0309-234 (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
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:
( ) 1, 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 Policy No.
rtITA`dTFK FIND 1$9..?9916-03
(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
Cooed shall forthwith comply with those provisions.
s�D'ate: ' r 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, 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 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) / �� f.Y Date/(. 7
I"
BUILDING PERMIT PERMTffsop
DATE VALUATION LOT (�.•'j 311 TRACT
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• . i .. 2)S2' 43A,%.20 �i # ?.51 ;39_1
JOB SITE
APN
ADDRESS mnnnrvu Urm'
OWNER
CONTRACTOR / DESIGNER / EN (NEER
.
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Iti"i' C.ik �yYT i.S lY w j , AIC" C.
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T,A QiT.L1q'1'." CA 9275:
aitif32.)2✓"x-1. i5 C'I T.tf 19ui1
USE OF PERMIT
�,?ut:a3.�:I�AA�S3.Y �:ttxiEl.T.x?�C1
VD, 3 OT41, PLAN PER11n, tion NOT 7',rir•I"110E 1:.',1X4 ,,X
VFALAU., I",3+?L, SPA OR ) R.tVEVE A Y f►PI1:1.Cr. Q11
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243,44W.20
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!,`OMS'i RUC•TIM YEE ;103 -000418-000 $i,i43,5 3
PLAN Ciil✓t K T't Re��L)Ci j! 7"3 ?;3
I4 ECiAVICAL ISE T401-9004.21-000 311,17.00
KI:EE. TRICA L F FX 1 fe l _0011-11'1'.0-000 037- srl
PL,litvli5ll O FYI? 101-000.419.0010 S24MO
STRGidr:i :t4OI ICN FTZ - 10.31FU 1 01-NY1-24 I-(?I:`tis
MAD1140 i M 101-000-413-000 WIN
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ART I21;'iJI3L RUS)? 270.00V-445.1300 31041615
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syn %�i.'�2
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RECEIPT—`-
DATE
BY
DATE FINALE
INSPECTOR
4 � -•�
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs-
Underground Ducts
Forms & Footings
/ / ..
Ducts
Slab Grade
Return Air
Steel
/ � .. t
Combustion Air
Roof Deck -
.L
Exhaust Fans
OX to Wrap
F.A.U.
Framing
_ 3D- y
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final z, -A
BLOCKWALL APPROVALS
POOLS-SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain v
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
- Q -
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) i
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) s
COMMENTS: A3 E1
78✓ 9. --
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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
50.375 VIA PUENTE LOT 41, LA QUINTA CA
CEILINGS:
TYPE: BATTS MAUNFACTURER: John Manville 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
F
BY. TITLE: ACCOUNT REPRESENTIVE DATE:
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INSULATION CERTIFICATE
This is to certify that insulation been installed in conformance with the current gefry
regulation, California Administrative de, Title 24, State of California, in th r ding located at
CEILINGS: "N,
TYPE: BLOW MAUNFACTURER: Certai
WALLS:
TYPE. BAITS MAUNF URER: Certainteed
GENERAL CONTRAC
THICKNESS: R-38
LICENSE #
: R-13
BY: TITLE:
PAIe6N SCHMID BUILDING PRODUCTS A MASCO Company LICENSE # 2215
BY: TITLE: ACCOUNT REPRESENTIVE DATE:
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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 760-275-8230
Builder Contact Telephone
RICHARD KROWN 760-250-1852
HERS Rater
Date
R J T BUILDERS
—------ -._._..__......
Builder Name
MEAQUITE SFICI 3 UNITS
Plan Number
GROUP 3
Telephone
#CCNRK6132g2 07-12-04 LOT #
Certifying Signature Date
Firm:DESERT ENERGY SERVICES
Street Address: P.O. BOX 621
Copies to: Builder, HERS Provider
41
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)
ElWherecloth backed, rubber adhesive duct tape is instal led,.mastic and drawbands are used in combination with cloth
backed, rubber adhesive duct tape to seal leaps 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
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) ❑ ❑
Pass Fail
❑ THERMOSTATIC EXPANSION VALVE
❑ Yes ❑ No Thermostatic Expansion Valve is installed and Access is
provided for inspection ❑ ❑
Yes is a pass Pass Fail
IN' ALLA,TION CERTiF'ICA,TE '(Page 3.of 13).. CF -61
S� Address .Permit Number.
1 r
• . '
DUCT•JEAKAGE AND DESIGN DIAGNOSTICS
DUCI' LEAUG4 RK-DILIQUON
Pressurization Test Results (CFM Q 25 PA) Test Leakage (CFM)
Fan: Flow
If Fan Howls Calculated as 400 cfni/ton x n.umbcr of tons, or 4s.21%7 x Hating Capacity
In Thousands o(•Btu/hr, enter calculated value here
If fan flow Is ineasured, enter measured value here
Leakage Fraction - Test LcAkage/(Measurcd'or Calculated Fan Flow) a 09 '0
Pass tf leakage fraction <'0.06 Pass Fall
O For AEROSOrL TYPE SEALANTS'ONLY•-The folloWing diagnostic testing was completed:
Duct Fan Pressurization at rough -in measured leakage (CFM)
CHECK AFTERTRIISHINO WALL,
0 Yes -DNo . 0 Pressure pan test or House pressurization -test.
0 Yes O No •O Visual Inspection of Duct Connections o 0
Pass' Fall
0"AHE� RROSTATIC EXPANSION VALVE *(T& ) *
{�l)Yes 0 No Thermostatic' Expansion Valve is lastalled and Access Is - provided for. inspection .
Yes'(s a pass Pass Fall
0 DUCT DESTfzN -
ACCA Manual D Design calculations.have.been
L 0 Yes O No completed, Ouct Design is on the plans and duct installation
matches plans.,
0 0
2. 0 Yes 0 No TXV is Installed or Fan ftow'has been verified. If no TXV, pass . Fail
verified fan flow matches design from CF-aL
Measured Fan Flow
Yes for both I .and 2 is- a Pass
D 1, the undersigned, Verity that the above diagnostic test Multi and the work FperforrnO associated with the tests) is in conformance
with the requirements for compliance credit. [The builder shall provide the HERS providcr.a copy of the CF -6R signed by the builder
employees or subcontractors certifying that diagnostic.tcsting and Installation meet the icquircments for compliance credit. I
Testi gnaturtir Data t Installing Subcontractor (Co. Name) OR
Performed y Oenera) Contractor(Co. Name)
COPY T.0,. - Building Department-
HERS- Provider (if applicabley
Building Owncr At Occupancy
o A-•25
up
-1 N5TALLA,TION CERTIFICATE (page 3.of 13).. CF -61
Sile Address Permit Number.
DUCT•JEAKAGE AND DESIGN DIAGNOSTICS
DUCT LEAKAGr4 Ri VILIC ION
Pressurization Teit Results (CFM Q 25 PA) Test Leakage (CFM) i._%
Fan: Flow
If Fan Flow Is Calculated as 400 cfm!ton x number of tons, or is 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 Leakagel(Measured or Calculated Fan Flow) a O
Pau tf Ieak4ge fraction <0.06Pass Fall
0 For AEROSOL TYPE SEALANTS ONLY• -The following. diagnostic testing was completed:
Duct Fan Pressurization at rough -in measured 'leakage (CFM) '
CHECK AFTER FRIISHINO WALL:
b Yes 'D No . d Pressure pan test.or Hotise pressurization. test
O Yes 0 No -O Visual Inspection of Duct Connections o 0
�
THERMOSTATIC EXPANSION VALVE PF M -
ll�Ycs 0 No Thermostatic -Expansion Valve is lnstalled Ptd Access is - provided for. inspection
Yes'is a pass
Pass Fall
O DUCT DESTGN -
ACCA Manual D Design calculations have. been
1, i3 Yes O No completed, Duct Design -Is on the plans and duct Installation
matches plans.,'
0 0
2. O Yes O No TXV is Installed or Fut ttow'has been verified: If no. TXV, Pass Fall
verified fan flow matches design from CF-f[L
Measured Fan Flow
Yes for both I .and 2 is- a Pass
O 1, the undersigned, Verity that'the above dlagnostic test resuld and the work Iperfoimrd associated with tite tests) is in conformancc
with the requirements for compliance credit. (The builder shall provide the HERS provider. a copy of the CF -6R signed by the builder
gn
employees or sub-contmotors certifying that dlaostic.testing and Installation meet the 'requirements for compliance credit. 1.
,
Testi - Stgriature Data Installing Subcontractor (Co. Name) OR
Pcdormad General Contractor (Co- Name)
COPY TO: - Building Department.
` HERS Provider (if applicable)
Building Oivncr at Occupancy
a A.
ffiRLLATION CERTIFICATE (Page 3.of 13) . CF -61
- :Site Address P=lt Number.
DUCT -LEAKAGE AND DESIGN DIAGNOSTICS
nil[ I' L EAUGl;{ RN•llUC'1'iUN
Presiurizatlon Teit Results (CFM Q 25 PA) Test Leakage (CFM)_z
Fan•Flow
If Fan Flow is Calculated as 400 cfm/ton x number of tons, or Qs2l'.7 x Heating Capacity
In Thousands of Bltt/hr, enter calculated value here
'If fare flow is measured, enter measured value here
Leakage Fraction -Test Wkaget(Memured -or Calculated Fan Flow)
Pass If IcakQgc 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- FRIISHINO WALL:
0 Yes 0 No . Pressure pan test..or Hodse presturization•test.
0 Yes O No •O Visual Inspection of Duct Connections o 0
Pass' Fall
, 0 IHERMOSTATIC EXPANSION VALVE'(TM -
asYes O No 7-6ermostatic'Expansion Valve is installed and Access is - provided for. inspection
'Yes,is a pass
Pass Fall
0 DUCT DESIGN
ACCA Manual D Design calculations have. been
L O Yes O No completed, Duct Deslgnls on the plans and duct Instaiialloh
matches'plans.,
• 0 .o
2, 0 Yes O No TXV is Installed or Fan flow -ha been verified. If no TXV, Pass Fall
verified fan flow matches design from CF- R.
Measured Fan Flow -
Yes for both I and 2 iso a Pass
0 1, the undersigned, Verify thafthe above diagnosdc test results slid the work l perfoimO associated with tire test(s) is in confonT=cc
with the requirements for compliance credit. IT6e builder shall provide the HERS provider. a copy of the CF -6R signed by the builder
employees or sub -contractor: certifying that diagnosdc.testing and installation meet tho requirements for compliance credit. )
Installing Subcontractor (Co. Natne) OR
Teen Signature; Date
Pcrfonnad atonal Contractor (Co. Warne)
COPYTO: - BulldingDepamnent• .
• HERS Provider or applicabley
Building Owncr at Occupancy
o A-•2 5
-..� nAM
M
ENS TAIIATION. CERT0FICATE (Page 3.of 13)..
:0W. Add .Pit Number
CF -6F
A&I
DUCTUAKAGE AND DESIGN DIAGNOSTICS
DUVII
Press4rization Teit Results (CFM @ 25 FA) Test Leakage (CFM),
Fait -Flow
If Fan Flow Is Cakuldled as 400 cWton xnumber oftohsoor4s2l'.7 x Hedlinscapacity
In Thousands o . f-Btuthr, enter calculated value hore
'If fan flow Ismeasured, enter measured value -here
Leakage Fraction - Test L#ka;c/(Measured-orCalculated Fan Flow) - , o t7
Pau if lcik4ge NOW <0.06 pass. Fall
0 For. AEROSOL TYPE SEALANTS ONLY'lThe'following dlagnbstic testing was completed:
Duct Fan Pressurization at rough -in measured leakage (CFM)
CHECK AFTE.R.TrNisHrNci WALL-:
0 Yes -.0-Nd b'- Presstire pan test -or Hot.ise pressurization -test.
0 Yes 0 No -0: Visual Inspection of Duct Connections D 0
pass: Fall
.CT."IRERMO#ATtCEXPA4STON.V-A.LV-E.(TM '
FYes ONo Thermostatic Expansion Valve Is Installed And Access is - provided for filspection
Yes' Is a Pass.
Pass Fall
0 DUCT DESIGN
RCCA Manual D Design coic.ultdons.have been
I. 13 Yes O 140 completed, Duct Design is on the plans and duct Installation
matches'plan3.,• -
0
2. 0 Yes 0 No TXV Is Installed or Fan flow'has been verified'. If no TXV, Pass 'Fall
verifled fan Cow matches design from CF -TIL
Mcisured Fan Flow
Yes for both I.and 2 is- a Piss
0 1, the undersigned, verify that'tho above diagnostic test resulti and the.. work Upirforrmd associatediWth tire test(s) is in conformance
with the requirements for compilindicndit. [The builder shall provide the HERS provider_ a copy*of the CF -6R signed by the builder
employees or sub -contractors certlfyfng that diagnostic.tasting4nd installation meet the *uIrcments for compliance credit. edit. J.
Nakne) OF,
Installins Subcontractor (Co. Tcsts Signature; Data .. Pedomad Con Warne)
eml Contractor(Co.
COPY T.6". - Building Departmen t - applicable}
HERS Provideror
Building OWner At Occupancy
A.-.25
Certificate of Occupancy
Tit!t 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: 50-375 VIA PUENTE
Use classification: S.F.D.
Occupancy Group: R-3
Owner of Building: RJT HOMES LLC
Building Officia
Type of Construction: V -N
NSPICUOUS
Building Permit No.: 0309-234
Land Use Zone: R -L
Address: PO BOX 810
City, ST, ZIP: LA QUINTA CA 92253
By: GARY SHOWALTER
Date: 07/26/04