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0309-233 (SFD)LICENSED CONTRACTOR DECLARATION I�heereby affirm under penalty of perjury that I am licensed under provisions of GI;apter 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 t13 �J 33 d7JC ani^^1 + 1:3011}A Date ' —^ a. Signature of Contractor K 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. (tV 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. 19TAT It, PIT. IN r) W3906-02 (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. gate" Applicant— le, J r ' 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 1 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. Sjgnature (Owner/Agent) f / / Date BUILDING PERMIT PERMITk DATE VALUATION LOT 030* 213 TRACT -�, '• -2,, . -3 S24;4,53.A,40 40 29Tt.��-1 JOB SITE — APN ADDRESS W-335 WA P YMMM� OWNER CONTRACTOR / DESIGNER / EN &NEER PO BOX, 8) S) 14125 F- 7Dt3`?'kms.". 3. Y MINE (W2)257-1,656 C, U4 49190 USE OF PERMIT =2'":t• Let 'f'A0, �E.A�7: 11iC7. PLRM3' �.is7 1'?dCl� lNC1 V1) B' CK MALL, 3; P004 GPA OR DWAVAY .A,1:IPROAC1£ TRACT CONSTRUCTDO."N 4,024.00 �VF 1�+JR.C:11/lar l°fC3 10.00 Sr OWRA0YJCAR P0RT ;"F Z,1V, 1?d Kf. C,,10Rc r OF CO3,K'r71V.1TCM0..N 2,1K1.51.1,40 CONSTRUCTION FF31 till -000-E' 8-000 Sl,'s43.30 nstW CH.TCK FEE ?01-000.439-318 $'.15 +IEC AMAOA,: VEZ -000..121 11O00 $137,fle .I 1+CTRPC:��:. HSP 101 PLiu Kul NCf FRE 10).-( C-419.000 1.26.13 SMONO'NIMUON FE R = R1TS1I) 101-000-2414M, §124.3.5 i.1k4U!Wt.1 101.000.423.000 1?1rrVZL4:)K`M i•i PAC"T FEMT mu 111 K.11,4UC PLAi1 N . R.f7llr Z70.OUG- 443.00;3 X08118 �{�l-B-'I��. �' e �' �4 ;%ZY: TTICNV ANDyyyy{'Il aiT( �t 1�1 .�0 :141 6,OBJ' r9i �• ( T 0 6 2GH15 r o ., 'EBW RECEIPT DATE BY DATE FINALLEED) INSPECTOR_ INSPECTION RECORD 1 ! OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts _ Slab Grade Return Air Steel _ / Combustion Air Roof Deck - Exhaust Fans f O.K. to Wrap ,3 - s -,f 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 g— 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 (f:,/.e> p 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 - _ ti Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring a Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: �'ed«�-�-=' 2 - 4 IV INSULATION CERTIFICATE This is to certify that insulation has been installed in confon-nance with the current energy regulation, California Administrative Code, Title 24, State of California, in the building at 50-335 VIA PUENTE LOT 40, LA QUINTA CA CEILINGS: TYPE:BATTS MAUNFACTURER; Certainteed THICKNESS: R-38 WALLS: TYPE:WALLS MANUFACTURER: Certainteed THICKNESS: R-21 GENERAL CONTRACTOR: RJT HOMES LICENSE# By., TITLE: PARAGON SCHMID BUILDING PRODUCTS A MASCO Company LICENSE # 221517 ,vZ 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 inth e buildinglo ed at cat CEILINGS, TYPE: SLOW MAUNFACTURER, Certainteed THICKNESS: R-38 WALLS: TYPE: BATTS MA FACTURER: GENERAL BY: TITLE: THICKNESS: R-13 LICENSE # PAF(AGON SCHMID BUILDING PRODUCTS SCO Company LC SCO Company LICENSE # 221517 TITLE: ACCOUNT REPR NTIVE DATE: ITLE: ACCOUNT REPRESENTIVE DATE: ay 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 inth e buildinglo ed at cat CEILINGS, TYPE: SLOW MAUNFACTURER, Certainteed THICKNESS: R-38 WALLS: TYPE: BATTS MA FACTURER: GENERAL BY: TITLE: THICKNESS: R-13 LICENSE # PAF(AGON SCHMID BUILDING PRODUCTS SCO Company LC SCO Company LICENSE # 221517 TITLE: ACCOUNT REPR NTIVE DATE: INSLA L' TION CERT�'ICA,TE '('Page 3 .of CF -6R Site Xddrass Permlt Number. DUCT -LEAKAGE AND DESIGN DIAGNOSTICS llt1(,"1' LEAKAGL� itk}DUC,"i`iUEV - Presiurization Teit Results (CFM Q 25 PA) Test Leakage (CFM) .i , Fan•Flow I -Han Flow is Calculated as 400 cfrn/ton x number of tons, or las 11'.7 x Heating Capacity In Thousands of•Btumr, enter calculated value here If fan flow is measured, enter measured value here Leakage Fraction - Test f,eekagd(Measured'or Calculated Fan Flow) - .Al�r' O Pau if Icak4go 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 AFTER FINISHING WALL: b Yes D No . d* Pressure pan test or House pressurization -test. O Yes O No S Visual Inspection of Duct Connections 0 0 Pass Fall ER STATIC EXPANSION'VA43EVi ' Ycs O No Ttiermostatic•Expansion Valve is Installed and Access Is - provided for. inspection Ycs'is a passP '. F • Pass Frill O DUCT DESTGN ACCA Manual D Design calculkdons.have.been 1•. l3 Yes. O No completed, Duct Design -Is on the plarls and duct Installation matches plans., ' 0 0 2. O Yes O No [ XV is installed or Fan ttow'has been verified. If no TXV, Pass . Fall verified fan flow matches design from CF -M Measured Fan Flow - Yes for both I .and 2 is- a Pass 0 1, the undersigned, yerlfy that'the above diagnosdo test resulti >ytd the work I perfor d associated with are test(s) is in con forrnancc with the requirements for compliance credit. [The builder shall provide the HERS provider, a ropy of the CF -6R signed by the builder diagnosde.testing and Installation meet the requircments for comptiance credit. ). employee orsub-contractors certifying that C J. f , / i..f l •. /�.a Tata *' Signaturee ,Cam installing Subcontractor (Co. Natne) OR Performed General Contractor (Co. COPYTOi - Building Department- ', HERS Provider or applicable)' Building Owner at Occupancy o A-•2 5 _. AAA4 EM INSTALS TION CERTIFICATE 3.of 13).. CF -6R VIA %M9 MUW1 goo DUCT -LEAKAGE AND DESIGN DIAGNOSTICS PA) Test Leakage (CFM) Presi4rlzatlon Teit Results (CFM Q 25 Fad•Flow If Fan Flow Is Cal6uldled as 400 cfrW.ton x number of tons, or 4s. 21'.7 x Hedfilig Capacity In Thousands of-ft/hr, enter calculated value here If fan flow Is measured, enter measured value- here Leakage Fraction -Test Leakagel(I'dea'sured-or Calculated Fan Flow) -, Pass'If leakage fraction <0.06 Pass Fall 0 For AERbSCFL TYPE SEALMSITS' ONLY-T4following diagnbstic testing was completed: Duct Fan Pre.siprization at rough -in measured leakage (CFM) CHECK AFTER FrNismo WALL: 0 Yes V Nd ff- Pressure pan test. -or Hods; presturization- test. 0 Yes 13 No -0: Visual Inspection of Duct Connections 0 13 Pass Fall W 1HERMOUAVC EXPADISION'VA.LVE (TM . Yes 0 No Thermostatic 'Expansion Valve Is Installed And Access Is - proyidcd. for. inspection 'Ycs*is a pass Pass Fail 0 DUCT DESIGN ACCA Manual D Design calculations have. been L 13 Yes 0 No completed, mpleted, Duct Design -Is, on the plans and duct Installation matches plans., 2. 0 Yes 0 No TXV is Installed or Fan flow has been verified. If no TXV, 0 '0 Pass Fail verified fan flow matches design from CF -IR. Measured Fan Flow Yes for both land 2 is- a Pass Q 1, the undersigned, verify thafthe . above diagnostic test resulti apd the work 1piafbrmed associated with tire tests) is in conformance with the mqufrcrmt3 for cornpllindo'credit. Me builder shall provide the HERS S provider *a topy*of the CF -6R signed by the builder employees or subcontmetors certifying that diagnostic.testing and Installation mat the requirements for compliance cr . edit. 1. Tats —cewt—urciDate 7nstalllng Subcontractor (Co. Naha) OR Performed General Contructor(Co.'Nimc) COPY70i BuildinSDepartment. HERS Provider (if applicableY Building OOMcr at Occupancy CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7) PALMILLA Project Title 50 TH & JEFFERSON PH 5-B 07-12-04 Date R J T BUILDERS CF -4R Project Address DARRELL MORGAN 760-275-8230 Builder Name MEAQUITE SFIC1. 3 UNITS Builder Contact Telephone Plan Number RICHARD KROWN 760-250-1852 GROUP 3 3 OF 3 Hr;Rs Rater /,/�Telephone (� #CCNRK613292 07-12-04 LOT # 40 Certifying Signature Date Firm:DESERT ENERGY SERVICES Street Address: P.O. BOX 621 Copies to: Builder, HERS Provider Sample House Number HERS Provider: CHEERS 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 tae 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 CL25 Pa) values Test Leakage Flow in CFM 31 If fan flow is calculated as 400cfin/ton x number of tons enter calculated value here 800 If fan flow is measured enter measured value here Leakage Percentage (I 00 x Test Leakage/Fan Flow) = 3.875 Check Box for Pass or Fail (Pass=6% or less) ® ❑ Pass Fail ® THERMOSTATIC EXPANSION VALVE (TXV) ® Yes ❑ No Thermostatic Expansion Valve is installed and Access is provided for inspection ® ❑ Yes is a pass Pass Fail CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7) CF -4R PALMILLA PH 5-13 07-12-04 Project Title 50 TH & JEFFERSON Project Address DARRELL MORGAN Builder Contact HERS Rater RICHARD KROWN Date R J T BUILDERS 760-275-8230 Builder Name MEAQUI.TE SF1C1. 3 UNITS Telephone Plan Number 760-250-1852 GROUP 3 2 OF 3 Telephone #CCNRK613292 07-12-04 LOT # Certifying Signature Firm:DESERT ENERGY SERVICES Street Address: P.O. BOX 621 Copies to: Builder, HERS Provider Date 40 Sample House Number HERS Provider: CHEERS 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) Measured Duct Pressurization Test Results (CFM Lk25 Pa) values Test Leakage Flow in CFM 74 If fan flow is calculated as 400cfrn/ton x number of tons enter calculated value here 1600 If fan flow is measured enter measured value here Leakage Percentage (I 00 x Test Leakage/Fan Flow) = 4.625 Check Box for Pass or Fail (Pass=6% or less) ® ❑ Pass Fail ® THERMOSTATI.0 EXPANSION VALVE ® Yes ❑ No Thermostatic Expansion Valve is installed and Access is provided for inspection ® ❑ Yes is a pass Pass Fail I CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7) CF -4R PALMILLA Project Title 50 TH & JEFFERSON Project Address DARRELL MORGAN Builder Contact HERS Rater ,, RICHARD KROWN PH 5-B 07-12-04 Date R J T BUILDERS 760-275-8230 Builder Name MEAQUITE SFIC1 3 UNITS Telephone Plan Number 760-250-1852 GROUP 3 1 OF 3 Telephone #CCNRK613292 07-12-04 LOT # 40 Sample House Number HERS Provider: CHEERS Certifying Signature Date Firm:DESERT ENERGY SERVICES 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) Measured Duct Pressurization Test Results (CFM CL25 Pa) values Test Leakage Flow in CFM 58 If fan flow is calculated as 400cfm/ton x number of tons enter calculated value here 2000 If fan flow is measured enter measured value here Leakage Percentage (I 00 x Test Leakage/Fan Flow) = 2.9 Check Box for Pass or Fail (Pass=6% or less) ® [] Pass Fail ® THERMOSTATIC EXPANSION VALVE ® Yes ❑ No Thermostatic Expansion Valve is installed and Access is provided for inspection ® ❑ Yes is a pass Pass Fail