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LICENSED CONTRACTOR DECLARATION
( 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 I- IO A �?Fl3t?1?f
Date /r'- 6 - r' Signature of Contractor —_L -)t - -
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.
( /) 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 STAFF, FUND Policy No. 1583906.02
(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.
1pate: 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) Date /il - '4-65
A20 3
BUILDING PERMIT PERMIT#
DATE VALUATION LOTTRACT
t
29959-1 ppyy62nc�nn,30 47
JOB SITE
ADDRESS t��ri: s i!IA U YTE
APN
772,170-033
OWNER
CONTRACTOR/DESIGNER/EN (NEER
W. 1.10 0 Ux
R .l INV k012AF.I: TS, a"i O7.
POBODX 810
14,25 L 11N1VL-R �1'S'� 'DFJ'VZ
!A QUU4TA � A 92253
;;8E.= .• AZ 83034
(602)257.1656 11-17AIN 41990
USE OF PERMIT
�o/� �{� �y{� }�j'(� `'gyp
5W01,E Ffiklyffl,.Ii, DVYScLi2.JNG
S.Pi.1, IAT 43, PLAN 5 M. PFUMIT DOES 'NOT INCLUDE BLOCK
W,1tei� IS. POOL, SRA OR DRNEWAY AP)'ROA,C1H
TRACT CONSTRUCTION 4,364.46 19
PORCH/PATIO 839.00 SF
0ARAGEICARPORT 1W.00 By
ESIDUCIVED LOS' OF C0 11fs9 '(TCrr1ON
262,580-10
?<''i<"fv"r+ ' ' SUMMARY
CONSTRUCTION FEE 101.000-418.000 11,210,00
PLAN CHECK FEE 101-0 39-328 �I,iJ3i.�3
MWHMOCAL IEEE 101.000.421.000 $130,00
ELECTRICAL FEE '101-000-4 20-000 $249.n ,
PLUMBING P192 101.000-419.000 %W.41)
STRONG MOTION VEE • 1RESID 101-000-24.1-000 $26.26
CRr' DDIO ME 101-0,00-4Z3-000 V5100
DEVELOPER IMPACT Fl:L►, $2,405,04
AFRI R4 PUBLIC PLACES • RESIE 7,70-000-"5-000 5136,4$
_— .1 r_ CON ITGTION AND PLAN C HF
�+S,S 313.76
:. , I -X43 PIM -PAW FHH.9
$0.00
;t�
QCT 0 6 200 0. 1 -TWT • X7781YU K
{ F044%CE DEPT.
RECEIPT
DATE �+
BY t
DA T�FINALE
INSPECTIA,
j
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
4 "
Ducts
Slab Grade
Return Air
7'
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
- —
F.A.U.
Framing
Compressor
Insulation
. Z _ <
Vents
Fireplace P.L.
Grills
Fireplace T.O.
z
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wail Firewall
Exterior lath
_ ? -
Drywall - Int. Lath
-
c
Final
- D _
Final —
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
p,Z 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
3
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 —
Utility Notice (Perm)
COMMENTS:
SIP Engineering
Consultants, LLC
2-6-04
Chad Meyer
RJT Homes, LLC
79700 50'h Ave
LaQuinta, CA 92253
RE: Structural Observation - Lot 43, 44 & 45
Chad,
14712 SW Scholls Ferry Rd
# 328
Beaverton, OR 97007
503-524-8268
503-213-6222 (fax)
D 0 "'� 0
ti
Sample observations were made of the above houses to ascertain whether the
general intent of the construction documents is being followed. With respect to the
structural items that remain uncovered and easily observable, this appears to be the
case, with no unresolved deficiencies remaining that I am aware of.
-AA '000asort
Mike Nelson, PE
INSULATION CERTIFICATE
This is to certify that insulation has been installed in conformance with the current energy
regulation, California Administrative Code, TiOe 24, State of California, in the building at
504$5 VIA PUENTE LOT 43-6A, LA QUINTA CA
CEILINGS:
TYPE'BATTS IVIAUNFACTURLR: Certainteed THICKNESS: R-38
WALLS:,
f.
TYPE:DATTS MANUFACTURER: Certainteed THICKNESS: R-21
GENERAL CONTRACTOR: RJT HOMES LICENSE #
By: TITLE:
PARAGON SCHMID BUILDING PRODUCTS A MASCO Company LICENSE # 221517
1�,WA" dut/TITLE:
BY: -/ ACCOUNT REPRESENTIVE DATE: iz10
. �.'-nrmlw
INSULATION CERTIFICATE
This is t certify that insulation has been installed in conformance W
e current energy
regulation, on, alifornia Administrative Code, Title 24, State of Ca ia, in the building located at
CEILINGS,
TYPE: BLOW UNFACTURER: inteed THICKNESS: R-38
WALLS:
TYPE: BATTS MALIN CT ER: Certainteed THICKNESS: R-13
GENERAL CONTRAC LICENSE #
BY: TIT
P ARAGO SCHMID BUILDING PRODUCTS A MA Company LICENSE # 221517
4ARAGO
BY: TITLE, ACCOUNT REPRES TIVE DATE:
d
INSTALLATION CERTIFICATE (Page s .of
CF -6R
DUCT•�EAKAGE AND DESIGN DIAGNOSTICS
PUQ' LEAKAGE REDU(:'1` ON —
Pressurization Teit Results (CFM ® 25 PA) Test Leakage (CFM)
Fan:Flow
If Fan Flow is Calculated as 400 cfmRon x numbcr of tons, or @s 21'.7 x Heating Capacity
In Thousands of-Btu/hr, enter calculated value here
'If fen flow Is measured, enter measured value here
Leakage Fraction -Test Leakaget(Measured or Calculated Fan Flow) a qtr 0
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 . d Pressure pan test.or House pressurization. test.
O Yes O No .0 Visual Inspection of Duct Connections o 0
Pass Fail
.W—TRERROSTATIC EXPANSION VALVE.(TM }
)? Yes O No Thermostatic Expansion Valve is Installed And Access is -provided. for. inspection
Yes' is a pass �' o
Pass Fall
(3 -DUCT DESIGN
ACCA Manual D Design calculations have, been
I. O 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 Fan flow 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
D 1, the underslp.ed, Verity thafthe above diagnostic test resulti and the work Iperformed associated with tire test(s) is in confomumcc
with the requirements for compliance credo. [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 toquimments for compliance credit. I
Testi Signaturej,Date Install/Jog Subcontractor (Co. Name) OR
Pedornxd general Con tractor (Co. Name)
COPY -TO: - Building Department
` HERS Provider (if applicabley
Building Owner at Occupancy
qugttst2001 o A-25
comm Fotnt;
0
ALLATION
TIFICATE
age 3 of
CF -6R
DUCT LEAKAGE AND DESIGN. DIAGNOSTICS
DUCT LEAKAGE REDUCTION
Pressurization Test Results (CFM ® 25 PA) Test Leakage (CFM) -2-
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) _ 0
Pass if leakage fraction < 0.06 pass Fail
❑ For AEROSOL TYPE SEALANTS ONLY -The following diagnostic testing was completed:
CHECK AFTER FINISHING WALL: Duct Fan Pressurization at rough -in measured leakage (CFM)
❑ Yes ❑ No ❑ Pressure pan test or House pressurization test
❑ Yes ❑ No ❑ Visual Inspection of Duct Connections o 0
Pass Fail
THERMOSTATIC EXPANSION VALVE (TX
IYes ❑ No Thermostatic Expansion Valve is installed and Access is - provided for inspection
( Yes is a pass /�' 0
❑ 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, o 13
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. ]
Q
Tests St re, Date Installing Subcontractor (Co. Name) OR
Performed General Contractor (Co. Name)
COPY TO: Building Department
HERS Provider (if applicable)
Building Owner at Occupancy
C(xnp16iW`.Forms 4ust20A1
A-25
ALLATION CERTIFICATE . (Page 3 of 13) CF -6R
Site Address Permit Number
DUCT LEAKAGE AND DESIGN.DIAGNOSTICS
DUCT LEAKAGE REDUCTION '
Pressurizatiou Test Results (CFM ® 25 PA) Test Leakage (CFM)
Fan Flow
If Fan Flow is Calculated as 400 cfrr✓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) _ 0
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 ❑ No ❑ Pressure pan test or House pressurization test
❑ Yes ❑ No ❑ Visual Inspection of Duct Connections 0 0
Pass Fail
THERMOSTATIC EXPANSION VALVE (TX
'? Yes ❑ No Thermostatic Expansion Valve is installed and Access is - provided for inspection
Yes is a pass y 0
❑ 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 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 -611 signed by the builder
employees or sub -contractors certifying that diagnostic testing and installation meet the requirements for compliance credit. ]
r%
Tests gnatu , Date Install ng Subcontractor (Co. Name) OR
Performed General Contractor (Co. Name)
COPY T0: Building Department
HERS Provider (if applicable)
Building Owner at Occupancy
COmpll nw-FO(m9 Attgust.2tZd1 A-25
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of T)
PALMILLA 5-A 05-11-04
Project Title
50 TH & JEFFERSON
Project Address
DARRELL MORGAN
Builder Contact
RICHARD KROWN
Firm: DESERT ENERGY SERVICES
Street Address: P.O. BOX 621
Copies to: Builder, HERS Provider
Date
R J T BUILDERS
CF -4R
Builder Name
760-275-8230 PALO VERDE SF2C4 3 UNITS
Telephone Plan Number
760-250-1852 GROUP 2
Telephone
05-24-04 LOT # 43
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 tape 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 X25 Pa)
Test Leakage Flow in CFM
If fan flow is calculated as 400cfin/ton x number of tons enter calculated
value here
Measured
values
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
❑ THERMOSTATICEXPANSION VALVE (TX
❑ Yes ❑ No Thermostatic Expansion Valve is installed and Access is
provided for inspection ❑ ❑
Yes is a pass Pass Fail
Certificate of Occupancy
a
4.
I..maoinTm �� _
of 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: 50-455 VIA PUENTE
Use classification: S.F.D. Building Permit No.: 03090-341
Ocuupal lcy Group: R-3 Type of Construction: V -N Land We Zonc: R -L
Owner of Building: RJT HOMES LLC. Address: PO BOX 810
City, ST, ZIP: LA QUINTA CA 62253
By: G.SHOWALTER
Date: 07/20/04
Building Officio-#(
POST IN A CONSPICUOUS PLACE