0309-239 (SFD)F—
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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
690645 B RX -A, , t5613t3tT,C
p*` ' �� t� 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.
'( 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 STATE F1.1id1? Policy No. R✓83904-02
(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:/ 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 I
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��i
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 b..uilding
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
��,Sig lure (Owner/Agent) Date2�1's
BUILDING PERMIT PERMT#
X309-2
DATEUATION LOT TRACT
.1 "? $2M.2.0 45 23859.1
I , • � • r^43e
JOB SITE
ADDRESS oii-"dmV1[ih.iI1.13J�TFt
APN
OWNER
CONTRACTOR / DESIGNER / ENGINEER
1" 11
RJT HOhM LLC12.TT
Iks1%Fi A'h�:13"d`. , I1 c.
PO BOX $10
141,5 R UNAr ZSrrY O -T4'ls
1,A,Q `INTA. C.A. 92253
P.TIOENM A% 85014
(602)257-1656 C13L# 4990
USE OF PERMIT
8ll'.T(3:TE FANWY L35X.iM1WG
S • LOT 45, .'PL.t N; SI°IACI. P1MRd1.'T D.C11tS T40T INC1.1JD9 BLOti;
WALLS, P004 SPA OR DRiV'SWAYd''U'PROACIF. ';S% tP.t.DUCTION TO
PLAN CHECK "Ut D11% TO MULTIPLZ ISS'UANC E OF S.A&'lZ)i L A1d TYi•+F
TRACT CONSTRUCTIOTI 4,024,00 I3F
PORC HIPATIO 863.69 Sr
0ARAODCARPORT 1:9.00 SF
COST 010 CON51IRTJCof
2 , aO
tiLRAOT FEE SUMMARY
CONSTRUCTION FEZ 1014000.41e,-000 $1.443.30
PLANE CHECK PEP. 101-000-439-31£1 $243.41
14 RCH"1C',AL PEE 101.000.421-000 V",00-
I11SICI 'P.IC AL FRE 101.000-420-000 $.2717,92.
Pl.,uMBDIG FEE 10.1 -OW -419-000 $249.23
S''TRONO MOTIC IN IMS , RE3110 101-000-241-000 $24.35
011AD1110 FEE 1X31 -L300 -423•t W $15,00
L7S11'P, L,0P9R IMPACT FES $2,403.00
ART IN PkIBLICw PLACED - ttl SIf 2'70-OW;11-45.000 $108.63
-- �"Ca1•il`FTFC°1"#c3i fk1�F1JY.a CFiEt
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:IHSS i�:Etr_ P;If3 i � „9
$0.00
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6 2- i
99,M4.08
RECEIPT
DATE
1r� ..._3 �1 �'
By ,
-'�
DAT FINALED
— II -o S -f
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade j/-
Return Air
Steel —Z
Combustion Air
Roof Deck
Exhaust Fans
OX to Wrap _ ? _
F.A.U.
Framing
Compressor
Insulation 3_Z _ c5
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
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I
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 -i
Encapsulation
Gas Piping
Gas Test
Appliances
FinalqqMM
-
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 Detector's
Temp. Use of Power
f�
(Perm) -
0
ALLATION CERTIFICATE A':i,:L• 3 of 13)
4,&,,&X .50-370 UiA TZ,1611�n
DUCT LEAKAGE AND DESIGN DIAGNOSTICS
T011UFL'AKA'' D1 TO'
Pressurization Test Results (CFM @ 25 PA)
Test Leakage (CINO
Fan Flow
If Fan Flow is Calculated as 400 cfm/ton x number of tons, or as 21.7 x Itcating 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
❑ 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
THERMOSTATIC EXPANSION VALVE (TXN'
CF-6R
tl: C
/Puss Fail
u
Pass Fail
,)!I Yes ❑ No Thermostatic Expansion Valve is installed and Access is - provided for inspection
Yes is a pass A90 C
❑ DUCT DESIGN Pass Fall
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, n
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) ism conformance
with the requirements for compliance credit. [The builder shall provide the HERS provider a copy of the CF-61k signed by the builder
employees or sub -contractors certifying that diagnostic testing and installation meet the requirements for compliance credit. I
I
Tesrs aturr, Date Installing Subcontractor (Co. Name) OR
Performed General Contractor (Co. Name)
COPN' 1 0, Building Department
HERS Provider (if applicable)
Building Owner at Occupancy
Compllettce Forms
August YOU
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 at
50-370 VIA PUENTE LOT 45, LA QUINTA CA
CEILINGS:
TYPE: BATTS MAUNFACTURER: Certainteed THICKNESS: R-38
WALLS:
TYPE: BATTS MANUFACTURER: Certainteed THICKNESS: R-21
GENERAL CONTRACTOR: RJT HOMES LICENSE #
BY.
TITLE:
PARAGON SCHMID BUILDING PRODUCTS A MASCO Company LICENSE # 221517
BY:/T—ITLE-. ACCOUNT REPRESENTIVE DATE:
INSULATION CERTIFICATE
N
S'
h b
This is to certify that insui 'on has been installed in conformance with the current energy
r
tative Co(
Admi
regulation, California trative Code, Title 24, State of California, in the building located at
CEILINGS:
TYPE: BLOW MAUNFACTCT RER: Certainteed ,-TSRCKNESS: R-38
WALLS
TYPE: BATTS MA CTURER: ertainteed THICKNESS. R-13
GENERAL CONACTOR:
LICENSE
BY: TITL
PARAGON SCHMID BUILDING PRODUCTS A MAS O Company LICENSE # 221517
BY:
TITLE: ACCOUNT REPRESENTIVE DATE:
01L
INST
TTA�i I1'f1T TTTT/1 ♦ TT
DUCT LEAKAGE AND DESIGN DIAGNOSTICS
CF -6R
tber JI PUGf��,
�_ 3�D
1 L1Q' LEAKA(E REDUC140N
Pressurization Test Results (CFM ® 25 PA) Test Leakage (CFM)AE
Fan Flow
If Fan Flow is Calculated as 400 efm/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) _ �w ❑
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:
O Yes O No ❑ Pressure pan test or House pressurization test
O Yes O No O Visual Inspection of Duct Connections ❑ ❑
Pass Fail
THERMOSTATIC EXPANSION VALVE (TX
Yes ❑ No Thermostatic Expansion Valvc is installed and Access is - provided for inspection
Yes is a pass 11E' ❑
❑ DUCT DESIGN Pass Fail
ACCA Manual D Design calculations have been
1. O Yes ❑ No completed, Duct Design is on the plans and duct installation
matches plans.
2. O 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 -611 signed by the builder
employees or sub -contractors certifying that diagnostic testing and installation meet the requirements for compliance credit. I
11441 1 0/
Tests _!hl(nYiurc, Date nsta ling Subcontractor (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
Certificate of Occupancy
T,mt 4 4 Q" -
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: 50-370 VIA PUENTE
Use classification:.S.F.D.
Occupancy Group: R-3
Owner of Building: RJT HOMES LLC
Building Official
Building Permit No.: 0309-239
Type of Construction: V -N Land Use Zone: R -L
POST IN A CONSPICUOU
Address: PO BOX 810
City, ST, ZIP: LA QUINTA CA 92253
By: G. SHOWALTER
Date: 06/15/04