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0309-231 (SATT)fc LICENSED CONTRACTOR DECLARATION -«-- - I 'hereby iiiIOUirider 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 W2 W04 '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 14hereby 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 Sdction 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., V FA TIE FON D 1-13i 996-11.11t, (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, 1: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: !:"r- 4 n% Applicant Warning: Failure to secure WorkersCompensation 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 r ' BUILDING PERMIT PERMIT# DATE VALUATION LOT 11. TRACT y JOB SITE APN ADDRESS W -19S �� � �e�a����c:cp M-41wo9zii OWNER CONTRACTOR / DESIGNER / ENGINEER ro , OY, 81 E. 14,25 .>re 'C.oNDY-.eRlIiTY X�P�WE, J- V li74994 USE OF PERMIT ,SFr - LOT 173, t'''f.,,lt,N PAM PLIlWlT !)OF. -, -NOT l3vf.°LUn,"?, BlAr1Cit 'Ehi.��1..Y,.S, j'� <C',� "'�,h. Gt'I� ?F�.A� �`',�'.h.�'',?•43'.'F3ta�1.4`�9I POR31.!i ".,' ) 967.69 S 00yr W 00 9119 }MtO.N CONT- TRFJt;TION 1178 101-000-41 8' 011Nl SPROb PLAIN, CHECK PIZ M111 HA.%!'rf rS&. 101 -O00"421.000 0)0-420-000 3 pujunm4o'n9m, '30*1 Lion -439--00 ti `710,00 ' ,°'rT7tf-. 190 Ir.tO ION 9,5E . MW ?. 0l 000-24 t QOt $147.76 ORADINO Y1719 TJEV'Z6-3PF_R .NI CT ,ff,I°s 7 vtr^ �...Y} `g�t�a - J.t (W �.. J,A�.is.�8 1�2EY.i�.�2"�w�\i?? (.+6S�OX, WIT' FT.Mwr ME eLZ RECEIPT UATE ' By DATE FINALED. INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck -/ —1y Exhaust Fans O.K. to Wrap - F.A.U. Framing - - y Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Z Fans 8 Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final 7— — S 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 Gas Piping PLUMBING APPROVALS Gas Test s _ Electric Final Waste Lines r 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 Utility Notice (Gas) Z I- ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smnko f)pfPetrns COMMENTS: �� Use of Power Final Utility Notice _CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7) CF4R PALMILLA PH 5-13 07-12-04 Project Title Date 50 TH & JEFFERSON R J T BUILDERS Project Address DARRELL MORGAN 760-275-8230 Builder Name OCOTILLO P-1 3 UNITS Builder Contact Telephone Plan Number (CHARD KROWN 760-250-1852 GROUP 3 HERS Rater Telephone" #CCNRK613292 07-12-04 LOT # 123 Certifying Signature Date Sample House Number Firm., ENERGY SERVICES HERS Provider: CHEERS Street Address: P.O. BOX 621 City/State/Zip: RANCHO MIRAGE CA. 92270 Copies to: Builder, HERS Provider 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) 0 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'- ❑ MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage) Measured Duct Pressurization Test Results (CFM (L25 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 (I 00 x Test Leakage/Fan Flow) Check Box for Pass or Fail (Pass=6% or less) ❑ ❑ Pass Fail ❑ THERMOSTATIC EXPANSION VALVE (TXV) ❑ Yes ❑ No Thermostatic Expansion Valve is installed and Access is provided for inspection ❑ ❑ Yes is a pass Pass Fail TALLA>rTION CERTiFICA,TE (Page 3013) CF-6R SI ress Permit Number. DUCT AAKAGE AND DESIGN DIAGNOSTICS MCI, QUeflON Pressurization Tut Results (CFM Q ZS PA) : Test Leakage (CFM) Fan. -Flow if Fan Flow Is Calculated as 400 cfmhon x number of tons, or @s 21'.7 x Heating Capacity In Thousands of-btu/hr, enter calculated value here If fan flow Is measured, enter measured value -'hate Leakage Fraction -Test Leakaget(Measured or Calculated Fan Flow) o Pass if leakage fraction <0.06. Pass Fail 0 For AEROSOL. TYPE SEALANTS• ONLY -The following diagnostic testing was completed: Duct Fan Pressurization at rough=in measured •leakage (CFM) CHECK AFTER FINISH NO WALL: O Yes .O No . O Pressure pan test.or House pressurization -test O Yes O No O Visual Inspection of Duct Connections o o , _ Pass Fall JHERMOSTATIC EXPANSION VALVE•Pf)M Yes O No Thermostatic -Expansion Valve is Installed and Access is - provided for. inspection Yes'is a passo• O DUCT DESIGN Pass Fall ACCA Manual D Design calculations have. been 1, 0 Yes 0 No completed, Duct Design is on the plans and duct,installation matches plans., 2. O Yes O No TXV is Installed or Fan ttow'has been verified. If no TXV, o verified fan flow matches design from CF -1R Pas Fall Measured Fan.FloW = Yes for both 1 and 2 is a Pass 0 1, the undersigned, yerify that'the above diagnostiq tett results and the work I performed associated 'with We wt(s) is in confomaance 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 Tests tgnature; ,pate PWins Subcontractor (Co. Naive) OR Pen'or>nod Ocneral Contractor (Co. 'Name) COPYTO: - Building Department ` HERS Provider (if applicable) Building Owner at Occupancy August 2 A-25 001 • ' TALL ..TION CERTIFICATE (Page 3.of 13) . CF -6R Sills Address Permit Number. DUCT-EAKAGE AND DESIGN DIAGNOSTICS DUCT LEMKA(;G4 REDUCTION Pressurization Teit.Results (CFM Q 25 PA) Test Leakage (CFM) D ' FahTlow If Fan Flow is Calculated as 400 efrrVton x number of tons, or 4&21'.7 x Heating Capacity In Thousands of•Btufnr, enter calculated value here If fan flow Is measured, enter measured value here Leakage Fraction - Test Leakage/(Measured or Calculated Fan Flow) 60 Pass if leak4$e fr<action 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 FRITSH. INO WALL.: O Yes '.O No'. d•. Pressure pan test.or House pressurization- test. O Yes O No •O Visual Inspection of Duct Connections o C Pass Fail ERMATIC EXPAD[SION'VALY-9' Yes O 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. Q Yes O No completed, Duct Design is on the plans and duct Installation matches plans., 2. O Yes O No TXV is Installed or Fin flow has been verified. If no TXV, o Pass o . Fail 'verified fan flow matches design from CF -IR - Measured Fan Flow '.Yes for both I and 2 is a Pass O 1, the undersigned, yerify that'the above diagnostic test miuld 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 certttytng that diagnostic.testing and installation meet the i-equtremen'ts for compliance credit. I Tests r iQ%ignature; Date '. Installing Su • contractor (Co. Name) OR , Performed General Contractor(Co. Name) COPY TOi - Building Department HERS.Provider (if applicable) Building Owner at Occupancy August 2001 -' A-25 P$STALLATION CERTIFICATE • (Page 30 13) . CF+76R rESite Address Permit Number. DUCT- EAKAGE AND DENUN DIAUNOS'rICS DUCT LIaAKAUX R.UDUC' ION Pressurization Teit Results (CFM ® 25 PA) Test Leakage (CFM) Fah -Flow If Fan Flow Is Calculated as 400 efrdton x number of tons, or 421•,7 z Heating Capacity In Thousands of-Btu/hr, enter calculated value here If fan flow Is measured, enter measured value here Leakage Fraction Test Leakage/(Mcasured or Calculated Fan Flow) a O Pass if leakrlge fraction <'0.06 Pass Fail 0 For AEROSOL TYPE SEALANTS ONLY following diagnostic testing was completed: Duct Fan Pressurization at rough -in measured leakage (CFM) CHECK AFTER FRIISHING WALL: 0 Yes Z No. O Pressure pan test; or House pressurization. test. O Yes O No O Visual Inspection of Duct Connections o Q Pass Fall R2THERR0$jATICPAN I. V• es; O No . Thetmostatic-Expansion Valve Is Installed and Access is -provided. for. inspection Yes' is a pass t� O DU DESIGN Pass Fall RCCA Manual D Design calculations have. been L Q Yes O No completed, Duct Design is on the plans and been. Installation matches'plans., _ 2. O Yes O No M is Installed or Fan ftow"has been verified. If no TXV, Pass Fall verified fan flow matches design from CF -IR P - Measured Fan Flow . Yes for both I and 2 is a Pass 0 1, the undersigned, Verity thafthe'above diagnostic test results and the workIperformgd associated wlth the test(s) is in confom,ancc 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 certlfying that diagnostic.testing and installation meet the requirements for compliance credit. l' Tats' r a ate sta Ing Mcontractor (Co. Nainc) OR Performed General Contractor(Co. Name) COPY TO: - Building Department ` HERS Provider (if applicable) Building Owner at Occupancy A -z5 August2001 o • . r.. r. Y"/•:+.':v.�'r•:e-/�r. ev%-r• nrnv%.,.</ti!r/:r•»:rrsrsr/n• `r, ,. r✓-/w•rsi•'irx+.�+...,•.,erg(•..nrrrw+..•nr.i•.:✓rr�.:hi:•/:»</•.a�:J-r,;.:.•✓v'i•�ii•.�J�r:,-:r.. •:/.</v'..:/•J'. 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 Califomia, in the building at 50-195 VIA SIMPATICO LOT 123, LA QUINTA CA CEILINGS: TYPE: SATTS MAUNFACTURER: Owens Coming THICKNESS: R-38 WALLS: TYPE: . MANUFACTURER: Certainteed . THICKNESS: GENERAL CONTRACTOR: RJT HOMES LICENSE # BY: TITLE: f PARAGON SCHMID BUILDING PRODUCTS A MASCO Company LICENSE # 221517 BY: TITLE: ACCOUNT REPRESENTIVE DATE: J � -: rJ:•.+r,..•a.rc..:.:r.n:/..r:✓IK'%.y+M'wnr,. ri r,.oRi!rriVJX+Y..�.oi - � � � � �y urrviv';rtY.'Yw ✓. bT.'KlNy: 'rs m.R!Y.bll�f.+f/�:?. r:T'Y./:J.IY+.+s T.:srF J."/t✓ns/Fi:: Jf!'(.i(✓f rrm( 'a....yY.i./. r.r..ri 1✓JN �...n.::•..:•. •.ry.J .. .. %•i •... ... .. •rr,PJ:/�'ri: r. .n ..r. /�/f!:IiJ.,...i Jri•%Nl.'Jrri%.J::•a:..>•.f/P'!'Irin�✓^1✓/ihRrJrlr%r/r/v J�%'.!+N;.. /r,.,•. ., ' INSULATION CERTIFICATE r' This is to certify that lnsulati has been installed in conformance with the rif energy + regulation, California Adminis a Code, Title 24, State of Califo the building located at CEILINGS: ,. TYPE: BLOW MAUNFACTURE ertainteed THICKNESS: R-38 WALLS: r o. TYPE: BATTS UNFACTURER: Certainte THICKNESS: R-13 GENERAL TRACTOR: LICE # BY TITLE: PARAGON SCHMID BUILDING PRODUCTS A MASCO Company LIC SE # 221517 BY: TITLE: ACCOUNT RBPRESENTIVE DATE: - � _.nr-ri..,,../:...,,,.>•.:.>r<.,.�ii>ra/ivii•/>w;+r,...ru. •s►ro...r..... r. +Y.�,: :-ri:•r.�.•n✓.1 a,•r,r;✓•�^. �.y�r� r:e/ r i ... ate: •. i •ate S qaCertifia- dmen cu ato 'f Oc&:Safet aoFBuild►ng� ,y. p Q ' . -This 'Certificate, s'issued pursuant to' the, requirements of: Section° 109 of: the California Building n }';Code, 'certifying ` that,�-at 'the time of issuance, this structure wasin _,compliance . with t e provisions .of ,the Builalirtg' Code and the'�various ordinances; of; the, City regulating budding k `construction ana_ lor.,use `vJa.. . '• ' y ,. r � _ ,•� i tY. ' l 'I r �... - ,i �,_ 1,} _ r • �.r. LL r _ ja BUILDING ADDRESS: 50-195 VIA -SIMPATICO s St Jr Building Permit No.: 0309-231 F Use -,classification: S.F.D. Occupancy Group: R-3 �` Type ofConstruction. V -N ry Land Use'Zone: r t. ' Address:; PO BOX 810 Owner of Building: R.J.T. HOMES LLC. City, ST,,ZIP LA QUINTA CA'. '92253. �I � .. � � - . } ` , . � . 'k` ..� '�:�• -g' G `SH0INALTER y .� `Date: 07/30/04 Building Offici i.• i _ j' �N, t ;;; POST IN A CONSPICUOUS PLACE. 4 �' '