0401-115 (SATT)LICENSED CONTRACTOR DECLARATION
t!pby 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
'6906-45 B RIC A 613 VAN
Date i R •CJ F Signature.of Contractor s {';°++ A rA�
�/ j O
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.
Sec( )r I have and will maintain workers' compensation' insurance, as required by
tion 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 ST.e,,yLe iJp Ta Policy No. 11$3 =iki,
(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: !f/ Applicant 1--k'
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 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 ifs
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 I
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 "� ! + k ' ?"%'% Date/ 09.4-,-j?,/
-j?,/
- ..t.. {.
A24
BUILDING PERMIT - PERMIT#
Eidtil-?L1:5
DATE VALUATION LOT TRACT
2a_£P 127 2995€1_2
.JOB 81TE
ADDRESS 's�„v5 �r.�.f� 51WXXIC
7! 7w41 — 0
OWNER
CONTRACTOR / DESIGNER / ENGINEER
XUTHCAMES LI-'
is.fTIN-1.r-mw11`I` s, WC.
FO:E OX 810
1425E, UATMST.i`Y DRIVE
.L,,.r?. (7UNTh,. CA 91223 3
1 HOMMI: AZ 81034
(602)M-1656 0314 4990
USE OFFPERMIT
goLS.ph M1 XSLAC M
t .
SIVA • LOT
LO 127, PLAN P1 8PUMfOOES NSr 114CLSDE P001,SAA,
`• .
BLOCK WAL((,% OR ARI YA 11 gpIpOAV g
TdAC T CONSTRUCTION 4394,00 OF
PORCHYPAIIY0 - 8611430 SF
GARAGWICA .POM ti 7.0n $
MIU 014 r'l NS-FI:R2t%'110111
177,x;?�K4
y� y^��/��+•� p•�1�'SMIA".�.'.1rD
PEITiL'Yd.0 Imo.+ 412.Jl.iVlY.N6d iIf
CONSTRUCTION FLIM 101-000-418-000
PLAN .CTS€,CK FEE 10 R -000-439-319 $wcf.$
MECHNNii;AT. ME 101-000-421-000 %WX1
BLECTRJC:ALYVE 10111-000-420-000 $1$5,43
r d
>iPTtti.MBTNGFIZ , 101-000-419-000 M.00
STRIX10 MOTION JrRE AMID 101-000-2A 1-000 $17.7.6
ORADMO FEE 101-000.423-000 $15,00
1?l3if 1�J.Ml1s.111�PA T F'x E
ISTM-T'OTAT, C011911.1J�'it`ION AND PI" affixnll
T8,189.86
TOM HT�Jkfiff FM DUE NOW
$4,189,86
• •JA:N2j 8 2004
✓
CITY OF LA QUINTA
.,
FINANCE DEPT. Tx.
JKYJ
RECEIPT
DATE
BY
DATE FIN ALED
IN
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
I BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms 8 Footings-
Z 77 Y_
Ducts
Slab Grade
i Z,7
Return Air
Steel
- / 7 - •/
Combustion Air
Roof Deck
O.K. to Wrap
�� .- _
�_� �t�/
Exhaust Fans
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 - I . Lath
- �.�✓ — •
Final - a
Final ' ~
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
- p _
Main Drain
Bond Beam
Z
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
�= fC=�
Heater
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
"/ a /—
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 -
Ublity Notice (Perm) Z / _
COM ENT �c4._/,'_-?-
T. ,-hice
se�.s
7 71 14712;SW "Scholls Ferry Rd -
# 328
*�
• SIP'�Eng:illieering',r
Beaverton, OR 97007
. "
• ' 3
,
•
C.O n s'u Ita n'ts�,"L LSC
> 503-524-826.81
(fax)
i �• `j'. r I '�.. _ � 1. .*
yn ••
4-27-04 + w r
' - r �• � �" . a
R.' r
". Chad. Meyer
RJT Homes, LLC
79700 50th Ave - , „ • k _ .
LaQuinta, CA 92253wt
• ,,
RE:-, Structural Observation - Lot 125, 126 &, Lot 127. `
,Lot
- •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.and easily observable, this appears to'be the;
,
case, with no unresolved deficiencies remaining that I am aware of.
• ..y „ • /V/l, • } ' tPOFESSI.O
.1N J r
'�
f.. • 277 e
,. , ^
e
Mike Nelson, PE . d Exr• X06 * ;
CN1\-
4:
r
OF CA��F�
•, y ' tib. - r } �" ,. .. .. ' ,.. •.,
INSTALLATION CERTIFICATE (Page 3 of 13)
CF -6R
jooL 50- P35 VLa WADA,
L Site Address Permit -Number.
O
DUCT LEAKAGE AND DESIGN DIAGNOSTICS
DUCT LEAKAGE: REDUCTION
' Pressurization Test Results (CFM Q 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:
Duct Fan Pressurization at rough -in measured leakage (CFM)
CHECK AFTER FINISHING WALL:
❑ Yes ❑ No P Pressure pan test or House pressurization test
p Yes ❑ No ❑ Visual Inspection of Duct Connections
❑
❑
Pass
Fail
X THERMOSTATIC EXPANSION VALVE•(TXV)
,
JRrYes' ❑ 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,
13
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. ]
Tests �gna 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
i
INSTALLATION CERTIFICATE (Page 3 of 13)
CF -6R
10 �2 a3s V a S P &
:Site Address Permit Number
DUCT LEAKAGE AND DESIGN DIAGNOSTICS
DUCT LEAKAGE'RLDUCTION
Pressurization Test Results (CFM @ 25 PA) Test Leakage (CFM)�g
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
I7 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 0, No - ❑. Pressure pan test or.House pressurization test
❑ Yes ❑ No ❑ Visual Inspection of Duct Connections
Pass
Fail
Vr 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 ❑ 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 1 and 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.]
Tests rgnature, Date Installing Subcontractor (Co. Name) OR
Performed General Contractor (Co. Name)
-
y
COPY TO: Building Department
c HERS Provider (if applicable)
Building Owner at Occupancy
Tom,: Yr. •
. ,
Compliance Forms August2001
A-25
INS ALLATION CERTIFICATE (Page 3 of 13)
CF -6R
Oc7 50 -ate vii.
Site Address Permit Number
DUCT LEAKAGE AND DESIGN DIAGNOSTICS
DUCTLEAKAGE REDUCTION
Pressurization Test Results (CFM ® 25 PA) Test Leakage (CFM)
F
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 1s measured, enter measured value here
Leakage Fraction = Test Leakage/(Measured or Calculated Fan Flow) _ 0--
❑
Pass if leakage fraction < 0.06 Pass 4
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
O Yes. ❑ No O Visual Inspection of Duct Connections o
o ,
Pass
Fail
Cr THERMOSTATIC EXPANSION VALVE (TXV)
Wyes ❑ No Thermostatic Expansion Valve is installed and Access is - provided for inspection
Yes is a pass
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 ❑ No TXV is installed or Fan flow has been verified. If no TXV, 1
O
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 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.]
Tests LgrgnatUe, Date Installing Subcontractor (Co. Name) OR
a
Performed General Contractor (Co. Name)
COPY TO:, Building Department
HERS Provider (if applicable)
Building Owner at Occupancy
Compliance Forms August 2001
A-25