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0401-116 (SATT);; — •' LICENSED CONTRACTOR DECLARATION I herehy, affirm,under penalty of perjury that I am licensed under provisions of Chatter (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 1IC A Date f v)!��'Signature of Contractor X " s t •t E� 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 �5;ATL )7�1� Policy No. 1983906-0I (This. section need not be completed if the permit valuation is for $100.00 or less). 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 orthwith comply with those provisions.,.) r Date: 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. I 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) BUILDING PERMIT PERMIT# DATE r VALUATION. LOT TRACT JOB SITEy��; ADDRESS �. —225 VIA SDIA 'ATIC0 r.3 APN OWNER CONTRACTOR / DESIGNER / ENGINEER 1111 H13WIS 11LC 1X €' WIV791a14-1S. PO .SOX 810 1425 :R . UNdW_T%R1TY 3 RWE 1�,A QrrS TfA CA, 92253 ; ROT-'�+1�` ,€ Z 85 334 (602.)257.,1656 CTLO 4990 USE OF PERMIT SPA, a 143T 17.6, PLAN 028' PEi:tyII T D08S' NOT INCLUDE POOL., SPA, D)AX Iti W-AdAA OP . DRIVYWAY AI'PROACH, iW RMUCTION TO PLAIN CHECK FEE DUE TO MULTIPLE I` SELT NCZ OF :s it PL.1 R TYPE TRACT CON= UC;TI0311 3.191.00 SF POR'C,1'Lr'.FA310 C1. ZAGE/CARPORT SP :6TgnI4/.%mw con CAS' C€.3ns; :i1'C,us.m 191,370,50 .P<'ERMIT-fi'f'Lx s'ah sld11t25€ C ONSTINUCTION FEE 101-000-418s000 $96J.M PLAW CHECK ISE 101-000-439-318 $305.62 h�1wC FEL? 101-000.42.1.000 • S10.40 EL.ECTAICIAL, FEE 301-000-420-000 $ 2W.y5 PLUMBING ME 10"t-000-419-000 $290.n0 STRONIG MOTION WE • X StIlD 102-000-241-000 $I9.14 GRADING FEE 101 ••€100.423*000 $15.00 %?EVZLOPtER.3.MPACT FEE $2,001xto �i.,11•s-T.0TA1, aC3NS'T1 MC-TIOI7 AVM PLAM C:E`,I: CY, LEA= PRE -:PAID FEM �?'V'�'°'��' S3,74a2ie'2J' "LAQUINTA REG'EIPTT° �"�H!�!�• DATE P'j• �J BY DATE FINED INSPECT INSPECTION RECORD r OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings _ _ y Ducts Slab Grade - /2 - 19 Return Air Steel _ -A Combustion Air Roof Deck -,I y — y Exhaust Fans O.K. to Wrap jv- - y F.A.U. Framing Qj . 3 _ y Compressor Insulation / Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation / Condensate Lines Party Wall Firewall Exterior Lath 3 _ Drywall - Int. Lath -G Final Final POOLS - SPAS BLOCKWALL APPROVALS steel 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 - �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:4. Final Cetiel Utility Notice (Gas) 7;7,,—,ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring _ Low Voltage Wiring Fbdures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power 90 1 Final Utility Notice (Perm) _,Z,/ INSTALLATION CERTIFICATE (Page 3 of 13) CF-6R Site Address Permit Number DUCT LEAFAGE AND DESIGN DIAGNOSTICS ` DUCT LEAKAQE REDUCTION Pressurization Test Results (CFM @ 25 PA) Test Leakage (CFM)_9 s Fan Flow If Fan Flow is Calculated as 400 cf Vton x number of tons, or as 21:7 x Heating Capacity In Thousands of Btuihr, enter calculated value here If fan flow is measured, enter measured value here , Leakage Fraction = Test Leakage/(Measured or Calculated Fan Flow) _ jW p Pass if leakage fraction < 0.06 Pass Fall 11 For AEROSOL TYPE SEALANTS ONLY -Thefollowing 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 D No ❑ Visual Inspection of Duct Connections 0 o Pass Fail THERMOSTATIC EXPANSION VALVE (TXV) P-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 TXV is installed or Fan flow has been verified. If no TXV, D 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. ] A11111V f I.&I Z_14%/ Tesco SOW-6-e, 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 August2001 A-25 - INS LLATION CERTIFICATE ICATE (Page 3 of 13) .. CF -6R #`lp .507aa5 Via Siarnoa Site Address Permit Number DUCT LEAFAGE AND DESIGN DIAGNOSTICS DUCT LEAKAGE 1tEDUCUON Pressurization Test Results (CFM Q 25 PA) Test Leakage (CFM) Fan Flow If Fan Flow is Calculated as 400 cfmlton 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) _ . C 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 O No p, Pressure pan test or House pressurization test .[]Yes ❑ No ❑ Visual Inspection of Duct Connections ❑ a Pass Fail THERMOSTATIC EXPANSION VALVE (TXV) Yes ❑ No Thermostatic Expansion Valve is installed and Access is. -:provided for inspection Yes is a pass %W p ❑ DUCT DESIGN Pass Fair ACCA Manual D Design -calculations have been 1. ❑ Yes ❑ No completed, Duct Design is on the plans and duct installation matches plans. 2. O Yes 13 No TXV is installed or Fan flow has been verified. If no TXV, 13 verified fan flow matches design from CF -IR Pass Fail Measured Fan Flow = Yes for both l 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. ) Tesrs Signature, Date Installing Subcontractor (Co. Name) OR Performed f General Contractor (Co. Name) COPY TO: Building Department ' HERS Provider (if applicable) Building Owner at Occupancy Compliance Forms August2001 A-25 r : o aO,uCef a- CY� 9,1n .. - �. � I • - f . � .. �Ir'llr�llr�r J` � �� . � • � / � - Y S U _ — � •y`}, -'ass � ` G auildin & Safef _De adinent r .,-'.This, Certificate' is ,►ssued''p,ursuanf" to the requirements' of Section of .the California,Building -109 __. Code; certifying' that,; at"= the -time y4of 'issuance, -'this structure was In compliance. , with tlie. „�. provisions of ."the , Building .Code, and the-, various 'ordinances ; of °the City �regulafing building , coristr`uctionarid/or use. �� r = '� ",% • _ til -• '� c� .. -: �,� E�.. �'• � ' � y - ,. + .. ,�V �.� G�e' +`, � G r'•) �. " '. F'+'_ .` � �_� ❑ r� )C, .� }oma. y - L� _V. ,. ,J BUIL`DING ADDRESS 50 225 VIA.SIMPATICO t } r ,, `. : . � . �M 1 ! • 1' moi• - � _ � J •. I �,u .. �, ` '.,3 c. r ..lr` '4 / t� - .N y �� 4, t'.. •j • k r t` Building Pe_ rmit,No 0401-116 ,Use classification: S.F D. ''f j Group �R-3t G Type"of Construction V=N� :� �� Land.Use Zone: R=L :,Occupancy t �•�, �� n s � � - ' � 1 _� 4 i r[� . �'�- .'r r V G'• y . � t � � M _ , �� ' , ; �; �- _ .,, . • _ - Address PO"BOX 810 ~ : 4• � Owner of Building: RJT HOMES LLC` a +,. " * G , City, ST; ZIP."LA QUINTA CA, _92253 ",• ;..^, N ,. y, �$y::G SHOWALTER rr ' Date: 08/09/04 { .. �.. rt 'Building Official e 'ea - ']! `�;, ) ... �C'. �, `'. ice] , t . ,N • .. � _ � t �y ►" POST IN A CONSPICUOUS'PLACE v -"i• .� r