0105-170 (SFD)LICENSED CONTRACTOR DECLARATION
I'hereby affirm under penalty of perjury that I am licensed under provisions of,
Chapl'6r 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect. r
License # Lic. Class i� Exp. Date
DatesI,
. ° ' `' Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that'l am exempt from the Contractor's
License Law for the following reason:
( ) I, as owner of the property, or m.y 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 A Professionals
Code).
( ) I am exempt under Section , B&P.C. for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations
( ) I have and willmaintain 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 S�,tl.`CI? FUND 2290940967f No. 229094 0ii957I
(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'agre9hat if I should become
subject to the workers' compensation provisions of Section 3700 of the'Labor
Coded shad forthwith comply with those, provisions r^
;
Dat,; , Applicant
Warnind: 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 oi� ; 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, repres ntatives of this City to enter upon
the. above- mentioned property for,inspectio- purposes. ,
/Signature (Owner/Agent) Date,
'BUILDING PERMIT PERMIT#
DATE r VALUATION LOT 0105.1, 70 TRACT
BLIC20 132
JOB SITE APN
ADDRESSAVEM
68100 ln. 0 RA3910 ' IRD KIS C-3
C°AMWRAL CECY.
I USE OF PERMIT
CONTRACTOR / DESIGNER / ENGINEER
S 1-37r AV I,T'.IL+A:I3.GRALID", W.i.(' 2, RMS.
i4 'A 922S3
0160)564.1866 Cir , S59
Sn..) ., KJ7,11d.11' DOES NOT f'NC:Z.:I.II)R, SI X)C K WALL, POOL OR DRI1►I 70"A Y.
APP.RfOA.CH
TR CI' CaNSZ'RUCTION 1,x'6"1.60 SF
PORC.:fV1;.A.1-10 21"71.00 SN'
5 TPKNCE Z1i0.' O.Lp
019J4J'lGMAR `ORT 469.00 SIP
5311B-TCYTAL', C<:11~7�1`7."WK T1'0N GUD1'i..A.M C',5-TF-.C.'K M,866.28
IDI n nn
_ .i..Tsa35 .i''i,.Fs,,PAiU FUS $0.00
I",Ki�i�.'.E. r JiMEN D1,11LC .Now
MAR 2 0 2002
CITY OF LA QUINTA
FINANCE DEPT
RECEIPT I DATE BYY DATE FINALED INSPECTOR
Za ctae
P"> "UT Fm Sit tNUR
CONSTRUC°T)ON FrX,
1.011-000,418-000
PLAN CHIa.'CK ITIM
1("I ••%i70-419-318
$616.58
MF.:G"F1.AP1TC AL, FU
101-000-421-000
$60.50
i d..Er:`1'1'Z.IC.;AL IPPS
101-000-420-000
$119.7:
PLUM13Y00 Tru
101-000.419-0100
$340-00
S` ROl+di11z OT'10N FEE - 1iL.i)D
101-000-2,41-000
$10.97
M I)MO F",
I CI t -C1 O -1.23-0f30
$20.0
$ ZVE1. WPL?R I.M1'ACT F",
y1,90.00
PRIXISE PLAIN
101-0 00—'M 1.345
$100.0¢0
y.
5311B-TCYTAL', C<:11~7�1`7."WK T1'0N GUD1'i..A.M C',5-TF-.C.'K M,866.28
IDI n nn
_ .i..Tsa35 .i''i,.Fs,,PAiU FUS $0.00
I",Ki�i�.'.E. r JiMEN D1,11LC .Now
MAR 2 0 2002
CITY OF LA QUINTA
FINANCE DEPT
RECEIPT I DATE BYY DATE FINALED INSPECTOR
Za ctae
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
- BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
i
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
- O sy
Exhaust Fans
O.K. to Wrap
. p
F.A.U.
Framing
.p 7j
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lathe_
Drywall -Int. Lath
Gam`
Final
Final
_ _ _
7
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
Water Piping
/ ��i
O �` I°G�
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower PansZ__
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
312- y/ _
Pool Cover
Encapsulation
Gas Piping
Gas TestZ.
�!
Z=2
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas) 3
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) I/v
i
t�l�cv
P.O. BOX 1504 APPLICATION ONLY
Building>~ ' 78-495 CALLE TAMPICO
Address -% 4-0 /111-6 MQUUINTA, CALIFORNIA 92253
(BUILDING: TYPE'CONST. OCC. GRP.
Mailing� G P
d , A.P. Number
c._!`{YXicc�sv - �. �V '`- "-' �
Address
City! _ ZipTel.
j 72 4-. 7j,o, i vZeZ Legal Description s I f SWC (I/Uf%J z
Contractor Project Description
�n.�l.� �•Filji''C...I��S' t �. • `�'ti t-'r� r�C T.t..C. .� � t -'i �� ' C /f l rc.:� ....� _.� f/
City Zip Tel _>6`r
State Lic. City
& Classif. �� j�r� Lic. if
Arch., Eng(,
.
Designer. %�
Addressr_ t / Tel.
-7170
OyZip State
7' L) C. Lst f� Cts " tr/7 Lia #
LICENSED CONTRACTOR'S DECLARATION
I her9byy affirm that I,am licensed under provisions of Chapter -9 (commencing with Section
a000))i����0000f DD'iviisiion 3 off/the Busf ess and Professions Co'de,.and my license is..in .ull f9r�ca ap�
SGNATURE / i d L;.--- - f t a DATE
OWNER -BUILDER DECLARATION b*=
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: /Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit [o construct, alter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for
the alleged exemption. Any violation of Section 7031.5 by Any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
I"" 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, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered for sale. If, however, the building
or improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
I I I, as owner of the property, am exclusively' contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractoris) licensed pursuant to the Contractor's License Law.)
i 7 1 am exempt under Sec. - B. & P.C. for this reason
Date Owner -
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
n Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of thg 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.
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation ,provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
Ihereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives -of this city to enter the above-
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
Sq. Ft. . y No. / No. Dw.
Size- / Stories 1 Units
New Cl'f Add ❑ ra Alter ❑ Repair ❑ Demolition ❑
I PERMIT I I AMOUNT
Plan Chk. Dep
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE,
Issued by:—
Validated by:
Validation:_
INSPECTOR
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
Permit
Desert•Sands" n' ifed School'District"
47 950'Dune°Palm"s`Road
Notice: �.: I,a Quanta; CA 92253
Document Cannot Be Duplicated'.., X7..60' 77;1 851`5
1.
CERTIFICATE OF COMPLIANCE •
Date -3/19/02 APN# 773-124-012
No. 23059 Jurisdiction La,Quinta
Owner NameHannes. Scherb`er E Permit# 0105-170
No. -51L740, Street Avenida Obregon Log #
City La:Quinta Zip.:, 92253" Study Area
. -
Tract # BLK2OU2 Lot;# 6 Square Footage 1767
Type of,Development ' Sin I Tamily Residence No. of Units 1
Comments New' Single'`Family Residence .of :1767 _sq. ft:
w ,6
At the. present tune;• the ;'Desert Sands - Unified School District does riot•. collect ; fees on garages/carports, covered
patios/walkways, residential additions under 500 square feet' - detached accessory structure`s-or replacement mobilehomes. It
has been determined the above-named owner is exempt from paying• schoolfees at this time•due t6 the following reason:
�-EXE"MP-TION NOT»APPLICABLE R
This certifies that school facility fees imposedpursuaht to ' Government Code 53080, in the amount of
2:14 X .-1;767 or V 3;781 38' the propertyhsted above and that building
,... .
permits and/or Certificates of Occupancy,for this square footage in=flus proposed project.rriay now be issued
Fees Paid,By' CC VIB _•A: P,,.,Lench Telephone 760/564-1866
Name on the check
By Dr."Doris• Wilson
Superintendent
Fee collected /exempted,by Crystal Scott. Payment'Received '' .$3,781.38
Check No 262073
Signature '
NOTICE: Pursuant to Assembly Bill 3081• (CHAP 549 STATS. 1996) this will serve`to'notify you that the 90-day.approval,period in which you'may protest the fees or other payment identified
above will begin to run from the dite`on'whi6h the building or:insta(latiorcpermit for this protect is_;sssued'or on which they are paid to the Dikrict(s) or to another public entity authorized to
collect them on the District('s)(s') behalf, whicheLer s earlieL
Collector: Attach a'copy of county or city:plan:check application 6rm to district ,copy for all waivers.'
Embossed Original- Building Dept./Applicant Copy - ilpplic.ant/Receipt : Copy Accounting
APF03-2001 1UE 12 1,5sPMVL'AW`tEPSyT(TLE PLM �JESERT:; rN; N� Z6C,3�! X072 P. 13
1tECORUING,REQUSSTEU BY Certified to be a true anoar°h ect coPY
A�tT,It]CAN`TITLF CO , , � a' a appears
ANcowims RLCORDEI) MAIL f0: ,
IiANNES SCHERBER 1 i
68'100 RAMON ROXD STE'C-8
CAT.HEDRALCITY;
Certific-a-tefoOccupancy
City OfLa.-Quinta-
Building and Safety Department
This Certificate issued pursuant to '=the requirements `of Section 109 of the Uniform _ Bui/ding %Code,
certifying that, at the time of issuance,; ttiis structure was incompliance �� h the varioussordinar�ces
of the City regulating bui/ding construction or use. For_1he fol%:wing:
BUILDING
ADDRESS:
51-740,AVENIDA OBREGON
Use Classification:
SINGLE FAMILY DWELLING
Bldg. Permit No.: :` 0.105-170
Occupancy, Group:
R-3 Type of Construction: .VN
Land Use Zone: RC
Owner of Building:
HANNES SCHERBER
Address:
68-100 RAMON ROAD; -STE. C-3
City:
CATHEDRAL CITY; CA 92234
By:
KIRK KIRKLAND
fb
Date:
APRIL 9, 2003
Building Official
POST IN A CONSPICUOUS PLACE
CERTIFICATE OF F
Project Title
Project Address
Builder ContA,d;:
er
LD. VERIFICATION. AND .DIA_GNOSTIC TESTING
". T.eleF
hone ' Sample Group Number
y///��
Date
Builder Names
Plan Number
CF -4R
,RoKifying'Signature,.':.7 to Sample House Number
Firm: HERS Provider:,.
, o Gl .�
Street Address: �S��D �/:✓�.��OY� .�,IYG 2� City/State/zip: G e/ O/d�
Copies to: Builder, HERS Provider
HERS RATER COM'R IANCESTATEMiENT
The house was: Tested' El Approved'aspart of sample testing, but was not tested
As the HERS rater providing diagnostic testing andfield verification, I certify -that the houses identified on this form
comply with the diagnostic tested compliance requirementstas checked on this form.
E6 Distribution system is fully ducted(i.e., does.not use building cavities as plenums or platform returns in lieu
Xof ducts)
Where cloth backed, rubber adhesive duct tape is installed, mastic and, drawbands are used in combination
with cloth backed, rubber adhesive duct (ape1o:seal1eaks 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 lQ�j
If fan flow is calculated. as 400cfm/ton x n6mber of tons enter
calculated value here,,.. �j O
If fan flow is'measured enter measured value here
Leakage Percentage (100 is Test Leakage/Fan Flow)
Check Box for Pass or Fail (Pass=6% or less)
OfTHERMOSTATIC EXPANSION VALVE
or Commission approved equivalent .
,KYes ❑ No Thermostatic Expansion Valve (or Commission approved
equivalent) is installed and Access.is provided.for inspection
Yes is a pass
❑ MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT
❑ Yes ❑ No ACCA Manual D Design requirements have been met
(rater, has verified..that actual installation matches values in
CF -1R and design on plan.
2. ❑ Yes ❑ No TXV is instahed;or Fan flow has been verified. If no TXV,
verified,fan.flow matches design from -CF -1k.
Measured Fan,Flow = —
Pass Fail
Yes for both' 1 and 2 is a Pass Pass Fail