04-6567 (SFD)o� �iG[�f1�1ri�/
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BUILDING & SAFETY DEPARTMENT
cF _ 1,5 q4. (760),777-7012
OF 78.49�C . , AMPICO FAX (760) 777-7011
-Iy 'iA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
Application Number . . . . 04=00006567. Date 4/20/05
Property Address . . 54685 AVENIDA OBREGON
APN: 774-273-021-9 _000000 -
Application description-. DWELLING - SINGLE FAMILY DETACHED
Property Zoning . . COVE RESIDENTIAL.
Application valuation 127679"
Owner Contractor.
VICTORIA LOZANO Owner
54-765 AVENIDA RAMIREZ
LA QUINTA, CA 92253
Other struct info . . . CODE EDITION 2001 CBC
# BEDROOMS 3.00
FIRE SPRINKLERS NO
GARAGE SQ FTG 482.00
NUMBER OF UNITS 1.00
1ST FLOOR SQUARE FOOTAGE 2067.00
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e
M
P.O. Box 1504• �� VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 4INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: Oy — 6 56 2Date:
Applicant: I Architect or Engineer:
Applicant's Mailing Address:
Architect or Engineer's Address:
Lic. No.:
0141,,
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S 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 Class License No.
Date Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed
statement that he or she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business
and Professions Code) or that he or she 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).):
44 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 and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work
himself or herself or through his or her own employees, provided that the 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 or she did not build or improve for the purpose of sale.).
U 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors'
State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to
the Contractors' State License Law.).
U I am exempt under Sec. , BA P.C.Xrla
his reason
Date Owner l` .0 2-01 h 0
WORKERS' 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 Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued. My workers' compensation insurance carrier and policy number are:
Carrier Policy Number
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
1,'717
th comply with those provisions.
Date Applicant
WARNIN : FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($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.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name
Lender's Address 0 A
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this 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 application, the owner, and the applicant, each agrees to, and shall, defend, indemnify and hold harmless the City of La Quinta, its
officers, agents and employeesfor any act or omission related to the work being performed under or following issuance of this permit.
2. Any permit issued as a result of this application becomes null nd v d 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 cancel tion.
I certify that I have read this application and state that the above in atio is correct. I agree to comply with all city and county ordinances, and state laws relating to building
construction, ;hyere yauthorize representatives of this county nt pon the above-mentioned property for inspection purposes.
Date Signature (Applicant or Agent):
------------------- I ---------------------------------
Application Number . . . 04-00006567
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Permit . . . .
Additional desc . .
Permit Fee . . . .
Issue Date . . . .
Expiration Date . .
BUILDING PERMIT
�x
737.50
10/17/05
Plan Check Fee . . 479.38
Valuation . . . . 127679
Qty Unit Charge
Per
Extension
BASE
FEE
639.50
28.00
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3.5000
THOU BLDG
100',001-500,000
98.00
Permit .
. . . . .
MECHANICAL
Additional
desc
Permit Fee
. . . .
65.50
Plan Check Fee
16.38
Issue Date.
. . . .
Valuation . . . .
0
Expiration
Date
10/17/05
Qty Unit Charge
Per
Extension
BASE
FEE
15.00
1.00
9.0000
EA MECH
FURNACE <=100K'
9.00
1.00
9.0000
EA MECH
B/C <=3HP/100K BTU
9.00
4.00
6.5000
EA MECH
VENT FAN
26.00
1.00
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6.5000
EA MECH
EXHAUST HOOD
6.50
Permit . .
. . . .
ELEC-NEW RESIDENTIAL
Additional
desc
Permit Fee
. . . .
111.99
Plan Check Fee
28.00
Issue Date
. . . .
Valuation . . . .
0
Expiration
Date . .
10/17/05
Qty Unit Charge
Per
Extension
BASE
FEE
15.00
2067.00
.0350
ELEC
NEW RES - 1 OR 2 FAMILY
72.35
482.00
.0200
ELEC
GARAGE OR NON-RESIDENTIAL
9.64
1.00
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15.0000
EA ELEC
TEMPORARY POWER POLE
15.00
Permit . .
. . . .
PLUMBING
Additional
desc
Permit Fee
. . . .
147.00
Plan Check Fee..
36.75
Issue Date
. . . .
Valuation . . . .
0
Expiration
Date
10/17/05
Qty Unit Charge
Per
Extension
BASE
FEE
15.00
13.00
6.0000
EA PLB
FIXTURE
78.00
1.00
15.0000
EA PLB
BUILDING SEWER
15.00
1.00
7.5000
EA PLB
WATER HEATER/VENT
7.50
1.00
3.0000
EA- PLB
WATER INST/ALT/REP
3.00
1.00
9.0000
EA PLB
LAWN SPRINKLER SYSTEM
9.00
6.00
.7500
EA PLB
GAS PIPE >=5
4.50
1.00
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15.0000
EA PLB
GAS METER
15.00
Permit .
. . . . .
GRADING PERMIT
Additional
desc
Permit Fee
. . . .
15.00
Plan Check Fee
.00
Issue Date
. . . .
Valuation . . . .
0
------------
' Application Number .
---------------------------------------
. . . 04-00006567
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Permit ." . . . . .
GRADING PERMIT
Expiration Date
10/17/05
Qty Unit Charge
Per
Extension
--------------------------------------------------=-------------------------
BASE FEE
15.00
Special Notes and Comments
2067 SF. SFD PERMIT DOES
NOT INCLUDE
BLOCK WALL; POOL/SPA
OR DRIVEWAY
APPROACH
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Other Fees . . . . .
. . . . ART IN PUBLIC PLACES -RES
20.00
DIF COMMUNITY CENTERS -RES
97.00
DIF CIVIC CENTER - RES
366.00
ENERGY REVIEW FEE
47,94
DIF FIRE PROTECTION -RES"
97.00
GRADING PLAN CHECK FEE
.00
DIF LIBRARIES - RES
225.00
DIF PARK MAINT FAC - RES
5.00
DIF PARKS/REC - RES
502.00
STRONG MOTION (SMI) - RES
12.76
DIF STREET MAINT FAC -RES
15.00
DIF TRANSPORTATION - RES
1098.00
Fee summary Charged Paid Credited
Due
Permit Fee Total
1076.99 .00 .00
1076.99
Plan Check Total
560.51 250.00 .,00
310.51
Other Fee Total
2485.70 00 .00
2485.70
Grand Total c
4123.20 250.00 .00
3873.20
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
47950 Dune Palms Road � BERMUDA DUNES �
MIRAGE
Date 4/21/05 La Quinta, CA 92253 Cr,RANCHOIIAN WELLS
INDIAN WELLS
DESERT
No. 27101 - d� PALM LA QUINTA
(760) 771-8515 YOINDID
Owner Victoria Lozano APN # 774-273-021
Address 54685 Avenida Obregon Jurisdiction La Quinta
City La Quinta Zip 92253 Permit #
Tract # Study Area
Type Single Family Residence No. of Units 1
Lot # No. Street S.F. Lot # No. Street S.F.
Unit 1 54685 Avenida Obregon 2067 Unit 6
Unit 2 Unit 7
Unit 3 Unit 8
Unit 4 Unit 9
Unit 5 Unit 10 -
Comments
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions under 5
00 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile ho
mes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason:
This certifies that school facility fees imposed pursuant to
in the amount of $2.24 X 2,067 S.F. or $4,630.08 have been paid for the property listed above and that
building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued.
Fees Paid By CC La Jolla Bank/Homero Lozano Check No. 800308
Name on the check Telephone 272.0451
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Espe Lara Payment Recd 1$0.00
$4,630.08 Over/Under
Signature
NOTICE: Pursuant to Government Code Section 66020(d)(1), this will serve to notify you that the 90 -day approval period in which you may protest the fees o
r other payment identified above Will begin to run from the date on which the building or installation permit for this project is issued, or from the date on which
those amounts are paid to the District(s) or to another public entity authorized to collect them on the Districtfs) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original -Building Department/Applicant Copy - Applicant/Receipt Copy -Accounting
06/26/2006 .09:38 760-777-9972 VINCE COVIELLO PAGE 01
CERT.I.FICATE OF FIELD V'ERIFICATI.ON pec DIAGNOSTIC TESTING (Page 3 of S) CF -4R
Project Address
3
re -
BuilderN'am"e
v1 Grp 2 C�
Builder Contact— Telephone
Loix_ - . (9.bo
Plan Number
0 Q -_es�l
.v
HERS Rater / Telephone
Sample Group Number
Climate 'Lone t
Compliance Method (Prescri _
Certi i Date
Sample House Number
�.-gyp- �?...
)'IA-
A-_.
Firm
Firm
HERS Provider
l.,ua..
Date of Thermocouple Cali ration
Street dress:
o ,
Ci /State/lip:
tC - sJD
Copies to: BUILDER, HERS PROVIDER AND BUILDING DEPARTMENT
ITERS RATER COMPLIANCE STATEMENT
The house was: ✓[Nested ✓ ❑ Approved as part of sample testing, but was not tested
As the HERS rater providing diagnostic testing and field verification, i certify that the house identified on this form complies with
the diagi Qstic tested compliance requirements as checked on this form.
✓ The installer has provided a copy of CF -6R (installation Certificate).
✓ THERMOSTATIC EXPANSION VALVE (TXV)
Procedures for field veriTcation of thermostatic expansion valves are available in RACM, Appendix R/.
✓ ❑ REFRIGERANT CHARGE MEASUREMENT
Verification for Required Refrigerant Charge for Split System Space Cooling Systems without Thermostatic Expansion Valves
Outdoor Unit Serial #.
Location
Outdoor Unit Make
Outdoor Unit Model
Cooling Capacity,
Access is provided for inspection. The procedure shall consist of
Btu/hr
.Date of Verification
✓
Er're—s
❑ No
visual verification that the TXV is installed on the system and
Date of Thermocouple Cali ration
❑
(must be checked monthly)
installation of the specific equipment shall be verified,
Yes is a pass
Pass
Fail
✓ ❑ REFRIGERANT CHARGE MEASUREMENT
Verification for Required Refrigerant Charge for Split System Space Cooling Systems without Thermostatic Expansion Valves
Outdoor Unit Serial #.
Location
Outdoor Unit Make
Outdoor Unit Model
Cooling Capacity,
Btu/hr
.Date of Verification
Date of Refrigerant Gauge C libration
(must be checked monthly)
Date of Thermocouple Cali ration
(must be checked monthly)
Standard Charec Measurement (outdoor air drv-bulb 5.5 T and above):
Note: The system should be installed and charged in accordance with the manufacturer's specifications and installer verification
shall be documented on CF -6R before starting this procedure. If outdoor air dry-bulb is below 55 °F rater shall use the Alternative
Charge Measure Procedure
Procedures for Determining Refrigei-ani Charge using the Standard Method arc available in RACM Appendix R1)2_
✓ ❑ Yes O No A copy of CF -6R (installation Certificate) has been provided with refrigerant charge
measurement documented.
Residential Compliance Forms April 2005