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0210-236 (SFD)—LICENSED CONTRACTOR,DECLARATION Thereby 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 690161-5 BMC A 6130/04 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 r 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. SecI have and will maintain workers' compensation insurance, as required by 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 ST�l. S FUND Policy No. ' ����,�� ,'92 (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: - 11 ,L.�. Applicant '� �? rl �t` �* Warning: Failure to secure Workers' Compensa ion 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 forthon 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 fhe building` • construction, -and hereby, authorize representatives of this City to enter upor the above-mentioned property for inspection purposes. Signature (Owner/AnentDate �.°. :.. ^ to BUILDING PERMIT PERMIT# Sl�s3.0^ip+ri DATE VALUATION �.A LOT k TRACT r� y JOB SITE' APN ADDRESS %.410 VM SWI FR19 OWNER CONTRACTOR/DESIGNER/EN (NEER LA.QUINTA CA 92253 PHORNM - A7, 85034 (607)257-1656 CBW 499* USE OF PERMIT KILR i?Att(13LY MM. ' 1WG SM•LOT .55, PI -Ad 310.18tIPERMIT O7r: nCr rNGLUDE biaCK. PAAAP004 A. Oft ,DRIVI A dPMKILACH, ' FrORCt1f1?. TIO .SY .R:t1.C4UI+P. �R1'M fr? IT OF COMMUMON cob 2,n4,C50.64) CONSTRUCTION "'IR 10*1-000-418-000 S1,264.50 1x1,.AX f`i"i;ECK F -MV 101 -OW-439-3 18 t trans MECHANICAL 101-000421.000 I•GL ECTMi.AL UM 101-000-c420-000 W PLSl:MP1,140 ME 101-000-419-000 V11110100 STRONO MOTION FEZ I'ES11) 1011 -MO -2.•1-000 $27.97 ,'A.1 YNGlE.E. 1011-0 00-421-000 $15,00 DEVELOPER IMPACl' ME 01,YA-1KYRAL CK PLAN $5,749.16 PRE -PAEDI-;- S0.00 Q - f NOV 20 200 ' v CITY OF LA QUINTA BY DATE FI IALD INSPECTOR/ INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings —IAX Ducts Slab Grade Return Air Steel Combustion Air Roof Deck _ ,t _ Exhaust Fans O.K. to Wrap .,3 F.A.U. Framing -3 -- Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. z Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath v15 Drywall - Int. Lath — OS Final i 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 C Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans �� O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection —6, 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: + c: r�' •` i ` f- , ;< `" s � � • c r' t .. s i 'F a, ..i � r � , '.; .� - .• ' ,� - '` ." , � •�-[ P ♦ �,`' c � � - . .� ,,� S^. ate• ....:-...� -" � ,,�, '• , �/.f//f/,H•fJ'!/'f/,'!/.!/!//l/%f/!/.1//d�N.!!f//!!/!!,%//!!/!//A'O.%1/!/.%!/O/4/!!'f/l0/O/f!/!//�f//!/,'O/f//O/O.f!/O/U///%J///.'O/!/.!/l!O/f//•9'/O/f/.%//0,00/O.O,'U/O/!/!/.f!/O%/%!///./J,!/.O,!/f/!/OOp'O.!//J,'!//O/U/O/O!/!/ � S _ k Yf r N '"II•IC ?'`h . ''r �. �, +f•1 r' - -1NSULATIO -CER ATE y r , " th the y This is to certify that insulation has been instener alle24nstateoof Cal California in in the building located at: } ' California Administrative Code, Title f R r ; • , �' �. regulation, �' ` ; i+ LA QUINTA ,CALIFORNIA S 50-410 VIA SIN PRISA, LOT 55, CEIL� THICKNESS: R-38 ' TYPE:BATTS r MANUFACTURER: CERTAINTEED T / } •' 7 . - �' ?"`•' , .c.�, . " _ r THICKNESS: R-2.b 1 CTURER: CERTAINTEED TYPE MANUFAATSt.'..✓..u.'v.�wlp`f`"„4tt 4. , .�r �^;'f ' , rt z, L"ri ��:j -�--� �,,... ..� �,. ,.�a,.;..,:.*„w>. .: �_.�,x: * - 'L•ICENSE#� OC>J ,�:•� L�,,.,�..„r.�-..,�� - , GEN LC T CT R RJ O ES s y # Y TITLE: S�.QiTGTri��_.:.,� d A MASCO COMPANY LICENSE # 632072 r „ N SCHMID BUILDING PRODUCTS, ; BATE: 1111312003'^��`•' s, r i B TITLE: ADMINISTRATIVE ASSISTANT 4' s D - = ENERGY -.: CA,0E Semces— P.D. Box 621 Ph/Fax (760) 564-2044 Rancho Mirage. CA 92270 Cell: (760) eMit 250-IEbSZ Email: RKrown62370anl.com a • -ello CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page 1 of 7) " CF-411 /DA 11h, < < A tib 40 Pr� c�[� Title Da -o A4 QvI l P Project &ddle ss uilder Na e _ ,l1 ill yA�Pc�wi c/Clo�� ��S-�'3�73- 3' Builder ContactTelephone Ian Number - 4 4 �iGNARD F PDW�I C�Go1250-1851 GA 12011 H S to Telephone Sample Group Number #�e�1 132°12. 17/93 -!5 aj . ertifyt g Signature r-1— Date Sample House Number Firm:_pESE(�T�►klE�iY 6E2V1 !ES HERS Provider: C•1i•�-E•Q.S. r Street Address: P0 . BOAC (0"21 City/State/Zip: 690-14011 I94cZ27o Copies to: Builder, HERS Provider . HERS RATER COMPLIANCE STATEMENT , r;.. r> The house was: 00'Tested ❑ Approved as part of sample testing, but was not tested As the HERS rater providing diagnostic testing and field verification, 1 certify that the houses identified on this form comply , with t e 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 areused in combination with cloth backed, rubber adhesive duct tape to seal leaks at duct connections. T eMINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT, - r ` Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage) " Measured Duct Pressurization Test Results (CFM Q 25 Pa) values ' Test Leakage Flow in CFM 1f fan flow is calculated as 400cfm/ton x number of tons enter calculated s value here p` ' oo If fan flow is measured enter measured value here Leakage Percentage (100 x Test Leakage/Fan Flow) Check Box for Pass or Fail (Pass=60/o or less) ®- ❑ " ' Passe r ,'Fail ❑ THERMOSTATIC EXPANSION VALVE (TXV) ❑ Yes ❑ No Thermostatic Expansion Valve is installed and Access is _ provided for inspection ; z ❑ a ' Yes is a pass Pass Fail Dt ENERGY .: �AOE� Semces P.O. Box 621 Ph/Fax (760) 564-21144 Rancho MiraW. CA 92270 Cell: f760) OW504W 250-1652 Email: RKrownB2370aol.com CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7) CF -4R Projec Title Da Qu Pro1ect ss _.�dd uilderNa e r �. 1b1j1�— wick 7 too 0P�1-� r -C Builder Contact Telephone Plan Numb er# 2 _ GI12oL1� / HE 19-0 RatTelephone Sample Group Number NRK 132°2. #c� ertifying Si nature" Date Sample House Number Firm: p"F—e'I"r�},tt m 6E2VI e -e5 HERS Provider. C.ti•E.E-Q.S. Street Address: 0 . E6 G2I City/State/Zip: 640-140,11 -0>227-0- Copies to: Builder. HERS Provider _ r HERS RATER COMPLIANCE STATEMENT The house was: 200TOested ' ❑ Approved as part of sample testing, but was not tested 'As the HERS rater providing diagnostic testing and field verification, 1 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. 190Uistribution 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. ' fi MO MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT, Y Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage) Measured Duct Pressurization Test Results (CFM Q 25 Pa) values Test Leakage Flow in CFM If fan flow is calculated as 400cWton x number of tons enter calculated R value here U 0 ' If fan flow is measured enter measured value here Leakage Percentage (100 x Test Leakage/Fan Flow) Check Box for Pass or Fail (Pass=60/a 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 _ A`Fail Desem ..... .... __rL ENERGYCAOEC .', 'PD. Box 621 Ph/Fax (760) 564-2044 Rancho Mirage. CA 92270 Cell: (7760) 89508=1 250-1&5Z . Email: RKrown62370aol.com CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7) CF -4R,.,. - ' Projec TitleDa -, Project d ss wilder Na e _ h � ) NAel,ick X7100 ��S-�'3�7 Pl.p.�.l't _SF3 -C3 Budder Contact Telephone Plan Number# „ wMol Z50-1062 Gcoup- LIE&S R r Telephone Sample Group Number . 71� #GGNRK 132°12. o eni ng Sf'gnature Date Sample House Number w Firm: pose smy 6seyI e -E3 _HERS Provider: e-A-F-F-e.S. Street Address: P -D . E30)g G2I City./State/Zip: 90 O MAGA •652270 'Copies to: Builder, HERS Provider HERS RATER COMPLIANCE STATEMENT C The house was: Tested ❑ Approved as part of sample testing, but was not tested r As the HERS rater providing diagnostic testing and field verification, 1 certify that the houses identified on this form comply , With the diagnostic tested compliance requirements as checked on this form. ' ErThe installer has provided a copy of CF -6R (Installation Certificate. 2r Distribution system is fully ducted (i.e., does not use building cavities as plenums or platform returns in lieu of ducts) s ErWhere 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. _ 1 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 f " Test Leakage Flow in CFM .. If fan flow is calculated as 400cfm/ton x number of tons enter calculated value here 4OU0 - If fan flow is measured enter measured value here Leakage Percentage (100 x Test Leakage/Fan Flow) Check Box for Pass or Fail (Pass=60/o or less) '�" - ❑ Pass Fail ❑ THERMOSTATIC EXPANSION VALVE (TXV) ❑Thermostatic Expansion Valve is installed and Access is Yes ❑ No provided for inspection. ❑ ❑ +. Pass Fail Yes is a pass CF-6R INSTALLATION CERTIFICATE (Page 3 of 13) S n! Permit Number Site.Address 5?) -V16. YyC Qi _ 4' DUCT LEAKAGE AND DESIGN DIAGNOSTICS : DUCT LEAKAGE REDUCTION " Pressurization Test Results (CFM Q 25 PA) Test Leakage (CFM)44 i Fan FlowCacity If Fan Flow is Calculated as 400 cfm/ton x number of n Thousands of B stu/hr, enter calculatedv slue here If fan flow is measured, enter measured value here ` Leakage Fraction = Test Leakage/(Measured or Calculated Fan Flow) Pass if leakage fraction 5 0.06 ass Fail C) For AEROSOL TYPE SEALANTS ONLY--The following diagnostic testing was completed: ` ' Duct Fan Pressurization at rough-in measured leakage (CFM) CHECK AFTER FINISHING WALL: t ❑. Yes ❑ No ❑ Pressure pan test or House pressurization test [� Yes C3No ❑ Visual Inspection of Duct Connections Pass Fail ❑ THERMOSTATIC EXPANSION VALVE(UND [3 Yes ❑ No Thermostatic Expansion Valve is installed and Access is ❑ provided for inspection Yes is a pass Pass Fail . ❑ DUCT DESIGN 1 • ❑ Yes- ❑ ACCA Manual D Design calculations have been ,.No _ . completed, Duct Design is on the plans and duct installation matches plans. . . TXV is installed or Fan flow has been verified.' if no TXV, 2: [3 Yes ❑ No verified fan flow matches design from CF-IR. , Measured Fan.Flow = Yes for both 1 and 2. is a Pass ' Pass Fail verify that the above diagnostic test results and the work I performed associated with the test(s) is in ❑ 1, the undersigned, fy provider a copy of the CF-6R. conformance with the requirements for compliance credit. (`Ihe b rider hallgnostic provide and. installation- meet the requirements signed by the builder employees or sub-contractors certifying for compliance credit.] ` 1 1 g Subcontractor (Co. Name) OR t' Tests Si atu , Date General Contractor (Co. Name) Performed COPY T0: Building Department applicable) HERS Provider (if app Building Owner at Occupancy W INSTALLATION CERTIFICATE (Psge 3 of 13) Permit Number Site Address ' DUCT LEAKAGE AND DESIGN DIAGNOSTICS �.. 3i . DUCT LEAKAGE REDUCTION Pressurization Test Results (CFM @ 25,PA) Test Leakage (CFM) Q Fan Flow If Fan Flow is Calculated as 400 cfm/ton x number of tons, or as 21 r calculated value here x Heating Capacity in '.Mousands of Btu/hr, enter c If fan flow is measured, enter measured value here ' Leakage Fraction = Test Leakage/(Measured or Calculated Fan Flow) Pass if leakage fraction 5 0.06 . /Pass Fail ❑ 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 ❑ Pressure pan test or. House pressurization test ❑ O ❑ Yes' ❑ No ❑ Visual Inspection of Duct Connections Pass Fail . ❑- THERMOSTATIC EXPANSION VALVE X Thermostatic Expansion Valve is installed and Access is 0 [3 - Yes . ' ❑ Yes [� No provided for inspection Yes is a'pass, Pass Fail ❑ DUCT DESIGN I ❑Yes ❑ No. ACCA Manual D Design calculations have been the plans and duct installation completed, Duct Design is on matches'plans. TXV is installed or Fan flow has been verified. if no TXV, 2. ❑ Yes ❑ No verified fan flow matches design from CF -1R Measured Fan,Flow a .... a ❑ - ,. Yes for both 1 and 2, is a Pass Pass Fail dersi ed; verify that the above diagnostic test results and the work I e the HERS rovidperformed era with opy of the(CF--6R. ❑ 1, the un . gn a builder shall rovid P P conformance with the requirements for compliance credit. [1bt diagnostic testing and. installation meet the requirements signed by the builder employees or sub -contractors certifying that for compliance credit] - 3 Install' g Subcontractor (Co. Name) OR Tests , Date General Contractor (Co. Name) r performed artntent COPY T0: Building Dep , applicable) .HER Provider (if app ' Building Owner at .Occupancy y " INSTALLATION:CERTIFICATE (Page 3 of 13) GF-�t Permit Number Site.Address. DUCT LEAKAGE AND DESIGN DIAGNOSTICS DUCT LEAKAGE REDUCTION Pressurization Test Results (CFM Q 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) Pass if leakage fraction 5 0.06 ❑ pass Fail fl For AEROSOL TYPE SEALANTS ONLY --The following diagnostic testing *as completed: Duct Fan Pressurization at rough -in measured leakage (CFM) CHECK AFTER FINISHING WALL: ❑. Yes ❑ No ❑ Pressure pan test or, House pressurization test a O Yes ❑ No ❑ Visual inspection of Duct Connections Pass Fail ❑ THERMOSTATIC EXPANSION VALVE X ❑ Yes ❑ No Thermostatic Expansion Valve is installed and Access is g ❑ ❑ provided for inspection yes is a pass Pass Fail, ❑ DUCT DESIGN 1 13 Yes. ❑ No ACCA Manual D Design calculations have been - _ 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, verified fan flow matches design from CF -IR Measured Fan.Flow = ❑ a • • . Yes for both 1 and 2. is a Pass .Pass Fail undersigned, verify that the above diagnostic test results and the work I performed associated with of the(s) is in ❑ 1, the gn conformance with the requirements for compliance credit. pg [The hat da�ostic testing and. installation provider the p1equirements signed by the builder employees or sub -contractors ce Tying for compliance credit.] > n ll• g Subcontractor (Co. Name) OR Tests Si e, Date General Contractor (Co. Name) Performed COPY T0:_ Building Department ' HERS Provider (if applicable) Building Owner at Occupancy h' • • •A +