA Manual D Design calculations have been 1. O Yes O No completed, Duct Design is on the plans and duct installation matches plans. 2. O Yes O No TXV is installed or Fan (low has been verified. If no TXV, o o verified fan flow matches design from CF -IR. Pass Fail Measured Fan Flow= Yes for both 1 and 2 is a Pass 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 -611 signed by the builder employees or subcontractors certifying that diagnostic testing and installation meet the requirements for compliance credit. j r rte/ Tests SYpature, Date Installing Subcontractor (Co. Name) OR PeTfomrd General Contractor (Co. Name) COPY TO: Building Department HERS Provider (if applicable) Building Owner at Occupancy Cornpliair" Forms August 2001 A-25