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0402-286 (SFD)LICENSED CONTRACTOR DECLARATION - I 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 # Lic..Class Exp. Date d� 1590641 34 B+.MC A Of3,6,•7 �p�i Date /!J 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, olecompensation, 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&RC. 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 WATE FUND . Policy No. 1593906-01 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 1 subject to the workers' compensation provisions of Section 3700 of the Labor v� Code, I shall forthwith comply with those provisions. Date: /- —/ aJr A Applicant u 0 i I s Warning: Failure to secure WorkersCompensation 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. . r 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 f1 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 r insp/fection purpose Signature (Owner/Agent) l %� $r� ,(rn / , 1`'' Date -fit" �• •'i� r e i 2L5. "BUILDING, PERMIT PERMIQ# DATE /g/VALUATION��yLOT TRACTna JOB SITE APN ADDRESS 7.9-560 VIA SIN CIiaDPWO w OWNER CONTRACTOR / DESIGNER / ENGINEER 12Xf HO3v OO. U_ Z' r rr LATV"f- 1wim, TNC, Po Bclx lfb 1425 L1AMMOi'3`•Y' 17T NE T-.t,QU'lzrnav CA 92253 PHOFM" £u?. 85034 (602)257-1656 Cr -4 4990 USE OF PERMIT SWOLI.1a1 NHL4..Y ME3-04G i SFD -1,0'1''1,5, P"X 3VIBC3. PERMIT OOPS NOT INCLUDEP001, SPA. BLOCk WALL% Oki D1UVE'Jd',A.Y.A.PPRO C.H ' RA-C'r CONSTVCT.IOW 4024100 817 fA(J,I1.MPATIO ' 906.00 vF GARA,(3MARPORT M,00 SP' EIM"TED CCity' OF C;C)NSIRUC;' ION, 24:'s►,V51.4,A0 PFVXfr D9 KE 9MM"R' . COWS`( RUCTION F'LE 101-000-418-000 $1,143.50 PLA -14 CHECK FEE 101-000.-439-1318 WA.1 s MECHANICAL ANIC.AL Fig E 101.000-421.000 sf n 00 E.1��rn`"( RII,CAL..1q77F��??E 0l-c0�00-420./O�06 $r-10,92 326141195 S'PR NO MOTION PEEl . R9,91O 101-000-2A.1-000 M.35 (1RA1iT1v`O RE 101.000.423-000 $13..00 13t+V9LOPEFb I.I+iiFIACT FEE $2,405.00 ART N PUBLIC PLACES • RIMIr 270.000.445-000 S'U'B-`.4'(Y1:AL CON'S's.I: TJO- MINT AANZ7 FLAN CI-MCKC $5,316.95 PRE -pox) MIS SO.00 Z` OW j; ,;1 6. 5 APR 012001 ff CIT1,OF 114 UVI TA RECEIPT--=-�---= :DATE I/ J `/ �l 'y V BY,- %/J�. L r•.4 1 ! lir' DATE FINALED INSPECTO INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings - — Ducts Slab Grade - 3 -,/ Return Air - Steel _ 3 _ 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 _ h! Drywall - Int. Lath Final Final BLOCKWALL APPROVALS Steel POOLS - SPAS 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 Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K for Finish Plaster Sewer Lateral Pool Cover Sewer Connection -fid _ 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 Utility Notice (Perm) COMMENTS: SEC� ENERGY-, C: A o P0. Box.62.1 Ph/Fax (760) 564-2044 3 Rancho Mirage, CA 92270 Cell: (7601250-1852 Email:.DESNRG-QlAOL-COM. " • r a CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page -I of 7)' CF -4R S• PALMILLA PH 7 DATE TESTED 11-9-04 *' Project Title Date 79-560 VIA'SIN CULDADO LA QUINTA, CA.. 92253 - RJT HOMES Project. AddressBuilder Name CHAD-MEYER 760-564-6555 MESQUITE 8F1C1 3 UNIT§, r `Builder, Contact Telephone Plan Number }; RICHARD KROWN 760-250-1852GROUP 5 :HERS Rater Telephone Sample:Group Number , I ' #CCNRK613292 11-18-04LOT 25 '1 OF.3 . Certifying Signature Date _ Sample Lot.Number [: Firm: DESERT ENERGY SERVICES LLC . HERS Provider:, CHEERS j► Street Address: P.O..BOX 621 City/State/Zip: RANCHO MIRAGE, CA. 92270 V. j.h Copies to: Builder, HERS Provider 'HERS RATER COMPLIANCE STATEMENT 14 The house was: ®Tested. El 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. The installer has provided a copy of CF -6R (Installation Certificate. Distrbution system is fully ducted(i.e., does not use building cavities as :plenums or platform retums•in lieu of ducts) Where cloth backed, rubber adhesive duct tape is installed, mastic anddrawbands are used in combination with,cloth backed, rubber adhesive duct tape to seal leaks at duct connections. is N MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT -� ' Duct Diagnostic Leakage Testing Results (Maximum 6% Duct_Leakage) a Measured 'Duct Pressurization Test Results (CFM @ 25•Pa) values Test Leakage Flow in CFM 92 If fan flow is calculated as 400cfm/t6n x number of tons enter calculated is Value here 1600.;.. , If fan now is measured enter measured value here „ Leakage Percentage (100 x Test.Leakage/Fan Flow) = 5.75 I' Check Box for Pass or Fail (Pass =6% or less) ® ❑ j Pass Fail THERMOSTATIC EXPANSION VALVE.(TXV) Z Yes ElNo Thermostatic Expansion Valve is -installed and Access is, 1. ` provided: for inspection J.. ENERGY ervices _ C. A D E C t. P0. Box 621 Ph/Fax (760) 564-2044 i Rancho Mirage, CA 92270 Cell: (760) 250-185.2 l Email' DESNRG PAOL.COM CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7) -CF -4R • ,. PALMILLA PH 7 DATE TESTED 11-9-04 Project Title Date 79-560 VIA SIN CULDADO CA QUINTA, CA.,92253 RJT HOMES Project Address Builder Name CHAD MEYER 760-5646555 MESQUITE SFICI 3 UNITS 3 Builder Contact Telephone Plan Number RICHARD KROWN 760-250-1852 GROUP 5 ,HERS RateA.L #CCNRK613292 Telephone Sam le G[oup Number 114 8-04LOT 2 OF 3 ), Certifying Signature Date Sample Lot.Number. 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 ..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, l certify that the houses identified on this. form comply with the..:diagnostictested -compliance requirements as checked on this form. - ® 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 retums in lieu of ducts) ® Where cloth backed; rubber adhesive duct tape is installed, mastic and drawbands are used in combination with cloth - t backed, rubber adhesive duct tape to seal leaks at duct connections. MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT i Duct Diagnostic Leakage Testing Results (Maximum 6%.Duct:Leakage) i Measured " ' buct Pressurization Test Results (CFM @25 Pa) + values Test Leakage flow in CFM 38 r l If fan flow:is calculated as 400cfm/ton x number of.tons enter calculated i valuc.herc 800 If fan. now is measured enter measured value here , Leakage Percentage (100 x Test Leakage/Fan Flow) _ -4.75 ' (. Check Box for Pass or Fail (Pass W/o or less) ® ❑ ; Pass 'Fail'. ® THERMOSTATIC EXPANSION VALVE:(TXV) F` 1; ® Yes ❑ No Thermostatic Expansion Valve is. installed and Access is - L provided for inspection 19 ❑ f Desert ENERGI( C.A D E.C. ` PO. Box 621 Ph/Fax•(760) 564-2044 Rancho Mirage, CA 92270 Coll: (760) 250-1852 Email:. DESNRG PAOL.COM w r CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page l:of 7) -CF-aR, ' `- PALMILLA PH 7 DATE TESTED 11-9-04 Pro1ect.TitleDate a•, _79-560.._ VIA SIN CULDADO LA QUINTA,CA. 92253 '` RJT HOMES' _G' ProjectAddress Builder Name CHAD MEYER 76064-6555 MESQUITE SFICI 3 UNITS Builder. Contact Telephone Plan Number RICHARD KROWN. 760250-1852. GROUP 5....._ HERS Rater' Telephone Sample Group Number i✓a'""' #CCNRK61'3292 LOT 25 3 OF 3 Certifying Signature Date Sample Lot Number. ' 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 HERS..RATER COMPLIANCE STATEMENT The house was: ® Tested ❑. Approved as part of sample testing but was not tested Asahe.HERS raterproviding diagnostic testing and field verification, I certify that the houses identified,on, this form comply #� Wift the diagnostic tested compliance requirements as checked on this form_ ® The installer has provided a copy of CF-6R (Installation Certificate. '�- �' ,Distribution system is fully ducted(i.e., does not use budding 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 �{ff Duct'Diagnostic Leakage Testing Results :(Maximum ;6% Duct Leakage), ,1 Measured" Duct Pressurization Test "Results. (CFM @ 25 Pa) values Test Leakage Flow in CFM 118 If.fan flow is calculated as 400cfmlton x number of tons enter calculated value here 2000 ra If tan flow is measured enter measured value here -le Leakage Percentage (100 x Test Leakagc/Fan Flow)'= 5:9 Check Box for Pass or Fail (Pass =G% or less) ® El - Pais Fail f ®THERMOSTATIC EXPANSION' VALVE ;(TXV) 4 ® Yes ❑ No Thermostatic. Expansion Valvc.is installed and Access is provided for.inspection L. NI STALLATIONtERTIFICATE 79-5.60 Via Sin Cuidado Site Address Fs Permit # -CF-6R An installation certificate is required to be posted at the building site or made available for allappropriateinspections. (The information provided on this forth is required; however, use of this form wprovide the infommation is optionl.) After completion of 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 Eqi ipntent. Equip. Type # of Efficiency Duct Duct or Heating Heating (pkg. heat CEC Certified Mfr, Make:& Model Identical (AFUE,etc.)' - Location Piping Load Capacity pump, etc.) Number Systems [>_CF -I R valuel (attic, etc.) R -value (Btu/hr) (BTU/Hr) FAU CARRIER 58STX110122 2 80.0% ATTIC R4.2 110,000 FAU CARRIER 58STX045108 1 80.0% ATTIC R-4.2 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.) M.fr. Name and Model Number Systems [KF -1 R value] (attic, etc.) R -value (BuOir) (BTU/Hr) A/C CON'D: -CARRIER"` 38BRC060000 1 . 12 ATTIC R-4.2 60,000 A/C COND. CARRIER. 38BRC048000 1 12 ATTIC. R4.2 48,000 A/C°CONDI CARRIER . '38BRCO24000 1 12 ATTIC R4.2 24,000 L>_aeads 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 CF -1 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 (front the Appliance Efficiency Regulations or Part 6), cohere applicable. - ANIPAM LDI Mechanical Diana oria 10/8/2004 HVAC Subcontractor (Co. Name) OR General. Contractor OR Outer NVATER HEATING SYSTEMS: Water CEC Certified Distribution Type If Recir- Rated Input Tank Efficiency Standby External -Heater Mfr Name.& (Std, Point -of- culation, # of Identical (kW or Volume (EF, RE) Loss (%) Insulation.R- .Type/:# Model,Number Use) Control Type • Systems Btufhr) (gallons) value FAUCETS & SHOWER HEADS: All faucets and showerheads installed are listed in the Commisions"Directory of Certified Faucets and Showcrheads, pursuant to Title -24, Part 6; Subchapter 2, Section 111. I, 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 requiremenmof the Appliance Efficiency Standards. In addition, (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 INSTALLATION CERTIFICATE . (Pave 3 of 13) CF-6R - Site Address Permit Number . • DUCT LEAICkGE.SND DESIGN DIAGNOSTICS QIjUI' LEAYAGI! REDUU110N • Pressurization Test Results (CFAt Q 25 PA) Test Leakage (CFM)-&e Fan Flow. If Fan Flow is Calculated as 400 cfmkon x number of tons, or as 21.7 x i•ieadng Capacity T ° in Thousands-of BhAr, enter calculated value. here s a-;+• If fan flow Is measured, enter measured value here ,[�D L 5 Leakage Fraction = Test Leakage/(Measured or Calculated Fan Flow) = �. ❑ ,w "- 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 (CFIvn t CHECK AFTER FINISHING WALL: •-� " . D Yes 0 No ❑ Pressure pan test or House pressurization test .::: ,:' ' ' s "• " _ 0 Yes O. No O Visual Inspection of Duct Connections Pass Fail ❑ THERNIOSTATIC EXPANSION VALVE rTXV) �F t7 Yes O No Tbermostatic Expansion Valve is installed and'Access is - provided for inspection Yes is a pass ° : .. ❑ a �A +`. Pass Fall 9 DESIGN DUCT ' n ACCA Manual D Design calculations have been 1. • O Yes,. O No completed, Duct Design is on the plans and duct installation ` matches plans. _ r ' 2. ❑ Yes CINo .,TXV is installed or Fan flow has been verified. If no TXV, ° ° Y �.: • verified' fan flow matches design from CF-IR Pass i Fail .. ` i • 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 eonfomrance with the requirements for compliance credit [The builder shall provide the HERS provider a copy of the CF-6R signed by the builder s , employees orsub-contractors certifying that diagnostic testing and installation meet the requirements for compliance credit ] G 1J Tris S if ature, Date Installing.Subcontractor (Co. Name) OR Performed General Contractor (Co. Name) '" COPY M:, Building Department • A �.. HERS Provider (if applicable} Building Owner at Occupancy, f Compliance FortesAugust2001 a-zs , h y E1-STALLA1ION CERTHICATE (Page3 of 13) CF*- Ph j'n iFA-- ;2 5 Site Address Permit Number DUCT LEAKAGE AND I)�SIGN DIAGNOSTICS DUCTLEAKAGE REDUC110N Pressurization Test Results (CFM @ 25 PA) Test Leakage (CFM) Fan flow L° Fan Flow is Calculated as 400 c.`m'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, eater measured value here /.2 O Leakage Fraction = Test Leakao(Measurei or Calculated Fan Flow) _ p ~ Pass if leakage f c6on < 0.06 ass Fail- "C3 ail- "O 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 O No O Pressure pan test or House pressurization test ❑ Yes ❑ No ❑ Visual Inspection of Duct Connections p ❑ Pass Fal] ❑ THERMOSTATIC EXPANSION VALVE (1'XVl Yes ❑ No Thermostatic Expansion Valve is installed and Access is - provided for inspection Yes is a pass p ❑ DUCT DESIGN Pass Fall ACCA Manual D Design calculations have been I. ❑ 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 Irno TXV, p p verified fan flow matches design from CF -IR Pass Fall Measured Fan Flow = Yes for both 1 and 2 is a Pass . O L 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 ['flue builder shall provide the HERS provider a copy of the CF -6R signed by the builds ertrployeesor subcontractors certifying that diagnostic testing and installation meet the requii-emenis for compliance credit ] Tau t ature, Date Installing Subcontractor (Co. Name) OR z Performed General Contractor (Ca Name) . ' ' COPY TO- Bur7dmg Department HERS Provider (if applicable) ' Building Owner at Occupancy t} GompGance Forms August 2001 -25 WSTALLAT'ION CERTIFICATE (Page3of>s) CF -6 Site Address Permit Number DUCT LEAK4GE AND DESIGN DIAGNOSTICS D U CT LE-AKAGE REDUCTION Pressurization Test Results (CFi•I 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 now is measured, enter measured value here AS_ Leakage Fraction = Test LeakageJ(Measwed or Calculated Fan Flow) = b ,. . Pass if leakage fraction < 0.06 Vass Fat1. O For AEROSOL TYPE SEALANTS ONLY -The following diagnostic testing was completed: Duct Fan Pressurization at rough -in measured leakage (CFA0 CHECK AFTER FMSHING WALL: O Yes O No O Pressure pan test or House pressurization test + O Yes- ❑ No ❑ Visual Inspection of Duct Connecdons o o •, Pass Fall ❑ THERMOSTATIC EXPANSION VALVE n XV) ` Yes O.No Thermostatic Expansion Valve is installed and Access is - provided for inspection 13 Yes is a pass 0 DUCT DESIGN Pass . Fail - - ACCA Manual D Design calculations have been 1. O Yes O No completed, Duct Design Is on the plans and duct installation , matches plans.. 2. O Yes 13'No TXV is installed or Fan flow has been verified. If no TXV, El❑ verified fan flow thatches design from CF -IR. Pass Fail Measured Fan Flow Yes for both I and 2 is a Pass ❑ L the undersigned, verify that the above diagnostic test results and the work I perforated associated with the tests) is in conformance with the requirements for compliance credit. (The builder shall provide the ITERS provider a copy of the CF -6R signed by the builder . • employees or sub coiitractots certifying that diagnostic testing and installation meet the requirements for compliance credit...J . Tests S196rure, Date Installing Subcontractor (Co. Name) OR r Performed : General Contractor (Co. Name) r COPY TO: Building Department , HERS Provider (if .applicable) Building Owner at Occupancy -, Compliance Fortns August.2001 A725