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0305-101 (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 �f Exp. Date 4 rUfi B 142'' lC.13 �. �' /1y64 Date — i`" Signature of Contractor•.�/f�''f '.r,"Zo fr y • '� OWNER -BUILDER DECLARATION W 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. (0,) 1 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 VTAT K FUND Policy No. 1583906-02 (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, shall l rthwith comply with those (rovisions. Date:/_+ ; Applicant.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 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 gbove information is correct. I agree to comply with all'City, and State laws••r le ating to the building construction, and hereby authorize representatives<of this City to enter.. upon the above-mentioned property:for i s pectio'n purposes. /fir Signature (Owner/Agent). c '�- t 1.. - -� ;_ R Date BUILDING PERMIT PERMIT# t DATE VALUATION i0.aA f.1 {i,t�?ej LOT TRACT JOB SITE «(( V,f. f'IY;T'Fi('�: ADDRESS APN 7 v •'�a JYI�^�}x? OWNER CONTRACTOR / DESIGNER / EN (NEER PO Bel, )Fi: 81 12 5 `.i.,17?SMU,Im"I f JDIRDfB LA QT104TA CA 9225,E Me,10;F lix AZ, 85034 Ff?'�'.j�:57•i f 5�i t .I?Ivt 4990 USE OF PERMIT . 1, P LJM 50Jd`1DJ. i!S 17, �, v j iq,.,AE 19-16. LSU L' D=-T.r ;,, , '�WZ P0014 EPA. OR OIC.<t,'R•'dltAd+il�zF�tk"?:k's�`�j . SP JUN 0 9 1003 PCiDt.Ce`t%�.l4TfZ'• i,E;�'.i.7J St' 0ARAC3Rit:�,�RPORT .:S fl;i 31+ ITY OF LA TA FINANCE DEPT t.:(�t;?°J' EaP' �:.t•;'�tai�'�'T:ii:'.1r.,f::�.IV ��',?3.t�,r�i7 g,. tf �ry.te��r;r��,,�� y�.yww♦♦�`11�1���".�t�!1.�'1�.�� 11FM�.e:l . Xf? x1�6.5.L'!ASI.�EA9J7V COMIT RUCITIM k•24 101•0001=13e CLOS:' si,v41t,00 PIT AN fr'1~{.Idn,'s * 4t TZ 101-000 t4. 95 31 L V, l lail, f 7 MVCHAV1C. 1,VZ)t 101-000.421,000 $4 00. so ZLPXTR1rAL FM 4259, V9 PLUMBING ITT- STROM) ,f►4UMN rf_, r - k INI) t 0 itilt~ 01VOIN> b i k� 10 t •'Jf3 - 2�-flilf.3 l,*► d) .AWF IN PUBLIC: MACES - iR ,,53127G'-Ci00--IA. -000 FEE DtW)SIT [RECEIPT DATE BY + DATE FINALEtD, L, INSPECTOR / F INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings / Ducts Slab Grade 1510 Return Air Steel .- Combustion Air Roof Deck Exhaust Fans O.K. to Wrap -3 F.A.U. Framing 0 — 9'— 3 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 Q- 2 Final — BLOCKWALL APPROVALS Final —At POOLS - SPAS steel Set Backs Electric Bond Footings Main Drain Bond Beam -z b - Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final - X t5;.- 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 Utility Notice (Gas) Eli 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: 8/29/03 FAX :503-213- John Hardwick 8-28-03 (� RJT Homes, LLC V Q U 79700 5dh Ave J LaQuinta, CA 92253 q '0 h RE: Structural Observation - Lot 47 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. Mike Nelson, PE Page 1 of 1 14712 SW SCHOL LS FERRY RD ��'�r'�Zr" ri�r� r;'r'Yr•a2�r'•�'�•'t• k`}�v�SI�.��NG�INE�f21NG��Y� # 328 BEAVERTON, OR 97007 SLI�A1V`f5�'�LL�� •.. ,�•+,� �� G�-�C PHONE: 503-524- 8268 6222 FAX :503-213- John Hardwick 8-28-03 (� RJT Homes, LLC V Q U 79700 5dh Ave J LaQuinta, CA 92253 q '0 h RE: Structural Observation - Lot 47 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. Mike Nelson, PE Page 1 of 1 I STALLATION CERTIFICATE (Page 3 of 13) CF -6R '5-0- t/PUERA1725- Site Address Permit Number DUCT LEAKAGE AND DESIGN DIAGNOSTICS L ,DUCT LEA-KAGE 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 < 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 THERMOSTATIC EXPANSION VALVE l Yes ❑ No Thermostatic Expansion Valve is installed and Access is - provided for inspection Yes is a pass /w ❑ ❑ DUCT DESIGN Pass Fail ACCA Manual D Design calculations have been 1. ❑ 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. Pass Fail Measured Fan Flow = Yes for both 1 and 2 is a Pass ❑ I, 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. ] to I Lo Tests gn Date nstalling S bcontractor (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 'ALLATION CERTIFICATE (Page 3 of 13) CF -6R Site Address Permit Number DUCT LEAKAGE AND DESIGN DIAGNOSTICS DUCTLEAKAGE REDUCTION Pressurization Test Results (CFM Q 25 PA) Test Leakage (CFM&C 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) = X p Pass if leakage fraction < 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 o 0 Pass Fail THERMOSTATIC EXPANSION VALVE tp Yes ❑ No Thermostatic Expansion Valve is installed and Access is - provided for inspection Yes is a pass O ❑ DUCT DESIGN Pass Fail ACCA Manual D Design calculations have been 1. ❑ 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, 13 0 verified fan flow matches design from CF -IR. Pass Fail Measured Fan Flow= Yes for both I and 2 is a Pass ❑ I, 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. ] A- q- In,4 L_'_0 ft/"� Tests Sr ture, Date Ins lling S contractor (Co. Name) OR Performed General Contractor (Co. Name) COPY TO: Building Department HERS Provider (if applicable) Building Owner at Occupancy Compliance Forma August 2001 ' A-25 ALLATION CERTIFICATE (Page 3 of 13) CF -6R Sitb Address 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 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 < 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 THERMOSTATIC EXPANSION VALVE (T Yes ❑ No Thermostatic Expansion Valve is installed and Access is - provided for inspection Yes is a pass g ❑ ❑ DUCT DESIGN Pass Fail ACCA Manual D Design calculations have been 1. ❑ 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. Pass Fail Measured Fan Flow = Yes for both 1 and 2 is a Pass ❑ I, 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. ] Tests _§�Vfat6, Date nstalling ubcontractor (Co. Name) OR . Performed General Contractor (Co. Name) COPY TO: Building Department HERS Provider (if applicable) Building Owner at Occupancy Compliance' F6rms August 2001 A-25 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: 50-290 VIA PUENTE ,LOT 47, LA QUINTA, California CEILINGS: TYPE: BATTS MANUFACTURER: Certainteed Thickness: R-38 WALLS: TYPE: BATTS MANUFACTURER: Certainteed Thickness: R-21 GEN L ONT , CT R:�RJT H S LICENSE # � (�� E:SceP�6,l�Ul F'A N SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072 [44, 11111� i TITLE: ADMINISTRATIVE ASSISTANT DATE: 11/14/2003