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0402-289 (SFD)P. l� +; 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 Iio0 5 ?—A VIC A Date /J "l fIaSignature 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). ' O 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: ( ):'al 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: CarrierSfA•'b�;FUND. Policy No. (This, section need not be completed if the permit valuation is for $100.00 or less). ( ) Al 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 Sectiori 3700 of 4he Labor Code, I shall forthwith comply With those provisions. Date:-Applicant'i c V I 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. Signature (Owner/Agent)`r'�/°�4<<��' Date r-^�•'�/� o `MIL -DING PERMIT PERMIT" DATE �• rVALUATION LOT -5 TRACT JOB SITE APN ADDRESS !9-680 M SIN CTWAD�i 2I �u 70-012 ' OWNER - CONTRACTOR DESIGNER (NEER 110 B X 810 _ "142 :E "t3:t+i I�. `' TT.'Y bIvP1 LA QX TM - CA .9 2253 PHGMM /AZ 8SO34 (602)257-1655 CBV-t 4990 • USE OF PERMIT 31-NM:L,J? :E'./1.pv UZ D'NE LWG Sf D 7 LOT Z; FI.,AN SMIACSI. PERMIT DOES 1+ NOT INC LUDE .tPOOL, S PA, BI 1;1;VA LU, 0R DV MAY APP1tOAC H T1 CT CONS 'l?t9CTION 4,346A 8P • ti -w $.�2yQ['�°.pOEpi .SP .. ' /i��C1.f�Sjtp;H•�/fi�'.�nN10'/1y','"` � SF 1 LIMED COST OF, CONS'l—Ia1rMOBT 267541.00 ' CONSTRUCTION FEE 101.000.418.600 $1,227.50 PL. U.4 CHECK VEZ &01-000-439-318 $1,044.51 Ft x-`1.1 NICALS+ E 101.000-421.000 $t4,100 , 9LEC"TRIC'AL, �.E 101-000-X120-000 P1t�1. MBT140 lr2 1{iI at Gt(Ym41 a=CICiC� 52d:.Utl &TRONO MCYTIOTI FEE - 1n1D 101-000-241-000 C. 0ADNO FER 101.000-423.000 300f•.EI,0P2RJA#PA.0 T d?ZE u2ya+0�.0U� AR'V lel PUBLIC PL.>'a,W 1$1,:.311[ .2'70-UtiC:e-44_5"000 MOM' TUB 11a.rAL CC_7NKA' Tt�'AaCJI:i'.AM PLAY, CMC C. LI -753 PRE-PAMFIMS RNM., FEES DMI, 10W $0.00 APR 0 1.200 r • ._.�J fav �f TACllY OF �f RECEIPT DATE' r BY. �� DATE FIN LED INSPE INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings / Ducts Slab Grade _ Return Air — Steel / Combustion Air Roof Deck Z - Al Exhaust Fans O.K. to Wrap _ — F.A.U. Framing Q— Compressor Insulation Vents , Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath - Q 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 C' _ .f! Heater Final Water Pipingz :IR 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 Eiz Temp. Use of Power Final Utility Notice (Perm) COMMENTS: 14712 SW Scholls Ferry Rd # 328 ' Beaverton, OR 97007 503-524-8268 ` 503-213-6222 (fax) ENERGY'C.A D E C — 4 P0. Box 621 Ph/Fax (760) 564-2044 , Rancho Mirage, CA 92270 Cell:, (760) 250-1852 Email: DESNRG 0AOL.COM. , + CERTIFICATE OF FIELD VERIFICATION'AND DIAGNOSTIC TESTING (Page :I :of 7)cF-4R; PALMIL. A PH 7 DATE TESTED 11-9-04 Projeet Title Date • - 79-680 VIA SIN CULDADO LA QUINTA, CA. '92253 RJT HOMES f -P—rojeTATTress Builder Name, CHAD MEYER 760-564-6555 IRONWOOD. ' SF3C5' . •3 UNITS Builder Contact Telephone Plan Number RICHARD KROWN 760-250-1852GROUP 5 y HERS Rater Telephone Sample Group Number` #CCNRK613292 LOT 22 2 01173 F3CertifyingSignature Certifying SignatureDate Sample Lot .Number,. Firm: DESERT- ENERGY SERVICES LLC HERS Provider: CHEERS Street Address: P:O. BOX 62t City/State/Zip: RANCHO MIRAGE, CA: 92270 Copies to': Builder, HERS Provider tt HERS RATER COMPLIANCE STATEMENT s � The house was: 0 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 l with the diagnostic: tested compliance requirements as checked on this form. f ® The installer has.provided a copy of CF -6R '(Installation Certificate. Distribution system is fullyducted(i:e., does not usebuilding cavities as plenums or platform retums in lieu of ducts) , ® Where.cloth backed, rubber adhesive duct tape. is.installed, mastic and dra,wbands are used.in combinationwith cloth backed, rubber adhesive duct tape to seal leaks at duct connections: • ® MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT �{ .ti { Duct Diagnostic Leakage Testing Results (Maximum'6%.Duct Leakage) - Measured' r Duct Pressurization Test Results (CFM @ 25 Pa,) values I! )i Test Leakage Flow in CFM 34� If: fan flow is calculated as 400cfm/tonx number•of tons enter calculated _ value hcrt 600 .. If fan flow is,mcasured.enter measured value here Leakage Percentage (100 x Test Leakage/Fan Flow) =- 5.66667., - 4 Chak Box for Pass or Fail (Pass =b% or less) . Pass ;Fail ® THERMOSTATIC EXPANSION VALVE (TXV) ®'Yes E No Therinostatic Expansion .Valve is installed, and Access is, ® 0. dd' - provided for inspection 4 . ENERGY "t C O E C �7 F: 3� PO. 8ox 621 Ph/Fax (760) 5642044. Rancho Mirage, CA 92270 Cell>(76.0] 250-1852, Email:,DESNRG MAOL.CONI J. c. i •. - . ' ';i _ ' is CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC 'TESTING (Page I of 4 CF -4R - PALMILLA PH 7 DATE TESTED 111-9=04 f Project.Title Date t 79-680 VIA SIN CULDADO LA QUI.NTA, CA. 92253 RJT HOMES ProjeCt Aa.aress Builder Name CHAD MEYER 760-564-6555 [IRONWOOD SF3C5 3 UNITS , s� Builder.Contact Telephone Plan Number RICHARD KROWN 760-250-1852 GROUP 5 HERS Rater. Telephone Sample Group Number 1.OF 3 t #CCNRK613292 11-18-04 LOT 22 Certifying -Signature Date Sample Lot Number 44 Firm: DESERT ENERGY SERVICES LLC HERS Provider: CHEERS " 1 Street Address: P:O. BOX 621 City/State/Zip: • RANCHO MIRAGE, CA.,92270 I Copies to: to: Builder, HERS Provider -HERS RATER COMPLIANCE STATEMENT The house was: 0 Tested ElApproved 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. { ., ® Distribution system is fully ducted(i:e., does not use building. cavities as plenums or platform returns in lieu of ducts) < ® Where cloth backed, rubberadhesive 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 REDIT Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage) Measured. Duct Pressurization Test Results (CFM @ 25 Pa) values' - Test Leakage'Flow in CFM 91 if If fan flow is calcul6tedas.400cfm/ton x number of tons enter calculated+ value here 2000, If fan floc= is measured enter measured value here y r Leakage Percentage (160 x Test Leakage/Fan Flow) _ 4.55. {' Check Box for Pass or Fail (Pass =G% or less) Pass Fail. N THERMOSTATIC EXPANSION VALVE (TXV) - I ® Yes ❑ No Thermostatic Expansion Valve is installed and Access is ' provided for inspection NERGY C A 0 En.c_... PO.. Box 621. Ph/Fax (760) 564-2044 Rancho Mirage, CA 92270 Cell: (7601250-1852 Email: DESNRG O)AOL,GOb1. • _' CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page 10 7) -CF aR , PALMILLA PH 7 DATE TESTED' t 11-944 Project Title Date 79-680'• VIA;SIN CULDADO LA QUINTA, CA. :9225S RJT HOMES s Project Address ress Builder Name CHAD MEYER 760-564-6555 IRONWOOD SF3C5- -3 UNITS Builder Contact Telephone Plan Number .� RICHARD KROWN 760-250-1852 GROUP 5 HERS Rate Telephone Sample Group Number. ` #CCNRK613292 I-18-Og LOT 22 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 r 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, I certify -that the houses identified:on this form comply, ' with the diagnostic. tested compliancerequirements 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 returns in lieu of ducts) i ®- 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 Test Leakage Flow in CFM 118` If fan flow is calculated 'as 400cfm/ton x number: of tons enter calculated! value here 2000. - •if fan flow is measured enter measured value here Leakage Percentage (100 x Test Leakage/Fan Flow) = 5.9 ♦ , Check Box for Pass or Fail (Pass =6% or legs) ® t. Pass `Fair ti t ®THERMOSTATIC EXPANSION: VALVE' (TXV),' ® Yes, ❑ No Thermostatic Expansion Valve is,ins_talled.and Access is rty prov.idcd'forinspection ® ❑, Lei STALL ATION CERTEFICATE .(Page 3 of 13) .. .. .... - CE -6R 74C� lir � �C� - T �r / ! Q / /S � _ _ • Site Address .•-'� permit Number DUCT LEAKAGE AND DESIGN. DIAGNOS'T'ICS DUC"f KAKAGIa RED1jCr1'1QN Prewtiratton Test Results (CFM (gi 2S PA) Test Leakage (CFM)—Z& Fuer Flow If Fan Flow is Calculated as 400 cfrWwfi x nurruer of tans, or w 11.7 x Heatiao Capaeiry In Thousands of Bturitr, enter calculated value here If tan fbw Is measured. enter measured value here _!7P Leakage Fmctioo? Tea L=&ngd(Meastaed or Calculated Fan Flow) pass if lcabso fitutiea < 0.06' Pass Ful e For AEROSOL TYPE SEALANTS ONLY -The following diagnostic testing was completed: Duct Fan Pressurization at rough -in measured leakage (CFIvQ CHECK AFTER FLwMUNG WALL: O Yes 13 No 0 Ptessurc pan test or House pressuti2a6on teat D Yes 0 No 13 Visual Inspection ofDuc t Connections o e Pass Fail 0 THEBAOSTATIC EXPANSION VALVE !'TXV1 C31 Yes ❑ No Ihetmosmfic Expansion Valve is installed and Access is - provided for inspection Yea is "a pass p P DUCT DESIGN Pass Fts11 ACCA Manual D Design wlculatioru hove bego 1. O Yes O To completed, Duct Design Is on the plans and dud Iristalladon ' matches plana.13 2. O Yes: O No -TXV is installed or Fan clow has been verified. Ifnes TXV, G ".: ified fan flow matches daiga from CF -IR Pass :ver . . Fail Measured Frac Flow Yes for both 1 and 2 is a Pass O L the undersigned. verify that the above diagnostic test results sad the work I perfmncd associated with the mst(s) is in con with ftr quiramats for compliance credit rMe builder shall pmvlde the BERS provider a copy of the CF -M signed by the ltudlder erMloyew or sub-eaotraettaa oertifyiag that dingrostic teneag and installatiar Meet ft tequittmteots for ramplianrx credit .) y G Teau gtutttxe, Date 1n3nNng Suheantraetor (Co. Name) OR Pafarmed General Contractor (Co. Name) COPY TO: Building Dcp==t 1BRS Provide (f applicable) Bmlding Owerr at Oocupattcy Compliance FOritts August2001 ET 39t7d t7Z6Z88Z" -ZO:S1 POW/SO/11 LNSTALLATION CERTIRCATIE (Page 3 of 13) CF' -6R RL) W 1' l 14. P)4-? 10 4 ;Zia Site Addrass`- Permit Number DUCT LEAKAGE AND DESIGN K4,GNOSTICS. . llUC'1' Llr'AKA(Gh; li�;llUCl'lUN • Pressuriztdon Test Results (CFM ® 25 PA)" Tez W-bSe (CF af)�� Fon Flow. If Fan Flow is Calculated us 400 cWtan x number of tom, or us 21.7 x Heating Capacity ` In Thousands 'o( Btu hr, enter calculated value here If tan flow is measured; enter measured value hers Lx0 Lcakagc Fracfion Tat WkageJ(Mr"umd or Calculated Fun Flow) _ 0 Pass if leakage fimetim c 0.06 Pass , Fail ❑ For AEROSOL TYPE SEALANTS ONLY -The following diagnostic tesdng wag completed: Duct Fan Pressurization at rough -in measurtd leakage (CFIvi) CHECK AFTER FIMSHING WALT. 0 Yes 0 No ❑ Pressure pan test or House pressurization test ❑ Yes 0 No ❑ Visual Inspe won of Duct Connections. to o Pass Fail C,7 THRIZMOMTIC EXPANSION VALVE tTXV1 ❑ Yu. 0 No lbermanatie Expansion Valve is insaalled'and Access is - providcd for inspection Ye9 is a para Pass Fall ❑ DUCT DESIGN ACCA MzuW D Design calculadons have bem 1. O Yob 0 No completed, Dud Design is on the dans and dud instaliallon matches plans. 2. 0 Yes ❑ No -TXV is insmUd or Fan flow eras bcca vcrificd. If no TXV, Pass Fall verified ft flow ==hes design frorn CFdR. Mcaaursd Fan now = Yes for both 1 and 2 is a Paas b �i, the nndersiptoti, wrify that the above diagnostic Ozt results and the work I performed associated with the teat(5) is in ct ntwu ancc . with the regtatcrrrnts for cmrVIiassca Ctedit. [The builder shall provide the iffw provides a copy of the CP -6R signed by the builder employ= or sub -contractors certifying that diagnostic tesft and iattsil ion meet Ike requircn=ts for compliwrcc acdie J Teats " Sjoature, Dau lastsMing subcoatsaetor (Co. Nnrne) OR Pabra cd General Contractor (Co. Nome) COPY M: Building Dcpartrtx,at HMU Provides (d applicablc) Bwid'mg 0�►na at Occupancy _ . CornlWance Foa n5 Augu5t•2001 " " _ A-25 01 39Gd- bzGzeez zv:sl 179Bl/S0/11 INSTALLATION CERTIFICATE (Pace 3 of 13) . CF -6R Sita Addrosb Permit Rumber DUCT LEAKAGE AND DESIGN DIAGV Osncs DUCT LEAK M RJEDUMON Pressuriratioa Test Results.(CFM Q :3 PA) Test Icika;e (CF?v!) 5 ELI Flow if Fan Flow is Calculated as 400 ctrW= x number of coos, or as 21.7 x [seating Capacity In Thousands'of Bt Ar, enter calCulated value hero If fait flow is measured, enter measured value here' ` I- Wage Fraction = Test l e &kWJ =sured or Calculated Fan Flow) _ t7 Pato if l nip fraction < 0.06 Pass . Fail - q For AEROSOL TYPE SE,t LM"TS ONLY -The following diagnostic testing was completed: Duct Fan Pressurization at rough -in messttred leakage (CFK CHECK AFTER FIIv'iSIMgG WALL' . C3 Yes d No q Prwm ptm test or House prce sudation test ❑ Yes D No ❑ Visual Inspection of Duct Connectiotts o : - Pass. Fail O THERMOSTATIC EXPANSION `h4).VE Pi'XVl O Yes ❑ No ruermostadc Expansion Valve is installed and Access is -provided for Inspection . Ya is a pass C . Pass Fall 13 DUCT DMON - - ACCA Manual D Design calculations have been 1. (1 Yes 13 N710 completed' Drat Owign is on the plans and dud installation mabrhea plans. 2. O Yes O No -TXV is instaned or Fan flow has taxa verified. If no TXV, Pass F2ll vetified Cm flow r antebes design frnrn MU Mmsared Fan Flaw - Yes for boli l and 2 is a Pass . ❑ L die undersigtod. verify that the above diagnostic test results and the wort I performed associated with the test(s) is ns =tfW=c.c with therequiietnmts for wmptiatxe nadir [the hullo shall pmvldc the HERS provlda a copy of the CFAX aignod by the buldci employee of sub eontrtwmrs certifying this diagowtic uxtiag and imtaltatioo meet 9x requircr=ts for compliance credit. ) Tars Si Date Iashlling Sidcontractor (Co. Nauss) OR Perlortiisd Gomrtil Contractor (Co. Name) . COPY M. Building Department HETES Provider (if applicable) Building Owner at Ocxupancy Cornpfiw" rtin FoAur,L5t 2031 A-25 Si 3Dtid• PZ6ZBBZ -.. 'Z17 ;91 b00Z/90/11 Calificate,of Oddupanc _ IKcawaetm OF Building & Safety Departrnen# T6is:Certificate is issued pursuant to the requirements of Sections 109 of theZalifornia Building.' Code, certifying that,. at -.the time of issuance, this- structure:' was in 'compliance with the? provisions of the :Building Code and `the various. ordinances of -,'the city. regulating building:. ; construction and/or use. BUILDING ADDRESS: 79-680 VIA`SIN QUI DADO ' ;Use classification: S.F.D. 'Building Permit No:- 0402-289.'' , Occupancy Grou R-3 , P Type of Construction: V -N _ Land Use'Zone: Owner of Building:,. RJT HOMES LL"C. Address: "PO BOX 810 - City, ST, ZIPLA QUINTA CA "92253: - c" - By: -G. SHOWALTER ' �+ - .• �. . ' Date:. 03%10/05. Buil din g Official" • POST IN A CONSPICUOUS PLACE • -.: L: .Li^' d-a"X'v,..-�. a 2T. :S2"'24. -'w T'XA3Ar. E#';ir. av+v;.i; a.. 's_,-.'vT�§2.,32 F.6L, :t3 �`'F' x f.:T.?�.1 &'kl`E. :..1 .,�;€s`Prn. xs,i x. -s, F � , :S.a "b `.^,6M. :..„:.Ts �ro...Y .,§,:.m,Y..+.u:'u?�,x'a"av% srS�.i:.•: �s +'�' t � ,