0401-121 (SFD)LICENSED -CONTRACTOR DECLARATION -
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l Hereby affirm under penalty of perjury that l 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 B%FICA 6J"af1r04
Daie � " T`"- `��' Y Signature of Contractor - -" •' • ;.r - f•^ l f > �..
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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 ST TE UNT) Policy No. 1581PJ6-01
1
(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 persori 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: I . '"/A" _.c ii.F'Applicant—t__ s ,/ t'" ;r.�z
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 9 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)--7t%f "fr�� ��� Date.}
BUILDING PERMIT PERMIT# .--•--�; -•
01-�
DATE VALUATION j LOT'`T CT ~�
ur'�c` t.0ri90 2
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JOB SITE
ADDRESS
APN
772-37"Is
OWNERf
CONTRACTOR DESIGNER ENGINEER
1TtMOVIS bZ
R lNWL7U•71IN, INC. 1`
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F'0 BOX X310
1425 T� VMTV i;+iT:t*DIME - ..;
LA.il..s"�'r� - Cr"e 9x253
I?.f����w .85034
(602.)257-165, MIA 4990
USE OF'PERMIT
X012 FAIMLY DVM1MG
SixD a 1.. f,A FGAN SF3AC3. PERMIT 11OES 140T INCLUDE POOL,
SPA, FfLO `K WALL.% OR D 1V"LAY A.Y.APPROACt1
f
TRACT CONOTRUCTION 4,618.00 SP
PORCHfPATIO 1,.249.00 SP .
GAAA0FJCAr%P0RT X3.00 SF
E'1511 1A!1LF IRO COST OF CONa':fa UCn011
182,310.60
."VINIS RUCTION VE—V 101.000-418.000 $1,220,00
PLAN CHUCK 14711? � i t31-LtOf1"Ra�-� 18 �1}100.17
MECHANICAL rEE 1.01.000-421.000 $170,50
IIFS?Z - 1101-00�OO�Rs[3.1c
t�tLtF�;(y�Tq.RICq'pAgL
�0y-O�tl10 e�.2A�/9�..:f1tA9
1'UTY19TWOFlt 101.000--419.000 S'J1&DO
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S TRO NQ MOTION WF, - RBSI1D 101-000-241-000
OPADi}4'O HE 101-000-423-000 $15,00
D1?N►EL PEP' 1119PAC`±' FEE U40,00
Alai' IN PUBLIC PLAC1:S - WIL 270.000,445.000
SUB - OTAL C:).t4'9`1'RTi'e✓Ti0N AND I LAg CIMCK
$5,774.07
PAID S
LESS PREPAID F✓�
� iI
$0.00
�D
JAN 2 8 200,
CITY OF! A QISWNTA +:
FINANCE DEPT.
RECEIPT
DAT � �
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BY , �✓
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
s BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
-
Underground Ducts
Forms & Footings
— $._
Ducts
Slab Grade
— 5-. y __
Return Air
Steel
y — — ,
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
—
F.A.U.
Framing=�
Insulation
_
Al
Compressor
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
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lim 2
Heater Final
Water Piping
J,
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 Voftage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:�', ,,,-%�
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+ 14712 SW Scholls Ferry Rd
F " • # 328 t '
t Beaverton, OR' 97007
a . , 503-524-8268 i .
503-213-6222 (fax):y ' ;
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Chad. Meyer
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RJT Homes, LLC ; f� •5 �,' _- ' '
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' 79700 '50'h.Ave , . - , /I
41
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92253 ti.;
LaQuinta, CA10
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" '.RE:'Structuralfbbservation - 'Lot 28
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• Sample-observa'tiohs were made of the above Houses to ascertain whether
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-the general intent of the construction documents is being followed.With
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.'. respect the structural items that remain uncovered and easily observable,
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• this appears -.to be ahe case, with no unresolved deficiencies remaining that
am aware o.
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Mike Nelson, PE
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CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7) CF4R. .;
PALMILLA PH -6 09-14-04
Project Title Date
50 TH & JEFFERSON R J T BUILDERS
Project Address DARRELL MORGAN 760-275-8230 Builder Name
IRONWOOD SF3C3 3 UNITS
Builder Contact Telephone Plan Number
RICHARD KROWN 760-250-1852 GROUP 4
HERS Rater Telephone
#CCNRK613292 09-14-04 LOT # 28
Certifying Signature Date Sample House Number
Firm:DESERT ENERGY SERVICES HERS Provider: CHEERS a
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
j 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 -611 (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 tape 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 f
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/ton x number of tons enter calculated -
value here '
If fan flow is measured enter measured value here
Leakage Percentage (100 x Test Leakage/Fan 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 ❑ ❑
Yes is a pass - Pass % Fail
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California Home Energy ;
Efficiency Rating System + k
A non-profit corporation promoting
better homes for a better
environment. CHEERS Energy Star Rating April i, 2004
This rating is for the home located at: Builder/Developer: RJT Homes- Palmilla, LLC
X -9-510 VIA SIN CULDA_ D`O
Project: Palmilla-29858-1
La Quinta, CA 92253 Plan Name: Ironwood- casita 3
" Lot Number: 28
Certificate Number: CRT82634943948800 Overall Rating Score
Date Inspected: September 14, 2004 $7.4
CHEERS Rater: Dexter Barr
HERS Analyst: R Krown CEA 98-93-204
Reference File: ' N/A
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Cert�fica:te f 0 cupancy
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This JCertificate is issued pursuant to the requirements `of Section 109 of the California- Building
Code,- �ceitifying',that,: at the, time.' of issuance; "this struc#ure .was :in' -compliance -with the.,"
1. ,-pro' visions of the Building Code .• ands the • various ordinances 'of the _ City,'re gulating-building r
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'construction and/or use. Y `
BUILDINGADDRESS:' 79-510 VIA SIN 'CUIDADO
�Use classification =SF.D. '-~ ` . -, . •'' • `"� Building Permit•No 0404=121 ,
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Occupancy Group . R=3 , Type.of Construction V -N - ` - Land Use Zone. 'R -L
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Owner,of+Building: RJT HOMES LLC T' '� Address: sPO BOX 810 '
Cit Y ZIP: 'LA QQINTA CA 92253
,.ST;
By: -G. SHOWALTER
j w, Date: 10/19/044 '
-
Building Official y
4Tf v POST INCA CONSPICUOUS PLACE.
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