0309-242 (SFD)V `LICENSED CONTRACTOR DEJLARATION
I hereby affirm under penalty of perjury that I am lil�,�nsed 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.
i License # Lic. Class Exp. Date
6905 B HIC A
000AV
Date fir' �'I ~r, 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).
( ) 1, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code). . I
( ) 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.
(�o 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 3T.AyN FUN,) Policy No. I383903•(>2
(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--,,-, r' (; � 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.
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) Date Ali
r BUILDING PERMIT PERMIT#
OM9-242 or
DATE VALUATION. LOT TRACT
03 S24521580130LOT29855�-1
-
JOB SITEAPN
ADDRESS .1 1 ly
S +yr) /y /y
y 7,!,370-032
OWNER s
CONTRACTOR / DESIGNER / EN &NEER
IM HOMES Y. LC
1 KV,& '1%gEN*1 S, !NC. .
PID BS'JX 810 ,
1425 R liNIV ::R`3'3C DRTV E
'LA <;pWA Clk 92253
PHfJENix AZ 85+034
(602)257-1656 C .0 4990
USE OF PERMIT
MNGLE F.AISJULY'DWEURIG
Sim- - LOT 42, Pi,N SP IA:C4. PERMIT L'?OES NU'£ INCL L(DF, BLOCK
i►ifrAl.LS, POOL, SPA OR 11RIV'EWAY APPROACK 73% RN,DUCTION TO
PLAN CFlYCK Irv-: DUE "TOMUL;TI.PLE I SUANCR OF., 3AfAft PI.,#al 't YPE
/
TRACT CONSTRUCTION 4,364"00 9F
PORt~'WPA IO 859.00sir
OARAOFJC RPOP.T "14.00 SF
XSrDiTA1X7 COST QF CO1N�".� IUC"rIOLK
262AW v
,PKRhm" Ti`RIE 9tTMMARY
CONSTRUCTIUN FF91 101.000-418.000 $1,210.00
PLAN CH9CK PEE I01 -O00-439-318 $259.33
MF.CIiANKIAL FC, 9 101.000.421.000 819G.OU
E1,,L*C'£RICA1_- YES 101-000-120-000 SI4 9.'n
PLiIMl rNO FEE 101 -0 00-419-000 419.000 $289.00
STRONG MOVON ielirfr • RESID 101-000-2,41-006 $26.26
CRADING ME 101-000.423-000 69.5.00
13E'",.TX1PER IMPACT "X $2,405,00
ART IN PUBLIC PI CES - R.T811 270.000.445.000
-- - — " — SUB- �'Tl�I, k TRLTC!IION AND PLAN CBECT.
Vit, X60.'16
1 B FRE -PAS- s 0
$0.00
10 6 2003 • �DrYE now
L
C11 wilOieTA
V
RECEIPT
DATE BY f
DATE FINALED
INSPECTOR
`-INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings 0– <
Ducts
Slab Grade / -Cr23
Return Air
Steel p"
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap 3
F.A.U.
Framing 3
Compressor
Insulation - j _
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
'
Exterior Lath
D II - Int. Lath
Final -v I
Final
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 I I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines 5
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection — . ' S
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 leg 7
,Utility Notice (Perm)
COMMENTS:
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• Y
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
50.415 VIA PUENTE LOT 42, 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; 044TITLE: ACCOUNT REPRESENTIVE DATE: l ,•
L/
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INSULATION CERTIFICATE
This is to certify that insulation been installed in conformance with the Curren er� r
regulation, California Administrativ ode, Title 24, State of California, i wilding Ivcyated at
CEILINGS:
TYPE: BLOW MAUNF
THICKNESS: R-38
WALLS:
TYPE: BATT MAUNFACTURER: Certainteed ICKNESS: R-13
GEN L CONTRACTOR: LICENSE #
BY: TITLE:
PARAGON SCHMID BUILDING PRODUCTS A MASCO Company LICENSE # 221517
BY:
TITLE: ACCOUNT REPRESENTIVE DATE:
f"�•.', •:.M... .r%%'rr, ...r /.r.r,//.ri.�/Y%'sr%Yr Frl•. •rl rr.•
ri/i':rvarrirs>i rr,r .!:1 v+rrr%Y:.r r•7/:/'%.r .Ire%,:f:I•,r•.rin:YYl..r•:^/ii /'r.., r•.!+ r.r /
0
' TAL-LATION CERTIFICATE (Page 3 .of 13) CF -6R
�4�i►�i> i..� 4�2_ S-6 _M;_ N/S L%'a P0e*_Mt-L_
DUCT -LEAKAGE AND DESIGN DIAGNOSTICS
DUCT LEAUGX REDUCTION
Pressurization Teit Results (CFM Q 25 PA) Test Leakage (CFMa3
Fan. -Flow
If Fan Flow Is Calculated as 400 cfn✓ton x number of tons, or As 21'3 x Heating Capacity
In Thousands 6(-Btu/hr, enter calculated value hijre
If fan flow Is measured, enter measured value here
Leakage Fraction - Test Leakage/(Measured or Calculated Fan Flow) a 0
Pass if leakege 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:
0 Yes D No . 17 Pressure pan tesfor House pressurization test.
0 Yes O No .0- Visual Inspection of Duct Connections o 0
Pass 'Fall
IRERMOSTATIC EXPADISION'
Yes O No Thermostatic -Expansion Valve is installed and Access is - provided for. inspection
0.
Yes'is a pass
Pass Fail
O DUCT DESIGN
ACCA Manual D Design calculations have, been
L a Yes O No completed, Duct Design is on the plans and duct Installation
matchesplans.,
o 0
2. 0 Yes 0 No TXV is Installed or Fan f ow has been verified. If no TXV, Pass Fail
verified fan flow matches design from CF -IR.
Measured Fan Flow -
Yes for both I and 2 is -a Pass
0 1, the undersigned, yerity that the abgvo diagnostic test resultd and the work I perfomlcd associated with.ttre 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 ivquirements for compliance credit. I
nSubcontractor (Co. Naine) OR
Tests a ; � ate In{ 8 .
Podomud Qeneral Contractor (Co. Name)
COPY. TO: - Building Department
`
HERS Provider (if appucabley
Building Owner at Occupancy
n A-•2 5
August 2001
Compliance Form9 0
IN -6R
TALLATION CERTIFICATE (Page 3 of ><s) CF
y
Site Address Permit Number
DUCT LEAKAGE AND DESIGN.DIAGNOSTICS
DUCT LEAKAGE REDUCTION
Pressurization Test Results (CFM @ 25 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 Btu/hr, enter calculated value here
If fan flow Is measured, enter measured value here
Leakage Fraction = 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:
CHECK AFTER FIMSHING WALL: Duct Fan Pressurization at rough -in measured leakage (CFM)
O Yes O No O Pressure pan test'or House pressurization test
❑ Yes O No O Visual Inspection of Duct Connections o 0
Pass Fail
THERMOSTATIC EXPANSION VALVE (TX
l!PYes ❑ No Thermostatic Expansion Valve is installed and Access is - provided for inspection
Yes is a passPasO
O DUCT DESIGN ' s Fail
I . ❑Yes O No ACCA Manual D Design calculations have been
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 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 -6R signed by the builder
employees or sub -contractors certifying that diagnostic testing and installation meet the requirements for compliance credit. ]
IV1 i. dIi
Tests i re, Date instalto Subcontractor (Co. Name) OR
Performed General Contractor (Co. Name)
COPY TO: Building Department
HERS Provider (if applicable)
Building Owner at Occupancy
Cornpllance Forms A6. -.2m.
A-25
TION CERTIFICATE
DUCT LEAKAGE AND. DESIGN -DIAGNOSTICS
DUCT LEAKAGE REDUCTION
3of1
CF -6R
Pressurization Test Results (CFM ® 25 PA) Test Leakage (CFM)
Fan Flow
If Fan Flow is Calculated as 400 cfmRon 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) _
(A— o
Pass if leakage fraction < 0.06
Pass Fail
❑ 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_ O No ❑ Pressure pan test or House pressurization test
❑ Yes ❑ No ❑ Visual Inspection of Duct Connections
0 ❑
Pass Fail
THERMOSTATIC EXPANSION VALVE (TXV)
P'Yes ❑ No Thermostatic Expansion Valve is installed and Access is - provided for inspection
Yes is a pass
lam' O
❑ DUCT DESIGN
Pass Fail
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
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 -6R signed by the builder
employees or sub -contractors certifying that diagnostic testing and installation meet the requirements for compliance credit. ]
Tests ignature, 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
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7) CF -4R
PALMILLA 5-A 05-11-04
Project Title
50 TH & JEFFERSON
Project Address
DARRELL MORGAN 760-275-8230
Builder Contact
RICHARD KROWN
Firm: DESERT ENERGY SERVICES
Street Address: P.O. BOX 621
Copies to: Builder, HERS Provider.
Telephone
Date
R J T BUILDERS
Builder Name
PALO VERDE SF2C4 3 UNITS
Plan Number
GROUP 2
Telephone
05-24-04 LOT # 42
Date
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 topa 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
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 Q 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
❑ ❑
Pass Fail
❑ ❑
Pass Fail
Certificate of Occupancy
T,vf 4 XP 12"
1 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: 50-415 VIA PUENTE.
Use classification: S.F.D.
Occupancy Group: R-3
Owner of Building: R.J.T. HOMES LLC
Building Offi ial
Type of Construction: V -N
INA
Building Permit No.: 0309-242
Land Use Zone: R -L
Address:, PO BOX 810
City, ST, ZIP: LA QUINTA CA 92253
By: G.SHOWALTER
Date: 07/12/04