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0402-285 (SFD)�✓:.• ""` �r, __ ,�„- . _,;.LICENSED CONTRACTOR DECLARATION __.. �.. -o 1,1; ireby affirm under penalty of perjury that I am licensed under provisions of f- . p x IMi ter 9 (commencing with Section 7000) of Division 3 of the Business and 04 W Professionals Code, and my License is in full force and effect. o =) an License # Lic. Class Exp. Date 690645 B MC A f)�f�Ofnt Datek ld-✓L�' 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 noPintended 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 Sections 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 STATE TkiND Policy No. 1583906.01 (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 subject to the workers' compensationlaws 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 l5rovisions. Date: tit% Applicant �-.„difCffISP Gil 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 appl�cation 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., t the above-mentioned property for inspection purp6ses. A. Signature (Owner/Agent) f 'f✓�- -r�+° > `%{ Date J r BUILDING PERMIT PERMITtt DATE(r �- EVALUATION�,,��yy x�.r roro LOTr�~” TRACTti 9 -. �11.6••T7.r'd��a9;b� S� �r�iJr CJ°i !. ,J JOB SITE I / APN ADDRESS 7,94=:f._1_VLA 1105 CUMA 0 '772-37.i,023" OWNER CONTRACTOR / DESIGNER / ENGINEER PO BOX W 14 25ri. i fNNERSi.1'Y• DRIVE X A Sit !�`�. yk CA 92253 1111-10E, WX ' A.2r; 850314 USE OF PERMIT 912VTWX17+.,isQll..Y DVM.J_.A_k4Cv SM • 1,0,T 33, FLAW SITIACI, 1'ERYIT DOZZ NOT 1.14CLUDE P' -001A SPA, BLOCK 1fi+W-ALU, OR. DRIVEWAYAPPROACH.- H. - '!'fiat, CONSTRUCTION 4,9MAD 19N VOKCHIPAT10*" 202.00 31; 0c112AC1F:iCARPORT 929M 8F EUMAM EeOST OF, C.OTITSB..0 UC770df 243.450M CONSTRUCT?ON FEE 101-000418-000 $1,143.50 PLAN CHECK MEYC?3-UL�0 si3�'�33� �r//_�.65 MECHANICAL ICAL FEE 101.000-421.000 $13%00 H 1.ECTR1CAL 1°.1iIZ 101-000.420-000 $257.92 PLUMBNO FEE 101-000.419--000 5249,25. :;i°2tOhIO MOTIOW FEE • RV.Slri 1011-000-241--000 $A.55 01.11hDrI40FEE 101.000.423.000 $15100 DEV,9113PE1:.IMPACT FEE $�,d03.QtJ .AWF IN PUBLIC PI C1 3 - RES11= 270.000.444N-000 $10W SUB- 17AL CO "TP,11) a3 01T.r'1'ND PT,,<l;> Crf1EC K 4Z SS M=2+'ATi7? eS $0 ,00 A,PR o-12 U U RECEIPT DATEt•f J DATE FIN LED INSPECTO - J f� I %� ].BY v AV INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms 8 Footings Ducts Slab Grade # _ _ Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K to Wrap , F.A.U. Framing -2ig- Compressor Insulation _ Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath _ 3" - Drywall - Int. Lath - Final / _C911_ Final 17.2- o BLOCKWALL APPROVALS POOLS - SPAS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines /9 - Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection 9-./57- Encapsulation Gas Piping Gas Test Appliances Final Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fbdures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Lml'dy Notice (Perm) COMMENTS: t' awry i E'NERGI( i SaEJ1flC@S { P.O. Box.621 Ph/Fax (760) 564-2049 Rancho, Mirage; CA 92270 Coll: (7601250-1852 , ; ; ■ r• i Email:':DESNRG, MAOL:COM ° 'CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page: I of ,7) CF-4R J PALMILLA PH 7 DATE TESTED 11-9-04 + .f Project Till$ Date. W79- " `VIA SIN CULDADO _LA QUINTA, CA.. 92253 RJT HOMES Project . .rens _ . - Builder Name f CHAD MEYER 760'-5646555 MESQUITE SIF -3-UNITS . Builder Contact Telephone Plan Number ' + RICHARD KROWN760-250-11352 GROUP 5 �. ? HERS Rater Telephone. Sample Group #CC_NRK613292 LOT 33 ■',� Certifying Igna re ' Date Sample.Lot Number 'Firm:DESERTIENERGY.SERVICES LLC 'HERS Provider: CHEERS '1 k Street Address: P.O: BOX 621 City/State/Zip: RANCHO MIRAGE,.CA. 92270 ► Copies to: Builder-, HERS Provider 'HERS. RATER. COIVI',PLIANCE 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. r I, ❑ TheL 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 draadbands are used in combination with'cloth �. backed, rubber'adhesive duct tape to seal leaks at duct.connections. f j i, f� ❑ MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT 4. i _Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage) Measured , Duct Pressurization Test Results (CFM @ 25 Pa) values Test Leakage F.low.in' CFM r If fan flow is calculated as 400cfm/ton x number of bons enter calculated" ' value lien If fan alo%i is measured enter measured value here v L Leakage Percentage Cl(lU x Tesl 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 provided for inspection ❑' ❑ ,LLATION CERTIFICATE 79-555 Via.Sin Cuidado Site Address :,-o > 3 3 Permit CF -6R 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.) 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 Equipment Equip. Type P 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 value) (attic, etc.) R -value . (Btuthr).. (BTUIHr) —_FAU.; - CARRIER 58STX 110122 2 80.0% ATTIC R4.2 110,000 FAU CARRIER 58STX045108 1 80.0% ATTIC. R4.2 45,000 Cooling Equipment Equip. Type i; 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 [ZCF-1 R value] (attic,.etc.) R -value (Btu/hr) (BTU/Hr) A/C COND. CARRIER 3SBRC060000 1 12 ATTIC R4.2 60.000 A/C COND. CARRIER 381311548000 1 12 ATTIC R4:2 48,000 A/C GOND. CARRIER 38BRCO24000 1 12 ATTIC R4.2 24,000 12! reads 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 reifuirements for manufactured devices (from the Appliance Efficiency Regulations or Part 6), where applicable. AMPAM LDI Mechanical Diana Coria 10/8/2004 HVAC Subcontractor (Co. Name) OR General Contractor OR Owner WATER HEATUNGSYSTEMS: � 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./€t Model Number Use) Control Type Systems Btu/hr) (gallons) value FAUCETS & SHOWER HEADS: All faucets and showerheads. installed are listed in the Commisions Directory of Certified Faucets and Showerheads, pursuant to Title -24; Part 6, Subchapter 2, Section l 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. Signature, Date COPY TO: Building Department HERS Provider (if applicable) :Building Owner,at Occupancy RCR COMPANIES Plumbing Subcontractor (Co. Name) OR General Contractor OR Owner i • 7 M 1 _ALL A l I0N CERTIFICATE E Z n• 1,:1 r -F. —6'R �a�w�i�� Phases 7 lob 3 Site Address Permit Number - DUCT LEAKAGE AND DESIGN DIAGNOSTICS - DUCT LEAK -WE REDUCTION Pressurliatlein Test Results (CFM Q 25 PA) Test Leakage (CFM)za-,/ , Fan Flow If Fan Flow is Calculated as 400 cfrtlhon x number of tons, or as 21.E x Hearing Capacity ` in Thousands of Bttdhr, enter calculated value here If fan flow is measured, enter measured value here /an f Leakage Fraction = Test Leakage/(Measured or Calculated Fan Flow) = o Pass ifleakage fraction < 0.06 pass Fail O For AEROSOL TYPE SEALANTS ONLY -The following diagnostic testing was completed: Duct Fan Pressurization at rough -in measured leakage (CFIvI) CHECK AFTERY MSHING WALL: O Yes O No O :Pressure pan test or House pressurization test t O Yes O No 0 Visual. Inspection of Duct Connections o 12~ Pass Fail J6 THERMOSTATIC EXPANSION VALVE (TXV) .M Yes O No Thermostatic Expansion Valve is installed and Access is - provided for inspection' Yes is a pass , O DUCT DESIGN' /Pass Fail ACCA Manual D Design calculations have been 1. ❑ Yes O No completed, Duct Design is on the plans and duct Installation matches plans. 2. O Yes 0 No TXV is installed or Fan flow has been vexifled. Ii no TXV, Pass Fail verified fan flow. matches design from CF -IR Measured Fan Flow a Yes for both 1 and 2 is a Pass ' 0 I, the undersigned. verify that the above diagnostic test results and the work 1 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 sub -contractors certifying that diagnostic testing and installation meet the requirements for compliance credit ] Tests S' aturc, Ila c Installing Subcontractor (Co. Name) OR PerfomKd General Contractor (Co. Name) s COPY TO: Budding Department = HERS Provider (if applicable) ` Building Owner at Occupancy Compliance Forms August 2001 - z 5 +"•i s . .'; DTS TALLATION CERTHICATE (Page 3 of 13) CF -6R Site Address Permit Number ' DUCT LE_AK4GE AND DESIGN-DLAGIINTOSTICS DUC T LEAILAGE REDUCTION Pressurization Test Results (CFYI @ 25 PA) Test Leakage (CFM) : - Fan Flow If Fan Flow is Calculated as 400 cfh�ton x numbs of tons, or as 21.7 x Heating Capacity. in Thousands of Bttr/ltr, enter calculated value here If fan flow is measured, enter measured value here 96 Leakage Fraction = Test Leakagd(Measured or Calculated Fan Flow) _ ❑ Pass if leakage fraction <0.06 7 Pass Fall. p For AEROSOL TYPE SEALANTS ONLY following diagnostic testing was completed: ; Duct Fan Pressurization at rough -in measured leakage (CFM) CHECK AFTER FINISHING WALL: - O Yes 17 No ❑ Pressure pan test or House pressurization test ❑ Yes O No O Visual Inspection of Duct Connections � . ❑ ❑ ' Pass Fail O9 THERMOSTATIC EXPANSION VALVE (TXV) s- 14 Yes ❑ No Thermostatic Expansion Valve is installed and Access is - provided for inspection f Yes is a pass ❑ DUCT DESIGN Pass Fail ACCA Manual D Design calculations have been ' 1. D Yes ❑ No completed, Duct Design is on the plans and duct installation . matches plans. , 2. 0 Yes ❑ No TXV is installed or Fan flow has been verified. If no TXV, _ ❑ ' verified fan flow matches design from CF -IR. Pass Fail Measured Fan flow= Yes.fdr both I and 2 is a Pass 0 I, the undersigned, verify that the above diagnostic test results and the work I performed associated with the test(s) is in conforrnance , with the requirements for compliance credit [The builder shalt provide the HERS provider a copy of the CF -6R signed by the builder employees or sub -contractors certifying that diagnostic testing and installation meet the requiirments for compliance credit. ] Tests S grtature, Date Installing Subcontractor (Co. Name) OR Performed General Contractor (Co: Name). t:OPY TO: Building Department AR HERS Provider (if applicable) Building Owner at Occupancy Compliance Forms August 2001 A-25 ' MON CERTIFICATE (page 3 Of 1. CF -6R Site Address Permit Number - • DUCT LEALKA GE: AND DESIGN DI.AGNCSTICS ' D U C'1' LE.AKAGE 1tED UCTIUN _ Pressurization Test Results (CFM Q 25 PA) Test Leakage (CFM)—:23 Fan Flow If Fsn Flow is Calculated as 400 cfmRon x number of tons, or as 21.7 x Heating Capacity ` t in Thousands of Stuft enter calculated value here If fan flow is measured, enter measured value'hereg *, Leakage Fraction= Test I a2kage fflkl astmd or Calculated Fan Flow)_ Pass if Mage fraction <0.06 ass Fat? Cl For!>,ERO$OL TYPE SEAL411'TS ONLY -The following diagnostic testing was completed: , J, butt Fan Pd l Pressurization at rough -in measured (CFM) CHECK AFTER FDZSHING WALL: , ❑ Yes 0 No O Pressure pan test or House pressurization test. 0 Yes 0 No O Visual Inspection of Duct Connections C s o .; Pass ' Fall s , - O THERMOSTATIC EXPANSION VALVE t"I'XV) # . ' t Yes 0 No Thermostatic Expansion Valve is installed and access is -provided for inspection Yes is a pass 0 DUCE DESIGN Pass Fail ACCA Manual D Design calculations have been 1. O Yes 0 No completed, Duct Design is on the plans and duct Installation matches plans. - 2. 0 Yes 0 No M is installed or Fan flow has been verified. If no TXV, o 13. ' Pass Fall verified fan flow matches design from CF -1R s 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 world performed associated with the tests) is in cnaformance with the requkcmeats for compliance credit [1be budder 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 J t '. Tests Sigdature, Date Installing Subcontractor (Co. Name) OR , • Perfnmrd General Contractor (Co. Name) COPY TO: Bur'lding Department HERS Provider (if applicable) Building Owner at Occupancy Comoliance Forms _ August2001 A-25