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0401-117 (SATT)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chagpr 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 Date/• .r t i, �.3 `� Signature of Contractor 't ''' `r ,1 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&RC. 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 STATE IeL�N'D Policy No. IMM -0 + (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:./,-' i, L'42 41- Applicant --r '2' t 3 r � c 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.,•c� 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) - y t y ` / --' ' Date/7v f ctt? BUILDING PERMIT PERMIT# DATE VALUATION LOT ry ' a i TRACT ' JOB SITE ADDRESS 501•-215 IA nSTWATTX,'0 APN OWNER CONTRACTOR / DESIGNER / EN (NEER RJT XC3:MM I,W RIT 11 - r T:t c,NT. 19('• PO BOX 810 1425 t, t7:Nt�E:ItMI Y" DRI'V'E L-A Q 1WfA Gla 92253 PHOP11mc A7• 85034 (rs+J2j253-%6r6 MIN 4990 USE OF PERMIT -04Gr isF.A1V L.Y A3TA.r 0 5WA - LDT .125 PLAN P38. PEj2.MIT IDOES 1-40T INCLUDE PC OL, SPA, F3LOM. WALLS., OR DRIVEI AY APPRO,tit ET, 150K "i7UCTIOW TO PLIV04. CHECK FEt DUZ TO 'bAF1LTIPLE ISSU AMC,E OF SAME PLANT SPE ,T'1e,ACIT CONSTRUCTION 1,254.00 OF POt CHiPA'i IO 960.00 SI+ OA11AG4? CARPORT 563,00 SP CONSTRUCTIO14 FLS: 161-000-4-1€ -000 $4�3.bid RLPN CfiECf:PE 9 101-000-439-318 fS2p6.5: MECHANICAL ,-.E 101-000.421.000 d,00 ELECTPUCAL, FEE 101-000-420-000 $$201.30 1aLU14IIb NG FRE 101 -MO-419-000 $100,00 S'f RO1d0 PA'OTIONt F22 - RESID 101 •000-241-000 $20.09 CSR-+9DII-10 FEE M.00 DEVELOPER 1IMPACT FZEW $1,oGf.QO ART IN PUBLIC I'I,AMS, • 1 EZU 2"/0.000a445 -MO / MR.-TOTA5:, CONW U Y;l'ON A)M MAW MIE, CK $3,719.91 LESS Mr-PAMMIT-Z $0,00 F[J28 2004 CITY OF LA QUINTA FINANCE DEPT. RECEIPT DATE By f DATEFI LEDIN SPECTO A5 L'fiy2 t INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings _ 3 - _ Ducts Slab Grade Return Air — Steel — Combustion Air Roof Deck Exhaust Fans O.K. to Wrap 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 — / -- Y Drywall - Int. Lath _ _ y Final - —k Final y 1 POOLS - SPAS BLOCKWALL APPROVALS 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 �j' 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 COMMENTS: )Ft— 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) — _ y J 14712 SW Scholls Ferry Rd # 328 y. Beavert6n,-OR 97007 SIP..'E ring ng.inee Co503-524-8268nsultants, _LLG. :503-213-6222 (fax) ....... ... 4-27-04 Chad Meyer kJT Homes, LLC 79,700 50th Ave LaQuinta, CA 92253 RE: Structural 'Observation Lot 125, Lot 1264 Lot 127 Chad, - 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 'an& e6siliobservable, this appears to be the - case, with.no unresolved• deficiencies remaining that I am 0warelof. QPpFESS/011 2717 Mike Nelson, PE, 6 EV. CNkV OF C INSTALLATION CERTIFICATE (Page 3 of 13) - CF -6R . �,� . so _Q1115 vtA pavkzb Site Address Permit Number O DUCT LEAKAGE AND DESIGN DIAGNOSTICS DUCT LEAKAGE REDUCTION Pressurization Test Results (CFM @ 25 PA) Test Leakage (CFM)Zd 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 ❑ For AEROSOL TYPE SEALANTS ONLY -The following diagnostic testing was completed: Duct Fan Pressurization at rough -in measured leakage (CFM) CHECK AFTER FMSHING WALL: O Yes ' ❑ No _ ❑ Pressurepan test, or House pressurization test ❑ Yes 0 No ❑ Visual Inspection of Duct Connections o ❑` Pass Fail THERMOSTATIC EXPANSION VALVE (TXVI [?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 ❑ No TXV 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 I and 2 is a Pass ❑ d, 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 lure, Date Installing Subcontractor (Co. Name) OR Performed General Contractor (Co, Name) COPY TO: Building Department HERS Provider (if applicable) Building Owner at Occupancy t • .Compli6mdForms August2001 A_25 s ` INSTALLATION. CERTIFICATE (Page 3 of 13) y CF -(R 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) _ ❑ ' Pass if leakage fraction < 0.06 Pass Fail ❑ For AEROSOL TYPE SEALANTS ONLY -The following diagnostic testing was completed: r ' Duct Fan Pressurization at rough -in measured leakage (CFM) CHECK AFTER FIMSHING WALL: ❑ Yes ❑ No "0 Pressure pan test of House pressurization test ❑ Yes' "❑ No O Visual Inspection of Duct Connections ' " ❑ o Pass Fail THERMOSTATIC EXPANSION VALVE (TXV) i 9Yes ❑ 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 i completed, Duct Design Is on the plans and duct Installation matches plans. 2. ❑ Yes ETNo TXV 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 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. ] r Testsi re, 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 . r ;, �- Certifi'ca te. .Occanqy,u ,- .of _ L ItmVoantm� 0.1 .:. :r BuildinSafet'Dartmentg e , . � � 4 ' � Building ursuant to . the re uirements -,of Section 109 ,ofr the-Californiat • This Certificate. is issued p ` q. _ - _ Code3 certifying J that, at '` the Gime of" issuance; this structure" was' in, j compliance, 4ith' the L , = provisions, �of.-the Buildirig' Codeand "the various ordinances of the 'City regulating building !,construction"and/or-use: ., s WILDING'ADDRESS-[50-215 VIA SIMPATICO, • _ 1 7 JAS �' . . _ b 7 ' . t - - _ , y ^. �.•. '.4 J. h _-.Use classification: S-F.D: =,A " " s Tyr _ Building�Permit No.: 0401-117% hJA's � � • �,' Ld ;f ,� f � r4y ti ���I � S �'.... - a• .w�i `•. .,.� Occupancy Group: y R=3- t�- Y U� ;' Type of. Construction: V -N: ` =t Land Use Zone:.R -L ^ �+ _•. y Owner of•�Building:.RJT HOMES LLC?