0206-217 (SFD)[p LICENSED CONTRACTOR DECLARATION r
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 # Lic::•CI'ass Exp. Date
Date s �� ' r /Signature of Contractor'a ,
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
X 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:
( ) 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.
(� I have and will maintain workers' compensation insurance, as required by
S4ction 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:
Cairier fi' PARI 'T Policy No.
(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 ["should become
subject to the workers' compensation provisions of Section,3700 of -the Labor
Code, !shall fo Awlth comply with those-orovisions. 1/F
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, indemnity
& 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:
/f
/ner/Anent),- ✓/ f '` Date
BUILDING PERMIT• PERMT#
/ M6-21 7
DATE ., X VALUATIONLOT 17 TRACT BILK 187
JOB SITE
ADDRESS 151-300 AVEMA. ORREGO ti�
APN 774-07 07
OWNER
CONTRACTORDESIGNER /EN (NEER
COVEJLrlTIMiVT
eCVriypHoYfS
2214 R RJDk-'_EV00D
4 7-? ? s 0 AD -AN lIT XET M22
11.W1-A.AN.A. CA
qnUTA CA 92253
(760)564-'7820 CSU! OZO63
USE OF PERMIT
M401M F.AFM11�Y !JWE I I N'G
SFD . NI RAOT DOS NOT II+iF:1. UDE BWCK WALL!; POOL, SPA 1-12
DPAIMAi' APPROACH 730.. PiA3 C1WX REF, REDUCTION POR :MUTIPLS
PI;F.MITS OF SAME PL,f2;?.I TYPE.
TRACT CONSTRUCTION 1,351,00 Sly
PORCHIPA'TIO 44,00 SP
r
GAIxA021C.A.R.°CrRT 461N.00 S'V
D C0.711 Cyr, MMMY7M:'i1f. K
xFgMIt1.'.1';
C':ONS'9'ILt1CTI(M ITIF 101-000418-000 HAM)
1't AN Ch SCK FFR 1,01-000439 -319 $07.90
'RE MPOSIT 101-000.439.318 42%04
l;rll:CHA N 1Z AL. ME 101-M-4-21-000 $60.00
,
E1,W-TI t1C`AL FFL; 101-000.420.000
1b1..CDMBI NCI FEE 101 -OW -4.I9-000
STRONG MOTION FER - IZUID 101 X00.241-'000 $10.58
5.11'AT INCI FIT? 101-000,423-000 $15.00
D.EV'L1.ONNR 1M.RACT RE S1A:C14
PRECISE PLAN 101-ObO-441-34 5 �lfras.ni►
;
a fv-`r _ NUMiaMON AND k'.i. � N G`-W,.CT:
A
53,150.18
TZ03 PRE -P= MO
42. moo
P1a•RM'Y' Fm IS 111QCJ VU1A'coof
pINPe1C°Eo _
REGEIPT
DATE J
//
BY t-
DATE FINALED
INSPECT
w
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
` BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
of -0
Ducts
Slab Grade
�
Return Air
Steel
Combustion Air
Roof Deck
lj
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
—U -
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
i
Final
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
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Water Piping
Plumbing Top Out
?
Heater. Final
Plumbing Final
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
_oyf • b Z ,Q((/
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
_
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)
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 # Lic. Class Exp. Date
773230 B 05/31/2(
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).
( ) 1, as owner of the property, am exclusively contracting with licensed
contractcrs'to `construct the project (Sec. 7044, Business:& Professionals
Code). ;
'OFI am exempt under Section' B&P.C. for this reason
Date Signature, of Owner
WORKEWS'COMPENSATION DECLARATION- ;a
I,hereby;afflrmAunder penalty of perfury on'e'-of the following declarations:
(' )' I have and'will maintain -a certificate of:consent to self=insure for workers'.
compehsatidn a's prbJidei for,by.Sections37.00M1'of*.the,.Labor-Code; foccthe
w
-performance: of fh'e'ork:forwhlch+this permit Isl§sued.
( ) 1 .have`and,wlll maintain workers compensation insurance asrrequired by
Sectiori 3700 of 'the LaborCode,`for the',performance of. the,work for .which Ythis
permlYis assued My workers compensation Insurance carrier & policy `no. are:
Carrier., EXEMPT' Policy.Nq.
(This 'section `need not be'completed if the, permit valuation is for $100.00 or, less).
O I certifythat in the performance of -the work for which this permit is issued; .
I -shall not employ any person in any.manner so -as Wbecome subject to'the
'workers': compensation-'lawsvof California,, and agree that if I .should become
Subject to the Workers';'compensation•'provisions of Section 3700 of the Labor
;Code, I shall forthwith complywithahose.provisions.
Date: Applicant
Warning.:, Failure to secure Workers Compensation coverage is'unlawful and
shallsubject, an --employer to criminal penalties and civil fines up to $100,000, -in
.addition to the cost of compensation, darriages-as provided for,in Section 3706
'of the Labof7,Coclejnterbstand 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
&`t5old 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) Date
.Lr
BUILDING PERMIT PERMIT#
0206-217
DATE VALUATION $110,286.90 LOT 7 TRACT BLK 137
JOB SITE
ADDRESS 53-330 AVENMA OEIR CION
APN 774-075-007
OWNER
CONTRACTOR / DESIGNER EN
ESIGNER/EENINEER
COVE DEtlELOPI
LEGACY HOkCES
22141-7, RM T_FWOOI)
47.750 AT)AMS 022$
SANTA ANA � iA
LA QUINTA CA 92253
(760)564-7320 CBL4 . ?2063
USE OF PERMIT
SIN[J? E• FAN= DWELLDNCT
SFD - PERMIT DOES NOT -INCLUDE BLOCK WALLS, POOL, SPA OR
DRIVEWAY APPROACH. 775%.PLA:14 CHECK FEE REDUCTION FOR IMIUTIPLE
PERMITS - OF. SAME PLAN TYPE.
TRACT'CONSTRUCTION' `; I,S31:00 SF
PQRCHIPATIO 44.00 SF
GARAGEIC'ARPORT - 469,00 13F
r -1 STLMATED COST OP CONSMUC 100
110,286.90._
PERA4rI FEE 3UT1104ARY `
CONSTRtjCT:ION FEE 101 -t000-413-000 $660,,50
PLAN CHECK`FEE 101-006=439-3'18— v $137:80•,
'
FEE DEPOSIT 101-000-439-3'13. -$240,,00 .
MECHANICAL FEE 1.01-000=42,1-000'
•
ELECTRICAL FEE,. 10j 000,-420-000 .. $123,30'
PLUMBING FEE 10.1-000-419s 00 $136:00.
-
`+ f
STRONG MOTION FEE RESID 1:01:-000-241-.000
nPan?NG FEE. 101-000-423-000 $Ig.04
bEVE66PER IMPACT FEE £1,997,00
PRECISE PLAN 101-006-;441-345 $100.00
SUB -TOTAL CONSTRUCTION AND PLAN C-FIECK
$3,150:-18
LESS PREE-PAID FEES
. -$250,00
TOTAL PER= FEES DVEE NOW
9
$2,9(_10,1€1
,
RECEIPT
DATE
BY
DATE FINALEO
INSPECTOR
t
Building 2�
Address
V144Q
P.O. BOX 1504 APPLICATION ONLY
7 495 , CALIFORNIATAMPI2
JIYg1�UINTA, CAIORNIA 92253
`" Li E--`°"'`"" r we "`� �' BUILDING: TYPE'CONST. OCC. GRP.
Mailing I 7� V d? D 6) 1
Address � !)d A.P. Number /
CityC %-70
Tel./ 2 /o 7
>1110 4MIit- V 3, 5 306 Legal Description��Contractor Project DescriptionsC/
Address We
Xb C
' "y u/a-T-yr ' T)7-�3/
State Lic. City
& Classif. 2 �U Lic. #
Arch., Engr., �
Designer
Address Tel
CityZip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
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 to construct, allot, 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 (5500).
i -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.)
l l 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 contractors) licensed pursuant to the Contractor's License Law.)
I'] I 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 sell -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
r] Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COM PENSATIONINSURANCE
(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
I hereby 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 sof this city to enter the above.
mentioned property for inspection purposes.
Signature of aQplicant Date
Mailing Address
City, State, Zip
Sq.
No. No. Dw.
Stories Units
I Nepld— Add ❑ Alter Of Repair ❑ Demolition ❑
i Sk I"ID vr"cn_c-Gz �7 v-- '� 36 S�
Itimated Valuation
PERMIT
Plan Chk. Dep.
Plan Chk. Bal,
Const.
Mech.
Electrical
Plumbing
S.M.I.
Driveway Enc.
Infrastructure
TOTAtf
REMARKS
AMOUNT
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 INSPECTOR
Issued
Validated
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING
CITYOFLAQ 14TA
FINANCEDEPT
i
NOV-01-2002 08:25 AM P.02
CERTIFICATE OF FIELbD V.ERIFICATXON-AN6,6iAGNOS'TYC TESTING -u C)~ -4R
Pret Tolle
Date"',
3 .3-�b.,�D� oJvt „. G-�1'.4'4•N �41t�is
Pro eyytt Address Guild Nam r T
3i,d CTelephone• '�" Plan Number _
r+ERS Raler Telephone Sample=Group Number
,qfnifying Signature Date Sample, House Number
rm __�G'1�S5dc, F K
__ HERS Provider;
Street Address:7���4 •.� Ci r
�✓ CItylStete/Zip
7�opie5 !oBuilder, HERS Provider
HERS RATER -COMPLIANCE ST61-EMQM
Tne noose. was: Tested" 'D' Approved as part of sample testing, but was not tested
As the HERS rater:providing diaggnosticlesting a nd.field'verifioation, I certify that the houses identified on this form
comp) with the diagnostic lested''compllance, requirements as 0e 6c1 on this'form.
Astribution system is fully'dupted (I,e:, does not use bullding cavities as plenums or platform returns in lieu
of ducts) '
,&Where cloth backed, rubber adh®sive duct tape is�installed,rastic a4drawbands are used in combination
w:tr cloth backed, rubber adhesive duct tape tos9al leaks.at duct`connections
J?I"M-INIMUM REQUIREMENTS:_FOR DUCT LEAKAGE. REbUCTIOWCOMPLIANCE-CREDIT
Duct Diagnostic t eakage Testing -,'Results (Mazlmurri'6%.'Duct Leakage)
Measured
Duct Pressurizallon Test Results (CFM•Q 25 Pa)
values
TestLeakbge;Flowln CFM b'
if fan flow is calculated as 400cfm/lon x nper. bf:tons enter
r `cumalculated value here
If fan flow, is measured enter measured value, here
Leakage Percentage (.100 x Tes(Leekage/Fan Flow)
Check Box for Pass'or.Fall (Passg6?/P or•,less) ❑
Pass Fail
I-THERMOSTATIC�EXPANSION VALVE (TXV)or Commtsston�'approved.equivalent
l(Yes ❑ No Thermostatic Expansion Valve (or Commission .approved
equivalent) is installed and'Access'isprovided for,inspection
Yes .isr a pass
❑ MINIMUM REQUIREM ENT$,FOR•DUCT DES(W COMPLIANCE -,CREDIT
0 Yes Q No ACCA-Manual D Desl®n=requirerri`enfs'have been met
(rates has.' that actual Install tlohmatches values in
CF -1 R and'd.esign on plan,..>•.
2. 2 Yes, 0 No` ";TXV-Is;installed'or Fan flow ht�sebeen verified, If no TXV,
.verifled.1fan.flowmatche's design,trom=CF71R.
Measured Fan Flow =
Yes. for both 1, -and 2 is `E=Pass
ass Fail
Pass Fad
I
' 'iiFi"St•
" CITY OF LA QUINTA SUB-CONTRACTOR LIST
JOB ADDRESS U��J
�%b�
-IERMIT NUMBER OWNER BUILDER,-
This form-shall be posted on the job with the°Bwldmg Inspection Card at all times in a conspicuous glace. Only persons appearing on this list,o� their: employees are authorized
to work
' , on.this.job. Any. changes,to'this
list-must be aPproyed'by Building Division prior to'commencement of work. Failure to. comply will result in a stoppage of
work and/or the
voidance
,
,.-
of building permit; For each'. dpplicable..trade,=all information 'requested below.must`be completed
by.applicant. "On File:' is not an acceptable:iesponse.
r
I ion::.::::
rrea�:.r::cLass�f yet.....,................................._...
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. _ _ .... .......
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License Number
Exp. Date
Carrier Name
Policy Number
Exp: Date
License Number
Exp. Date
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*(Certificate of Occupancy
City of La Qvinta
Building and Safety. Department
This Certificate issued .pursuant to the requirements of Section 109 of ' the Uniform Building Code,
certifying that, at the time of issuance, this structure was in' comp'' iance with the various ordinances'
of the. City regulating building construetion or use. For the following:
BUILDING ADDRESS: 53=380 AVENIDA:.08REGON
.Use Classification:. SFD Bldg.. Permit No.: 0206-217
:Occupancy Group: R-3, U=1 Type of Construction: VN Land..'Use Zone: RC
Owner of Building: COVE DEVELOPMENT
Building Official
Address:
2214 N. RIDGEWOOD
City:
SANTA ANA, CA
By:
K. KIRKLAND
Date:
11 /6/2002
POST IN A CONSPICUOUS PLACE