0402-282 (SFD)LICENSED CONTRACTOR DECLARATION
hereby 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 # r Lic. Class Exp. Date
690645 B Vii "C'' A f1 0/04
Date1-1,"i Signature of Contractor
OWNER -BUILDER DECLARATION J
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). "
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.
( ) 1 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 Policy No.
J
(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. .7
Date: Ii -� Applicant •-V.r�f.d.,.a, .�"%/
• 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 y
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) �. _f �f t .k�. �*• Date
r `7:
BUILDING PERMIT PERMIT#
DATE L{ C VAL_UATION', LOT. ..'.;'.` TRACT ; f
29s Jas t
JOB SITE '
'APN
ADDRESS 9-545 IY1
iv-37o'-vu i
OWNER
CONTRACTOR/DESIGNER/EN INEERRi -
y UX
"tea,.••.... i.iyw1�..(�
F0 VXX 810
1425 E3:, �;.YB�;1;' ' lf`Y )DRIVE � <
LA. QUArl-A CA 92253
R FIGEAW AZ 95034 ,
(0 2) 57-1656 C:'8)',11 4.990
USE OF PERMIT
r -Ah .1S DWELIMIG
SPO - LOT A, PLAZA S113,SC3. PERMIT J;:xLS NOT 21' r`1.i:JEW PC 0LP
?• I' RLOCk W.>XIA OR QRMrF`f<v'AY AT, PRO ACH
TRACT,' CONSTRUCTION 4.618.00 SF
P ORC,HiRATIO z,04S Ob 'SW'
�.
PF12 I111" : SUArAR.Y
a
CO'92TRUICTION YLE 103 -000,418.000 $1,260.50,
i' LtUw C6 -1-W9. FLIE '101.000-439-316 $1,092.67
MILICH.hNICALFEE '101-000.421.000 ��•ao,�v
1,L,EIC TWI CA:L FEE 101. -o":10 -d".20-006; $8149XV
s:
NLUMBIlN A,
STRONG FEE.' 9L. SJ a 101(-/Q;f3�f3-?AI -(000
`
a1�9{.97
p
00
i EVEL•0J EER IMPACT 1iZE,, $2,405.00
AlVf 1W PL13"UC P,LAC1~S RESIL 270.000.4.45- �19u.1i
F z,
S .-iCgU& Ci'�pp i `-RUC'TT0], `ANr3�P�g3pA1�•�j��"ri"����';K
/+Ai:o' %!% A11' ^.i�"A'1L6� }: < i°'�
{'4+1;
s5,79.16
-$0,0o
U �� moi!' l: pl[, s 1U Fr. �. W .DL! now YY
.
t�il+.�;!' �v9, i V
CI` y OF Lid QJ5TA.
RECEIPT
DATE/ 1 °r�p
BY
DATE FINALED
INSPECTO
•/ %:.:•sem l.�
I
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
_
Ducts
Slab Grade
Return Air
Steel
5
Combustion Air
Roof Deck
- / _
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
— [ —
Compressor L
Insulation
Vents /
Fireplace P.L.
Grills
Fireplace T.O.
_
Fans 8 Controls
Party Wall Insulation
_
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final _ Y -
Final �_+
BLOCKWALL AP ROVALS
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 Lines
. ji
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
Final
Utility Notice (Gas)
ELECTRICAL APR VALS
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
Utility Notice (Perm)
COMMENTS:
M
SIP Engineering
Con. uatants,, -L.LG
7-2-04
Chad Meyer
RJT Homes, LLC
79700- 50th Ave
LaQuinta, CA 92253
RE: Structural Observation - Lot 31
Chad,
7
14712 SW Scholls Fe Rd E , >r
#'328 ° Y,: A Y¢kk 11
, {
Beaverton, OR 97007
503-524-8268
503-213-6222 (fax)
I
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 noticeable deficiencies.
Dese L '
NERGY, =-
CA0E.C"
ervices
S
+ P0. Box -621 Ph/Fax (760) 564-2044
Rancho Mirage, CA 92270 Cell: (7601250-1952
Email: DESNRG Or AOLCOM `
A. CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page.I of 1). ` CF -4R
,. PALMIL:LA PH 7 DATE TESTED 11-9-04 ,
:Project Title Date -
79 -545 VIA SIN CULDADO LA QUINTA, CA. 92253 RJT HOMES
t rojec r ss MEYER Builder Name
i
760-564-6555 IRONWOOD ,SF30 3 UNITS
Builder Contact Telephone Plan Number "
RICHARD.KROWN 760450-1852 GROUP S
HERSRate0XIL
Telephone Sample Group Number
LOT 31 xr:
#CCNRK613292 11-18-04 �
Certifying Signature, Date Sample Lot Number
f Firm: DESERT ENERGY SERVICES LLC HERS Provider: CHEERS:
Street Address: P.O. BOX 621 City/State/zip: RANCHO MIRAGE, CA. 92270
Copies to-, Builder, HERS Provider-.
'f HERS RATER COMPLIANCE' STATEMENT
k ,
The house was: ❑ Tested ® Approved as part of sample testing but was not tested
{
As the HERS rater providing diagnostic testing and field verification,l,cerbfy that the. houses, identified on this form comply
with the diagnostic tested compliance requirements as checked on this forma
❑. 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 tape is installed,; mastic' and drawbands are used in combination with cloth
1' backed, rubber adhesive duct tape to seal leaks at duct connections. r
I ❑ MINIMUM REQUIREMENTS FOR DUCT LEAKAGEREDUCTION COMPLIANCE CREDIT ,
Duct Diagnostic Leakage Testing Results (Max,imum 6% Duct Leakage)
' .. Measured r
Duct Pressurization Test. Results (CFM @ 25 Pa) values
t
{ Test Leakage Flow in CFM
+ ` ; If fan flow is calculated as 400&n1/ton x. number of tons enter calculated
` vaIue''lie re F
If fan flow is measured cuter measured value here`
Leakage Percentage (100 x Test Leakage/Fan Flow)
Check Box for Pass or Fail (Pass=6% or less) ❑
El
' . Pass Fail
❑ THERMOSTATIC EXPANSION VALVE:( TXV)
E] Yes ❑ No ermostatP
Thic Expansion Valve is installed and Access is.
provided forinspection' ❑ ❑ Y
11INS`Y'ALLATION-CERTIFICATE CF -6R
79-545 Via Sin. Cuidado yp T 3
Site -Address
An installation certificate is required to be posted at the.building site or made available for all appropriate inspections. (The information provided on this form is
required: however, use of this. form to provide the information is optionl.) Aflercompletionor final inspection, a copy must be provided to the building.
department (upon request) and the building owner at occupancy, per section 10-103(b).
HVAC SYSTEMS:
Heating L•quipment
Equip. Type
# of
Efficiency
Duct
Duct or
Heating
Heating
(pkg. heat CEC Certified Mfr, Make &
Identical
(AFUE,etc.)'
Location
Piping
Load
Capacity
pump. etc.) Model Number—
Systems
[>_CF -IR value]
(attic, etc.)
R -value
(Btu/hr)
(BTU/Hr)
FAU CARRfER 58STX110122
2
50.0%
ATTIC
R4.2
110,000
FAU.— :CA.ARIEk 5SSTX04510S
1
50.0%
ATTIC
R4.2
45.000
Cooling Equipment
Equip. Type
'of
Effeciency
Duct
Cooling
Cooling
(pkg. heat CEC Certified Compressor Unit
Identical
(SEER, etc)'
Location
Duct
Load
Capacity
pump. etc.) Mfr. Name and Model Number
Systems
[>_CF-111value]
(attic, etc.)
R -value
(Bttyhr)
(BTU/Hr)
A/C.COND. CARRIER 38BRC060000
2-
12.
ATTIC
R-4.2
60,000
A/C COND. CARRIER 38BRCO24000
t
12
ATTIC
R-4.2
24.000
1'2treads greater than or equal to.
1, the undersigned, verify that the equipment listed above is: 1) is the actual equipment installed, (2) equivalent to or more efficient than that specified in the
certificate of compliance (Form CF71 R) submitted for compliance with the Energy Efficiency Standards for residential buildings, and (3) equipment that meets
or exceeds the,appropriate requirements for manufactured devices (from the Appliance Efficiency Regulations or Part 6), where applicable.
11r1i(Jy(� �i(A } AMPAM LDI Mechanical
Diana Coria 10/8/2004 HVAC Subcontractor (Co. Name) ,
OR General Contractor OR Owner
WATER HEATING SYSTEMS:
Water CEC Certified Distribution If Recir- Rated Input Tank Efficiency Standby External
Heater Mfr Name &, Tvpe (Std, culation, # of Identical (kW or Volume (EF, RE) Loss (%) Insulation R=
Typel# Model Number Point -of -Use) Control Type Systems Btu/hr) (gallons) value
FAUCETS & SHOWER HEADS:
All faucets and showerheads installed arc listed in the Commisions Directory of Certified Faucets and Showerheads, ,
pursuant to Title-24,,Pan 6, Subchapter 2, Section I 11.
1, the undersigned. verify that the equipment.listed in the category above my signature is the actual equipment installed and that the equipment meets or exceeds
the requirements of the Appliance Efficiency Standards. In addition. I have verified that the equipment is equivalent to or more efficient than the equipment
specified on the Certificate of Compliance submitted to demonstrate compliance with the Energy Efficiency Standards for residential buildings.
RCR COMPANIES
Signature. Date Plumbing Subcontractor (Co. Name)
OR General Contractor OR Owner
COPY TO: Building Department
HERS Provider (if applicable)
Building Owner at Occupancy
INHML TION CERTIFICATE (Page 3 of 13) : CF -6R
-i-Hint( - (Ti 3
Site Address Permit Number .
DUCT LEAKAGE AND DESIGN DIAGNOSTICS
'
DUCTLEAKAGE REDUMION
Pressurization Test Results (CFM @ 25 PA)Test L.eahage (CFM)
Fan Flow a
If Fan Flow is Calculated as 400 cf n1ton x number of tons, or as 21.7 x Headng Capacity
in Thousands'o(BbAr, enter calculated value here
If fan flow is measured, enter measured value here
Leakage Friction = 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 ❑ Pressure pan test or House pressurization test
❑ Yes ❑ No ❑ Visual Inspection of Duct Connections fl ❑
•; Pan Fail
❑ 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. 13 No completed, Duct Design Is on the plans and duct installation
' F _ . matches plans.
2. (3Yes 13No TXV is installed or Fan now has been verified If no TXV, o ° 1"
r
Pass Fail
verified fan flow matches design from CF -IR
Measured Fan Pow =
Yes for both I and 2 is a Pass..
❑ 1, 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 subcontractors certifying that diagnostic testing and installation meet the requirements for compliance credit ]
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
Compliance Forms August 2001 A-25
tit? 1 d s`M�Fj. A'
ks, ,.... -%
.— f V , C_' �, •�.`' - r . - i _ - _ ,,.: c � /' J r �. a` - +
Ci/moo
erriTicate� of 1.0-cc, ancy
y
INCOWORATID VII ' c. _ `�. T` D ..- �`J
,
r
.•; ,
_ . _ ..
sr .'fir :y • ,£,. .� '.n ` , '* ••� J G
OF T L.� U�Il�1 f
►n g a ety.Department�
:.� , Y� ;
,
y 1
This Certificate,is.issued;� 4 rsuanf to�the requirements of:Section 109 of the California Building
,Coale, cert fjiing _ that, ai",,the time of issuance,• this r structure was in', cor»pliance r with 'the
�- -provisions -of `the+, Building Code aril 'the:''various ordinances ~of the City regulating building
cons'fruction_and
/or use.'
'
ADDRESS: ,79-"545 Via.`Sin Cuidado
-'BUILDING
M , •
� ti 'ice
Use=classification °� '
S.F D M�r� s s �� r�
,� Building Permit,,No•. 0402-282
J
®Occupancy Group R-3 Type ofFConstruction VmN - J Land Use Zone:,R
ti
41
r ^sa
Owner.ofbullding: R.J.T. HOMES `, Address. rP'O. 60X'810
, �` ; `
City?,ST, ZIP :LA`QUINTACA 92253
-
w' TE �.
_4 :j •�.�'�
` -.,' ; . ........
Date:
, .10/04/04
y BUiIding,`0fficial`
..` • i" �
f . !•►' -
- p •. r - •y � a 'S - �y `
F. r. � . .t
L w u
Y ;POST IN A CONSPICUOUS PLACE '�'
tit? 1 d s`M�Fj. A'
ks, ,.... -%
.— f V , C_' �, •�.`' - r . - i _ - _ ,,.: c � /' J r �. a` - +