The URL can be used to link to this page

0402-287 (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 +590645 la MC A �/30/04 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, 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: Policy No. Carrier q!'P,TE f�Lrltl� 1593006-01 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 subject to the workers' compensation provisions of Section 3700 of the Labor Code, I.shall forthwith comply with those -pro v, signs. { -� Date: f ._. ter;! Applicantrs.r� (' . ✓1i ® 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 i each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applieaton 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 St'ate•laws relating to the building. construction, and hereby authorize representatives of this City to enterrupon the above-mentioned property for inspection purposes. '7 Signature (Owner/Agent) 4-4 A Dated 2� BUILDING PERMIT PERMIT " I� +J DATE p ` { VALUATION . LOT C}40-2''0*7 TRACT 24 7,9858.1 JOB SITEf t i APN � ADDRESS T9-5= WA \F A "W CUMAD 0 �� •�� OWNER CONTRACTOR / DESIGNER / EN (NEER PO -ROX 810 1.42.5 E. 'lJbT1Vr-_Rff "Y DRIVE LAQIMITA CA 92253 MI,ODll"`Si . la: $:SfJ34 (602)25? -1656 C.13L.fk 4990 USE OF PERMIT Mar 1.1^• T+'iumm`.+f DWE1..ul'uG SFD - LOT W, P.f P.N &1`3AIPT PERMIT DOES'NO INCL.t EtE ROJF., 'P.,, 8WC K WA1,63. OR, DRIVEWAY APPROACH TRACT CONSTRUCTiON 4,6&49.00 OF 1:ORCINPATIt^! 1„�Z .Qin SP C3A11.1'r IYCA1ik'ORT .763,00.`l? Ma A ED COST OF •C0I01111 174;°1. 011 2,823 310.641 CONSTRUCTION FEE 1011,000-118-000 31;2M00 KAN CHECK FEE 101-000-439-318 $1,100.17 MECHANICAL FEE 101.000-42.1-000 911AD.50 SLECT,WC A1, riEF 101-000-420-000 $259.19 PLUMD1140 me 101.000.419.000 %310,0 ST 0340'+fi0TJOIN' PEZ • RE olid 101-000-241-000 $29.23 GRAD IG FEE 101-000-423.000 $15.00 DEVELOPYA)HP Ai T IEEE $2,405.00 ARTIN PUBLIC PLA KS-11.EIM rIO-000-445.000 MOM, 33 C;F.I..`I°i)TAL COVM, TRiTMON AND ;PTS• CMCK !45,7774.07 IMS FRE-IJAM VEE. S MOO APR 012004 , CITY C7 LA E.'.WINTA f RECEIPT DATE �� /tf�l B� DATEFINALED INSPECT INSPECTION RECORD - OPERATION DATE I INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade - 5- Return Air Steel Combustion Air Roof Deck S" Exhaust Fans O.K. to Wrap 5 -"J.2- `' F.A.U. Framing - Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation 7 P2=77 Condensate Lines Party Wall Firewall Exterior Lath - a Drywall - Int. Lath i o, r - 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 I I Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines A - j,, 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 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: a • L. — Diseft NERGY �G.A 4 E C a �+e mt�s — PO. Box 621 Ph/Fax (760) 5642044 Rancho Mirage, CA 92270 Cell: (7601 250-1852 Email:.OESNRG (AOL.COM. CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page] of 7).=- CF -4R k PALMILLA PA, 7 DATE TESTED 11-9-04 :". Project Ttle Date 79-580 VIA SIN CULDADO LA QUINTA, CA. 92253 RJT HOMES project Address Builder Name CHAD MEYER 760.564-6555 IRONWOOD SF3C3 3`UNITS BuildeFContact Telephone Plan Number RICHARD KROWN - 760-250-1852. GROUP 5 HERS Rater Telephone Sample Group Number , A . #CCNRK613292 11-18-04 LOT 24 , Certifying Signature Date Sample Lot _Number " Firm: DESERT ENERGY SERVICES LLC HERS Provider: CHEERS Street Address: P.O. B& S21 City)State/Zip: RANCHO MIRAGE, CA. 92270 Copies to: Builder; HERS Provider ` .HERS1 RATER COMPLIANCE STATEMENT The house was: p g • , 0 Tested ®' Approved as art of sample testing but was not tested Asthe.HERS rater providing diagnostic testing and field verification, '1 certify that the houses: identified on this form comply ti with the diagnostic tested compliance. requirements as checked on this form. The installer has provided a copy of CF-6R'(Installati'on Certificate. , ❑ Distribution system is fully ducted(i.e., does not use building cavities as plenums or platform returns in lieu of ducts)' Q 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. s, ❑, MINIMUM REQUIREMENTS FOR.DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT y Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage): j1 ,. :. Measured Duct Pressurization Test Results (CFM @ 25 Pa) values Y Test Leakage Flow in CFM If fan flow is calculated as 400cfmlton x number of tons enter calculated t value here ; If fan now is measured enter "measured value here Y Leakage Percentage (100 x Test Leakage/Fan Flow) Chcck :Box for Pass or Fail (Pass =6% or less) 0 El _ f Pass Fail I) ❑ THERMOSTATIC EXPANSION; VALVE:(TXV) ' ❑ Thermostatic Expansion. Valve. is" installed, and Access is! Yes � 0 No :.. 0 ❑ provided for.inspection _ INSTALLATION CERTIFICATE 79-580 Via Sin Cuidado • ' S. CF -6R mte'Address Pcn-nit # 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 option[.) After completion of final inspection, a copy must,bc provided to the building departrnent (upon request) and the building owner at occupancy, per section 10.103(b). HVAC SYSTEMS: Heating Equipment Equip. Type: # of Efficiency Duct Duct or Heating Hearing (pkg. heat CEC Certified Mfr, Make & Identical (AFUE,etc.)' Location Piping Load Capacity m puny, etc.) Model`Number Systems [2!U -IR value]. (attic, etc.) R -value. (Btu/hr) (BTU/Hr) FAU . CARRIER 58STXI 10122 2 80.0% ATTIC R4.2 110,000 4. FAU CARRIER 58STX045108 1 80.0%• ATTIC- R4.2 45,000 Cooling Equipment j Equip: Type # of Effeciency Duct Cooling Cooling (pkg. heat CEC Certified Compressor Unit Identical (SEER, ctc)' Location Duct Load Capacity puam» etc.) Mfr. Name and Model Number Systems [2CF-1 R•value] (attic, etc.) R -value (Btu/hr) (BTU/Hr) A/C COND. CARRIER 38BRC060000 2 12 ATTIC R4.2 607 A/C COND. CARRIER 38BRCO24000 I 12 ATTIC R4.2 24,000 2 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 -I R) submitted for compliance with the Energy Efficiency Standards for residential buildings, and (3) equipment that meets or exceeds the appropriate rTirements for manufactured devices (from the Appliance Efficiency Regulations or Pan 6), where applicable. AMPAM LDI Mechanical e ` Diana Coria10/8/2004 HVAC Subcontractor (Co. Name) f I OR General Contractor OR Owner NATER HEATING'SYSTEMS: Water CEC Certified Distribution . If Recir- Rated Input Tank • Efficiency Standby External » „ • -, Heater. Mfr Name & Type (Std, culation, 4 # of Identical , (kW or Volume (EF, RE) . Loss (%o) Insulation R- Type/# Model Number Point -of -Use) Control Type Systems Btu/hr) (gallons) value FAUCETS & SHONVER HEADS: All faucets and showerheads installed are listed in the Commisions Directory of Certif cd Faucets and Showenccads. pursuant to Title -24, Part 6, Subchapter 2, Scction 111. 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, 1 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. RC R COMPANIES f . Signature, Date Plumbing Subcontractor (Co. Name) x OR General Contractor OR Owner COPY TO: Building Department HERS Provider (if applicable) Building Owner at Occupancy r INSTALLATION CERTIFICATE .p a11.;/a 0,4' - -7 .L -� 3 of 13) CF -6R O nc -1 Site Address Permit Number DUCT LF AKAG., .A_ND DESIGN DIAGNOSTICS DUM, LLAh.4GE REDUCTION Pr essurizatfoa Test Results (CFM @ 25 PA) Test Leabse (CFM)_1-3- Fan Flow If Fan Flow is Calculated as 400 cfm/ton x number of tots, or as 21.7 x' Heating Capacity in i housands of BWfnr, enter calculated value here ' If fan flow_is measured, enter measured value here _/020 Leakage Fraction = Test Leakagel(Measured or Calculated Fan Flow) = p� ❑ y _ Pass if leakage fraction < 0.06 Pass Fail y O For AEROSOL TYPE SEALANTS ONLY -The following diagnostic testing was completed: Duct Fan Pressurization at rough -in measured leakage (CFM) t CHECK AFTER FIMSHING WALL: • 0 Yes 0 No 0 Pressure pan test or House pressurization test 0 Yes. 0 No O Visual Inspection ofDucrConnections o ❑ Pass Fail ❑ THERMOSTATIC EXPANSION VALVE (TXT Yes 0 No Thermostatic Expansion Valve is installed and Access is - provided for inspection ' J _ Yes is a pass � ❑. _ . O DUCT DESIGN Pass Fail ACCA Manual D Design calculations have been ; { 1. ❑ Yes 0 No completed, Duct Design Is'on the plans and duct Installation , matches plans. 2. 0 Yes 0 No TXV is installed or Fan flow has been verified. If no TXV, - o O verified fan flow.matches design from CF-IPPass Fail Measured Fan Flow= } Yes for both 1 and 2 is a Pass - c 0 L the undersigned, verify that the above diagnostic test results and the work I performed associated with the test(s) is in conformance with dee requirements for compliance credit [The builder shall provide the HERS provider a copy of the CF -6R signed by the builder employees or sub -contactors certifying that diagnostic testing and installation meet the requirements for compliance credit ] Tests Si Date Installing Subcontractor (Co. Name) OR j Perforuxd General Contractor, (Co. Name) _ COPY TO: Bm1ding Department y HERS Provider (if applicable) Building Owner at Occupancy C=pl;aruz Forms August20011 A-25 NSTALL TION .CERTIFICATE (gage 3 of 13) CF -6R /> Ct F- /Ct j 04 A P —7 L o f Site Add, ess Permit Number -- DUCT � E_4 4G ', e� N� DESIGN Dz4GII�OS'TICS DUCP L-EAKAG!✓ REDUC110 V Pressurization Test Results (CFM (a 25 PA) Test Leakage (CFIv., L 7 Fan Flow , If Fan Flow is Czlculatcd as 400 cfm/ton x number of tons, oras 21.7 x Beating capacity in Thousands of Stu/hr, enter calculated value hers If fan flow is measured, enter measured value here I aO Leakage Fraction Test Leakage/(Measured or Calculated Fan Flow) Pass if leakage traction < 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 FIIJISHING WALL: ` ❑ Yes ❑ No ❑ Pressure pan test or House pressmization test ❑ Yes '❑ No ❑ Visual Inspection of Duct Connections o . o - Pass Fail ❑ THERMOSTATIC EXPANSION VALVE,rrXVM Yes ❑ No lbetmostadc Expansion Valve is installed and Access is - provided for inspection Yes is a pass D . O DUCT DESIts'�i * Pa FaU - • • ' ACCA Manual D Design calculations h6t been ^" I. ❑.Yes C3No completed, Duct Design is on the plans and -duct Installation completed, plans. a . ". 2. ❑ Yes O No TXV is installed or Fan flow has been verified. If no TXV, verified fan flow matches design from CF -UL Pass Fail ' Measured Fan Flow = Yes fcr both 1 and 2 is a Pass 1 0 L the undersigned, verify that the above diagnostic test results and the work I performed associated with the test(s) is in conformance w . 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 compHance credit J Tam si ature, Date Iastaliing Subcontractor (Co. Name) OR Performed General Contractor (Co. Name) COPY TO: BtnidingDepartment HERS Provider (if applicable) 'Mz Budding Owner at Occupancy If CampGance Forts August 2001 7- .. , Cas.}A aS SALLA ION CERTIFICATE Rase 3 of 13) CF -6R Site Address Permit Number DUCT T :4-K4G E: AND DESIGN DIAGNOSTICS QUM' LE. KWE REDUCTION Pr essurfmdon,Test Results (CFb2 @ 25 PA) : Test Lealag-. (CFM) j Fan Flow If Fan Flow is CJculated as 400 cWton x number of tons, or as 21.7x Heating Capacity in Thousands of Btuthr, enter calculated value here If Mn flow is measured, enter measured value here. y8 Leakage Fraction = Test Leakagef(Measured or Calculated Fan Flow) _ ❑ Pass if leakage fraction < 0.06 1 Pass Fail 11 For.kEROSOL TYPE SEALANTS ONLY The following diagnosdc testing was completed: Duct Fan Pressurization at rough -in measured leakage (CF..M) CHECK AFTER FINISHING WALL: O Yes O No O Pressure pan test or House pressurization ted O Yes O No O Visual Inspection of Duct Connections C1 Pass Fail O THERMOSTATIC EXPANSION VALVE (TXVI )6Yes O No' Thermostatic ExpansionValve is installed and Access is - provided for.ittspecdon Yes is a pass X ' Tars Fail O DUCT DESIGN ACOA Manual D Design calculations have been I. ❑'Yes O No completed, Duct Design is.on the plans and duct Installation - matches plans. ' 0 2. ❑ Yes ci No TXV is installed or Fan flow has been verified. L-' no TXV, Pass 0 Fail . verified fan flow thatches design from CF -1R Measured Fan Flaw = 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 requittments for compliance credit. ['Ihe, builder shall. provide the HERS provider a copy of the CF4R signed by the buflda employees or sub -contractors certifying that diagnostic testing and installation meet the requirements for compliance credit .j Tests Si ture, Date .: fnttalling Subcontractor (Co. Name) OR Perfo>med C=cral Contractor (Co. Name) COPY TO, Building Department HERS Provider (if applicable) Building Owner at Occupancy Compliance Forms August2001 F' ,�