0401-122 (SFD)LICENSED_CONT.RkTOR'DECLARATION<__
i'hereby affirm under penalty of perjury that I am licensed under provisions of
H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
I� W Professionals Code, and my License is in full force and effect.
o =) ch License # Lic. Class Exp. Date
I3 HIM A 6/30104
Dat'- % r �� Signature of Contractor "tai r! ci s
.f
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). uu:
() I am exempt under Section B&P.C. for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
j,,hereby affirm under penalty of perjury one of the following declarations:
I have and will maintairi 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.
(hr) 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 I:VND Policy No. 1$8190641
(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,
(,,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. Y;
Dare. Da<�•' t2Gr Applicant—
Warning:
pplicant 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 property for -inspection purposes.
griature (Owner/Agent) 2' # r� �� Date l `'
r r -� � • f
2'-'V
BUILDING PERMIT PERMIT#
DATEVALUATION ' LOT TRACT
$243,51, Y AO 21 29858-2
e
,/.. �) (""/-/
JOB SITE"
ADDRESS J ��•y•�7 Cj%i1�1�:�, >—?��ili
20 3
APN _
>?
OWNER
CONTRACTOR / DESIGNER / ENGINEER
PC BOX 810
1425 L `(31MMU "TrY DRIVia
:4,.t1.QiT',a4" A CA u22S3
85034
(0li2)'Z574656 MV1 4390
USE OF PERMIT
!�' � nAgq •(� ,+ 7 ty y�^p
NOT INCGI UOP, Pool,
SPA, YiLOC K WA..f.L% Daft 0ia..I )(WAY APPR,0ACH
TILACT CONSTRUCTION 4,024.0D 5F
,PORC;a"3IPATIO 90.60 w')"
GAR.MEXA RPORRT 729A P
xyyyt/��tY�YY__��xx,�R y� �yI i/;; dxh�ST� ` y�Y`��.��9:tSIT
k:.■+ •\.LS,A� i..:J 131.1 isr'1�.1.YllY.l.l3:n
t.:ONSTRUC;7"<C)1`IFla 1101-000,418-000 $1,14..30
Pt:AM CSI{:f f;,`4 Woe '101-000-439-318
N11?l`FIR'kilCM, FEE 101-000.4121.000 S13106
B) TR,IULMe 101-000-:420-000 $237,92
Pi,Ltiti4ANG AM 101.000-41%9.000 $267,25
STAOIN10 MOTION FEE - R.&Si0 101 -000 -%gid 1-000 SU39
ORADINO FEE 101-000-423-000 MAIO
r1n91:$.a.7!'m?wlphc.Tx` F,
AaT IN 1'tiBUC PLACES -MIK 270-000-445-000 5108.72
S0 -'w FST. Z CSS TId1 �C`l`£CJAI €ll+ 1�I AAI C I�'F�
.$5,33 C3.95
$0.00
'AL -PIdBULMS DIM—NOW
JAN 28 2004
'CITY OF LA, tdUINTA
FINANCE DEPT
r.
RECEIPT
DATE i
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
3 _2 j-
Ducts
Slab Grade
-
Return Air
Steel
3 —
Combustion Air
Roof Deck
s _ —
Exhaust Fans
0. K. to Wrap
_
F.A.U.
Framing
// —
Compressor
Insulation
—14
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
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 I
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
2
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:....�,.oT
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
Utility Notice (Perm)
CIR.:Gnn`innn`"r�nn
14712 SW Scholls Ferry Rd
# 328
Beaverton, OR 97007
503-524-8268
503-213-6222 (fax)
)\v .
6-7-04
Chad Meyer
RJT Homes, LLC J�
79700 5e Ave ® �'
LaQuinta; CA :92253
RE: Structural Observation - of 26 & 27 .
Chad,
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 unresolved deficiencies remaining that I
am aware of. -
/� Q�pfESSlpNq
NICs
`L6277 D
Mike Nelson, PE
SVG `
CERTIFICA'CE OF FIELD VERIFICA'CiUN-AND DIAGNOSTIC TESTING (Page hof 7) CFVR
PALMILLA. PH. -6 09-14-04
Project -Title Date
u 50TH & JEFFERSON _ _ _ R J T BUILDERS
Project Address.`DARRELL MORGAN y 760-275-8230 Builder. Name
_ _ _ _ _ MEAQUITE SFIC1 3 UNITS
Builder Contact Telephone Plan Number
RICHARD KROWN 760-250=1852 GROUP 4
..KERS Rater — Telephone
K613292 9-14-04
#CCNR0
.��- .- LOT i11�i�'r��=
Certifying Signalure Date — Sample House. Number
DESERT ENERGY SERVICES CHEERS
' Firm: - HERS Provider.
P.O. BOX 621 RANCHO MIRAGE CA. 92270
Street Address: _y Citr/StatelZip: i ._
Copies to: Builder. HERS Provider
f HERS RATER COMPLIANCE STATEMENT
The house was: ❑ Tested ® Approved as part of sample testing• but was not tested
1.` As the.HERS rater providing diagnostic testing and field verification. I certiN that the houses identified on this form cdmply
with. the.diagnostic tested compliance requirements as checked on this form.
❑ The installer has provided a copy of CF -611 (Installation Certificate.
El Distribution system is fully ducted (i.e.. does not use.building cavities as.plenums or platform returns in lieu of ducts)
l ❑ Where cloth backed: rubber adhesive duct tape is installed, mastic and drawbands are used.in combination with'clotli
backed. rubber adhe'sivc duct tape to seal leaks at duct connections-
j�. ❑ MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT
Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage)
Measured
Duct Pressurization Test Results (CFM (L25 Pa) values
Test, Leakage Flow in CFM
If fan flow is calculated as 400cfin/ton x number of tons enter calculated
value here
If fan (low is measured enter measured value:here
Leakage Percentage (1 00 x Test Leakage/Fan. Flow) _
I Check Box, for'Pass or Fail (Pass=6% or less) ❑
Pass Fail
i.
❑ THERMOSTATIC EXPANSION VALVE (TXV)
❑ Yes ❑ No Thermostatic. Expansion Valve is installed and access is
provided for inspection ❑
Yes is a pass " Pass Fail
I
INSTALLATION. CE JIF'ICAT.E (Pagc,3 of'_
CF -6R
;0<,��7 7q- 5ZD via• 7) OjAjdadb
Site Address Permit Number
DUCT LEAKAGE AND DESIGN DIAGNOSTICS
DUCT LEAKAGE REDUCTION
-
Pressurization TestResults (CFM @25 PA) Test Wkage (CFM) 78
Fan Flow
If Fan Flow is Calculated as 400 cfm/con x number of tons, or as 21.7 x Heating Capacity
in Thousands of Btufnr, enter calculated value here
,
If fan flow is measured, enter measured value here
'•
Leakage Fraction = Test Leakage/(Nfcasured or Calculated Fan Flow)
Pass if leakage fraction < 0.06 Pass
Fail
j
=O,For.AEROSOL'TYPE SEALANTS ONLY-The,following diagnostic: testing w.as completed:
- �r
Duct Fan Pressurization at rough -in measured leakage.(CFN4)
,.
.CHECK AFTERF�fISHri\'GWALL:
O Yes ❑ No ❑ Pressure pan test or House pressurization test
O Yes O No . ❑ Visual Inspection.of.Duct Connections 0
01
`
Pass,
Fail -
,f THERNIOSTATIC EXPANSION VALVE (TXV)
gYes O.No Thermostatic, Expansion Valvc is installed and Access is -provided for inspection
r`
Yes is a pass
Pass
❑ DUCT DESIGN
Fail
ACCA Manual DDesigmcalculations have been
1'
)
.
.1. ❑ Yes' O No completed; Duct Design is on the plans and duct installation
matches plans.
2. " O Yes O No TXV is installed or Fan flow has been verified. If no TXV, 0,/
Pass
Fail
verified fan now matches design from CF -IR
Measured Fan Flow;-
low=Yes
Yesfor both l and 2•is a Pass
❑ 1, the undersigied, verify that the above diagnostic test results and the work 1 performed associated with the test(s) is in conformance l
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. ]
44Z! Z _
.. r .. ..
Tests Date Installing tub6ontractor (Co. Name) OR
Performed General Contractor(Co. Name)
t
COPY TO: Building DePardricnt ..
t
HERS Provider (if applicable)
Building Owncr"at Occupancy
i
A-23•
Compliance Forms August 2001
IN C 'IFICATE (Page:3 of _
CF -6R
1- 57� Vtr,� Cu da
l
Site Address . • Permit Number ,
., DUCT- LEAKAGE, AND- DESIGN DIAGNOSTICS
DUCT -LEAKAGE REDUCTION
- Pressurization Test -Results (CFM Q :5 PA),,Test Leakage (CFM)
Fan Flow
,.
If Fan Flow is Calculated as 400 efhifton x number of tons, oras 21.7 x Heating Capaciiy
in Thousands of. Btu/hr, enter calculated value here
If fan flow is measured, enter measured value here
LealageFrzction =Tcst Leakage/(Measured or Calculated Fan Flowj
Pass if leakage fraction Y.0.06 pass
Fail '
•D For,AEROSOL'TYPE SEALANTS ONLY=Thefollo%ving diaguostic'testing was completed:.
Duct Fan Pressurization at rough -in measured -leakage (CFivn
;.
.CHECK AFTER FMSHINIG WALL:
❑ Yes ❑ No ❑ Pressure pan test or House -pressurization test
O Yes '' O No, O Visual. Inspection of Duct Connections o
o .
Pass
Fail
(8' THERMOSTATIC EXPANSION VALVE (T\'��
• Yes -O No -Thermostatic. Expansion, Valve is installed and Access is - provided for inspection
+y
Yes is a puss o
p
❑ DUCT DESIGPass
N'
Fail
ACCA Manual D Design calculations have been
1. ❑ 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, 0
p
.
verified fan flow matches design from CF -IR 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 conformance
with the requirements for compliance credit [The buildershall 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)
h
Tess " (J)" re, Date Installing Subcontractor (Co. Name) OR
Perfomud General Contractor(Co. Name)
COPY -TO: - 'Building Department -
•HERS Provider (if applicable)
Building Owner at Occupancy
Compliance Forms August 2001
A'25 .
,
jc
TIC f OccupancyCert�too
_
o�
JX MTED
~
G� of9 �•t, Building & Safety Department
This' Certificate'is :issued pursuanflo'thd requirements'of Section, 109 of the California Building'
j Code, certifying that,..at = the F' time ' of issuance, this structure was in compliance`" with -the' z
provisions. of the °Building Code ' and.. the various ordinances, of, City `regulating building
11
~
construction and/or use, �f. , _ '' x
- .... - � LTJ. V.•
• - _. ` 7 J ^� - vr'^ � . . ..J-., , rte. :. f ,Y�. •yam _ �!
BUILDING.ADDRESS:'.79-520 VIA -SIN CUIDADO
"
classification: S.F.D. ` Building.Permit.No.: 0401-1224.
.Use,
Occupancy Group: R-3 '' Type of,Construction V -N '_ r ' ; in, ;Land <Use Zone: R -_L' '
Owner of_Building:� RJT 'HOMES LLC'. � � Address !PO 60X'810
4
Ciity,,ST, ZIP:"LA,QUINTA -CA 92253
By: G. SHOWALTER
Date: 10/19/04 Ya �4, • ;
�ilding Offlcla
POST. IN A CONSPICUOUS PLACE '
ipy
.000
Loi, Certifica ,e of -Occupan
f artment
6tDep
OF-.. -BUilding Sa
Y,
.1hi& Certificate is -issuedpursuanf-to the'equirementsof Section ofthe' CaliforniaC
Buildina
Code. I certifying that, at the 7time of ' issuance, ' thisstructure was in compliance Hance. With, "the
-and the various okdihances''of the -City.. regulatin,
.prpvisions.'of the Building C'0 de _q building
-construction and/or.:use:
IM17-1110110.11