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02-10239 (SFD)LICENSED CONTRACTOR DECLARATION" hereby affirm. under penalty -of perjury that I am licensed'under provisions of. .Chapter9 (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 Ezp. Date 690645 B MC A%� r.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: () f 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 <fA�1i I"ltN Policy No. 1M.9064N (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., �.rDa6e:.1.�;,.rw�l�Applicant r/� ;�✓ Warning: Failure to secure Workers' Compens9tion coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the. Labor Code, interest and attorney's fees. �1 IMPORTANT Application is hereby made to the Director ofsBuilding and Safety for a permit subject to the conditions and restrictions set forth. on his application. K. r, 1. Each. person upon whose behalf this application is made & each person at `. whose request and for whose benefit work is performed under or.pursuantto any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not :commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state 'that the above information is correct. I agree to comply with all City, and State laws relating to the building . construction, and hereby authorize representatives of this City to enter upon . 'the above-mentioned property for inspection purposes. + Signature (Owner/Agent) -.g•` u-J�'" Datef -� w - - BUILDING PERMIT PERM T# ` 02:! 0 1,39 DATE VALUATION !yyr��FF�99 qq�Ry► LOT TRACT JOB SITE► n. ADDRESS APN yV 7:`2^4901-'013 OWNER CONTRACTOR / DESIGNER / EN (NEER RJTBMW 1: CI, 1425 11:TNIVEIZUr v LA QUNTA CA 922 S 3 pf-MEMFC AZ 81034 (021)257-1656 MR. 090 USE OF PERMIT Imo`fir,11,11F. 'Ayt ly-YPP�UvEj3/:���(..YZ)11}�i�' i=Y #.i P �d4l�l_' .7Ay l�lJJ"LZ9 Wl�'�ui,fll.rJ' ilid tliVi.4fi IJVL.V .14�}A h ��4�.f.,kul L��� ��.'�.lV..•�Y. .4,1,ua po(r) .,, SPS, OR Milli` Ay i+ P ILGAQa! TRACT CONO'i W1 'TION SF 9F V %d 1$.U%'d.LAJ,A'sR� �W1Cf.i F✓'.F:, �Yid:SY 1.7�.LLi.F1 ��1..A91d� fi:�� �n��tlS.4'�^V ��-�r��yy ff 'y��i �i'g�} p�,/�' u� 9: F.RWF F F2 6z 1.: SSLAA7.Y ADY PLAN CHECK F171F, 100. 17 'NUEC ,Aadlt.°A1L, FEE 101 H0110•42 a -000 $170, 4 !':.i IC.9 RICA1, FTM l CA S -€IOFB -U i1 $X59. s� FL1SDANO FIZE'101-000-419-000 gx:{^0.41x•000 �$f2l8ff..24s3 dmdOX0,1-V1011 11 rry p ti44LLID 10! /00-2 1 ^000 ' ORA1 i146M.t� FOZPQO����d SUN 1`4 AID Y303 $0.00 HOW CITY Or LA QUINTA FINANCE DE RECEIPT DATE BY DATE FI ALED INSPECTOR f. _ b INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts F,pins & Footings Ducts Slab Grade 4 — 3 Return Air Stebi — Combustion Air Roof Deck — ,Z — 3 Exhaust Fans O.K. to Wrap — p3 F.A.U. Framing — — Compressor _ Insulation p Vents l Fireplace P.L. Fireplace T.O. Grills Fans & Controls _ Party Wall Insulation t/ \ Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath _ 3 o Final ' .�v-- y ��� 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 — Heater Final Water Piping _ _ _ 2 � Plumbing Final Equipment Enclosure 9 Top Out PlUmbin J Shower Pans / O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Gas Piping �— Encapsulation Gas Test Appliances D Final COMMENTS: Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole . Underground Conduit - Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels O Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power EJZ Final Utility Notice (Perm) � . ISI �rniiiirriirrririninrrirrnirrinninirrrrnroinirr�r�i�rrrcrir�rnrri�rrrncrvrnrnnrrrirrrninriini�iiyvririnniiicirrcrrrsirrnrirnrrrrrrirr�rrrivrnrrrnrriinrrrr�rrzrrcicirrriiiri�rniivnrr o. ol 15•t :INSULATION CERTIFICATE r r This is to certifythat insulation has been installed in conformance with the current energy ? �rniiiirriirrririninrrirrnirrinninirrrrnroinirr�r�i�rrrcrir�rnrri�rrrncrvrnrnnrrrirrrninriini�iiyvririnniiicirrcrrrsirrnrirnrrrrrrirr�rrrivrnrrrnrriinrrrr�rrzrrcicirrriiiri�rniivnrr o. ol 15•t :INSULATION CERTIFICATE , This is to certifythat insulation has been installed in conformance with the current energy ? regulation, California Administrative Code, Title 24, State of California, in the building located at 50-375 VIA SIN PRISA, LOT 52, LA QUINTA, California CEILINGS: t J TYPE: BATTS MANUFACTURER: Certainteed{ Thickness: R-381/0 WALLS: �. TYPE: BATTS ` MANUFACTURER: Certainteed Thickness: R-21 1 GEN CO T CT : RJT H S LICENSE # r p TITLE:�7��i✓ � P N SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072 TITLE: ADMINISTRATIVE ASSISTANT DATE: 11/13/2003 9 3 i r r brrrniriirriirirrnirrrnrmcrnnzcni�rrnrrinrniirrarrrrni�rnnuirrwicicri2nrrrniciirnrircirrcr�r�nirrnrnitrninrnr�inmirnr�irr�inirrcrircr�rrrrviizrriurorrrrrcziriinirrrrriiierinr� 15•t f x ^Yi>. (Page 3 of 13) Cv4k INSTALLATION CERTIFICATE, (p g Permit Number Site.Address . —31,57 VZ.A; , DUCT LEAKAGE AND DESIGN DIAGNOSTICS •DUCT LEAKAGE REDUCTION - - Pressurization Test Results (CFM @ 25 PA) Test Leakage (CFM) , �., Fan Flow ty If Fan. Flow is Calculated as 400 cfm/ in x number of Thousands of B stu/hr, enter calculated here , • If fan flow is measured, enter measured value here = Leakage Fraction = Test Leakage/(Measured or Calculated Fan Flow) . Pass if leakage fraction 5 0.66 (pass Fail {3 For AEROSOL TYPE SEALANTS ONLY The following diagnostic testing was completed: ' Duct Fan Pressurization at rough -in measured leakage (CFM) CHECK AFTER FINISHING WALL: ❑. Yes ❑ No 13 Pressure pan test or House pressurization test [30 [] Yes ❑ No ❑ Visual Inspection of Duct Connections Pass A Fail ❑- THERMOSTATIC EXPANSION VALVE X ❑ Yes ❑ No Thermostatic Expansion Expansion Valve is installed and Access is ' provided for inspection Yes is a pass Pass Fail � f ❑ DUCT DESIGN ACCA Manual D Design calculations have been `' 1 Yes. ❑ No - _ completed, Duct Design is on the plans and duct installation " matches plans. 2.•' ❑Yes No TXV is installed or Fan flow has been verified. If no TXV, fan flow matches design fromMeasured h verified verified Fan.Flow a ❑ ❑- t • .. 11 Pass Yes for -both I and 2.is a Pass 'Fail Y dersi ed, verify that the above diagnostic test results and the work 1 provide the HERS proviperformed der ccopY of the (CFs6R. ❑ 1, the un gn . conformance with the requirements for compliance credit. [Th�abtu s�c testiand. installation meet the requirements , -contractors certif}'ing signed by the builder empl ees or sub ? for compliance credit.] f Instal g SubcontractorName) OR , t Date4 Tests General Contractor (Co. Name) Performed COPY TO: Building Department Provider (if applicable) HERS Building Owner at Occupancy INS TALLATION CERTIFICATE (Page 3 of 13)CF-6R Site.Address Permit Number , A DUCT LEAKAGE AND DESIGN DIAGNOSTICS DUCT LEAKAGE REDUCTION Pressurization Test Results (CFM (a3 25 PA) Test Leakage (CFM)_ Fan Flow If Fan Flow is Calculated as 400 cfm/ton x number of tons, or as 21,.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) Pass if leakage fraction 5 0.06 4ass Fail fl For AEROSOL TYPE SEALANTS ONLY The following diagnostic testing was completed: a y Duct Fan Pressurization at rough-in measured leakage (CFM) CHECK AFTER FINISHING WALL: ❑. Yes ❑ No ❑ Pressure pan test or House pressurization test, a a ,' yes,. ❑ No ❑ Visual Inspection of Duct Connections Pis Fail �5 . ` ; ❑' THERMOSTATIC EXPANSION VALVE X V❑ Yes ❑ No Thermostatic Expansion Valve is installed and Access is ❑ [3 provided for inspection Yes is a pass Pass Fail ❑ DUCT DESIGN 1 ❑Yes ❑ No ACCA' Manual D Design calculations have been ' - - _ completed, Duct Design is on the plans and duct installation matches plans. , 2•' 13 Yes No TXV is installed or Fan flow has.been verified. If no TXV, verified fan flow matches'design from CF-I& Measured Fan Flow!= 13 Yes for both I and 2. is a Pass Pass Fail ` performed associated with the tests) is.in , ❑ l the undersigned, verify that the above diagnostic test results and the work I pert rovider a y of the CF conformance with the requirements for compliance credit. [Ile builder shall eta e a HERStion meet theprequiemen 6R. signed by the builder emplo es or sub-contractors certifying that diag°LnSubcontractor for compliance credit ] (Co. Name) ;OR Tests , Date General Contractor (Co. Name) Performed De Department - COPY TO: Building P liable) - HERS Provider (if app Building Owner at O.ccupancY INSTALLATION CERTIFICATE (Page 3 of 13) CF -6R Permit Number SiteAddress .... DUCT LEAKAGE AND DESIGN DIAGNOSTICS %/ DUCT LEAKAGE REDUCTION Pressurization Test Results (CFM (a; 25 PA) Test Leakage (CFM) Fan Flow If Fan Flow is Calculated as 400 cfm/ton x number of tons, or as 21.7 x Heating Capacity . in Thousands of Btu/hr, enter calculated value here, if fan flow is measured, enter measured value here ' Leakage Fraction. = Test Leakage/(Measured or Calculated Fan Flow) 5 0.06 ❑ . Pass if leakage fraction Pass Fail For AEROSOL TYPE SEALANTted: ❑ S ONLY - The following diagnostic testing was comple Duct Fan Pressurization at rough -in measured leakage (CFM) CHECK AFTER FINISHING WALL: ❑.Yes ❑ No Pressure pan test or House pressurization test ❑ Ye3' . ❑ No ❑ Visual Inspection of Duct Connections Pass Fail ❑- THERMOSTATIC EXPANSION VALVE X : ❑yes k ❑ No Thermostatic Expansion Valve is installed and Access is 13 [3 ` provided for inspection Yes is a pass Pass Fail ❑ DUCT DESIGN 1 E3 Yes. ❑ No ACCA.Manual D Design calculations have been Duct Design is on the plans and duct installation - • : , completed, matches plans, . ❑ TXV is installed or Fan flow has been verified. If no TXV, 2. [3 Yes No fan flow matches design from CF -IR. verified Measured Fan Flow t. Pass yes for` both 1 and 2. is a Pass . Fail performed associated with the test(s) is.in' ❑ I, the undersigned, verify that the above diagnostic test resu it and the work I pert of the CF -6R. builder shall provide -the providert conformance with the requirements for compliance credit. [The the requirements -contractors certifying that diagnostic testing ande nsta signed by the builder emplo s o sub F 'for compliance credit.] Install' g.Subcontractor (Co. Name) OR . Tests i ate General Contractor (Co. Name). Performed COPY T0: Building Department Provider (if applicable) HERS Building Owner atOccupancy �-0j ertifieatd.oroccypancy.-. � .- C., IWTM s GOF'T9� Buildin &. Safet Pepartment g • Y - , This Certificate is issued pursuant to the requirements of Section 109 of the. California, 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: 50-375 VIA SIN PRISA- • , Use classification: S.F.D.- Building Permit No0210-239 Occupancy Group: R-3 Type of Construction: N -V Land Use Zone: R -L Owner of Building R.J.T. HOMES LLC. - 'Address: P.O. BOX 810 _ City, ST, ZIP: LA QUINTA CA 92253 By: G SHOWALTER ; -- Date:• 01/20/04. - Building Official > POST INA CONSPICUOUS PLACE.