0309-235 (SATT)LICENSED CONTRACTOR DECLARATION
I ',oereby 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
Date r:� 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).
( ) 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
Stion 3700 of the Labor Code, for the performance of the work for which this
peYmit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
i)"�:{). f iu �`7�' �'',3 1 �ii�i`�t'i'i•�il
(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. }J
pat'e:. Applicant J +
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.
I Signature (Owner/Agent) Date
BUILDING PERMIT PERMIT u .
DATE VALUATION LOTTRACT
tYt'
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JOB SITE
APN
ADDRESS-
DDRESS
OWNER
OWNER
CONTRACTOR / DESIGNER / EN &NEER
%t T.14. IAEKS1 LLC -
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f61 (4)%d7A.'.a G' 4990
USE OF PPEyyRMITY�++
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0ONSTRUC" ION FEE 103 -01DO-4• 1 ib i_000
%.A.W CHVIIZ FES: 104-000-43`.318
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ELLY.CTRIC A1., E'. t 101••0720 4-20-000
'13i;LMBINO FEE 101.00"19-000 31 fit+, 9
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RECEIPT
DATE
BY
DATEFINALED
INSPE r R
i=
r�
g, /y
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
-e? P-
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
- -
Final
Final -
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
I
Gas Piping
PLUMBING APPROVALS
If
Gas Test
Electric Final
Waste Lines
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:
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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 j
Utility Notice (Perm) p
- -- -__-- --=- St' OA
INSTALLATIO. ICA TE (Page 3 of 13) CF -6R
LP.erNt Number:
Slte. Address
DUCTAAKAGE AND DESIGN DIAGNOSTICS
Pressurization Teit Results (CFM Q 23,PA) Test Leakage (CFM)
Fan -Flow
If Fan Flow Is Calculated as•400 cfm/ton x number of tons, ores 21.7 x Hcuting 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) a o
Pass if leakage fraction <'0.06 Pass Fail
0 For AEROSOL. TYPE SEALANT'
ONLY -The following dlagnostic testing was completed:
Duct Fan Pressurization,at rough -in measured leakage (CFM) '
CHECK AFTER FINISHINO WALL:
b Yes .D No.. O Pressure pan test.or House pressurization test.
17 Yes 0 No ..O` Visual Inspection of Duct Connections a o
Pass Fail
."ET RMONSION VALVE (T -M, ,
'es 0 No Thermostatic -Expansion Valve is installed and Access is - provided for inspection
o
Ycseis a pass / Pass Fall .
DUCT DESIGN
ACCA Manual D Design calculations have.been
1; C3 Yes 0 No completed, Duct Design is on the plans and duct Installation
matches plans.;
0 0
2. O Yes O No TX. is installed or Fan flow has been veritied. If no TXV;;' Pass Fail
ved fled fan flow matches design from CF -R
Measured Fan Flow a
Yes for both I and 2 is a Pass
ci ted with the 0 1, the undersigned, verity that the. above diagnouic a 4she lul Ovide the HERS provider a opy of the CF -6R signed by the builder
with.the requirements for compllance'credit. [The b p
employees or sub -contractors certifying that diagnostie.testin.g and installation melt the ioguirements for compliance credit. ]"
- !res 1 Sube ctor.(Co. Natne) OR
Tests Si "Date General Contact (Co. Name)
Performed
COPY TO: - Building Dcpartnicnt
• HERS Provider (if applieabley
Buildin; Owner at Occupancy
A-zS
August 2001
Compliance Form9
IN-STALEATION CERTFICA►TE ." 4 (Page s.of`xs)
CF-6R
—tom; ►A t
Site Address Permit Number,
DUCT-LEAKAGE AND DESIGN DIAGNOSTICS
DUCI' LEAKAGA RN;llUC ION
--
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"Btufnr, enter calculated value here
;
- If fan flow Is measured, enter measured value here
Leakage Fraction Test Leakage (Measured or Calculated Fan Flow) a "
0
Pass if leakage fraction l0.06 Pass'
Fair
0 ForLAEROSOL TYPE SE_ ALANTS ONLY:,The'following diagnostic testing was completed:
Duct Fan Pressurization at rough-in measured leakage (CFM)
�.•' CHECK AFTER- FINISHiNO WALL:.
0 Yes 13 No . O: Pressure pan test.or•HpUse pressurization-test.
'0 Yes 0 No '0 Visual Inspection of Duct Connections o
0
Pass
Fall
Je°TERMOSTATIC EXPANSION'VALVE IT V "
tQ'Yes O No Thermostatic Valve is installed and Access is - provided for. in
�
(
o
Yes is a pass
/Pass
Fall
0 DUCr DET N
ACCA Manual D Design calculations have. been "
L 13 Yes o No completed, Duct Deslgn'Is on the plans and duct Installation
" matches plans.,
o•
= 2. O Yell O No TXV is Installed or Fan flow has been verified; If no TXV, Pass
a
Fall
,
verified fan flow matches design from CF-IR .
Measured Fan Flow a
Yes for both l and 2 is a Pass "
0 1, the undersigned, Verify that"the above dlagnosdc test results and the work I performe4 associated with Ithe test(s) is in conformance .,
the CF-6R signed by the builder
with the requirements for compliance credit. jibe builder shall provide the HERS provider. a'Copy of
the regutrements for compliance credit. J
employees or sub=contractors certifying that diagnosdc.testingesnd installation mat
7 77—
A
Installing subc tractor (Co. Naive) OR
Tests i re; Date :
Contiactor,(Co. "Name)
Parformed General
COPY T0: - Building Department
`. HERS Provider . (if applicable}
Building Owner at Occupancy
1
d
p 2.5
August 2001
Compilaxe Form?
i
CERTIFICATE,OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7) CF -4R,
PALMILLA 05-11-04
Project Title Date
50 TH,& JEFFERSON R J T BUILDERS
DrX A&INbRGAN 760-275-8230. Builder Name
PALO BREA P-3 2 UNITS
Builder Contact Telephone Plan Number
RIC ARD KR WN 760-250-1852 GROUP 3 1 OF 2
rR r Telephone
W #CCNRD613292 5-11-04 , LOT # 117
Certifying Signature Date Sample House Number
Firm: HERS ENERGY SERVICES HERS Provider: CHEERS
f P O: BOX 621
Street Address: 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
4 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.
f ❑ The installer has provided a copy of CF -611 (Installation Certificate.
❑ Distribution system is fully ducted (i.e., does not use building cavities as plenums or platform returns in lieu of ducts)
1 Where cloth backed, rubber adhesive duct tape is installed, mastic and drawbands are used in combination with cloth
backed,. rubber -adhesive duct tape to seal leaks at duct connections
D MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT
Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage)
4 Measured
Duct Pressurization Test Results (CFM X25 Pa) values
Test Leakage Flow in CFM
If fan flow is calculated as 400cfm/ton x number of tons enter calculated
1 value here
l:
If fan flow is measured enter measured value here
1
Leakage Percentage (I 00 x Test Leakage/Fan Flow) _
Check Box for Pass or Fail (Pass=6% or`less) " ❑ ❑
Pass - Fail
❑ THERMOSTATIC EXPANSION VALVE (TXV)
Q 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 05-11-04
Pro•ect Title Date
50'TH & JEFFERSON R J T BUILDERS
ppr
Builder Name
&WA&,r RAbRGAN 760-275-8230 " PALO BREA . P-3 2 UNITS
Builder Contact Telephone Plan Number
RICHARD KROWN 760-250-1852 • GROUP
3 2 OF-.2
H R er Telephone
#CCNRD613292 05-11-04 LOT # 117
ertify ng ignature Date Sample House Number
Firm: HERS. ENERGY SERVICES HERS Provider: CHEERS
P.O. BOX 621 - RANCHO MIRAGE CA. 92270
Street Address: City/State/Zip:
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.
ET 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 lea�Cs 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 CL25 Pa) values
Test Leakage Flow in CFM
If fan flow 'is calculated as 400cfm/todx number of tons enter. calculated
value here
If fan flow is measured enter measured value here
Leakage Percentage (100 x Test Leakage/Fari Flow)
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 0..
Yes is a pass Pass Fail
• .,..� � :.•,:• r �•.J•: .� •�.-,.��:n•n:r. i^•.rJ�^i•✓-....,w„-��rJrr.,�:rwr•rv-ri•r..r..-r^,rz•i•r;•r..i-rv�rrrvii✓�,a��.rrlrnraJ:J..�,,n•�•:ra�;r. �.er•i�rnwr-.-•,i: r....iti•i. �
' INSULATION CERTIFICATE
This is to certify that insulation has been installed in conformance with the current energy
fY 9Y
regulation, California Administrative Code, Title 24, State of Califomia, in the building at7, -
,
II
50-230 VIA SOT 117_I,A QUINTA CA -
# S ttAPATPca
I I CEILINGS:
TYPE: BATTS MAUNFACTURER: Certainteed THICKNESS: R-38 ;
WALLS:
:• TYPE: BATTS MANUFACTURER: Certainteed THICKNESS: R-13
J
GENERAL CONTRACTOR: RJT HOMES LICENSE #
S
BY: TITLE:
PARAGON SCHMID BUILDING PRODUCTS A MASCO Company LICENSE # 221 17
BY: TITLE: ACCOUNT REPRESENTIVE DAT
:...:.•,...•r•.�..:..�.,.:.:,:•n•-�:-f:^: vi�i�::�.i.r.-r:r.:..c�:n,.ivon..,.�,��.,,,...•n...•r.:r.:viv.,.•r:n:..,avirra.r. _��:;•,.vyr✓rorv:�:rs,..,, .: �r
J /'/v:•r: r. �.v.pr.VnY•v: �✓.�,yi�..r'%f.i•S!th•:•'•: r: r1i •moi �1...�,..r<:..':%:/,
7
14712 SW Scholls Ferry Rd
3 # 328 i
Beaverton, OR .97007 j
503-524-8268
t 1 503-213-6222 (fax)
2-6-04 '
Chad Meyer {
RJT Homes, LLC
i ,
79700 5&, Ave
LaQuinta, CA 92253
'
RE: Structural Observation - Lot 117, 118, 119
�j0 as3o 50-aaL 0 50 -.;2/0 -
• � •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.
? QPpfESS/0'j,
/rLlQ'it
~ ` 277
Mike Nelson, PE EV°6
zJ' cNlb�
�� OF CAl\tA
LA
SIP Engineering
,Consultants, LLC
14712 SW Scholls Ferry Rd
3 # 328 i
Beaverton, OR .97007 j
503-524-8268
t 1 503-213-6222 (fax)
2-6-04 '
Chad Meyer {
RJT Homes, LLC
i ,
79700 5&, Ave
LaQuinta, CA 92253
'
RE: Structural Observation - Lot 117, 118, 119
�j0 as3o 50-aaL 0 50 -.;2/0 -
• � •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.
? QPpfESS/0'j,
/rLlQ'it
~ ` 277
Mike Nelson, PE EV°6
zJ' cNlb�
�� OF CAl\tA
:_�
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I
Cerrir[Cat6 of Occu
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=-R-0F Y f Building &=Safe_ ty,Department.
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is_ issuedr pursuant tothe requirements of 'Section 109 of the California Buildingt
sThis-:Certificate
' Code; -certifying., that, -at ,.the time ' of, issuance;, this, -structure was in_' compliance`s with :, the, `
r' provisions, of the'BuildihO, Code and the; various, ordinances•-of the City regulating, buildirig
;construction and/or use.
BUILDING ADDRESS. 50-230 VIA SIMPATICO
� � ~ � MRS
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_
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Use classification: S.F.D. Building Kermit No.:A309-235,-
Occupancy Group: R-3 _ --`-'Type of Construction: 'V-N Land'Use Zone: R-L .
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. .� j . , - : • ~' .. � ', i �' ,•Tony - � - "n,,,, r'.. ? ti , r c
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Owner of Building: `RJT'HOMES LLC Address: PO'BOX 810" _.
' K y City,;. ST--ZIP: -LA QUINTA CA 92253
. By:' G'.SHOWALTER u
Date: -05/12/04
-
Building,01 fficiar,'
POST• IN 'A' CONSPICUOUS PLACE' �L
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