04-6136 (AR)BUILDING & SAFETY DEPARTMENT
P.O. Box 1504 (760).777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
- 7-71
LA Q,PINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
APN:
Application description . . .
Property Zoning . . . . . . .
Application valuation . . . .
Owner
------------------------
RICHARD LAHEY
54607 RIVIERA
LA QUINTA CA,92253
04-00006136 Date 9/20/04
54607 RIVIERA
775-031-019- - -
ADDITION - RESIDENTIAL
LOW DENSITY RESIDENTIAL
15000
Contractor
------------------------
OWNER
---=-- Structure Information REM/ ADD 51. SQ.FT. -----
Construction Type . . . . . TYPE V - NON RATED
Occupancy Type . . . DWELLG/LODGING/CONG <=10
Flood Zone . . . . . . NON -AO FLOOD ZONE
Other struct info CODE EDITION 2001 CBC
FLOOD ZONE NO
FIRST FLOOR SQ FTG 51.00
-------------------------------------------------------=--------------------
Permit . . . . . . BUILDING PERMIT
Additional desc . .
Permit Fee . . . . 162.00 Plan Check Fee 105.30
Issue Date . . Valuation . . . . 15000
Qty Unit Charge Per Extension
BASE FEE 45.00
13.00' 9.0000 THOU BLDG 2,001-25,000 117.00
-------------------------------------------------------- --------------------
Permit . . . . . ELECT - ADD/ALT/REM
Additional desc
Permit Fee 16.79 Plan Check Fee 4.20
Issue Date . . . . Valuation . . . . 0
Qty .Unit Charge Per Extension
BASE FEE 15.00
51.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY 1.79
-------------------------------------------------------------------L--------
Permit ... . . . . MECHANICAL'
Additional desc
Permit Fee 30.50 Plan Check Fee 7.63
Issue Date . . Valuation . . . . 0
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:
Applicant:
Applicant's Mailing Address:
Date:
Architect or Engineer:
Architect or Engineer's Address:
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under enalty 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 Lic is in d effect. C
License Class �jGIJ License No,ZA DateO r/u,Contractor -- L i.
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).):
U 1, 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 I, 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. for this reason
Date
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
i sued M o cers' mpensation insurance came ar�d poliaorfSf4lbe �:
Came Policy Number GZ/C.i UJ V�l t� (� li
_ I certify that, in the performance of the ork 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, 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 r i ' ns.
4
Date r Applicant
If V
WARNING: 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
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, indemnity and hold harmless the City of La Ouinta, its
officers, agents and employees for 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 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 c nc Ilation.
I certify that I have read this application and state that the abov, info ation is correct. I agree to comply with II city and county ordinances and state laws relating to building
constructio , and he by authorize representatives of this cou ty t nter upon above -me o ad prop Ay for inspection purposes.
Signature (Applicant or Ag
Date en (•�((%y
Jr
Page 2
App lication'Number .
. . . . 04-00006136
Date 9/20/04
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 9.0000
EA MECH APPL
REP/ALT/ADD
9.00
1.00 6.5000
EA MECH VENT
FAN
6.50
-------------------------------------------------------------
Permit . . .
PLUMBING
---------------
Additional desc
Permit Fee
27.00
Plan Check Fee
6.75
Issue Date . . . .
Valuation
0
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 6.0000
EA PLB FIXTURE.
6.00
:'2.00 3.0000
EA PLB GAS PIPE
1-4 OUTLETS
6.00
-------------------------------------------------------------
Special Notes and Comments
remodel kitchen also
----------------------------------------------.----------=-------------------
adding:51 sq. st.
Other Fees . . . . .
... . . ENERGY
REVIEW FEE
10.53
STRONG
MOTION (SMI) - RES 1.50 .
Fee summary Charged
Paid
Credited
Due
Permit Fee Total
236.29
.00 .00
236.29
P1an,Check Total
123.88
.00 .00
123.88
Other Fee Total
12.03
.00 .00
12.03
Grand Total
372.20
.00 .00
372.20
Date
9/20/04
No.
26442
Owner
Richard Lahey
Address
54-607 Riviera
City
La Quinta Zip 92253
Tract #
Type
Residential Addition
Lot # No. Street
Unit 1 54607 Riviera
Unit 2
Unit 3
Unit 4
Unit 5
Comments Kitchen Addition
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
47950 Dune Palms Road
La Quinta, CA 92253
(760) 771-8515
S.F.
120 Unit 6
Unit 7
Unit 8
-Unit 9
Unit 10
APN #
Jurisdiction
Permit #
Study Area
No. of Units
4���1FIEDSC�o
,� cs� 1TIfU� o
Q BERMUDA DUNES,r'
rn RANCHO MIRAGE �(=J
INDIAN WELLS
PALM DESERT ,y
LA QUINTA ,.j
QINDIO
O
775-031-019
La Quinta
i
Lot # No. Street S.F.
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions under
500 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile
homes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason:
Residential Addition 500 Sq Feet or Less
EXEMPT
This certifies that school facility fees imposed pursuant to
Education Code Section 17620 and Government Code 65995 Et Seq.
in the amount of $0.00 X 120 S.F: or $0.00 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 Exempt - Paul Allen Smith Check No.
Name on the check Telephone 831-9879
Funding Exempt
By Dr. Doris Wilson
Superintendent
Fee collected /exempted
Signature
Sharon McGilvrey
/) / . I.
e—
Payment Recd
Over/Under
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 or
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 District('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original - Building Department/Applicant. Copy - Applicant/Receipt Copy - Accounting.
09/22/2004 12:05 7603462856
NEW 6X6.4?POST W/EXISTING
"5IMP50N" CB BASE
a. i —�—�
ErX15TING 2'-6"X2.'-6." -i--'
X2'-0" DEEP PAD I
FOOTING I
#4 CONT. TOP &. BOTTOM
I
SECTION
NEW 6X6 POST W/EXI5TING
"SIMP50N" CE3 'BA5E
11
PITCHFORD DESIGN
PAGE 01
NEW 4' CONCRETE SLAB W/ t
BARS @ 18" O.C. EA WAY @
OF SLAB
NOTE: SPECIAL INSPE
1 REQ' D BY DEPUTY IN'
APPROVED BY THE
•�' I BLDG DEPT.
I
I
I
r-- - -----------I
•I I
i
I
I
• I
•I
I E a �E;
EXISTING 2'•-6'X2'-6"' �� m
X2'-0" DEEP PAD I �A
FOOTING
PLAN
USE THIS DETAIL
IN LIEU OF DETAIL
S . 0'N SHEET 5
#4 BAR HIGH & LOW W/ 8"
EMBEDMENT INTO EXISTING
DRILL HOLES PER "SIMPSOP
& USE "SIMPSON" S.E.T. E
- ICBO #ER 5279
wrrw���w��rr
�ww��r��rw ww w
CITY OF Lfia e INTA
BUILDING & SAF,�I-1 DIEPT.
FOR CONSTRL; !TION
t/ 2f �/ !4
DATIff I ELD RE:V I �,LON 9-21-04
3
MID -HT
ION
CTOR
PAD
I" REQ .
;FOXY
A KITCHEN EXPAN51ON & REM DE,
MR. & MR5. RICHARD LAHEY
54--607 RIVIERA
LA QUINTA, CALIFORNIA
ROBERT A , ' P I TCHF R
D
DESIGN AND
DRAFTING
11-625 E(LE(TI( 5 T f -2
PALN 0f5E01 (ALIF0R IA
160 3 A 6 2856 92 60
FOF
MANDATORY MEASURES CHECKLIST: RESIDENTIAL (Pate t or 2) MF -1_R
Note: Lowriseresidential buildings subject to the Standards must contain these measures regardless of the compliance approach used.
!tents marked with en asterisk (• j may be superseded by more stringent compliance requirements listed on the Certificate of
into the permit documents, the features noted shall be considered by all parties es
Compliance. When this checklist is incorporated
e mandatory measures whether they are shown elsewhere in the documents
minimum component performance specifications forth
or on this checklist only.
t., ,.�,,,.:,..,a • rha,lr nr initial annlicable boxes when completed or enter N/A if not applicable.
DESCRIPTION
DESIGNER
ENFORCEMENT
I
Building Envelope Measures: +_
• $1,50(a): Minimum R-19 ceiling insulation.
§150(ti): Loose fill insulation manufacturer's Inbeled R-Voluc.
• § 1so(e): Minimum R-13 wall ittaulation in wtwd flamed wails or equivalent U -Factor in meta) frame walls
does not apply to exterior mass walls).
{
• §150(d); Minimum R-13 raised floor insulation in framed floors.
than 0.3%. water vapor transmission rate no
11
§150(1) : Stab edge insulation -water absorption rate no greater
grater than 2.0 inch. -
§118: Insulation specified or installed meets insulation quality standards. Indicato type and form.
§L16-17: Fenestration Products, Fxterior floors, and Infiltration/Exfiltration Controls
L Dom and windows between condititmed and unconditioned spaces designed to limit air leakage.
2.. Fenestration products (except field -fabricated) have label with certified U -Factor, certified Solar Heat
✓-'
Gain coefficient (SHGC), and infiltration certification.
3. Exterior doors and windows weatherstripped; all joint,; and penetrations caulked and sealed.
§I50(g): Vapor barriers mandatory in t timate Zones 14 and 16 only.
§150(f): Special infiltration barrier installed u, comply with § 151 meats Commission quality standards,
-�
§150(ey Installation of Fireplaces, Decorative dac .Applitutces and Gas Lugs.
I
. Masonry and factory -built fireplaces have:
I
a. Closeable metal or glass door
b. U.uside air intake with damper and control
c. Flue damper and control
WA
2. No cuntinuousburning gas pilot fights allowed.
I
Space Conditioning, Water Heating and Plumbing System Measures:
§� 110-§ 113: HVAC equipment, water heaters, showerheads and faucets coni Pied by the Commission.
§15(Klt): Heating and/or cooling loads calculated in accordance with ASHRAF. SMACNA or ACCA.
J
§150(i): Setback thermostat on all applicable heating and/or cooling systems.
i
§1500): Pipe and tank insulation
I. Storage gas water heaters rated with an Energy Factor less than 0.58 must be externally wrapped with
insulation having an installed thermal resistance of R• 12 or greater,
2. First 5 feet of pipes closest to water heater tank, ton -recirculating systems, insulated (R-4 or greater)
3. Back-up tanks for solar system, unfired storage tanks, or other indirect hot water tanks have R.12
external insulation to R-16 combined intemal/extomal insulation,
1 4, All bu ;A-er-exposed piping insulated in recirculating sections of hot water systems.
j S. Cooli g s tete. pyg`lu�v 55"-Fins+�tt d.
j i. Ti'i im3utr�i,%Gpgri,��_eatmg�s c nt indii t�m a c nkIV W. --'— --- ---- _I_
..--
---_-- _-J
- AP � � J�►=�-�,
DEPT
OF?
r
DA TE 71
5-9-106 V A i ✓
i ��
' MANDATORY MEASURES CHECKLIST: RESIDENTIAL (Page 2 of 2) MF -1R
Note: Lowrise residential buildings subject to the Standards must contain these measures regardless of the compliance approach used.
Items marked with an asterisk (•) may be superseded by more stringent compliance requirements listed on the Certificate of
i Cottgtliance. When this checklist is incorporated into the pemtit documents, the features noted shall be considered by ail parties as
minimum component petformancc specifications for the mandatory measures he
they are shown elsewhere in the documents
or on this checklist only.
Instructions: Check or initial applicable boxes when completed or enter N/A if not applicable.
DESCRIPTION
DESIGNER
ENFORCEIVIENT
Space ('onditloning, Water. Heating and Plumbing System Measures: (continued)
4
• §$50(m); Ducts and Fans
1. All ducts and plenums installed, scaled and insulated to most the requiremr..nt ofthe 1998 C.MC Sections 601,
603, 604, and Standard 6.3; ducts insulated to a minimum installod level of R-4.2 or unclosed entirely in
conditioned space. Openings shall be sealed with mastic, tape, aerosol sealant, or other ducttlosure system
that mean the applicable requirements of UL 181, UL I81 A, or UL 181 B. if mastic or tape is used to seal
openings greater than 114 inch, the oombitation' of mastic and either mesh or tape shall be used. Building
1
eav ities shall not be used for conveying conditioned air. Joints and scams of duct systems and Muir
components shall not be scaled with cloth hack rubber adhesive duct tapes unless such tape is used in
combination with mastic and drawbands.
2. Building cavities; support platforms for air bundlers, and plenums defined or constructed with materials
other than sealed sheet metal, duct board or flexible duct shall not be used for conveying conditioned
air. Building cavities and support platforms may contain ducts. Ducts installed in cavities and support
pladbrrns shall not be compressed to cause reductions in the ;ross-sectional area of Elio ducts.
3. Joints and seams of duct systems and their components shall not be scaled with clath back rubber
adhesive duct tapes unless such tape is used in combination with mastic and drawbands.
4. fixhauat fen systems have back draft or automatic dampers.
5. Gravity ventilating systems serving conditioned space have either autumatic or readily accessibtc,
manually operated dampers,
6. Protection. of Insulation. Insulation shall be protected from damage, including that due. to sunlight,
moisture, equipment maintenaucc, and wind but not limited to the following: Insulation exposed to
weather shall be suitable for outdoor service e.g., protected by aluminuntsheet metal, painted canvas,
f�
or plastic cover. Cellular foam insulation shall be protected as above or painted with a coating that is
water retardant and provides shicklinj from solar radiation that imi cause do elation of the material.
/
§I i4: Pool and Spa Heating Systems; and Equipment.
1. System is certified with 78% thermal efficiency, on-off switch, wcatherproo; operating instructions, no
electric resistance heating and no pilot light.
1. System is installed with:
n. At least 36" of pipe between filter and heater for future solar heating.
I b Cover for outdoor pools or outdoor spas.
3. Pool system has directional inlets
and a circulation pump time switch.
§ 115; Gas fired central furnaces, pool heaters, spa heaters or household cooking appliances have no
continuously burning pilot light. (Exception: Non -electrical cooking appliances with pilot < 150 Btu/hr)
§11?(f): Cool Roof material mectspecified criteria
—�
i Ligbting Measures:
Luminaires for general lighting in kitchens shall have lamps with an efficacy�olQls/wouor
greater for general lighting in kitchens. This general lighting shall be controlled by reac!lly
accessible lighting cvutrol panel at au eotrauce to the kitchen
1 _
§ 150(1)2.: Rooms with a shower or bathtub must have either at least one luminaire with lamps with an
otificacy of 40 lumens/wan or greater switched at the entrance to the room or one of the alternatives to Ills 1�
requirement allowed in § I50(k)2.; and incandescett'reccssed ceiling fixtures are IC (insu:ation cover)
1
approved I /
1
Com pFla—n Forms --- -- August 2001'--- --- -------------- A-6
CERTIFICATE OF COMPLIANCE:
LAIAe-1 T? FS4RtK .[r
7S4-40-7 �4V (�� L-4 /U l cjT. .
P"ttks
'p(T�'ta)� Z85
Method (Package or Computer) Climate Zone.
1 of 3) CF -IR
► .- zo -ems
Building Pcrmit #
Plan Chuck / Date
'Field Check / Date
GENERAL INFORMATI N
Total Conditioned Floor Area — _—ft'A► Average Ceiling Height: .— fl
Conditioned Slab Floor Area ft'
Building'rype: V' Single Single Family Addition
(check one or more) Multi -Family Existing -Plus -Addition
0
Front Orientation -7 _ North / South ast West / All Orientations
(input front orienbAierrin degrees from True Noah and circle ane)
Number of Stories t1
Number of Dwelling Units:
Floor Construction Type: Sla ised Floor (circle one or both)
RADIANT HA_R JER required in climate zones 2.4.8-151 Required for this submittal_ yes '-- no
HUII.DING ENVELOPE INSULATION Nf
Component Frame Type•
Type wd = wood
stl = steel
Cavity
Insulation
R -Value
Sheathing Total R-
Itisulation Value,
R -Value
Assembly Location/Comments
U-Fnctorl (attic, garage, typical, etc.)
Walt .--_- - _
U -Factor SH.GC Shading Art. Fins
Z
O
Wall .`.—
Front
Roof`—
_ ---
\ 1-
- ---- __ -_-
Rear
F
Roof
- -
Floor
Ri�1Ftt
S li t
�... •--•
-- --- -
Floor
_
Slab Edge
t ..-
77-
- -- - ---- --- -
- `•-"•=-"t "'� r'_�1:!1,x v-� :a�a�7 nrG nuc u_trCa ror a ween-�1'amea wall that meets cavity R -value
insylation requirements forthe Presctimti�c PaAeAw.
FENESTRATION
Fenestration
(hien- Aree
_ .au_wulll LG V IGGJ
Fenestration Fenestration Exterior Overhangs/
/T a/Pos.
tation W
U -Factor SH.GC Shading Art. Fins
Front
Front
Lefl
LeR
Rear
_ ---
\ 1-
- ---- __ -_-
Rear
F
---
- -
Ri�1Ftt
S li t
�... •--•
-- --- -
-_
_
,
Compliance Forms _ August 2001
t CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 2 of 3Z CF -1R
Ot t I—Z4D—CAI
Project Title Date
t HVAC SYSTEMS
Note: Input hydronic or combined hydropic data under Water Heating Systems, except Design Heating Load.
Distribution
Heating Equipment Minimum Type and Duct or Heat Pump
Type (furnace, heat Efficiency Location Piping Thermostat Configuration
ouma. etc.) , tAFIJE or HSPF) (ducts. attic. etc.) R -Value TVDe fsAt or rutckatte)
Cooling Equipment Minimum Duct
Type (air conditioner, Efficiency Location
hest pump, cva , cooling) SEER attic etc.) _
SEALED DUCTS and TXVS (or Alternative Measures)
CJ Sealed Ducts (all climate -zones)
(Installer testing and certification and HERS rater field verification required)
'rxvs, readily accessible (climate zones 2 and 8-15 only)
(installer testing and conification and HERS Rater or field verification required)
U Refrigerant.Charge/Air Flow (climate zones 2 and 8-15 only)
(Installer testing and certification and HERS Raterm field verification required)
OR
0
Duct Thermostat
Heat Pump
Configuration
(split or oackaecl
f1 Alternative to Sealed Ducts and TXVs (see.Package C or D Alternative Package Features for Project Climate Zone)
Climate Zone Window SHGC Window U -Factor SEER Heating
0
WA'rER HEATING SYSTEMS
Energy' External
Rated' Tank factor or Tank
Water Heater Distribution Number Input (kw (rapacity Recovery Standby' Insulation
T T e in System or Fttu/hr) (Vatlons Efficiency_Loos (%) R -Value
1. For small gas storage water heaters (rated inputs of less than or equal to 75,000 Btu/hr), electric resistance, and heat pump water heaters, list Energy _ -
Factor. For large gas storage water beat ere (rated input of greater than 75,(100 Btulhr), list Rated Input, Recovery Efficiency and Standby toss.
For instantaneous gas wafer heaters, list !;!cd input and recovery efficiencies.
SPECIAL FEATURES (add extra sheets if ncessary). Package C and D: TXVs, Sealed Ducts, Radiant
Barriers (see installation requirements for radiant barriers in Section 8.1.3:of the 2001 Residential Manual),
Package C: thermal mass (thermal mass type, covering, thickness. and description).
-WV'4.sb (D- b ��a 68-U, mss r.-oe &0xs1r"
_� 7-.- 3 is o. ��a vqac as,�:uU r-tcl t%,�K7`
Su Dc X16 taC. �rc� Cl1 ( )c�-" - L `�CtS[ cu i:::�r nz�
Compliance Forms 4 August 2001 -'------- — — - A-3
.ly�a�
CERTIFICATE OF COMPLIANCE: RESIDENTIAL
Project Title
COMPLIANCE STATEMENT
3 of 3) CF -IR
I-Zo-o4
This certificate of compliance lists the building features and performance specifications needed to comply with
Title 24, Parts 1_ and 6 of the California Code of Regulations, and the administrative regulations to implement.
them. This certificate has_been signed by the individual with overall design responsibility. When this certificate
of compliance is submitted for a single building plan to, be built in multiple orientations, any shading feature that
is varied is indicated in the Special Features/Remarks section. The undersigned recognize that compliance using
duct sealing and.TXVs requires installer testing and certification and field verification by an approved HERS
rater.
Designer or Owner (per Business and Professions Code) Documentation Author '
Name:
Name:
__-...�.,( -•— �
Title/Firm: JC�
r �'.^_j ---
Address; �_� !�_�� ' AAddress:
17
Telephone: ��/`� "1"r'� ..- .—_—____-- Telephone: _
Lie.
- —
ZO-04'
- --�` --— (date) (signature) (date)
Enforcement Agency
Name:
l Title:
Agency:.. --
Telephone: _ _ .----
(signature: stamp) — - -- _ -- -- -- (date)
Compliance Forms --- --- August 2001
A-4
Copy 1 JCM Inspections Copy 2 Project Superintendent Copy 3 Governing Agency Page I of
JCM Inspections
39725 Gatand Lane Suite F
L
Palmtqegert, CA 92211
JNSPECTION113
j,-",
Phone: 760-3�6-'5554 Fax:760-772-3895
INSPECTIONS
EPDXY INSPECTION REPORT
w Date.fJ_,-J
ProjectName:
.
i �
Project No:
r�
- �< �, � A ^ - 9Y nil .-A
a, C" r1�3
C_ Q_1
(XI
Project Address:
1. City:
. .1
}Title 24
A )Other:
_W5 UBC
J Ck
File #'
App#
[] D 1.1
E] D 1.4
Clion't: Sub -Contractor:
Other
General Contractor: y
-Architect, Structural Engineer:
C
CIN Grnt�,D
sn
_t -4'i A
e r% .1 el
E] Anchor Bolts Rebar
Weather.
Epoxy Type:,
s An.
Epoxy Shelf Life: �o_\) t
U n resolv.4 Items:
=42, -e-
RNone.
Hole Cleaning Method(s):
r
El See Below
Description of Work Inspected: r
Q. -4 C �A%rv)nr
ckl;�_ "'M,
t A
7—
C A-�
en ik rs n r r
\-%n r
7
A Nr -5,
r VA
qL
T.11 I A
A, - 4
An
.00
Work complies with written approval from Structural Engineer and ICBO Evaluation Report #
I hereby certify that I have inspected all of the above work, unless otherwise noted, and to the best of my ability I have found this work to comply with theapproved
plans, specifications -applicable building laws.
Final report issued at project completion.
Inspector: Jack Millin ICC Cert 0-i 841116-41
Contractor's Representative:
rficXt
Aillno��
Copy 1 JCM Inspections Copy 2 Project Superintendent Copy 3 Governing Agency Page I of
REGISTERED INSPECTOR'S WEEKLY REPORT
JON TANDY
37630 Medjool Ave.
Palm Desert, CA 92211
Office (760) 772-7192
Fax (760) 772-7193
Pager (760) 776-3338
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLY
❑ POST TENSIONED CONCRETE ❑ ASPHALT (leTHER OIG.
❑ REINFORCED MASONRY ❑ FIRE PROOFING
JOB;LO
REPORT SEOUENCE NO.
TV �SZ@UCTURE LA16
PERMIT N0.
DA�Pj
OI
(/ O AY OF WEEK
MATERIAL DESCRIPTION S
s�
ARCHITECT
S CTOR HRS. CHARGED
Ou ks
O
ENGINEER
ASSISTANTS HRS. CHARGED
INSPECTION GENERAL --SUB ---��� SUB
DATE CONTRACTOR 1'L7 CONTRACTOR
Pi�tUW\
IAti
COPY SENT TO CLIENT O
CONTINUED ON NEXT PAGE O
PAGE OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MV
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE
NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED
PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS.
�S��NATRE 0 OF REGISTERE INSPECTOR
J4 o • t �
DATE OF REPORT REGISTER NUMRFR
• f r
CITY OF LA QUINTA SUB-CONTRACTOR•L�LIST ����
JOB ADDRESS '' PERMIT NUMBER OWNER G BUILDER
This form shall be posted on the job with the BuildingInspection Card at all times in a conspicuous lace. Only persons appearing on this list or their employees are authorised to work
„a. ,.,,.ems +., +hic list mimt hp gnnrnvPcl by the Buildina Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance
f building permit. For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response.
9P
Ca ttitra t
State ConttaGt or s .410se
_
Wo rker s Com p ensatlon r1Sur ance
;.:.. y .1
1 ........
Company Name
Classification
(e.g. A, B; C-8)
License Number
(xxxxxx)
Exp. Date
(xx/xx/xx)
Carrier Name
.(e.g. State Fund; CalComp)
Policy Number
(Format Varies)
Exp. Date
(xx/xx/xx)
License Number .
(xxxx)
Exp. Date
(xx/xx/xx)
TV
Wr
L
IL
►�
t
/e , AG
L�
tt
aL
�d LIL a r1lil