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0305-206 (SFD)LICENSED CONTRACTOR DECLARATION U) I hereby affirm under penalty of perjury that I am licensed under provisions of I— Chapter 9 (commencing with Section 7000) of Division 3 of the Business and N LU Professionals Code, and my License is in full force and effect. O =) M License # Lic. Class Exp. Date lLJ ro" oZ t -Date Signature of Contractor co 0 ~ J U C:1 OWNER -BUILDER DECLARATION WLLI I hereby affirm under penalty of perjury that I am exempt from the Contractor's 1(n 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). ( ) 1, 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 N Date Signature of Owner ON O) IL Q WORKER'S COMPENSATION DECLARATION p � I hereby affirm under penalty of perjury one of the following declarations: Lo FZ 0 () 1 have and will maintain a certificate of consent to self -insure for workers' X W compensation, as provided for by Section 3700 of the Labor Code, for the 0J Q performance of the work for which this permit is issued. co Q () ( ) I have and will maintain workers' compensation insurance, as required by O U QSection 3700 of the Labor Code, for the performance of the work for which this rn H permit is issued. My workers' compensation insurance carrier & policy no. are: Z Carrier €%'I'.AT Policy No. Cb 5 �O 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 provisions. 4�v 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, 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. r Signature (Owner/Agent) Date W +� BUILDING PERMIT PERMIT#�P� DATE r� a, VALUATION . S'11(k2o =.311 LOT v i TRACT JOB SITE :'Lv �? APN ADDRESS OWNER CONTRACTOR / DESIGNER / EN INEER CA, 92253IY(s !UQX Iii W;:, CMIA 4590 USE OF PERMIT •! .,. •. ••'7 •�'.1 17i"I aaj : 17FEN a: :' �ilY'v 8''C.Av.l�A L/ . �3:�', '3.••.a/Jl;+ /1.�.:V•M h. l �,iiJ'S.i, Cl4'•.d,' e'.T~i+LZS�ia•�.L�CAJ.i3 $'E"skiu I a's,' ITT RICAtMIA RY =41.1, '.'r lam`; 1 M ,000 -41 £i- 000 J,210.00 PIAN FK9 ULC KANICAA, 'E1 Z t' t Flit"Uh9kN0 Q1 _000-4119-000 il a 12`CNO 1401'10H Get':; 10 101 -000-IMJ •'�ti!� ��•.�5 (II2.Ph )BIK! FZZ 101-000.423'.000 gIM• it . RIA ART IN Y?'UNUC PI AQU - RME 270,,000.445 000 `31p63•�T�::!`.f'irk.>"�:�d�^ti3`.i��►�T��"333'��Ft3 �?�.:�?�TC�'F, �:y,��^£S.'�'�.i 2 "J RECEIPT DATE, s BY DATE FINALED INSPECT S INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Fo,Rns & Footings $ — Ducts Slab Grade A. Return Air Steel gs — -- j Combustion Air Roof Deck 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 Drywall - Int. Lath Final - Final 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 Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines — Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans .000�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 0 - Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: ��rir.�imririniriia_iNririrr�rirrernrciurriirrr.urorurnwinrrrninrnr�irriricr�rvr�rirnrur�rnrirnrnrirniariirrrAinrcr�riniriirniiznr.�rci�rnriruvnrcr�riiuiurrnirrnrnrirnrniirarniirnri7irririirrnrrrnrninrlr�riro� INSULATION CERTIFICATE r This is to certify that insulation has been installed in conformance with the current energy regulation, California Administrative Code, Title 24, State of California, in the building located at: y, 50-335 VIN SIN PRISA ,LOT 51 , LA QUINTA, California p CEILINGS: TYPE: BATTS MANUFACTURER: Certainteed Thickness: R-38 r r ani WALLS: TYPE: BATTS MANUFACTURER: Certainteed Thickness: R-21 i GENENT CT : RJT H S LICENSE Y: TITLE: 1 �r y A N SCHMID:BUILDING PRODUCTS, A MASCO COMPANY LICENSE #, 632072 r P TITLE:, ADMINISTRATIVE ASSISTANT DATE: 11/14/2003 J i r F Wi�rii rnrnrrirrirrcriiirirrrnroiianiiirniirririiinv,•rniiiiri-iiririvrrrir�rirrrnrirrrrilrnrnriiurrridivi�rni�rrrrniirrr�irr�rrrcuicrnrir�ririiiririiriiiirin- . ; r � .. � - / 33 S �t res«u lA CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7) ' CF -4R 0OIC5 -e—' PAMILLA 02-23-04 Pro ect Title Date 50I;TH & JEFFERSON _ R J T BUILDERS f WR&'' r'MbRGAN760-275-8230 Builder Name PALO VERDE SF2C2 3 UNITS -Builder Contact Telephone Plan Number - r GRANT RICH, 760-250-2084 GROUP 1 1 OF 3 • ' H S Rate Telephone - # CNNGR2074391 LOT # 51 - Certifying Signature Date Sample House Nu y s ' " Firm:DESERT ENERGY SERVICES HERS Provider: CHEERS Street Address: P.O. BOX 621 City/State/Zip; RANCHO MIRAGE CA: 92270 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 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 tae is installed, mastic and drawbands are used in combination with cloth backed, rubber adhesive duct tape to seal leaks at duct connections- Y ®MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT - Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage) f . Measured Duct Pressurization Test Results (CFM (25 Pa) values ' Test Leakage Flow in CFM 82 If fan flow is calculated as 400cfm/ton x number of tons enter calculated 4 4 value here 2000 If fan flow is measured enter measured value here " Leakage Percentage (I 00 x Test Leakage/Fan Flow) = 4.1 ' t Check Box for Pass or Fail (Pass=6% or less) ® ❑ Pass Fail ® THERMOSTATICEXPANSION.VALVE (TXV) 5 • ' Thermostatic Expansion Valve is installed and Access is ® Yes ❑ No provided. for inspection Yes is a pass Pass Fail r CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7) CF -4R PAMILLA ' 02-23-04 P 50'ro ect Title Date TH & JEFFERSON R J T BUILDERS R&NbRGAN 760-275-8230 Builder Name PALO VERDE. SF2C2 3 UNITS Builder ContactTelephone Plan Number GRANT RICH. 760-250-2084 GROUP 1 2 OF 3 H # S Rate Telephone �;R CNNGR2074391 �. 9—Oq LOT # 51 Certifying Signature Date Sample House Number Firm: HERS ENERGY SERVICES CHEERS HERS Provider: Street Address: P.O. BOX 621 City/State/Zip: RANCHO MIRAGE`CA. 92270 Copies to: Builder, HERS Provider HERS RATER, COMPLIANCE STATEMENT .The house was: ®'Tested ❑ Approved as partof sample testing• but was not tested As the HERS rater Iproviding 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, rubber adhesive duct tae 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 (L25 Pa) values Test Leakage Flow in CFM 119 If fan flow is calculated as 400cfrn/ton x number of tons enter calculated value here 2000 If fan flow is measured enter measured value here Leakage Percentage (I 00 x Test Leakage/Fan Flow) = 5.95 Check Box for Pass or Fail (Pass=6% or less) ® ❑ Pass Fail. ® THERMOSTATIC EXPANSION VALVE (TXV) ® Yes ❑ No Thermostatic Expansion Valve is installed and Access is ® ❑ provided for inspection Yes is a pass Pass Fail CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7) CF -4R PAMILLA 02-23-04 Pro ect Title Date PH & JEFFERSON R J T BUILDERS ppr AA r Builder Name D ►EL�RGAN 760-275-8230 PALO VERDE SF2C2 3 UNITS Builder Contact Telephone Plan Number GRANT RICH 760-250-2084 GROUP 1 3 OF 3 H Rater Telephone # CNNGR2074391 3 � �-0y LOT # 51 Certifying Signature Date Sample House Number DESERT ENERGY SERVICES CHEERS Firm: HERS Provider: Street Address: P.O. BOX 621 City/State/Zip: RANCHO MIRAGE CA. 92270 Copies to: a 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 compliance requirements as checked on this form: ®' The installer has provided a copy of CF -6R (Installation Certificate. 0 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 tae 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 34 If fan flow is calculated as 400cfm/ton x number of tons enter calculated value here 800 If fan flow is measured enter measured value here Leakage Percentage (I 00 x Test Leakage/Fan Flow) = 4.25 Check Box for Pass or Fail (Pass=6% or less) ®. ❑ Pass Fail ® THERMOSTATIC EXPANSION VALVE (TXV) ® Yes El No Thermostatic Expansion Valve is installed and Access is provided for inspection ® ❑ Yes is a pass Pass Fail .:Cerf�'Ica A .Occupanof, Cy y INCOUORATM r . OF _ ufiing� a e y- , ep_artment� � 7� ' This Certificate 'is issued, pursuant to `the 'requirements of Section 109 of,the `California Buildin Code, , certifying that, at the " time . bf issuance, , this 'structure 'was> in compliance :-with :the provisions of the, Building ,Code and the` various ' ordinances of the' City. regulating "building construction and/oryuse. .. � .W . ,Y•.' i r' � r - _ .� � ; •-,• r ,..3 +e - - i,:1 `: y ti' c %''� BUILDING ADDRESS:' 50-335 VIA'SK PRISA "' y Use cl • asslficatlon` S.F.D. Buildin P � � � g ermit No.:; 3050-206 Occupancy Group:'R-3 = .. :Type of. Construction: V -N LandtUse Zone R -L 4A _71, a .`` Owner of:Buildin- RJT HOME a - g S LLC 'Address: PO BOX 810 s City, ST, ZIP: L'•A QUINTA CA. 92253 , G. SHOWALTER ' #''Date: ° 04/30%04 t , :3, 3 • _, y - = 'Building 'Official, - s_ •.. t . ;; ,.. - „� -�' *' `-• , , • - v ;' .� �POST.IN A`CONSPICUOUS PLACE �. �" •, L + ' —