0309-240 (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 (# p���^yy� yLLic�/
.yryC`llass Exp. Da{tee^(302(
.CA
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).
( ) 1, 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
Stiction 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 "� Policy No. 15817906-02
(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 L' V,
rr' r J - i y�. .�
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) ` %r DateL/ - •' .� . °1,•
BUILDING PERMIT PERMIT# -
03009-240
DATE VALUATION LOT TRACT
44, �9KS9.1
JOB SITE
ADDRESS_."__`410: I�rEi Z SN� b:
APN
f'I2ti�10.0'34
OWNER
CONTRACTOR / DESIGNER / EN &NEER
T2.7`.t'I-TomI, LLC
I3.iI.11wevnm% a,wc,
PO DOX 810
1425 X TJMV'F.,R.:1i'3"Y z7FJ�dTs
LA, QMUA CA 92,253
PHOENM AZ $3034
(603)237.1656 10BLO 4990
USE OF PERMIT
OLE FAWLY 3'DTW.VT., G,
SFRID - LOT 44, PLAN Stt''�tAC3. PZRMIT DOES NOT INCLUDE HIAXX
WALLA POOL, SPA OR DRIVEWAY A3APROAC'M
TRACT COTaSI'RUCTiON 4,616.00 87
hi2l3CifffPATIO 5ff
GARAG ICDA ORT 70.00 or
°' . 7' PRE SUAlii ARY
CONSTRUCTION FEE 101.000.418.000 sl.280,07
PLAN CHECK P'E-9 ICII-000-439-3118 $1,100.17
ME :HKNICFFAL FEE 101 000.421.000 100.50
Z LRXT R1CAI. PKE° 101-000-420-000 $x,50,39
PLUM 91ble Rim 101 •000.419 -OW $310.00
S't'klJNO MOTION FRE, lr.(LMD 101-000-241-000 $28.23
0 iRADINO ME, 301.-000-42.1.000 $15.40
r}EVELOPSR IMPACT FEF, $2,405.00
ART IN PUBLIC PLACE0 - ME K 270-000-445-000 $205.73
1�STRUC'T'1011 AND P;LAW CHECK
$5 ;74.07
D A� 0 6 2Qp3 I.�:S�q. PNE-FA IDMU
$0,00
:I1rM115: X FT: EN DITE NOW
Cs� C
&5,774.07
V
RECEIPT
DATE
BY
DATE FINALED
INSPECT
INSPECTIOjN 'RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
. BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
A
Ducts
Slab Grade
J
Return Air
Steel
1.15 ol .1Combustion
Air
Roof Deck
— <
Exhaust Fans
O.K. to Wrap
c — H
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
c
Final —
Final —
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Top Out
— _
Plumbing Final
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral .
Pool Cover
Sewer Connection
22, e93
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 4/
Temp. Use of Power
Final
Utility Notice (Perm) — —
COMMENDS71•
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7)
PALMILLA 5-A n--91-nA
Project Title
50 TH & JEFFERSON
Project Address
DARRELL MORGAN 760-275-8230
Builder Contact Telephone
RICHARD KROWN
Certifying Sigriaiure
Firm: DESERT ENERGY SERVICES
Street Address: P.O. BOX 621
Copies to: Builder, HERS Provider
�Q
CF -4R
Date
R J T BUILDERS
Builder Name
IRONWOOD SF3C3 3 UNITS
Plan Number
GROUP 2
Telephone
05-24-04 LOT # r44
Date
Sample House Numb
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 -
El MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT
Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage)
Duct Pressurization Test Results (CFM (& 25 Pa)
Test Leakage Flow in CFM
If fan flow is calculated as 400cfm/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
AXION CERTIFICATE (Page 3 of
CF -6R
zonwAaaress Permit Number
DUCT LEAKAGE AND DESIGN DIAGNOSTICS
DUCT LEAKAGE REDUCTION
Pressurization Test Results (CFM ® 25 PA) Test Leakage (CFM )e
Fan Flow
If Fan Flow is Calculated as 400 cfnVton 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) _ 10
Pass
Pass if leakage fraction < 0.06 Fail
O For AEROSOL TYPE SEALANTS ONLY -The following diagnostic testing was completed:
Duct Fan Pressurization at rough -in measured leakage (CFM)
CHECK AFTER FfNISHING WALL:
O Yes O No O Pressure pan test or House pressurization test
O Yes O No O Visual Inspection of Duct Connections D o
Pass Fall
THERMOSTATIC EXPANSION VALVE (TX
es O No Thermostatic Expansion Valve is installed and Access is - provided for inspection
J Yes is a pass D
O DUCT DESIGN Pass Fail
ACCA Manual D Design calculations have been
1. O Yes D No completed, Duct Design Is on the plans and duct Installation
matches plans.
2. 0 Yes O No TXV is installed or Fan flow has been verified. If no TXV, D D
verified fan flow matches design from CF -IR. Pass Fail
Measured Fan Flow =
Yes for both I and 2 is a Pass
O 1, 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. Inc 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� Ay /6'/ Tats i Date Install�t bcontractor (Co. Name) OR
Perfomxd 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
llU(;'1' LEAKAGE REDUCTION
Pressurization Test Results (CFM ® 24 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 Stu/hr, enter calculated value here
If fan flow Is measured, enter measured value here
Leakage Fraction a Test Leakage/(Measured or Calculated Fan Flow)O
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:
❑ Yes ❑ No ❑ Pressure pan test or House pressurization test
❑ Yes ❑ No ❑ Visual Inspection of Duct Connections a C3
Pass Fail
THERMOSTATIC EXPANSION VALVE (TX
'7f Yes ❑ No Thermostatic Expansion Valve is installed and Access is - provided for inspection
Yes is a pass O
❑ 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, 0 a
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 confomwnce
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 subcontractors certifying that diagnostic testing and installation meet the requirements for compliance credit. l
�jj (!I
Tests gnature, Date Installing 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
INS ALLATION CERTIFICATE (Page 3 of 13) CF -6R
Site Address Permit Number
DUCT LEAKAGE AND DESIGN DIAGNOSTICS
DUCT LEAKAGE REDUCTION
Pressurization Test Results (CRM ® 25 PA) Test Leakage (CFM)
Fan Flow
If Fan Flow is Calculated as 400 cfm1ton 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) p. ❑
Pass if leakage fraction < 0.06 /Pass Fall
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 O Pressure pan test or House pressurization test
O Yes O No O Visual Inspection of Duct Connections a a
Pass Fall
THERMOSTATIC EXPANSION VALVE (TX
9Yes O No Thermostatic Expansion Valve is installed and Access is - provided for inspection
Yes is a pass a
R DUCT DESIGN Pass Fall
ACCA Manual D Design calculations have been
1. O Yes ❑ No completed, Duct Design is on the plans and duct installation
matches plans.
2. ❑ Yes O No TXV is installed or Fan flow has been verified. If no TXV, a a
verified fan flow matches design from CF-iR. Pass Fall
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 -611 signed by the builder
employees or subcontractors certifying that diagnostic testing and installation meet the requirements for compliance credit. 1
0� U 14l
Tests i mMri, Date I sta ' g Subcontractor (Co. Name) OR
Perfomxd General Contractor (Co. Name)
COPY TO: Building Department
HERS Provider (if applicable)
Building Owner at Occupancy
C.ompIlime, Fortes August 2001
A-25
W
TION CERTIFICATE (Page 3 of 13) CF -6R
DUCT LEAKAGE AND DESIGN DIAGNOSTICS
AUC T LEAKAGE REDUCTION 1
Pressurization Test Results (CFM ® 25 PA) Test Leakage (CFM)
Fan Flow
If Fan Flow is Calculated as 400 cfrn/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/(Mcasured or Calculated Fan Flow) _ e'
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 O Pressure pan test or House pressurization test
O Yes O No O Visual Inspection of Duct Connections O 0
Pass Fail
2P THERMOSTATIC EXPANSION VALVE (TXV)
es O No Thermostatic Expansion Valve is installed and Access is - provided for inspection
Yes is a pass O
O DUCT DESIGN Pass Fail
ACCA Manual D Design calculations have been
1. O Yes O No completed, Duct Design is on the plans and duct Installation
matches plans.
2. O Yes O No TXV is installed or Fan flow has been verified. If no TXV, 0 0
verified fan flow matches design from CF -IR. Pass Fail
Measured Fan Flow =
Yes for both 1 and 2 is a Pass
O 1, the undersigned, verify that the above diagnostic test results and the work 1 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. I
I� to /1y /a,/ Tests i Date Ins�ll�t beontractor (Co. Name) OR
Performed General Contractor (Co. Name)
COPY TO: Building Department
HERS Provider (if applicable)
Building Owner at Occupancy
Cornplianoe Forms August 2001 A-25
r
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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
50-010 VIA PUENTE LOT 44 -SA LA QUINTA CA
CEILINGS:
TYPE: SATTS 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: TITLE: ACCOUNT REPRESENTIVE DATE:
This is to certify that insi
regulation, California Ad
CEILINGS:
INSULATION CERTIFICATE
has been installed In conformance with the current energy
ative Code, Title 24, State of California, in the building I ed at
TYPE: BLOW MAUNF,
WALLS:
TYPE: BATTS MAUNF/
GENERAL. CONTRACTOR:
BY: /
Certainteed —,TffiCKNESS: R-38
PARAGON; C`HMID BUILDING PRODUCTS A
THICKNESS: R-13
LICENSE #
BY: _ TITLE: ACCOUNT R
Company LICENSE # 221517
DATE:
s
f
Certificate of Occupancy
0
Tar 4'
G 9w5
of Building & Safet Department
Y p
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: 50-410 VIA PUENTE
Use classification: S.F.D. Building Permit No.: 0309-240
Occupancy Group: R-3 Type of Construction: V -N Land Use Zone: R -L
Owner of Building: RJT HOMES LLC. Address: OP BOX 810
City, ST, ZIP: LA QUINTA CA 92253
By: G. SHOWALTER
--�' Date: 062/23/04
Building Off' Ial
POST IN A CONSPICUOUS PLACE