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0309-236 (SATT)-LICENSED -CONTRACTOR DECLARATION- r �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 690645 Z'MC A. 0613 Date ilia 7 - 4" 3 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). O 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: (f) 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) 1 have and will maintain, workers' compensation insurance, as required by Se6tion 3700 of the Labor Code, for the performance of the work -for which this permit is issued. My workers' compensation insurance carr : carrier & policy no: are Carrier STATE. FUND Policy No. (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 37.00 of the Labor Cod"eI shall forthwith comply with those provisions. 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'. SigKture (Owner/Agent) ` i • t'i rt f ,y -� e° . Date / i'}-•�^+''l, PERMIT# ,- y BUILDING PERMIT,_ 36 DATE VALUATION 1�ij.+ . LOT 1 I8 TRACTJOB SITE� DDR Ss 50.22.0' VIA 4P AVIC:C� APN 77t°r400-011 OWNER CONTRACTOR /DESIGNER'[EN INEER i PJrT' I -lo k's LLC Pur 114W.0a 1%OVI M. INC, PO BOX 810 _ 1425 E, 't7hqT�'��tM7.T DRIW, 1AQUINI:A (a.�fi. 92253 PHOEND AZ 85034 _ a�t�2)2 7�I85� CBIA 4990 F USE OA��'// ��PERyyMIITE j WH;p g rpv yM VA. LOT 1111, PI AN F-28. P.R'RMIT OOPS NOT INC'IXIDE R -LOCK W',Ak.L% POOL, SPA OR DMEt7lA'it`• APPROACH, 751/6 REIJiT;".'TION TO PLAN C HE',CX IES DUS TO 1AULTIPIX ISSUANCE OF S"t PLAN TY'PZ TRACT CONSTRUCTION �4IQ,6..Od'SF PORCH/PATIO 568.00 SIT CJA11AWCAR.'r?CJRT . $33,00 3F EIS'1',#_MAIM) s<309T OF CJ63la P"MUC-71014. 191,3170.50 7�if:F2'i�.i b' �1'AI.Ri� • CONSTRUCTION PBE .10.1-000.418-000 $461.50 PIANCHFIC P'LE y 1(31-(i0t?-�i:s9-3i $50162 ' MECHANICAL FEL 101-000-421-0.00 $105.00 FI:.WTRTCR L- FEE 1.01-000.420-000 $204.95 PI UMBINU rFI% 101-000-419-000 $330.00 STRONCiMOTION ITI(ls'-PY--:illi 101 -000x. -M-000 -akA,O1N(#AR1~ I01 -NO -473-000 • WrION -9 12; 21 f , � Ims x, .,P i' 9 X0.00 s RECEIPTDATE BY DATE FINALED INSPECT INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings D - 9- Ducts Slab Grade Air Steel -Return Combustion Air Roof Deck _ 5 Exhaust Fans O.K. to Wrap F.A.U. Framing_ ^ Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans 8 Controls Party Wall Insulation Condensate Lines Party Wall Firewall x Exterior Lath Drywall - Int. Lath Final - -� Final .� —L4 BLOCKWALL APPROVALS POOLS-SPAS' OOLS-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 Electric Final Waste Lines - 3 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 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 , a Utility Notice (Perm) �- COMMENTS: ©l � ZL �7 -�-y f—v� �✓ / �� r 7 ee> 5N W 14712 SW Scholls Ferry Rd . # 328' Beaverton-, OR 97007 ' 503-524-8268 503-213-6222 (fax) °. ILA -SIP Engineering Consultants:, LLC 14712 SW Scholls Ferry Rd . # 328' Beaverton-, OR 97007 ' 503-524-8268 503-213-6222 (fax) °. • 's..lsevrwvrv,,mc!'nrra�»'x+� nivY:vim:mair,.YfY�r.+rarivrv�+rrna�:i._ niirva�'nvs•rfrr.srn'iivi.•r.'�. •r :r,<t-•�',.,•r' r • � < <' : srr••r.'✓:;o•:(�r•.»nrearvvx:vvrnvnr�i.�»'evvivi nvr.,vn.. . _ INSULATION•CERT1FtCATE , This is to certify that insulation has been installed in conformance with the current energy , regulation, Califomia Administrative Code, Title 24, State of;,Califomia, in the building at r 4 50=220 Via -Simpatico, Lot 118,PLa Quinta,.California ��` - .. ; C ICINGS: • . �;. %• TYPE: Batts MANUFACTURER: Certainteed THICKNESS: R-38 ' Y r WALLS:' �~ . - '' TYPE, Batts . MANUFACTURER Certainteed THICKNESS: R-13' ' GENERAL CONTRACTOR: RJT Homes f LICENSE#: • * BY. ,. _ TITLE: PARAGON SCHMID BUILDING PRODUCTS, A Masco Company ' LICENSE # 221517 ' ' BY 1 -TITLE: ACCOUNT REPRESENTATIVE DATE: 2/18/2004 M7^�ry r+f: P �' t/rlr/IJYW.%YR//l./firf//risrir.•I.%:M'!�'�nYTr.•rr�?niA+YI/r'MSy;HS'/5'�s�s�t�u7txryvrylJl�w»arlA7ntRiJH/.tA,v115H'//Meunrr�y�l����ie'��i�xN'�r�'irltsrlt�irrlvY�'3'/arX➢>9�ilfXi�d7rr��,n r•[r:%4if.:YV:I�M995s1J'1:��1:t/�iN.f!8RZ1rtYJ'lf•/.9�..P.50'•�P7�'O•:OS:OI�SYdY.tf.'9a�tfL1](dRl9[GY.O�a76R1!iT�..^IIRTTJJ.'J,.Y•1'19RG7t1M"TiMW�VI'/�:O�:Or^IOfO.[9.�9�.9.SJ6'I:y,T.VN3%t•N1:N'9RV:N: AiV:h`, r•!:V.V<•✓.:•n.:�. . INSULATION CERTIFICATE This is to certify that insulatidn has been installed in conformance with the current energy regulation, California Administ Ye Code, Titie 24, State of Califomia,.in the building located at r y r - CEILINGS: TYPE: Betts. MANUFAC RER: C ainteed THICKNESS: WALLS•... , ;. ,. TYPE: Batts - MANUFACT ER: ertainteed THICKNESS - GENERAL CONTRACTOR: LICENSE # - BY: TITLE: e PARAGON SCHMID BUILDIN RODUCTS - A Masco Comps y LICENSE # 221517 BY: TITLE: ACCOUNT REPRESENTATIVE DATE: 2/18/2004 -. .. r.••�wr'•'N.r1!+f„r.PM'✓'�!QY!"1.fY.fr(CM/fIYN.M.:/.W:V/1R'.M.P10!r'KfY.f✓.PHXf/.:N'!J'YM'/..bYlYilir.`rY: lr>+rlrli,.'Y.K.J7.:1S(W17�;f/.4fiYTlPY.%lM.iHM.rYYd'YYY.INY.NN�rrr'rirrY..Y.�rro.w..>•+rv: %•r:-: r.w,,.•r ,:.. �•�; :P, CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7) CF -49 PALMILLA 5-A 05-11-04 Project Title Date 50 TH & JEFFERSON R J T BUILDERS Project Address Builder Name DARRELL MORGAN 760-275-8230 ACACIA P-2 3 UNITS Builder Contact Telephone Plan Number RICHARD KROWN 760-250-1852 GROUP 2 3 OF 3 HERS er Telephone ' #CCNRD6132 2 05-24-04 LOT # 118 Certif ing Signature Date Sample House Num er Firm: DESERT 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) - ® Where cloth backed, rubber adhesive duct tae 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 47 If fan flow is calculated as 400cfln/ton x number of tons enter calculated value here 800 If fan flow is measured enter measured value here Leakage Percentage (I 00 x Test Leakage/Fan Flow) = 5.875 ' 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 . CERTIFICATE OF FIELD VERIFICATION AND.DIAGNOSTIC TESTING (Page I of 7) CF -4R PALMILLA 5-A 05-11-04 Project Title Date 50 TH & JEFFERSON R J T BUILDERS Project Address Builder Name DARRELL MORGAN 760-275-8230 ACACIA P-2 3 UNITS Builder Contact Telephone Plan Number RICHARD KROWN 760-250-1852 GROUP 2 2 OF 3 HERS Ra Telephone #CC RD613 92 05-24-04 LOT # 118 CertiffingSi6atutY Date Sample House Number Firm: DESERT 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) ® Where cloth backed, rubber adhesive duct tae is installed, mastic and drawbands are used in combination with cloth backed, rubber adhesive duct tape to seal leaCs 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 69 If fan flow is calculated as 400cfm/ton x number of tons enter calculated value here 1200 If fan flow is measured enter measured value here Leakage Percentage (100 x Test Leakage/Fan Flow) = 5.75 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 CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7) CF -4R PALMILLA 5-A 05-11-04 _ -r P oject Title Date ' 50 TH & JEFFERSON R J T BUILDERS Project Address Builder Name DARRELL MORGAN 760-275-8230 ACACIA P-2 3 UNITS Builder Contact Telephone Plan Number RICHARD KROWN 760-250-1852 GROUP 2 1 OF 3 HERS Rditer Telephone #CCNRD613292 05-24-04 LOT # 118 Cerfiqing Signatu a Date Sample House Number Firm: DESERT 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 : w The house was: ' ® Tested ❑ Approved as part of sample testing' but was not tested Y 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 to a 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 4 Test Leakage Flow in CFM 91 If fan flow is calculated as 400cfm/ton x number of tons enter calculated _ value here 1600 F If fan flow is measured enter measured value here Leakage Percentage (I 00 x Test Leakage/Fan Flow) = 5.6875 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 • W i INSTAL ATION! ER� IFICATE (Page 3.of 13) CF-6R -Sits Address Permit Number. DUCT-LEAKAGE . ' -D E'SIGN DIAGNOSTICS DUCT LEAKAG4 REDUCTION Pressurization Teit Results (CFM rQ 25 PA) Test Leakage (CFM)__kgC Fan-Flow If Fan Flow Is Calculated as 400 cWton x number of tons, or As 2L7 x Heating Capacity In Thousands of•Btu/hr, enter calculated value here If fan flow is measured, enter measured value here—' Leakage Fraction - Test Leakagcl(Measured or Calculated Fan Flow) " Pass if leakage fraction <0.06. Pa$s Fall 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: 0 Yes .O No . 0 Pressure pan test.or House pressurization test. O Yes O No O Visual Inspection of Duct Connections- ., o o. Pass` Fall WTD HERHOUATIC EXPANSION VALVE'fT){V) ' Yes O No Thetmostatic-Ezpansion Valve is Installed and Access is - provided for: inspection i Yes is a pass /� . - Pass o Fail Q DUCT DESIGN " ACCA Manual D Design calculations have. been , [, i3 Yes o No completed, Duct Design-is. on the plans and duct. Installation matches plans., , 0 2. O Yes O No TXV is Installed or Fan flow has been verified. If no TXV, Pass 0 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, verify that'the above diagnostic test results and the work.! perfoim0'8S$ociated, with the testi) is in tonformancc ` with the requirements for compliance credit. [The builder shall provide the HERS provider, a copy of the CF-6R signed by the builder gnand installation meet the regulrcments for compliance credit. ] employees orsub-contractors certifying that diagnostic.testing - J 16 ----r Instal ing S onnacwr.(Co. Name) OR Tots Signature;�Date General Contractor (Co. Name) . Peed COPY. TO: - Building Department , x , HERS Provider (if applicable) Building Owner at Occupancy J A-25 August 2001 . .' MSTALLATION CERTIFICATE(Page 3 .of ><s) CF-6R . : Site Address Permit Number. DUCTAAKAGE AND DESIGN DIAGNOSTICS QUC1' LZAKA(;X REDUCTION -- Pressurization Test Results (CFM ® 25 PA) Tut Leakage (CFM) Fan-Flow If Fan Flow Is Calculated as 400 cWton X number of tons, or.@s 21;7 x.Hecting Capacity In Thousands of-Btu/hr, enter calculated value here It fan flow Is measured, enter measured value here Leakage Fraction - Test Loakaget(Measured or Calculated Fan Flow) a -Q 0 Pass if leakage fraction <'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 FINISH. INO WALL: O Yes :O No . 0. Pressure pan test.or House pressurization- test. O Yes O No .O Visual Inspection of Duct Connections a o Pass Fall 4TH HERMOSTATIC EXPANSION VALVE PS yes O No Thermostatic "Expansion Valve is installed and Access is - provided for. inspection . Yes,is a pass. Pass p. Fall O DUCT DESIGN ACCA Manual D Design calculations have been 1. 0 Yes O No completed, Duct Design-is. on the plarts and duct Instaliation matches plans., , a 2. O Yes O No TXV, is installed or Fan flow has been verified, If no TXV, Pass o Fall verified fan flow matches design from CF-RL Measured Fan Flow - Yes for both 1 and 2 is a Pass 0 1, the undersigned, yerity that *the above diagnostic test resulti and the work I performed associated with the wt(s) is in conforrs,ance ' CF-6R signed by the builder with.thc requirements for compliance credit. (The builder shall provide the HERS provider, a copy of the the requirements for compliance credit. ] employees or sub-contractors certifying that disgnostic.testing and installation meet Testi T4sIaturc7j­D­atc Installing bcontractor (Co. Name) OR General Contractor(Co. Name) Performed COPY TO: - Building Department ` HERS Provider (if applicabley Building Owner at Occupancy A-25 August 2001 IN• TALLATION CERTIFICATE (Page 3.of 13) . CF-6R :Site Address Permit Number. DUCT•.EAKAGE AND DESIGN DIAGNOSTICS QUM'LIKAKAGt RIEMUC IoN Prasurizatlon Teit Results (CFM Q 25 PA) Test Leakage (CFM) Fan-Flow If Fan Flow is Calculated as 400 cfm/ton x number of tons, or $s 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) a t] Pass if leakw fraction <0.06 Pass Fall C3 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 D-No . D Pressure pan test or House pressurizatiotrtest. O Yes O No .O Visual Inspection of Duct Connections o 0 Pass Fall �dyTHERMQI TATIC EXPANSION VALVE'(TXV) V. Yes O No Thermostatic Expansion Valve is Installed and Access is - provided for. inspec' tion Yes is a pass Pass 0 Fall O DUCT DESIGN AC Manual D Design caiculatlons have. been 1. 0 Yes 0140 completed, Duct Design-Is on the plans and duct Installation matches'plans., 0 2. O Yes O No TXV is installed or Fan flow has been verified. If no TXV, Pass 0 Fall verified fan flow snatches design from CF-TR - . - Measured Fan Flow m Yes for both I and 2 is a Pass O 1, the undersigned, yerify'thatihe above diagnostic test results and the work I performed associated with the test(s) is in conformance copy the CF-6R signed by the builder with.thc requirements for compliance credit. (The builder shall provide the ITERS provider. a of installation meet the requirements for compliance credit. J employees or sub-contractors certifying that diagnostic.testing and - 520 0 I4at..,5.e !...Ming SuAM ntractor (Co.. Name) OR Tela General Contractor (Co. Name) Performed COPY Tg: - Building Department - HERS Provider (if applicable] Building Owner at Occupancy A-25 August 2001