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0309-238 (SATT)(V U) W O CY M r1L W � t` ' 1 Zr- �0o F- wwr1_. E- a N Z LICENSED CONTRACTORDECLARATION ,,!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 E t34• 13 Fifty ,A Ot4l30lZt Date fJl • 6:e 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 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. ( )' 1 have and will maintain workers' compensation insurance, as required by Sec ion 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 STATS FUND Policy No. 1523006•,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,.1 shall forthwith comply with those provisions. ,Date: rrM r. ,. s•. �itApplicant 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. i Signature (Owner/Agent) Date ✓1 - BUILDING -PERMIT PERMIT# - DATE VALUATION -LOT TRACT '120 29859-1 JOB SITE ' ' ADDRESS -M 'VIA ffJNW.l 'J'JC4ry APN 7i - • dt3 au OWNER CONTRACTOR / DESIGNER / EN (NEER I3J"i HOWS Wr Ryr 1brVF.; i EN7 3, Im. T.AQMW At CA. 92253 ,[ OENIX AZ -8,50'd4 x%0 )2 "a4.1Ci CRT-if4�'9u USE OF PERMIT MILE k'.@,M'!I. t XNACBW iFA - L t,120�- PLAN i ZA' PERMIT i;T(.1E, NOT PitM19t1L B3OCK •iVAl;A P()«%, SPA. OR DRIVIVOYA. Y APPROACH RUC�TY�'�'t?d1.f1e0 .��a'y��' �IZ��kt��'Y��2:y4Al2�iap'� POPtC:iidP.11' 10 13.06 9 0ARAGUC.ARP'ORT $33.0 OF E MKI ? CoUr 011' C"431491RiFMO.E1t .i#? 70'.13iA . PERWry'KE SUMMARY (:ONMUCTION FEE 101.000-43.8.00'0 $947, T.it PLA -4 CHECK FEE 101.000-439-318 $91.245 h+4ECHMIC.AL FEE 161-000.!4,21.-000 $1M0 ELECTRICAL F.fJH: tt�l-t��?Q�4.241-Ok1(1' '.. _ $2005 PLUMSTWO FIM, 101.010-41:9-000 9220.00 PR.ONCIMOTIONFEE •MWD 101<•000-241.-000 $.19:90 :? ORADI GFE tZ)1�Q0©=4 3�C1C14. SS950 . Dom' ' PFR IMPACT MW %M-'MTAL f` 6.4, .?til'CT' ON A PLAN CHECK. $4,334.70 LESS ME -PAID F :�, $03 at . ,M.GC7IS./A"d' ..9',.r�-Es .8 ulp., JN(Y9N Y4,M4B70 06 t�LJ u '� rae., c- ppjl --- RECEIPT DATE " . } BY DATE FINALE INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings - a/ - 3 Ducts Slab Grade / - - 3 Return Air Steel - Combustion Air Roof Deck 3 S Exhaust Fans O.K. to Wrap _ F.A.U. Framing _ Compressor Insulation cs _ Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath - Final - 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 Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines 3 Heater Final Water Piping 1 Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K for Finish Plaster Sewer Lateral Pool Cover Sewer Connection 5 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: 03 �p��p� C� � 1�1`7C�• a � D CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7) C-4R'- PALMILLA 5-A 0541-04„ Project Title Date •50 TH & JEFFERSON R J T BUILDERS Project AddressBuilder Name DARRELL MORGAN 760-276-8230 ACACIA P-2 . 3 UNITS i Builder Contact r Telephone Plan Number RICHARD KROWN 780-250-1852 GROUP 2 S Ra Telephone #CCNRD 13292 - 05-24-04' LOT# 120 tifying Signature Date Sample,House Num Firm: DESERT ENERGY SERVICES HERS Provider: -CHEERS F.O. ' RANCHO MIRAGE,CA.92270 Street Address:. :City/State/Zip: _ 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 thaf 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 ❑ MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT Duct Diagnostic Leakage Testing Results (Maximum 6%Duct Leakage) Measured Duct Pressurization Test Results (CFM C& 25 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 z Test Leakage/Fan Flow) _ Check Box for Pass or Fail (Pass=6%o 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 INSTALLATION. CERTIFICATE (Page 3 of 13) CF 6R. %° Site. Address Permit Number DUCT LEAKAGE AND DESIGN DIAGNOSTICS DUCT LEAKAGE KEDUCTION Pressurization Test Results (CFM @ 25 PA) Test Leakage (CFM) �—1 Fan Flow If Fan Flow is Calculated as 400 cfmlion 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) _ EX ❑ { 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 . 0 Pressure pan test or House pressurization test ❑ Yes 0 No ❑ Visual Inspect ion of Duct Connections ❑ Pass Fail ❑ THERMOSTATIC EXPANSION VALVE (TXV) ❑ Yes ❑ No Thermostatic Expansion Valve is installed and Access is - provided for inspection _ " Yes is a pass ❑ ❑ ❑ 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 0 No TX is installed. or Fan flow has been verified. If no TXV, ❑ ❑ verified fan flow matches design from CF -IR. Pass Fail Measured Fan Flow = " Yes for both land 2 is a Pass ❑ I, the undersigned, verify that the above diagnostic test results and the work I performed associated with the tests) 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. ] 'rests S' ture, Date Installing Subcontractor (Co. Name) OR Perronned - General Contractor (Co. Name) COPY TO: Building Department • _.. HERS Provider (if applicable) - Building Owner at Occupancy .. Compliance Forms - 4gust2001 A-25 ' INSTALLATION CERTIFICATE ' .(Page 3 of 13) CF -6R SLP " Site Address Permit Number DUCT LEAKAGE AND DESIGN. DIAGNOSTICS DUCT LEAKAGE REDUCTION,, Pressurization Test Results (CFM @ 25 PA) Test Leakage (CFM) t 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) _ ❑ _ 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 FINISHING WALL: O Yes ❑ No ❑ Pressure pan test or House pressurization test' - 0 Yes ❑ No ❑ Visual Inspection of Duct tonnections o ❑ ' Pass Fail . - .. Y ❑ THERMOSTATIC EXPANSION VALVE (T -XV) O Yes ❑ No Thermostatic Expansion ;Valve is installed and Access is - provided for inspection Yes is a pass ❑ ❑ ❑ DUCT DESIGN Pass Fail ACCA Manual D Design calculations have been 1: ❑ Yes ❑ No completed, Duct Design is on the'pians and duct installation - matches plans. 2. ❑ Yes ❑ No TXV is installed or Fan flow,has been verified. If no'TXV, ❑ - • o verified fan flow matches design from CF -IR. ''• Pass Fail ' Measured Fari Flow= .. x, Yes for both'1 and 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 providei 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. ) e ti Testsgnature, Date Installing Subcontractor (Co. Name) OR. ' Perfomwd' General Contractor (Co. Name) COPY TO: Building Department HERS Provider (if applicable),- ' Building Owner at Occupancy Compliance Forms Atigusl2001. o. , A-25 �" .^+7r].�!`�'.•n. �mnn✓r�rr. ✓rv�'vr. rr7xn�/.arf�srA,_�➢�oVe�7,wrv�SAy}yfv�svl�:sv7rsF➢t7..v�v/PoAnrx»�1'+��aa�rsC.Y!„9snit .m. nv»•rrRJRSaarrrry»ryrWw�rxp�!rwi,9Trr� msrrnun-..r/or....,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 bullding at 50-200 VIA SIMPATICO`LOT 920-5A LA 4UINTA CA TYPE: BAITS MAUNFACTURER: Certainteed THICKNESS: R-38 ' WALLS: r TYPE: BATTS. MANUFACTURER: Certainteed THICKNESS: R-13 GENERAL CONTRACTOR: RJT HOMES LICENSE# r BY: TITLE: . PARAGON SCHMID BUILDING PRODUCTS A MASCO Company, , LICENSE # 221517 BY: TITLE: ACCOUNT REPRESENTIVE DATE:., co hyirvrrsy/frivio�r,• i/c< iwframri!�armvx�ra�rivY+�•�nrr.�nrrRr�»�ssRsy'S'I'i�ymrnnwsrs�svtiSiC�irNzrmr.�aryuyw,yqy,•Iiens�iriverfn'iN►Mr�x7r/Rvir�riv�i��v � y , .. - .•� r , �+'�YliMai/sesVfv/r,•1:3; . la[ :�s:varwbwme:ra;et a�pssvfvss�,t.caeae[rs.Mwn fsmnv. .m:.a r,,%Mr. .dV:vr�sv:vrni►•rarwwarsv 9:yr wx; ,. INSULATION CERTIFICATE This is to ce ify that insulation' has been installed in conformance with the current energy ' regulation, -Ca mia Administrative Code, Title 24, State of California, in the. building locate - R CEILINGS: UNFACTURER: C2 TYPE: BLOW rtainteed THICKAtt_SS: R-38 P11. y r WALLS: TYPE: BATTS MAUNFA URER- t - Certai THICKNESS: R-13 ' r GENERAL CONTRACTOR: LICENSE , BY: ITLE: s: ,.PARAGON SCHMID ILDING PRODUCTS MASCOComp any LICENSE # 221517 BY:1 ' TITLE: ACCOUNT PRESNTiVE DATE: 1 ' a �)1!RT`A'YJY.•M•///YMMN7'�IIYfVYJ711Y.JA'lA'.YP%l7IYVA.NOOrYY.h7IJ9JYlN9Ja1V'l4PA+VAiN.C'NNi'N7!/N^,iF.//`7V"/Y69atl'.Y+')'►YT%YMBVF .� I .. •,•. ... -.D9•.DY,%!'.tlY//r/✓%iA.:Pa0i�1YRiV/7�J/Yf�/to•1i^/YWri�/•/'l.•'Mmi•i,/•/.,•r' . 100, te, of Ocvupanc .Certific_a . - :y. _. OF 'I'k � a' a epa men _ ,�Bu�ld�ng _ This Certificate is issued pursuant to .the requirements,,of Section ;109 of the California Building -Code,, certifying that, ; at the 'time of. -issuance; this structur"e, was in compliance' with the, provisions of 'theBuilding ode and -the various ordinances ;of the City ''regulating building constructto'mand/oruse:. 5 , BUILDING:ADDRESS: 50=200VIA SIMPATICO ~ ' r ' •� 4 _ We se classification S.F.D. J - �"', Buildmg'Permit No:: -0309-238 _ ■ • rlit �� ` - Type of Construction " V=N ,- _, Land Use Zone:' R -L• .OccupancyGroup R-3:� : ,( V Owner,of Building: RJT HOMES LLC t % . Address: PO BOX 816'% •+ • • ,, �'. " is -.City,.ST, ZIPS LA QUINTA CA 92253 ., By:'G`SHOWALTER` ate: 06/01/04 ' t Building Off' al "POST.IN A CONSPICUOUS PLACE''." ' Mll