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0210-235 (SFD)LICENSED CONTRACTOR 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 04 W ; ' ProWe sionals Code, and my License is in full force and effect. O =) ch License # Lic. Class Exp. Date LLJ Z r ,,-Eat( co O. • Signature of Contractor OWNER -BUILDER DECLARATION W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's I— .� License Law for the following reason: Z_ . ( ) 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). co () I am exempt under Section B&P.C. for this reason LO C; 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 Se tion 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 S! A°fl ),� Policy No. ka•�.a (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. D"ate: �Applicant v ?� 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 Ouinta, 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. Ignature (Owner/Agent) �:.:-r� C P-r� Date��- t��• ir�"c. - BUILDING PERMIT PERMIT# DATE VALUATION LOT TRACT $20,453.20 i6 294615 -1 a 0 SITE APN ADDRESS ti} iti�JOB Mi�. 724047 OWNER CONTRACTOR / DESIGNER / EN INEER WIT NOWS 1~LL ;I3S1'1l.11afmai m, Tue. Po k -OX 810 14251?, LAg13$1�'1: k CA 92233 Pk►OFNIX ; 95034, USE OF PERMIT S1NVE, y }M1LYgNED.0 1 SK-) • Li: T 56, P1.A1q S1?1AC1. MMIT 1 OZS NOT INC1,.UDR B1,OCK WAiA-41^Ca04 9PA OR 1DRIW+`WA51" APPROACH, TS U:UiFS=T6.(m TO 1i5 oal CHECK P99 D 1KTO 11AIA..i IPLE ISSLi.rl<,.WCE OFA SAM PLAN TYPE TRA.CTC'0N.1;TR IFC l' akl 4.014,00.9F PORC'lHIP.h.1110 902.118 SF GARA rMATPFO i 729,00 ZF E"'isS:M1'!.'d`'.-.ks Cour OF.'com'Snlljcmom T.'1 RMT1:+' igi71"ARY CONOT PLAN CHYX1C. FEE $N3.41 MECHANICAL FIST r 01.400421.000 $137,00 E.Lr:;'i'lMA:t, FEX P1i✓t;1MBNO FLCL 101 -0100-419-000 $249.2$ Z', u'iRCHC3MOTION-FEE - RE1,31D 101-ft00-241-WO VA- 35 Me'aIDING FEE 101.000-0"zi-000 MAI D.E'1;I-OP IMPA-a T FEE, $7,A4 r, stet SM1JA-LE:)A.YJ PLAUV C17•A':h. K $4.564.08 Pit, P-VP.RWf X11 X8 Dr-114'.11TOW NOV 20 2002 . �1• CITY OF LA QUINTA, FINANCE DEPT. [RECEIPT DATEB1 111 DATE FINALE INSPECTOR 9 M INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade 2j— Return Air Steel — /_ Combustion Air Roof Deck _z _ 3 Exhaust Fans O.K. 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 -- 1 Drywall - Int. Lath —3 c5 Final ✓ Final 2 -- -- 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 I Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines y r3 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: ,.,.� ,' ,. • � � } �' .:. . � _ Rte_ - ' , - +' r . s ... � Vii,'.. ` , ". Y •�. , . ` f n t • - - `y���'�;-r"�. P • , [. y ,�.-. _ •,t - • � S . _ ,\' � 'fin - 1 _ 'Y • 1. /l%J//l/////%r/I%/1/!r///%l.%I.'Y//!/!'/I%J.%/%///d%/•/!/ll/l//IMWI/1////l.%d////l%!/I/l'//Y./.%//!////•%//J//%!%l.%/%/J/I/I///J./l/// rrri/.crirrrnicrn . �t. .....................rrrfr%r_ .. _ 1. .. •L "T` - .."i� w ��-rte .� _ ick` 1 �, .. .. �yy . ` .. r, ..' ` INSULATION CERTIFICATE .«e - ���-,r , �;• r` t insulation has been installed in conformance with the current energy / This is to certify that :a4 • + regulation, California Administrative Code, Title 24, State.of California; in the building' located at: 50-330 VIA SIN PRISA, LOT 56, LA QUINTA, California c, ... CEILINGS: ' • :. y ' + TYPE: BATTS_ •MANUFACTURER: Certainteed . .Thickness R-38 �'%., is - .,. 7 � � l` , « _� 111 eYr••A.rt�•r:.dlt•.•.--..♦. a •.,,"`"s". ., _ ,.,r i-..•,,... +r.w,,�.f.� .•. +�•.w.-..h .: y N A.w, t• sX � `'Int.> � WALLS.` '""`---.,,': ;-�. ,..' �-:.,.- ;r:.: � ..-7•^_,.-e-,•,•..�-�.•.r��---�..,. :�.� +�-� �.� ` ,. `•, ." x •'drb` �e•,AV _ Yp y / TYPE: BATTS MANUFACTURER: Certainteed Thickness 1i < 4/4, a GENE C T CT RJT H ES LICENSE # l ' .:; i r yPR01, BY TITLE;�t:U�L_�� S ' PA ON SCHMID BUILDING PRODUCTS, A MASCO COMPANY • LICENSE # 632072 / ' _ 4 TITLE ADMINISTRATIVE ASSISTANT. DATE: 11/13/2003 g / - - - . Fi�i�ir./nrcriiiocrice%c%i✓nicri%�%i%i%i%ni�roin�/r�r✓iiirniiininrsi�rirni�irir•/ni�irrciirizi%�/riri�/ri3rn/i%irirciiii'✓wrlr�rni�rrioicrnrlrrii%ri�ii%ru-%i%�u•rwv..v/i'r�ioiiu%c%%/rrir�/r � rird.. . ''•` ~•F^ r ,h, . �ti T1s' r �' 4,. '• - .R ,'�,.' ^ -�: T - i Dt - ENERGY '-� CADEC Swwcm — `. P.D. Box 621 Ph/Fax (760) 5642044 Rancho Mirage. CA 92270 Cell: 1760) 885iMM 250-1852 Email: RKrmm6237@aol.com ' CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page l of 7) CF -4R IDA11 t 1,4 P14 Projec Title Da 7�•7ao u��u� w /A �ul�i�� l— un -r1 P Project &ddlessguilder Na e J NNARdwick 7!00?71-41-77F 1.-C Builder Contact Telephone Plan Number AI w 2 Gt H Ra Telephone Sample Group Number ft—e-14W 13zCM V1 lo -r- .�� 3c ertifying Signature Dath Sample House Number Firm: PesF— iY 6E2VI ems HERS Provider. &A -F -a -F -S. Street Address: P-0 . Eoa( (i'1 1 City/State/Zip: 90114oj"yc^2270 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 comph• 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, 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',, 'r ` . Duct Pressurization Test Results (CFM Q 25 Pa) values - Test Leakage Flow in CFM - ' If fan flow'is calculated as 400cfm/ton x number of tons enter calculated - value here . { If fan flow is measured enter measured value here i Leakage Percentage (100 x Test Leakage/Fan Flow) _ - Check Box for Pass or Fail (Pass=60/o or less) ❑ ❑ Pass . Fail El THERMOSTATIC EXPANSION VALVE (TXV) [I Yes ❑ No Thermostatic Expansion Valve is installed and Access is ❑ provided for inspection Yes is a pass Pass Fail INST ti CERTIFICATE Site.Address 5d-3�3o. DUCT LEAKAGE AND DESIGN DIAGNOSTICS EAKAGE REDUCTION DUCT L Pressurization Test Results (CFM @ 25 PA) Test Leakage (CFM) �1 Fan Flow, If Fan Flow is Calculated as 400 cfm/ton x number of tons, or as 21.7,x Heating Capacity . of Btu/hr, enter calculated value here in Thousands If fan flow is measured, enter measured value here K Leakage Fraction =Test Leakage/(Measured or Calculated. Fan Flow) - Pass if leakage fraction 5 0.06 t. ❑... Pass Fail ❑For AEROSOL TYPE SEALANTS ONLY - The following diagnostic testing was completed: Duct Fan Pressurization at rough -in measured leakage (CFM) 1' CHECK AFTER FINISHING WALL: ❑. Yes ❑ No ❑ Pressure pan test or House pressurization test ❑ O ❑Yes No ❑ Visual Inspection of Duct Connections Pass Fail r, ❑- THERMOSTATIC EXPANSION VALVE X [31 Yes E3 No Thermostatic Expansion Valve is installed and Access is 0 .. ❑ ; ' . provided for -inspection Yes is. aPass Pass Fail ❑ DUCT DESIGN 1 Yes 13 No ACCA Manual D Design calculations have been Duct Design is on the plans and duct installation ' - completed, matches plans. 2 ' TXV is installed or Fan flow has been verified. If no TXV, [3 Yes ❑ No fan flow matches design from CF -IR. verified Measured Fan"Flow Yes for both 1 and 2. is a Pass Pass '. Fail t that the above diagnostic test results and the work I performed associated with the test(s) is.in ❑ 1, the undersigned, verifyproprovider a copy of the CF -6R. conformance with the requirements for compliance credit. [Th�bbuild r tic testing and. installation meet the requirements -contractors certifying signed by the builder empl ees or sub F �T for compliance credit.] tl , f In ta11 g Subcontractor (Co. Name) OR Tests ate General Contractor (Co. Name) Performed COPY TO: Building Department HERS Provider (if applicable), * Building Owner at .O.ccupancy p M INSTALLATION CERTIFICATE (Page 3 of 13) CF -6R . Permit Number ° Site.Address DUCT LEAKAGE AND DESIGN DIAGNOSTICS , UCT LEAKAGE REDUCTION_. , Pressurization Test Results (CFM @ 25 PA) Test Leakage (CFM) Fan Flow r If Fan Flow is Calculated as 400 cfm/ton x number of tons, or as 21.7 x Heating Capacity Btu/hr, enter calculated value here' in Thousands of If fan flow is measured, enter measured value here Leakage Fraction =Test Leakage/(Measured or Calculated Fan Flow) - 5 0.06 ❑ • Pass if leakage fraction ,® Pass , Fail {� For AEROSOL TYPE SEALANTS ONLY - The rollowing diagnostic testing was completed Duct Fan Pressurization at rough -in measured leakage (CFM) . CHECK AFTER FINISHING WALL: ❑. Yes ' ❑ No [3 Pressure pan test or House pressurization test . ❑ O ❑ Yes .. ❑ No ❑ Visual Inspection of Duct Connections pis Fail ❑- THERMOSTATIC EXPANSION VALVE X Thermostatic Expansion Valve is installed and Access is ❑ ❑ ❑ Yes ❑ No , provided for inspection Yes is a pass _ Pass Fail ❑ DUCT DESIGN I ❑ Yes ❑ No ACCA Manual D Design calculations hate been Duct Design is on the plans and duct installation I _ completed; matches plans: s . 2 E3 Yes C3 No TXV is installed or Fan flow has been verified. If no TXV, fan flow matches design from CF -1R s verified Measured Fan.Flow = ❑ O Yes for both 1 and 2. is a Pass Pass Fail undersigned, verify that the above diagnostic test results and the work 1 performed associated with hof the(CFS6R: ❑ ° I, the gn ostic testing and. nstallattiion meet theprequirements conformance with the requirements -for corripUance.certif [lb diagnostic sub -contractors certifying signed by the builder emplo ees or for compliance credit.jiD` _ fns 11ing Subcontractor,(Co. Name) OR Tests ate - General Contractor (Co. Name) Performed COPY T0: Building Department Provider (if applicable) HERS Building Owner at .O.ccupancy .