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0401-114 (SATT)� �Alz"LICENSED CONTRACTOR DECLARATION I hereby affirm -under penalty of perjury that I am licensed under provisions of r` Chapter 9 (commencing with Section 7000) of Division 3 of the Business and cv W Professionals Code, and my License is in full force and effect. � :3 M' License # Lic. Class Lip. Date .3141C A ��f311J0�1 Date's "� {� Signature of Contractor <_'� �' i'r (_x17,V 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 isnot 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 I 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. (ac)"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 STKFE t'`tv'1eT� Policy No. 15 5911 -01 (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: Applicant— Warning: pplicant Warning: Failure to secure Workers' Compensations 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 enteVupon the above-mentioned property for inspection purposes. Signature (Owner/Agent) V-! i- Date �rf BUILDING PERMIT PERMIT# t1�ItbA�l��4 DATE'VALUATtIfON LOT TRACT ���✓��en - :,) tc% .1 �, -' J JOB SITE j,,�•�ry�, ADDRESS APN 4Y.u�i. OWNER CONTRACTOR/DESIGNER/ENGINEER RJT H10MU9 U.0 WT ?:t�'1r`1•! sIMMIM, INC. 1'f�PoxX3'10 ]425 '(117Z"a'1r*RWYI)FtI E LA qMTIA CIA, 92253 PHOENIX AZ 85034, (002)251.1536 (MA 4MI USE OF PERMIT ML7+".�, "" VAtf PLY A M SFA • LOT 15, PLAN PIA. PERMIT OOES1 SNC T INCLtfDK POO1, SPI, FILOC'1C WAIa S X)R. tDIUVk:WAY APPROACH. 7574 REDUCTION TO VI MI CILS"FUI DUE TO MULTIPLE ISSUA110E OF SAME P1.." TYPE r TRACT CONSTRUCTION '2,04.00 BF PCi1:if:TrilP��.:CifS 99'7.OD S#3` -GARA1HJC.Ui1P0R457,00 9F 4 F IMAM C0.51'OF CfiNawl:-MC,ITON 1119,361zo COM .RUCTIO79FEIF 101.000-418.000 $919.50 PLAN CHI= FEE 101.000-439-318 $193.92 MECHANICAL 101.000.421-000 IS! IV. 51D ELECTFUCALFEE. 10.1-00,0-420-000 $185.43 PLuk,01,00 FEE 101.000.419.000 $2080.00 TP -014 Q MO'd ION nI✓ RiL) 101-000.2,41-000 $17.94 GRADING FEE 101 �0.0t1-423.000 &19100 ft1 +''S,aXa1'E'f3.1AlPA.CT FELE $:�G+i11,Ot1 t �l•,1B4PE f�iAL t' OINTE11�t.�;C179N �fWD P' 3' CITEC� $3,(,) LFUSS FRE -FAM F=3 $0,00 TOW, Fina r TFX, S U1" E' NOW P +ter ✓ RECEIPT DATE �` rd `eY f DAT FINALED INSPEC . INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR ' BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings , 2 30 Ducts Slab Grade _ y Return Air Steel Combustion Air Roof Deck 3 - Exhaust Fans O.K. to Wrap F.A.U. Framing Compressor Insulation _/ _ Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath — — Drywall - Int. Lath Final Final BLOCKWALL APPROVALS POOLS - SPAS Steel Set Backs Electric Bond Footings 2 p - Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines .. /0— Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection — y/ Encapsulation Gas Piping Gas Test Appliances Final Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fbdures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) 1 7 2_ 4,,�q7�. ;�_ �rJ y 45 INSTALLATION CERTIFICATE (Page 3 of 13) CF -6R 50-;mC5 VLA akk t.0 SI a Address Permit Number DUCT LEAKAGE AND DESIGN DIAGNOSTICS DUCT LEAKAGE REDUC 101 • Pressurization Test Results (CFM @ 25 PA) Test Leakage (CFM)_&_$r'0 Fan Flow - If Fan Flow is Calculated as 400 cf rVton 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) = p 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 ❑ . Pressure pan test or House pressurization test ❑ Yes ❑ No '❑ Visual Inspection of Duct Connections .. o Pass Fail 19 THERMOSTATIC EXPANSION VALVE (TXV) Iff Yes ❑ No Thermostatic Expansion Valve is installed and Access is - provided for inspection r Yes is a pass 1w. 0 ❑ 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 O No TXV is installed or Fan flow has been verified. If no TXV, 0 0 ' verified fan flow matches design from CF -IR Pass Fail , 4 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 providera 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. j Tests gnature, DateO Installing Subcontractor (Co. Name) OR Performed General Contractor (Co. Name) COPY TO: Building Department i HERS Provider (if applicable) Building Owner at occupancy y . INSTALLATION CERTIFICATE (Page 3 of 13). CF -6R a i.A� 50-aLF; VlaSiho � C , ,. Site Address Permit Number DUCT LEAKAGE AND DESIGN DIAGNOSTICS DUCTLEAKAGE IiE;DUCUON CFM) Pressurization Test Results (CFM @ 25 PA) Test Leakage (CFM)—dg— Fan 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 Leakaget(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 FIMSHING WALL: ❑ Yes ❑ No O Pressure pan test or House pressurization test ❑ Yes ❑ No 'O Visual Inspection of Duct Connections o` o _Pass Fail THERMOSTATIC EXPANSION VALVE (TXV) IrYes ❑ No Thermostatic Expansion Valve is installed and Access is - provided for inspection Yes is a pass /B' : 0 s, ❑ 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. a r 2. ❑ Yes ❑ No TXV is installed or Fan flow has been verified. If no TXV, 13 0' 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. J. Tests i re, Date Perforn ed Installing Subcontractor (Co. Name) OR General Contractor (Co. Name) ' COPY TO: Building Department HERS Provider (if applicable) Building Owner at Occupancy Compliance'Forms August2001 A-25 - T 'INSTALLATION CERTIFICATE (Page 3 of 13) CF -.6R -0 Via. 4ia Site Address Permit Number . DUCT LEAKAGE AND DESIGN DIAGNOSTICS DUCT LEAKAGk 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) _ W p 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) o CHECK AFTER FINISHING WALL: t` O Yes ❑ No 'D Pressure pan test or House pressurization test -' ❑ Yes ❑ No ❑ Visual Inspection of Duct Connections ' o Pass Fail R THERMOSTATIC EXPANSION VALVE (TXV) 5FYes ❑ No Thermostatic Expansion Valve is installed and Access is - provided for inspection Yes is a pass O _ ❑ DUCT DESIGN Pass Falla ACCA Manual D Design calculations have. been 1. O Yes ❑ No {' completed, Duct Design Is on the plans and duct installation matches plans. 2. ❑ Yes O No TXV is installed or Fan flow has been verified. If no TXV, o 0 , 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 -611 signed by the builder employees or sub -contractors certifying that diagnosiic testing and installation meet the requirements for compliance credit. ] Q ' - • Tests Signature, Date —���- Installing Subcontractor (Co. Name) OR Performed General Contractor (Co. Name) COPY TO: Building Department HERS Provider (if applicable) ` Building Owner at Occupancy Complieno6 Forms August2001 ;' A-25 'i ,'- af- , . ..� :,, - a - L rI. :O�: 7�l -. -�• a - '-Y a£' .. � .. c �;, . "'y - ,j _ ' \,.��. ,. a^ J� M • - Qer.t�fica.te:�ocqpfc.a.4 y _ .r .. _ T d1f 'aBuildin&_ g Y- .Safet"r:y79epartnient',':OF: This Certificate is issued piirsuant,to the requirements''of Section 109 of the, California. Building`. ' J Code; -certifying #hat;'�at the °time of ;issuance,:.-this structure -was °compliance With,the. , provisions; of the Building Code `and the various ordinances ofZ,the. City-regulating; building construction?and/or use. 4 A Vii, ". � , .: . K '•" �^ .`.:J � 2 .� - - - Z , - _ - _ ;� - 1 BUILDING'ADDRESS:'50-245 VIA SIMPATICO c . ldg Perit No.: 401-114SFDUse classification _ +:�, t Group: R-3- ° ` 't, Type of Construction - V-N ry ° �, Land.Use`Zone:'A L ,Occupancy ,;� t r r aFP t `r 7s tom c:. Owner of Building: RJT:HOMES LLC 4V ' �, `` �+ A�d6 *ss: PO BOX 810", ; ' } .. Ana .. • r i .' - 3 J; t a U V~- �-;City, ST, ZIP: LA QUINTA,CA 92253, , -. r By. G SHOWALTER Date: 09/20/04' Building'Official R POST IN A'CONSPICUOUS'PLACE 'i ,'- af- , . ..� :,, - a - L rI. :O�: 7�l -. -�• a - '-Y a£' .. � .. c �;, . "'y - ,j _ ' \,.��. ,. a^ J� M