0309-232 (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 Exp. Date
fii}f1f•4:'>_ F3 7iL�:'• ,lf,. r7 f.:9?('J�;
IDate. � ' �'� 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 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) 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 Policy No.
aA'x 9 PUNA.) ill;0%4412
(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: j� Applicants `t
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. r
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) / CJ i l '� Date
EW
BUILDING PERMIT PERM T#
DATE VALUATION LOT �� f TRACT
OA -1 "11:,5117 1119 1q;S£/• 1
JOB SITE — -
ADDRESS'
APN
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x -M 70..029
OWNER
CONTRACTOR /DESIGNER / EN (NEER
i?"q HOMES TIC
RM D41C
110'ISOX Ell 1) Q
14 UMNE RUIr T 1w�IRIVF>
Wil, 1257-1
USE OF PERMIT
SNNGI. E .7R.�>1TI' Y DWEL ZIG
D - LOT 3�. PLAN 3F2A.0 Pr- R1AYI' DOES NO I-NCIA10F,131,C."K
WALL% POtA1 ',UW. 10P. J)P.IVKWA ( APP R tiC•:H
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VRl N10 A,6.03'ION' "ft • E(:wsFl) 101 -DOO $16.3:
(JR.AI3M0 FF..F, $1510ft
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RECEIPT
DATE
Jam' =� • �'.� •
By`/INA
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E
— � -
INSPECT
IF
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
-172-Ig
Return Air
Steel
-
Combustion Air
Roof Deck
- 3 •
Exhaust Fans
O.K to Wrap
5 - y
F.A.U.
Framing
IEEE
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 S
BLOCKWALL APPROVALS
POOLS - SPAS
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
,Z - p
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
0. K. for Finish Plaster
Sewer Lateral
Pool Cover • '
Sewer Connection
-/ q -
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)
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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 at
50-295 VIA PUENTE LOT 39, LA QUINTA CA
CEILINGS:
TYPE: BAATTS MAUNFACTURER: John Manville THICKNESS: R-38
WALLS:
TYKE: BATTS MANUFACTURER: Certainteed THICKNESS: R-21
GENERAL CONTRACTOR: RJT HOMES LICENSE #
/
BY: TITLE:
PARAGON SCHMID BUILDING PRODUCTS A MASCO Company LICENSE # 221517
9Y; TITLE: ACCOUNT REPRESENTIVE DATE:
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.. .. ./ ...,... :.?�.: rr. •rr:•r.r:•-.. .: . - �•.. ...r., r•/r.... •e•/rti..:•irr.:/: i/r.r... /:r•.`•r:•.. �,`%-: � � r.. r .. >r./
INSULATION CERTIFICATE
This is to certify that insulation ha been installed in conformance�in
ent energy
regulation, California Administrative ode, Title 24, State of i ornia, the building located at
CEILINGS:
TYPE: BLOW
WALLS:
TYPE: BATTS
GENERAL
BY:
MAUNFACTU
ACTURER:
SCHMID BUILDING PRODUCTS A MASCO
THICKNESS: R-38
THICKNESS: R-13
NSE #
Y: TITLE: ACCOUNT REPRESENT
. _ .,r . . • r .. r. a. n. ri �./: i :.: r•/./: r: /.;i •r.�/: r /%/:vqs•'/rryvr: /:.. i:.: c..-n•r.•r../•n,.<t•,c�•,v/.•,.,/.11f v+•n. »'.r -r
LICENSE # 221517
DATE:
JN L ,. TION CERTIFICATE (Page 3.of 13) .
CF-61R
V 14GGC-s lU
- Site Address Permit Number.
DUCT-LEAKAGE AND DESIGN DIAGNOSTICS
DUCI' LEAKA_G_Lr ltEllWhON ��JJ
Test Leakage (CFM4; ! '
Presiurizatlon Test Results (CFM Q 25 PA)
Fad•Flow
If Pan Flow Is Calculated as 400 cfrnAon x number of tons, or 4$ 21'.7 x Heating Capacity
In Thousands of Btufhr, enter calculated value here
If fan flow Is measured, enter measured value- here
Leakage Fraction -Test I.A.Akagct(Measured or Calculated Fan Flow) W
o
Pau if Ictiksge fraction <0.06 Pass
Fall
0 For AEROSOL TYPE SEALANTS ONLY-The following. diagnostic testing was completed:
Duct Fan Pressurization at rough-in measured •leakage (CFM)
CHECK AFTERTINISHINa WALL:
0 Yes :0 No • O Pressure pan test or Hoose pressurization-test.
_
0 Yes 0 No -0 Visual Inspection of Duct Connections 0
0
Pass
Fail
*HER140S 'AT[C EXPADISIONVALYE' TM
• t 0es O No 'Ibermostatic-Expansion Valve is installed slid Access is - provided for inspection .
Yes' is a pass >
Pass
a
Fall
0 DUCT DESTGN
ACCA Manual D Design calcuf kdons.have. been
1, 13 Yes O No completed, Duct Design is on the plans and duct Installation
matches plans.,
0
2. 0 Yes O No TXV is installed or Fin flow has been verified. If no. TXV, pass
0
Fail
verified fan flow snatches design from CF-M
Measured Fan Flow
Yes for both I .and 2 is- a Pass
0 1, the undersigned, yetify thaftho &boyo diagnostic test resulti apd the work 1 •performed associated 'with tire wt(s) is in conformance '
with the requirements for compliance credit. (The builder shall provide the HERS provide{ a copy of the CF-6R signed by the builder
employees or subcontractors certifying that diagnostic.tcsting and Installation mat the *ulremcnts for compliance credit. I.
Testi T Signature; ate % installing Sub on etor (Co. Name) OR
Tutsod oeneral Contractor (Co. Name)
porfocop
YT.0 - Building Department. .
` HERS Provider (if applicable)
Building Owncr at Occupancy
A-•2 5
. ..._....� OM1 ., .
ATION CER
7
DUCT.L.EAKAGE AND DESIGN DIAGNOSTICS
PUM, LkAa" REPUMUN
Pressimizatlon Tait Results (CFM Q 25 PA) test Leakage (CFaz
Fah:Flow
If Fan Flow Is Cal6ulated as 400 crrdton x number of tons, or 4&21'.7 x Hcdflng Capacity
In Thousands of Btu/hr, enter calculated value hole
If fart flow Wmeasured, enter measured value here
Leakage Fraction - Test Le.akagel(Mcisured'or Calculated Fan Flow) a C3
Pus If lcikqfraction <0.06 Pass Fall
0 For AERbSCFL TYPE SEALANTS' ONLY -The following diagnostic testing was completed:
Duct Fan Pre.siurization at rough -in measured leakage (CFM)
CHECK AFTER-FrNmirNa WALL:
b Yes -.0 No . d*- Pressure pan t6st.or House. pressurization- test.
0 Yes 0 No -0: Visual Inspection of Duct Connections 0 0
Pass, Fall
eTHER140�TA][tCEXPADISIONVALV.E'(TM-
ROVcs C).No Thermostatic' Expansion Valve is. Installed And Access Is -provided. for. inspection
Yes"k a pass
Pass Fail
0 DUCT DESIGN
ACCA Manual D Design colqui stions.have*en
L a Yes 0 No completed, Duct Design is on the plans and duct InsthIlaUoh
matches plans., -
D .a
2, C) yes C) N pass- 'Fall
M is Installed or F�n floiVhss been verified. If no TXV,
verified fan flown
-At;hcs design from CF -RL
Measured Fan Flow
Yes for both I and 2 is- a Pass
.0 1, the undersigned, Verify thafthe . abqyo diagnostic test msulU and the work .I'pirfbffned 44ociated with the test(s) is in conformance
its for compliando'cridit. . copy of the CF -6R signed by the builder
with the mquircn= Me builder shall provide the HERS provider a
employees orsub-.contractors certlfylng thatd1' osticjcs ting and installs don mat the ireq uIrements for compliance credit.. 1.
Agn
Subcontractor (Co. Nsk�ne) OR
Two S 4,natumiDate Installing
PerformedGeneral Contractor(Co.'Nifne)
COPY TO, Building Department .
HERS. Provider (if applicableY
Building 0wncr At OCCUPAnCY
o A-2 5
1) rki I
ATION CERTIFICATE
3 o
CF -6R
DUCT.L.EAKAGE AND DESIGN DIAGNOSTICS
DUVII LUAK4GX liEllUGfION
Pressurtzation Teit Results (CFM Q 25 ?A) Test Leakage (CFM) 422
Fah -Flow
If Fan Flow Is Cil6uldted as 400 cfi*ton X number of togs, or;s2l',l x Heating Capacity -
In Thousands of Btu/hr, enter calculated value Mira
If fan flow Is measured, enter measured value- here
Leakage Fraction - Test 1.4kagd(Measured-or Calculated Fan Mow) a 13
Pau if leakage fraction <0.06 Pass. Fall
C3 For AERbsorLTYPE SEALANTS' .ONLY -The following diagnostic testing was completed:
Duct Fan Pressurization at rough -in measured leakage (CFM)
CHECK AFTER-PIT11SHING WALL:
bYcs -D - No Pressure pan test.or HoUse pressurization- test.
0 Yes ONo .0: Visual Inspection of Duct Connections
Pass* Fall
JHERROS'TATIC EXPANSION VA kU(T='
XS Yes CI No Thermostatic -Expansion Valve Is Installed And Access Is - provided, for. inspection
'yes,is a pass11M7. P
Pass Fall
O DUCT DESIGN
ACCA Manual D Design Wcul kdons-havOeen
L C3 Yes 0 No completed, Duct Design IT on the plans and duct Installation
matches'plans,• .
13 V
2. 0 Yes 0 No TXV Is Installed or Fan floiVhas been verified. If no TXV, P"s 'Fall
verified fan flow matches design from CF -UL
Measured Fan Flow
Yes for both Land 2 is- a Pass
Q I, the-undersigned,yet'ifythafthe. above diagnostic test msulU apd the -work 1pejformed associated with tire test(s) is in conformance
with the rquiremcrits for compliance . credit. Me builder shall provide the kETO provider. a copy*of the CF -6R signed by the builder
employees or sub -contractors certifying that Alapostic.testIng'and Installation meet the Pcqulrcrncnts for compliance cr.cdit. 1.
Tests Signaturtevato LInstsj;jng Subcontractor (Co. Name) OR
Performed Ocneral Contractor (Co.Name)
COPY TO; Building Department.
HERS Provider- (if applicable)
Building Owner 99 Occupancy
A_.25
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7) CF -4R
PALMILLA PH 5-B 07-12-04
Project Title
50 TH & JEFFERSON
Project Address DARRELL MORGAN 760-275-8230
Builder Contact Telephone
RICHARD KROWN 760-250-1852
Date
R J T BUILDERS
Builder Name
PALO VERDE SF2C2 3 UNITS
Plan Number
GROUP 3
HERS Rater*-'
Telephone
!#CCNRK613292 07-12-04 LOT # 39
Certifying Signature Date Sample House Number
Firm: DESERT ENERGY SERVICES HERS Provider: CHEERS
Street Address: P.O. BOX 621
Copies to: Builder, HERS Provider
City/State/Zip: RANCHO MIRAGE CA. 92270
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 certify that the houses identified on this form comply
with the diagnostic tested compliance requirements as checked on this form.
❑ The 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-
❑ MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT
Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage)
Duct Pressurization Test Results (CFM (L25 Pa)
Test Leakage Flow in CFM
If fan flow is calculated as 400cfin/ton x number of tons enter calculated
value here
If fan flow is measured enter measured value here
Leakage Percentage (I 00 x Test Leakage/Fan Flow) =
Check Box for Pass or Fail (Pass=6% or less)
❑ THERMOSTATIC EXPANSION VALVE (TXV)
❑ Yes ❑ No Thermostatic Expansion Valve is installed and Access is
provided for inspection
Yes is a pass
Measured
values
❑ ❑
Pass Fail
❑ ❑
Pass Fail
��-a-V► �c Certificate, of Occupancy
44"
G OF'Building & Safety Department
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: 50-295 VIA PUENTE
Use classification: S.F.D. Building Permit No.: 0309-232
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
Date: 08/13/04
Building Official
POST IN A CONSPICUOUS PLACE