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0301-235 (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. License# YLicc.}tClass /� Exp. Date �{p+ g vt VV'Yy .r.�✓ilX AD. �i�S\fl iJ�!� % d s° rDate - ( �/��% 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). (' ) 1, 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. ,NQ ) 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 8l'at TE FUND Policy No. 1SIKO V (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 s all jorthwith comply with those provisions. ,.Date:-� rf m Applicant Pir / %> Warning:.Failure to secure Workers'tompensation 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 s ,permit, or cessation of work for 180 days will subject permit to cancellati I certify that I have read this application and state that the above information correct. I agree to comply with all City, and State laws relating to the buildi construction, and hereby authorize representatives of this City to enter up vr, the above-mentioned property for inspection purposes. Signature (Owner/Agent) i Date v-4 BUILDING PERMIT PERMIT# DATE VALUATION LOT • ,. TRACT n� . &2.�d0 w� a. A ITE JOB SITE- ADDRESS ADDRESS 3-��I. VIA SIR? fi.`a`Eq ' _ JAPN _ 772. 3YQ-02.4 OWNER CONTRACTOR/ DESIGNER / EN IINFE'R Yy��g` i`:� HOMES S 6.. . CI 1 s5:�;UNl�'�U.M? DME CA 9225a PHOE Ar 9.50311 (6o?)257 P 1656 MR, 43,94 USE OF PERMIT &1N0Y1.,Y 1KU�f ru3WnNG. SVD- 1.C2T $3 PLAN S1'02 lC'X PXkMIT'DOZ3140T iNC LUDS, BLOCK' 4`VALIA POOL, ;PA Oft DRIVEWAY APPROACH �y 1 TRACT r. WOu°1°RUCTION P r PORICH P.kr1ry gol.na af? 0ARACHKI &PORT 81610 3F .t ) �"O?'a'`:€" Off' ��f:� 44ti il:�fi:�T:�®>�tAK ..2�TMr��,942.10 ��yyyy,.y-qq 5 ••�� ppyyo�,, 'y, �/ y� y1}.t��gTIMA Ci..61,t J;.la:C6.A5a 6U7.4a.RKAR �Y. CO1`3KTRUC`1ION FEE 101--000.41S-WO sl, 4u4 PILAW C k!X1, i 42, 101••000.4139.318 sx,Gn,r�{t MECIFIA IC A11 FRE 101-0001-1121»000 $150.00 i?,LECT141C ALt FE -F, 101-000-420-000 $2.51,56 �1>tax�> a�a s,�Q 1C11�0Ct43�:g1 nt10t9 17".00 STRONO MOTION F'F.i; a kt&52.ii 101 -000-241 40016. $215.49 01 AD N 0 F`V,E '101-000-423-000 $15.00 MIX M Pt1RIAC P'LACM - R,UIE 270--000.145-000 $M7 4 03 -I. ';AL C:OM€1 'PT)'CPHOW.AND PLAN 011RO $5,:544-V 1 L0.3 PX34"AMYEEIS $0.00 FEB 1120 03 , OF LA QU , 7E , ' DE BY ref DAT INA D' INSPE ---7J IdANCE-tiJ - v 241.+` INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings 2 -- Ducts Slab Grade Return Air Steel 5 Combustion Air Roof Deck Exhaust Fans O.K. to Wrap F.A.U. Framing ,� _ 3 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 �' — z - _ BLOCKWALL APPROVALS POOLS - SPAS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Pibg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Heater Final Water Piping Plumbing Top Out. 3 Plumbing Final Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection — Z -3 Encapsulation Gas Piping Gas Test Appliances Final Final Utility Notice (Gas) �4 ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring ti/ —ZZ C3 Low Voltage Wiring Fixtures Main Service Sub Panels _ Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS:®v�v�� 45 Men ENERGYCAaEC P.O. Box 621 Ph/Fax (760) 564 2044 Rancho Mirage. CA 92270 Cell: (760) 80546M 250-1pj5Z Email: RKrown62371ftol.com CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page 1 of 7) CF -411, p►�-�,E--�,�ED: Prc,1lG�,Title�l L /`� QUl�� Da %�u.n1PS' d � � Projects &ddless wilder Na e '=1 N NAkdwick (7&9) �� -x'327 "GoZ cam= Builder Contact Telephone Plan Number ' w 2 G0 2o1J� # H R Telephone Sample Group Number eaifyrng tignaturc Dae Sample House Number - Firm: P"Eff HERS Provider: G.I4- Street Address: P-0 - Boat: G21 City/State/Zip:1 0- O M 1"rcr,,Q1 •g24ro Copies to: Builder, HERS Provider HERS RATER COMPLIANCE STATEMENT The house was: L7 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 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'_' s Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage) Measured Duct Pressurization Test Results (CFM Q 25 Pa) values Test Leakage Flow in CFM t �•. If fan flow is calculated as 400cfm/ton x number of ton_ s enter calculated ' value here � • ' If fan flow is measured enter measured value here ' Leakage Percentage (100 x Test Leakage/Fan Flow) _ J -J , Check Box for Pass or Fail (Pass=60/o or less) ❑ - _ Pass fail', ❑ THERMOSTATIC EXPANSION VALVE (TXV) ❑ Yes ❑ No Thermostatic Expansion Valve is installed and Access is ❑ 1:1provided for inspection. Yes is a pass - Pass=. Fail Dmem ENERGY .: A o E �� l . P.D. lox 621 Ph/Fax (760) 564 2044 + Rancho Mirage, CA 92270 Cell: (760) 805WOM 250-I &S,% ` . Email: RKrown6237Qaol.com CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page 1 of 7) - CF -411 i 10AI.3 Ak- -res-ril�c • � � ,��• vj " ` Pr'itle 7 Da 7o w // Qui �� / S u�►,t P Project&ddless lauilder Na e --1 y )-dam—N wick (70 0) W � 5- ;07 _S&az -,C-4 , Builder Contact Telephone Plan Number eAAIZD r. w 2 GA 2o1Je # HEog7Rat r Telephone Sample Group Number 43 Certifyi g Signature �-" L Date Sample House Number EQ Firm: Pe6'f F,�IELCjY dE2VI CES •', HERS Provider: e -A F—E-1'S. Street Address: Ro . Boa( G2I City/State/Zip: rA�I,T NO M,R�ACE7D 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, 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 -611 (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" - t Duct Pressurization Test Results (CFM Q 25 Pa) values r A:- • , - - Test Leakage Flow in CFM If fan now is calculated as 400cfm/ton x number of tons enter calculated s. • _ { value here - If fan flow is measured enter measured value here - • Leakage Percentage (100 x Test Leakage/Fan Flow) y� Check Box for Pass or Fail (Pass=60/o or less) IR r, ❑ Pass Fail ❑ THERMOSTATIC EXPANSION VALVE (TXV) ❑ Yes ❑ No Thermostatic Expansion Valve is installed and Access is i provided for inspection. _ - ❑~ '`� ❑ ' 7 Yes is a pass Pass Fail Dwam ENERGY == �AaE� -. " P.O. Box 621 Ph/Fax (760) 564-2044 Rancho Mirage, CA 92270 Cell: (760) 9050M 2 Email: RKrown62370aol.com CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7) " : CF-41R Projec Title Da 2 7 0 0 et. 51D All Qu k Projec�t d� ss uilder Na e : s 1 J1 N NAkkic-k %loo 0?�5'-�'3�7 Pv�.�i" SG,2• c y Builder Contact Telephone Plan Number# 71 - - aw4 Moo 250-1 A�52 G t2oy� H R er Telephone Sample Group Number #GGI�( 132°12. 1 44 ehify ng Signatures-" ate Sample House Number .,t Firm: P"F-'_'r �,1,IEQGY 6E2V1 C-E3 HERS Provider: G.8-F—F P-15 c Street Address: PO . E6$ G2I City/State/Zip: 640-901119W- •052270. J 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, 1 certify that the houses identified'on this form comply y ' with t e diagnostic tested compliance requirements as checked on this form. ,_,/The installer has provided a copy of CF-6R (Installation Certificate. ' `Ito Distribution system is fully ducted (i.e.. does not use building cavities az plenums or platform returns in lien 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 f A ' Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage) s Measured Duct Pressurization Test Results (CFM Q 25 Pa) 'values a Test Leakage Flow in CFM If fan flow is calculated as 400cfm/ton x number of tons enter calculated ' value here 4,00 ' ' z a ,. 7 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) v. a.: ❑ r Pass Fail THERMOSTATIC EXPANSION VALVE (TXV) Thermostatic Expansion Valve is installed and Access is ❑ Yes ❑ No ; provided for inspection. ` " Yes is a pass 4 'Pass' Fail o ' , (Page 3 of 13) CF-6R t INSTALLATION CERTIFICATE (P 3 L) 1�7LVIA %I Permit Number 5ite:Address ' V•C�� _....:' DUCT LEAKAGE AND DESIGN DIAGNOSTICS DUCT LEAKAGE REDUCTION 7Pressurization Test Results (CFM @ 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 ❑ ' 1 Pass Fair ❑For AEROSO4TYPE 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 pressurisation test - ❑ D Yes ❑ No [3 Visual Inspection of Duct Connections pis Fair THERMOSTATIC EXPANSION VALVE (TXV) ❑yes ❑ No Thermostatic Expansion Valve is installed and Access is " ❑ ,�r provided for inspection Yes is a pass Pass Fail ❑ DUCT DESIGN 4 1 ❑Yes ❑ No ACCA Manual D Design calculations have been completed, Duct Design is on the plans and duct installation matches plans. Z , [ ❑Yes [3 No T is installed or Fan flow has been verified. -If no TXV, verified fan flow matches design fromMeasured Fan Flow a . ❑ [3 Yes for both I and 2. is a Pass Pass Fail performed associated with the test(s)•is.in ❑ 1, the undersigned, verify that the above diagnostic test results and the work 1 of the requirements for compliance credit: (The builder shall provide the nEta provider.eet theprequiremen 6R. conformance with theostic testing and. signed by the builder employees or sub-contractors certi ing that diaS° ` for compliance credit.] I Iris Ilia Subcontractor (Co. Name)"OR } Tests a Si ate General Contractor (Co. Name) ' Performed COPY TO:Building Department • HERS Provider (if applicable) Building Owner at Occupancy INSTALLATION CERTIFICATE (Page 3 of 13) Permit Number, Site.Address < 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). a Pass if leakage fraction :5 0.6 ❑ Pass ' Fail fl 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 0 , [] Y� (] No Vis al inspection of Duct Connections Pass Fail F ❑- THERMOSTATIC EXPANSION VALVE X Yes ❑ No Thermostatic Expansion Valve is installed and Access is provided for inspection Yes is a pass Pass Fail ❑ DUCT DESIGN 1 ACCA Manual D Design calcuiWons have been [3 Yes [3 No - _ c completed, Duct Design is on the plans and duct installation matches plans. TX ❑ V is 'installed or Fan flow has been verified. If no TXV, 2: [3 Yes No' verified fan flow matches design fromMeasured Fan.Flow a Yes for both l and 2. is a Pass Pass Fail that the above diagnostic test results and the work I performed associated with the test(s) is in - ❑ I, the undersi�rted, verify p p of the CF -6R. conformance with the requirements for compliance credit. [Thai adoer ht�ic pte�st geand. nstallationvmeet the requirements signed by the builder empl ees or sub -contractors certifying for compliance credit.] • 1, tall, Su contractor (Co. Name) OK Tests t re, Date ,General Contractor (Co. Name) performed COPY T0: Building Department ti HERS Provider (if applicable) , Building Owner itoccupancy INSTALLATION CERTIFICATE (Page 3 of 13) GF -6R Permit Number ' Site.Address . DUCT LEAKAGE AND DESIGN DIAGNOSTICS - DUCT LEAKAGEREDUCTION ssurization 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 3 For AEROSOL TYPE SEALANTS ONLY - The following diagnostic testing was core .:pitted: ` Duct Fan Pressurization at rough -in measured leakage (CFM). CHECK AFTER FINISHING WALL: ❑. Yes ❑ No ❑ Pressure pan test or House pressurization test 0 [3 Yes ❑ No ❑ Visual Inspection of Duct Connections pass fail ❑ THERMOSTATIC EXPANSION VALVE (TX . ❑ Yes ❑ No Thermostatic Expansion Valve is installed and Access is 13 a provided for inspection yes is a pass Pass Fail ❑ DUCT DESIGN 1 13 Yes ❑ ACCA Manual D Design calculations hand been -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, verified fan flow matches design from CF -1R Measured Fan.Flow = . ❑ ❑ Yes for both 1 and 2. is a Pass Pass Fail sin with the • undersigned, verify that the above diagnostic test resuhs and the worklape>fie HERS Prov drmed era copy of the(CF-6R: ❑ I, the un . he conformance with the requirements for compliance credit. ['Iit�a`diagno shall testing and. installation meet the requirements signed by the builder empl s r sub -contractors certifying for compliance credit.] 4ns2lnil g Subcontractor (Co: Name) OR Tests t a ,Date General Contractor (Co. Name) Performed COPY T0: Building Department HERS Provider (if applicable) Building Owner at Occupancy . nw • it . j , � i r ,.. ? '� . x i'. � , • _ _ _ . r - - • t t j- . y• e - ��''' p, y •Gk `r-''�' `{ -'�- .r, d1 �• s •, �,, L •` . �:• .. - _ -{'.` e , '� �`' ^•_ '`. .: i. �y' - �. ' ..-,r � " ii"- �' '.. 'w .. ~� . r �, : � } r• . i it • Y '-� • � r"• - r ' .• ._ ,., /f//!/!//U.U!/.%//l/,!/.!/U!/UI!_,'!/U/,!/.l/.1//!/:V/U/////!/U/f//U/U////f//f//!/I/.!/.lJ/U/!//!/%//!//!//U/U/!////•!//!/.!//U/fI%/.f/l/U/!//!/!//U////U////f/.!/U11.%/%/•UUU:!/.'f//nI//U!//d!/f//U//I•l///J!//U/+//U.!//!/!//U/f/.%//l/%/%� 'INSULATION CERTIFICATE• - #; 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: 50-415 VIA SIN PRISA, LOT 53,LA QUINTA ,CALIFORNIA J s CEILINGS:. J TYPE:BATTS MANUFACTURER: CERTAINTEED THICKNESS: R-38 - `� WALLS: _ • TYPE : BATTS MANUFACTURER: CERTAINTEED THICKNESS: R-24 # i GEN L ONT C O : RJT ES LICENSE Lo - I3 r r;. TITLE: ��i W4 & -tj '' '. Dw g(y. +y. li!Fwlr-� ,. "..�', ..��r+•- t •�. .Yt. -` ,. _.. n... .,.5 '• '?. f`,.+' .,,1.`r` .•..-. ' M ..y.. •h .. T� .y -. " NBUILDING' PRODUCTS; A MASCO COMPANY LICENSE # 632072 . P SCHMI�D g ;- TITLE. 'ADMINISTRATIVE ASSISTANT DATE: 11/13/2003 • "t ' `.. a .r. _ ., - . r+ . ' _ VT ,� - •Q - + � n .► I, j ♦\ � r ' • T f,yy •, S�.•U �`% • 4i r •I , r ` �,•'��•♦ = _ �' .�x•�• .u- � . n, u.,.'•+wry-� • .sat F � 17, �' � , � .k� N ' �g 'i� '� { ` - "r r' ' + •�'e � * � 1 � 1 a F „ • � i z • ' .. c . • kk 41. t` t, Fi•' f • • 'i ",� 7?' : N .i'1 , .,.a �' t .. a kf. •:tr ... . k t - . t �i,Yw • i .. ♦ : t ' ' •y '.. . � i •, Y ` , -.. • . �' .i •. ''i ` . + \T .. • ; 1 . _ ` ^ • t' ... , � ! r . ,, y. j r� _• 1.. •