The URL can be used to link to this page

0402-284 (SFD)t LICENSED CONTRACTOR DECLARATION Ji 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 # Lia Class Exp. Date 690645 - B�7mf", c4. , ai010K �' Da a �' ' " 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 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. _ S Tr",Ttt FE�d1_?�..,r 1333906-01 (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°subiect 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: UI -!�% Applicant— Warning: PPlicant .,k�� y .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 propertyforinspection purposes. r/AgentSignature (Owne' 4 DateI1 _Z`Zf BUILDING PERMIT ` "t"M" DATE �� ly VALUATION LOT TRACT �t1 � �9r:3..9�1 32 c�i:tiu�l JOB SITE APN ADDRESS' - OWNER CONTRACTOR/ / EN (NEER / `PO I O.K 8l 0 1425 Z iY-MMMU Y T33' V.2, LAS Q , TfA CA 92253 m:?.c3r'm13:' AZ 83004 USE OF PERMIT !L.iA'd 4.T:4di k'L".54, Z i! iTs.L'd.el-iLL`Y V I liaff 74 PLA14 SFdACZ, PEMIT T 30fw ES 3, T INCII:UDE POOL, 9M. -TOTAL CONMRT-Ta .W.AIM l?;C.N1, CIMUCK x;5,531.21 ry '.d,t• TAL PIMM;T f! 3'115 DUE INOW APR o CITY CP LA Mul"•i AI `! RECEIPT DATE IJ /� BY y`� DATE FINALED INSPECTOR DUCT CONOTRUCTION . '> 4,3600 SF - � 'PORCHIPJV10 901.00 Sill 0ARAWCA.i2PORT7X00 8F E&'x-MA M C05" T' OF COKSL`f. UC 10111'' 26 4,.138..90 C(MUTRUC'i ION FEE 1011-000-4118-000 51121331) PLAN CHECK FEE 101-000-439-318 $1,036.83 fARCHANIC.A,L, FEE 101.000.421-000 $13U100 KLECTFa1G`•1ri L FUt 101-000.420-000 $249.72 pil►hti iFBC► ,l E l tsl -000-41 9.-000 52�1.1it1 STRONG MOTION FEE a RE SID 101-000-241-060 X26. i1 (. R ANiiTtJ FFE 101-000 4:23-000 szs.00 l.'WE;,�SPBR. IMPACT FTI? ART ftT PUBLIC PLACES - RROJE 7110-000-445-000 $15793 9M. -TOTAL CONMRT-Ta .W.AIM l?;C.N1, CIMUCK x;5,531.21 ry '.d,t• TAL PIMM;T f! 3'115 DUE INOW APR o CITY CP LA Mul"•i AI `! RECEIPT DATE IJ /� BY y`� DATE FINALED INSPECTOR ,+ INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade y - - Return Air Steel - �, - Combustion Air Roof Deck _ / - Exhaust Fans O.K. to Wrap F.A.U. Framing _ 7, Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath - Drywall - Int. Lath 61, Final - Final — — POOLS - SPAS BLOCKWALL APPROVALS 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 / - a 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: 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) Deseret - EI�LEt�GY C A D E C 4 emces ` PO'. Box 621 Ph/Fax (760) 564-2044 Rancho Mirage, CA 92270 Cell: (7601250-1852 w Email DESNRG (gM0 x6m. - t t _ . CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING.('Page I of 7.) cF-aR t PALMILLA PH 7 DATE TESTED ' . ` 11-9-04 Project Title - } Date - - N _ 79-565 - - VIA SI.N CU LDADO LA QUINTA, CA. 92253 RJT HOMES. rojec Address Builder Name CHAD MEYER 760-564555 PALO VERDE SF2C2 3 UNITS "'Builder Contact Telephone Plan Number, t RICHARD KROWN . ,. 760-250-1852 GROUP 5 _ HERS,Rater Telephone 'Sample Group Number. A #CCNRK613292 11-18-04 32 ^> SLOT Certifying Signature Date Sample Lot Number ' Firm: DESERT ENERGY'SERVICES LLC HERS Provider:. CHEERS 4 E Street Address: P.O. BOX 621 City/State/Zip:. RANCHO MIRAGE, CA. 92,270 1 Copies to:. Builder, HERS Provider `. HERS RATER COMPLIANCE STATEMENT 4: 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: s ❑ 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). t. - ❑ 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 Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage) Measured .. Duct Pressurization Test Results (CFM @.25 Pa) values 4 ' Test -Leakage Flow in CFM r' If fan flow is calculated as 400cfm/ton x number of tons enter calculated ' ` valuc•hcre,. w . If:fan.tlow is measured enter measured value -herd Leakage �Percentagc (100 x Test Leakage/Fan Flow) - Check Box for Pass or Fail (Pass:=6% or less) ❑ s ❑ - Pass . Fail ❑ THERMOSTATIC EXPANSION VALVE,(TXV) ' ❑ Yes ❑ No Thermostatic Expansion Valve is installed and.Access is ;. I . provided.for inspection Q Q A. aS TflALLATI ®N CERTI y i ATE (Page 3 of 13) PA 2 UP- Site Address r'aRnti Number DUCT LEA-K4,G.' AND DESIGN DL4GNOS T ICS. D U Cl' Li±'AKAGL 1tW U MION Pressurization Test Results (CFM @ 25 PA) Test Leakage (CFM)_,�ff . Fan Flow f t If Fan Flow is Calculated as 400 chation x number of tons, or as 21.1 x Heating Capacity in Thousands of Btuthr, enter calculated value here ; If fan flow Is measured, enter measured value here _.41 Leakage. Faction = Test Leakage!(Meastmd or Calculated Fan Flow)= Fp - Pass if leakage fraction < 0.06 ass '.'Fail O For AEROSOL TYPE SEALANTS ONLY -The following diagnostic testing was completed: Duct Fan Pressurization at rough-in measured leakage (CFlvi) . ti ' • ; • CHECK AFTER FINISENG WALL: O •Yes O No O Pressure pan test or House pressurization test O Yes O No O Visual Inspection of Duct Connections p p. Pass Faff _t O TITERIKOSTATIC EXPANSION VALVE PI'XVI ' Yes [3-No Thermostatic Expansion Valve is installed and .Access is - provided for inspection !] Yes is a pass Pass - ❑ DUCT DESIGN Fail ACCA Manual D Design calculations have beth 1. ❑ Yes O No completed, Duct Design is on the plans and duct installation matches plans.. 2. O Yes ❑ No TXV is installed or Fan flow bas bees verified If no TXV, •p p verified fan flow matches design from CF-BL 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 confottitasice %it6 the requirements for compliance credit [Tbe builder shall provide the HERS provider a copy of the:CF-6R signed by the builder employers or sub contractbrs catifymg Ihat.diagnostic testing and installation meet the requirements for compliance credit ) TWA Tess SliKatur:, Date Installing Subcontractor (Co. Name) OR Pedomud General Contractor (Co. Name) . COPY To-' , BmIding Department ITERS Provider .(if applicable) Building Owner at Occupancy Compliance Forms AugustV>34 -25 - '_All .VS 1 a LATION CERTU -C_ TE (Page_ of l-) CF— ..: Site Address Permit Number DUCT LEAILAGE REDUMON Pressurization Test Results (CFA4 Q -'a PA) Test Leakase (CFM) /G Fan Flow If Fan Flow is Calculated as 400 efmIton x number of tons, or as 21.7 x Heating Capacity in Thousands of BbAr, enter calculated value here If fan flow is measured, enter measured value here Lealo:ge Fraction = Test Leakaget(Measured br Calculated Fan Flow) = D V - Pass if leakage fraction < 0.06 ass Fail - O For AEROSOL TYPE SEALANTS ONLY -The following diagnostic testing was completed: t y. Duct Fan Pressurization at rough -in measured leakage (CFM) CHECK AFTER FINUHING WALL: M ❑ Yes O No ❑ Pressure pan test or House pressurization -test ❑ Yes ❑ No O Visual Inspection of Duct Connections 13 o ; Pass Fail ❑OTHERMOSTATIC EXPANSION VALVE rrXV} ' Yes i7 No Thermostatic Expansion Valve is installed and Access is - provided for inspection Yes is a pass t7 Pass Fail i ❑ DUCT DESIGN ACCA Manual D Design calculations have been 1. O Yes ❑ No completed,.Duct Design is on the plans and duct Installation matches plans. ; 0 0 2. ❑ Yes ❑ No TXV is installed or Fan flow has been verified. If no TXV, Pass Fail, - verified fan flow matches design from CF -IR Measured Fan Flow= Yes for both l 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 J with the requirements for compliance credit. ['lire 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 instaltation meet the n�toi•ements for compliance credit. ) /0 s-, G ' Tau Siplatutz, Date Installing Subcontractor (Co. Name) OR Perfumed General Contractor (Co. Name) ` COPY TO: Building Department HERS Provider (lf applicable) Building Owner at Occupancy Compliance Forms August 2001 - 2 5 • EVSTALLATION CERTI ICA R (Page 3 of 13) CF-61R Pi3�TAiMQ ' - She Address Permit Number rUCT LES, DS1CN J"OS'CS �. DUCT LE_4K4GE 1ZEDUC'1'10N f Pressurization Test Results (CFM @ 25 PA) Test Uzl ge (CFM). Fan Flow 'Fan Flow is Calculated as 400 cfni/ton x number of tons, oras 21.7x Heating Caper-- ty in Thousands of Btuft enter calculated value here If fan flow is measured, enter measured value here 2.170 Lzak-age Fraction = Test ieakaget(Measured or Calculated Fan Flow) o Pass if leakage fraction < 0.06 ass Fail D For AEROSOL TITS SEALANTS ONLY -The following diagnostic testing was completed: Duct F,an Pressurization at rough-in measured leakage (CFK CHECK AFTER FM SHING WALL: O Yes ❑ No ❑ Pressure pan test or House pressurization test O Yes ❑ No O Visual Inspection of Duct Connections 0 o Pass Fail O 'THERMOSTATIC EXPANSION VALVE =VI Yes O No 'Thermostatic Expansion Valve is installed and Access is - provided for inspection 13 Yes is a pass Pass :Fail O DUCT DESIGN ACCA Manual D Design calculations have been 1.. ❑Yes D No completed, Duct Design.is on the plans and duct installation. . ` matches.plans. N 2. ❑ Yes ❑-No, TXV is installed or Fan flow has been verified. If no TXV, Pass v' F Fail • verified fan flow matches design from CF•IR Measured Fan Flow Yes for both I and 2 is a Pass ❑ i, the undersigned, verify that the above diagnostic test results and the work 1 performed associated with the tests) is in confonnaoce with the requirements for compliance credit. [The builder shall provide the HERS provider a copy of the CF4R signed by the builder employees or sub-contractors certifying that diagnostic testing and installation meet the requii ments for compliance credit. ] - + Tests�etifi=e,Date Installing Subcontractor (Co. Name) OR .i Performed General Contractor (Co. Name) COPY TD.*, Building Department HERS Provider (if applicable) Bw1ding Owner at Occupancy - ComprarreForms August 2031 M � - y wat&,o, ccupanc a LL�, _ • - . .- � til ] 4r .r i ^, r `v • ' .�. ,. ,� `<; .,J I.crwirovnTm 4'�' Mu V - tis &= Safety Departrment of9BWiding' This .Certificate�is- issued pursuant to the requirements Section 109 ,of ahe California Building - - _. :Code _c6rti in J that,'at the ' time of . issuance,-' this structure. was, -in, compliance with they " provisions of'the'Building Code and the .,various; ordinances of: the -`City'Vregulating building, j construci�ion and/or use., - �~. rC )'..I ♦.. �` `s� `I. � +M, -s• .. V �} r•i � e . _ V .yy :'i,�.V` jti4` - 1 BUILDING°ADDRESS: 79-565 VIX'SIN CUIDADO ..�' _\ , S. � �'�, �3 ,. r r' ., . -, . t4 4: t.A •., � tf+' �1 .•'�• q. ❑ C, r. Building'Permit No 0402-284-; ,-Use Classification: S.FBuildin S.F.D.F.D. y,�4 - f ,. 'Occupancy Group. R-3� �c•Type of Construction V -N r Land Use Zone: R L , a S : f ix a • . ., �. ., �; i - Y+ / 1sl _� •' ♦ ,.ice Owner of•Building: RJT'HOMES LLC,... Address: ;PO BOX 810 a City,'ST,-ZIP : LA QUINTA .CA. 92253 4 • fit'- f 3 „+ w-"' '" �:. __ _. - _ .. k: By •G. SHOWALTER Date: 11/04/04 Building Officia f ' .s �.y `r a y �. • .. �.. moi• .>. r .. •` . ^ -- ` r �',, •., s ,.. �,..� POST IN A CONSPICUOUS PLACE