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0306-208 (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. .4 License # Lia Class Exp. Date ,/Date r Signature of Contractor r 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: () 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 PTATE l'tJ�1i's Policy No. (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 provisions.; Date: 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 lawsorelating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. ` ' Signature (Owner/Agent) Date` ' PERMIT# ' BUILDING PERMIT -DATE / 1 �' VALUATION Fpr��rT � j LOT, 459 TRACTJOB ADDRESS APN OWNER CONTRACTOR / DESIGNER / EN (NEER RXf HOW'S 1-1 C 110:81OX t3I0 1t4: 1.. CMA 49901 : USE OF PERMIT amu ��.:� F�?:��3..�' .T3''��:�.I.��i�• *b-%' M.TNe )'V7 '1 � Pr,..H..rr tanr,.te..'. FPE,. -" in 4-J-1135 1dititerv(!�t'eseirai; is J -t -4"n` - %VA :7�e% Poo)., PA ��f'i..t.,.iJl�,�t�`s'V�i'L��.{t,.�p�°.'.d��:� .. - THAC,°t CO��iiiTTIVICTIO'd' PT a $l7CF.tiI%f e Ct;+ &M 09 83 it :� :',Sa1�.;r�.x� D C70; iT i �+i'S:.t aCit:!.}:�J. t ��:'.a, .R« U y�� ''I�/(y�( (fig.. :1t •:i�7'4Lvl1l T INE S V.I.JAARAI . +<.'•Cs i';;i 6'ItC:fvrJ01�1 3• tF 1,:i00-` -41 Pli t0' 3t• x1.114310 RUIN M iCI C FIX21 4 ? -000-A N. 4 Wis.15 100,CMFUCAL ?ZZ 101-000-421,000 MIN ,LEC'RIC.FtL,FVY 3iii'tt; +�>'$fiwbf g3:fZ.S . P ;f jM BDR+ �.... Ryna) 103-0fl6441-000' ?t:3 'I'63"rw, ANTI PLAK CMCJ L35 e%ice=PAM, V90. jr�[ tail' q4--•--.�.-'� ., .LJ �7fa3' P—NERNI3,rt"�bi•S'.k-9.0urp, TIOW ;iM..➢.7iY�. 3r.i.i.� 20 CITY' OF LA QWN iA. Fbjk�A NCI 0Fr` -� . RECEIPT DATE✓ ✓ /! j ; BY r! ' DATE FINALED INSPECTCV INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings - 2a - 3 Ducts Slab Grade Return Air Steel Combustion Air Roof Deck 91 - Exhaust Fans OX to Wrap / % F.A.U. Framing 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 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 Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines „j Heater Final Water Piping 40Plumbing 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: 1.�vE7�rs 9 - Al Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring 3 — Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles. G.F.I. Smoke Detectors z Temp. Use of Power Final Utility Notice (Perm) - 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 # Lie. Class Exp. Date 690645 B HIC A 6/30/04 Date 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 STATE FUND Policy No. 1583906-02 (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 provisions. Date: Applicant 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, indemnity & 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) Date PERMIT # BUILDING PERMIT 0306-208 DATE VALUATION $243,511.40 LOT 49 TRACT 29858-1 JOB SITE ADDRESS 50-255 VIA SIN PRISA APN 772-390-010 OWNER CONTRACTOR / DESIGNER / EN (NEER RJT HOMES LLC RJT nNESTMENTS, INC. PO BOX 810 1425 E. UNIVERSITY DRIVE LAQUINTA CA 92253 PHOENIX .AZ 85034 (602)257-1656 CBL4 4990 USE OF PERMIT SWOLE FAMILY DWELLWO WALLS, POOL, SPA OR DRIVEWAY APPROACH TRACT CONSTRUCTION 4,024.00 SF PORCH/PATIO 906.00 SF CIARAGEICARPORT 729.00 SF ESTEVIATED COST OF CONSTRUCTION 243,511.40 PERMIT FEE SUbUAARY CONSTRUCTION FEE 101.000-418.000 $1,143,50 PLAN CHECK FEE 101-000-439-318 $M.15 MECHANICAL FEE 101.000-421-000 $137.00 ELECTRICAL FEE 101-000-420-000 $237.92 PLUMBING FEE 101.000-419.000 $267.25 STRONO MOTION FEE - RESID 101-000-241-000 $24.35 GRADING FEE 101-000-423-000 $15.00 DEVELOPER IMPACT FEE $2,405.00 ART IN PUBLIC PLACES - RESIE 270-000.445.000 $108.78 4 - SUB -TOTAL CONSTRUCTION AND PLAN Cl= $5,316.95 LESS PRE -PAID FEES $0.00 TOTAL PERMIT FEES DUE NOW $51316.9; RECEIPT DATE BY DATE FINALED INSPECTOR J sr�iiiircccrFi�ecririrrcoirrdrHrcunorrrirorrr�iiznvsziinr�rrr�rrroioirr�r�r�rcrirnrniirczrininrirniirrnrirrrrnriziimrrirurinarniciiirinririnrii�isirinrcririririrciirr�iirrrrriiiiirriini INSULATION CERTIFICATE 1 t This is to certify that insulation has been installed in conformance with the current energy i' ;, regulation, California Administrative Code, Title 24, State of California, in the building located at: j50-255 VIN SIN PRISA ,LOT 49, LA QUINTA, California CEILINGS: O/oTYPE: BATTS MANUFACTURER: Certainteed Thickness: R-38 r 1 r WALLS: A r TYPE: BATTS MANUFACTURER: Certainteed Thickness: R-21 j; GENE C NT TO JT H S LICENSE #A'Tb%6675;4 / TITLE: S�QfTI✓�LI��CIIUID�% ! A N SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE #632072 r y TITLE: ADMINISTRATIVE ASSISTANT DATE: 11/14/2003 r 'r _ 1 friniciiirnrninriicrarriiirrnicznr�inrrrirsrciinirnrrrorvrwiirnorrrrinrizoiiirrric�arrniwirwirrinicz�iirruirrrinr�rcrin�^iiri�ziiziiirisznrrr�iri2cr�iircii-irciirnrcr�. �rnurrri �ciirizir�rnmr TALLATION CERTIFICA,TE (Page 3.of 13) CF -6R AA 04 4 P.ermlt Number. : St a Address DUCT, EAKAGE AND DESIGN DIAGNOSTICS ." llUC'1' LI;AKA(y� 1tLDUC'1'lUN ' Pressurization Teit Results (CFM ® 25 PA) Test Leakage (CFM)-� Fan -Flow If Fan Flow is Calculated as 400 cf Wton x number of tons, or as 21.7 x Heating Capacity In Thousands of-Btutlhr,.enter calculated value here If fan flow Is measured, enter measured value here Leakage Fraction -Test LAakage/(Measured or Calculated Fan Flow)- o Pass if leakage fraction <0.06 Pass Fail' O For AEROSOL TYPE SEALANTS ONLY ?Th' following diagnostic testing was completed: Duct Fan Pressurization at rough -in measured leakage (CFM) CHECK AFTER' FINISHING WALL: 0 Yes .O'No O Pressure pan test or House pressurization test. _ O Yes O No O Visual Inspection of Duct Connections a o Pass Fail THERMOST TtC EXPANSION'VALn(T-0' iC ftes O:NoThermostatic Expansion Valve is installed and Access is - provided for. inspection. � o. Yes,is a pass /Pass Fail DUCT DESIGN _ACCA Manual D Design calculations have. been L 13 Yes O No completed, Duct Design is on the plans and duct Installation matches plans.; • o 0 2. O Yes O No TXV is installed or Fen Row has been verified. If no TXV, Pass Fall verified fan flow matches design from CF Measured Fan Flow = Yes for both I and 2 is a Pass O 1, the underslgged, verify that'tha above diagnostic test results and the work 1 performed associated with tltie test(s) is in conformance with the requirements for compliance credit IThe builder shall provide the HE provider. a copy of the CF -6R signed by the builder employees or sub -contractors certifying that diagnosoc.testing and installation meet the requirements forcompliance crodit. ] Tots St installin ubcontractor (Co. Name) OR Performed Qeneral ntraetor(Co.`Name) COPY. TO:.,.- Building Department HERS' Provider (if applicabley Building Owner at Occupancy a A-25 August 2001 Ctxnplian� Fonn9 Uzi ALEATION CERTIFICATE (Page 3 .of 13) CF -6R :S10 Address Permit Number. DUCT -LEAKAGE AND DESIGN DIAGNOSTICS Dt1CT LEAKAGLr REDLI ITIUN Preuurizatlon Telt Resulb (CFM ®u PA) Test Leakage (CFM) Fan -Flow If Fan Flow is Calculated as 400 efm/ton x number of tons, or p21.7 x Heating Capacity In Thousands of•Btu/hr,.enter calculated value here If fan flow Is measured, enter measured value- here Leakage Fraction Test Leakaget(Measured or Calculated Fan Flow) a o Pass if leakage fraction <0.06 Pass Fail O For AEROSOL TYPE SEALANT&ONLY -The_following diagnostic testing was completed: Duct Fan Pressurization at rough -in measured leakage (CFM) CHECK AFTER FINISHING WALL: O Yes .O No .. O Pressure pan test.or House pressurization test. O'Yes O No O Visual Inspection of Duct Connections o 0 Pass Fall . THERMO. TIC EXPANSTON'VALVE ErYes O No Thermostatic -Expansion Valve is installed and Access is - provided for: inspection m yes, is a pass /pass o Fail Cl -DUCT DESIGN ACOA Manual D Design calculations have. been 1. O Yes, O No completed, Duct Design is on the plans and duct Installation matchesplans., a 2. O Yes O No TXV is installed or Fan now -has been verifled..If no TXV, Pass 0 Fall verified fan now matches design from CF -11L ' Measured Fan Flow Yes for both 1 and 2 is a Pass. Ce. O 1, the undersigned, verify that the above diagnostic test results and the work I P socof CF -6R slued by the builder gn y a orfOrTnO with the requirements for compliance credit. [The builder shall provide the HERS provider P.Y the the requirements for compliance credit. ] employees or sub contractors certifying that diegnostic.testing and installation meet D - - Insta ing Sub on.ctor (Co. Name) OR Tats Sign ;Date General Contractor (Co. Name) Perfomxd COPY. TO: - Building Department r • HERS Provider (if. applicable Building Owner at Occupancy A-.25 August 2001 _ Comdr Forms •INSTALLATION CERTIFICATE (page3:oti �s) CF-6R Site dress Permit Number. DUCT• EAKAGE AND DESIGN DIAGNOSTICS DUCT LEAKA" Ri✓DUCUON Pressurization Teii Results (CFM Q 75 PA) Test Leakage (CFM) Fan•Flow If Fan Flow Is Calculated as 460 cfrrdton x number of tons, or @s 21'.7.x Heating Capacity In Thousands of •Stu/hr,.enter calculated value here . if tan flow Is measured, enter measured value- here Leakage Fraction Test Leakagd(Measured or Calculated Fan Flow) 0 Pass if leakage fraction <0.06 Pass Fail 0 For AEROSOL TYPE SEALANTS' ONLY-The following diagnostic testing was completed: Duct Fan Pressurization at rough-in measured leakage (CFM) CHECK AFTER FINISHING WALL: O Yes .O No O Pressure pan test-or House pressurization test. 0 Yes O No 0 Visual Inspection of Duct Connections 0 0 Pass Fail R THERMOSTATIC EXPANSION VALVE (T)CV1 -- 121-Yes 0 No Thermostatic Expansion Valve.is installed and Access is - provided for. inspection 'Yes,isapass 'Pass Fall Cl-DUCT DE i ACCA Manual D Design calculations have. been 1. 13 Yes . O No completed, Duct Design is on the plans and duct Installation matches plans., • 0 0 2. O Yes O No TXV is installed or Fan flow has been verified. If no TXV, Pass Fall verified fan flow matches design from CF-IR. Measured Fan Flow Yes for both 1 and 2 is a Pass O 1, the undersigned, Kerity 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 builder shall provide the HERS provider, a copy of the CF-6R signed by the builder employee orsub-contractors certifying that diagnostic. testing and installation meet the iequirements forcompliance credit. ] 3 o Tots S .Date Installing Su contractor (Co. Naive) OR Performed General Contractor (Co. 'Name) COPY. TO: - Building Department 00 • HERS' Provider (if applioabley Building Owner at Occupancy A-25 august 2001. • � ,�� `, • � . �• >• _ '� .4 � � � by . ' �s�, � •. �-- to OCcu - �. eit_.tifCaof oncy Y 4, § z - � -7 � �� 4r 4+ �' .. i`.� _ 1 - _ � ' - •,� , IN00601A� �r y��1"�+/ .. ` .� ' lye � ` OF, � Y ° �' Building, & Safety ? zirrtrnent This Certificate sjis`sued pursuant to the -requirements of Section 109{of-the-California Building Code,_ certifying at the"time ._of -issuance, ,this structure .,was in compliance with -,the, . ` .that,. Provisions.` -of 'the --Building Code various`- ordinances. =of the City.`regulat�ng building r -and--then y Y R construction and&'r use; Bl11LaIIVG ADDRESS 50-255yVIA'SINIMSAf Use classification: ' S.E:®. ' ` . ' Building Permit No. 0306-208 ° ,7 • Occupancy Group: R�3' +�'. s .� �" Type of ConstFdation: V=N * .., 'LandjUse Zone.,•R L -l' `.. iA � tel. •t �� :,� _ � ,.. rr ; 'ir��`� �•� .- C •,.4 A. -�e -i 1`.- .. C Y ` !� `� ^ p 4 �� f;• ] 1 ` Owner of Building >RJT HOMES ILt'' 1; Address: PO�BOX 810 City, ST, ZIP: L.A QUINTA CA. 92253 SHOWAL.TEW Date: 03%08/04 ` Building ,Offici -� POST IN A`CONSPICUOUS PLACE