9611-004 (AR)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
C 41957 133% `!'31./98
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
5816 (Sed. /U44, Business & Nrofessiohals Gode).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
O I am,exempt under Section , B&P.C. for this reason
Date //f -'" �'X, 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.
(Qr�Mave 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 °istsueNJ� Wily (workers' compensation insurance carrie r8 olicy no. are:
Carrier 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 I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
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, 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 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'Irelating to"the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property,for inspection purposes o' /
Signature (Owner/Agent) CL .S ��`> �' Date 1 f ' Joe,
• i:�Y•r1 .
BUILDING PERMIT
PERMIT#CONTROL°#.'•
}4 277
DATE VALUATION $.Fd.7x.xQ LOT'
TRACT
JOB sI E &27.5 IUVIMA
APN
ADDRESS
OWNER
CONTRACTOR / DESIGNER / ENGINEER
RULLPHI
2i MMRA
79-920 IIWS-�A DRIVE
1A01A1N A C.A. 92253
L&0UJW1!A CA 92253
USE OF PERMIT
GO ITIAi3
1 ESIDIRNTiAj, A!JWH.t N
q)-62.51FCj f TIC:, ST1:A-?
t rL5*� l X VAlJ 16 -Ai
. V`,i .K .�vl e.. �.1 Y.JY NW YFv/ v tvl.V
1.81•
k
�Y
Fi?y�i<Iii�laTED COM OF ONS D1MV,f 101N
C
14,72 .�`t110
PLAN CklfIrX £Ts)? 101-W)U-4."39-318
$05-30
r:'t*.1S'I1PUC II110N FEa +4 11010-41st
$162.00
iki}:::: 1AN1C: tUt I; €'E 11111 -WO -441111-000
W.(.CTRtt:AL 'ME ) 0 i _000-1204A)
'CCW MOT ON FRE - IRESID J01-00.0-241-000
51:47
Q ,SLST3IT�`. t'.A-: ` ONS'l�1A1«.IC110N AND PLAN CHECK5'u35.3�
U ! J.DS" PRE -PAR) FE -S
$0,00
NOV 0 5 1996 I "AL PERMIT tek;F,10, ;1 UE NOW.
$341.5.39
RECEIPT
DATES
DATE FINALED ,
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
I INSPECTOR
OPERATION
"DATE
INSPECTOR
BUILDING APPROVALS-
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air ,.
Steel
Combustion Air
Roof Deck
Exhaust Fans
OX to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wall Firewall
OP
Exterior Lath
Drywall - Int. Lath z
Final
Final >1'
POOLS - SPAS
BLOCKWALL APkOVALS
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 Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
OX for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
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)
Desert Sands Unified School District
Notice: 82-879 Highway 111
Document Cannot Be Duplicated Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
Date 11/5/96 APN # 761-461-023
No. 14978 Jurisdiction La Quinta
Owner Name Ralph Rubinstein Permit #
No. 56225 Street Riviera
City La Quinta zip 92253
Tract # Lot #
Type of Development Residential Addition
Comments
room
Log:, #
Study Area 106
Square Footage 189
No. of Units 1
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 or replacement mobilehomes. It has been determined 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 Government Code 53080
in the amount of 0.00 x 189 or $ 0.00
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.
v
Fees Paid By n/a -' Tele )hone 775 7933
Name on the check
By Dr. Carol McGrew
Administrator in Charge
Fee collected /exempted by Pauline Pearson Exempt . $0.00
Check No. n/a
Signatureb6Q-�
Collector: Attach a copy of county or city plan check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant Copy -.Applicant/Receipt Copy - Accounting
PGA WEST II RESIDENTIAL ASSOCIATION, INC.
P.O. 60''X1282 • La Quints, CA 92253
November 5, 1996
Ralph J. Rubenstein
Post Office Box 571324
Tarzana, CA 91357
RE: PGA WEST II Residential Association
56 225. Riviera / H22 / Architectural Variance
Dear Mr. Rubenstein:
Thank you for responding to .our letter of October 28th regarding clear approval from your
neighbors for the proposed room addition at your above referenced residence. We are in
receipt of the appropriate documentation, and are pleased to issue a formal, approval from
the PGA WEST II Residential Association Architectural Committee.
Your, prompt response is greatly appreciated. Please have your contractor contact this
office for a final walk-through upon completion of this project.
Thank you for your cooperation in this matter. Should you have any questions, please do
not hesitate to contact me at (619) 776-5100.
Sincerely,
PGA WEST II RESIDENTIAL ASSOCIATION
John H. Handel
Association Manager
cc: Board of Directors
Architectural Committee Chair
\\monarch\users\suzy\pga2\rubenstein ok 11.5.96.doc
I . Meet the component prescnpuve rt:_qutremcnt for Package D for slab -on -grade construction or
Package E for raised floor construcaon (see Chapter 3).
j
2. "Heavy" and "LightMass" mass walls may meet the Package D or E requirements for mass wall
insulationinstead of R-13 (see Chapter 3).
3. For compliance of additions and altcranons only, dual glazed "greenhouse*? windows and skylights
may be assumed to meet this requirement. "
-t. The Package.D or E fenestration area plus the area of any glazing removed because of. the addidon.-
S. All mandatory. measures for HVAC systems must be met (see Chapter 2).
6. No eiectnc resistance space heaung may be installed.
7• A standard .water heatrng system is explained in Section 6.6.
3. If the total number of water heaters increases. in the residence, then the enure existing plus ad bion
system must meet the water heating energy budget (see Chapter 6). Table 3-4 lists water hcatutt;
wstem combinations which have been pre -calculated. to comply with the water heating budget.
T4 Revised. Janus .
ry 1992Resid..ntiat Manual .
%' C0N1PL1ANCEANAL
I'S IS'OF
the existing structure, except when caiculaung the
AN ADDITION
ALONE
water heating energy use tor any aadition in which
\nv addition —that is, the sum of all new
the total number of water heaters in the building
increases. The anglvsts may be pertonned using
,:onditionea spaces and associated new extenor
.
either a special prescnptivc package according to
walls. ccilinvs. and tloors within the building —
the size of the addition or with the point s%•stem or
:nay he shoe to meet the
cncitv budget as a
any approved computer periormancc mcmod.
�eparatc cnan•. This proccaure docs not involve
Table .7-1: Prescriptive Compliance of Additions -
Summary of Section 152(a)1 Requirements of the Standards
COMPONENT't
.
_ 1O0 ft
100=499 ft` 500-999 ft" >_• 1000 ft`
Insulation
Ceiling
R-19
Package) Packaec Packaec
Wall`
Floor
R-13
R-13 R-13 Package
R-13
Packaec Package Packacc
Fenestration
U -Value .
i % of CFA
0.75
<_ 50 ft-4,Pkg
0.75 Package Packaec
+ Removed Pkg + Removed. Packaec
Shading
Na
Package. Package Packaec
Thermal Mass
Na
Package Package Package,
i Space Heating
Mandatorys
Package. Package Packaec
& Cooling
(No cicctric )6
(No electric) (No cicctnc ) (No electric)
Water Heating
No Increase &
.
No Change
Na
Na Na Na
Replacement:
NO Increase
Standard
Standard Standard Standard
Increase
Uowcd
w/Calculation.
:%, lowed Allowed=kllowcd
w/Calculation w/Calculation w/Calculation
I . Meet the component prescnpuve rt:_qutremcnt for Package D for slab -on -grade construction or
Package E for raised floor construcaon (see Chapter 3).
j
2. "Heavy" and "LightMass" mass walls may meet the Package D or E requirements for mass wall
insulationinstead of R-13 (see Chapter 3).
3. For compliance of additions and altcranons only, dual glazed "greenhouse*? windows and skylights
may be assumed to meet this requirement. "
-t. The Package.D or E fenestration area plus the area of any glazing removed because of. the addidon.-
S. All mandatory. measures for HVAC systems must be met (see Chapter 2).
6. No eiectnc resistance space heaung may be installed.
7• A standard .water heatrng system is explained in Section 6.6.
3. If the total number of water heaters increases. in the residence, then the enure existing plus ad bion
system must meet the water heating energy budget (see Chapter 6). Table 3-4 lists water hcatutt;
wstem combinations which have been pre -calculated. to comply with the water heating budget.
T4 Revised. Janus .
ry 1992Resid..ntiat Manual .
Table 3-Z15: = Prescriptive Packages for Climate Zone 15
Package Package
Com onent A B
P
Package.
t .
e
Package
U.
Package
E
BUILDIING ENVELOPE
Insulation Minimums: .
Ceiling
R-30
R-38
R-49
R-38
R-38
Wall
R- 19
R-19
R-29
R-21.-
R-21
"Heavy", Wall
(R-5.5)
(R-4.5)
N/A
(R-4.7#3)
'.(R-4.76) .
"Light Mass" Wall
[R-7.01.
[R-6.01
N/A
N/A
N/A
Slab Floor PerimeterR
7
R-7
R-7
NR.
NR 2
Raised Floor
R- 19
R-19
R-21
R-193
R-19
FENESTRATION
Maximum U -Value'
0.65
0.65
0.40
0.65
0.65
Maximum Total Area
NR
16%
16%
16%
16%
Maximum Total Nonsouth Facing Area
9.6%
NR
NR
NR
',NR
Minimum South Facing Area
6.4%
NR
NR
NR
NR
SHADING COEFFICIENT; .
South.Facing Glazing
0.15
0.15
0.40
0.40
0.4.0
West Facing Glazing
-0.15
0.15
0.40
-0.40
0.40
East Facing Glazing
NR
NR
0.40
°0.40 ';
0.40
North Facing Glazing
NRNR
0:66
0.66.',,
0.66
THERMALMASS
REQ
NRREQ
20%
INFILTRATION CONTROL
Continuous Barrier
NR
R.EQ
NR
NR-
NR
Air=to=Air Hcat Exchanger
NR
REQ.
NR
NR
NR
SPACE HEATING SYSTEM((
Electric Resitance Allowed
NO
NO
YES'
NO
NO
If Gas, AFUF---
78%
78%
78%
78%
78%
If Heat Pump,
Split System HSPFB =
6.8
-6.8.
6.8
6.8
6.8
Single Package System HSPF =
6.6
6.6
6.6
6.6
6.6
SPACE'COOLING SYSTEM
if Split System A/C, SEER =
-10.0
10.0
10.0
10.0
10.0
If Single Package A/C, SEER9 =
9.7
9.7
9.7
9.7
9.7
DOMESTIC WATER HEATING TYPE .
System must meet budget,
Meets
Meets .
Meets!o
Meet.
Meets
see §151(b) and 151(f)(8)
Budget
Budget
Budget
Budget
Budget
LEGEND: NR = Not Required: N/A = Not Applicable: REQ = Required
r
See notes following Table 3-216.
?.rtivicate 0z COMPliance: Residential
I
(Page I OT 22) CF -1R
Date
oject Title %��.
6V I£94
Budding Permit 9
oject Address
C
p(f - -Z7 S—?q33 Plan Check/ Date
ocumentation Author - Telephone
Field Check/ Date Climate Zone r1iorcementampliance Method (Package. Point System or Computer)
agency Jse Only
;ENERAL INFORMATION
otal Conditioned Floor Area:
$9 tt2
3uilding Type:
Single Family Addition
Existing -Plus -Addition
:heck one or morel
=ront Orientation:
Multi=Family t/
North / East / •out es / All Orientations
(Input orientation ipmoagrees and circle one.)
NuMber of Dwelling Units:
=loor.Construction Type:
Sla Raised Floor (circle one or both)
BUILDING SHELL INSULATION
Left ....... ( )
Construction
3omponent Insulation
Assembly Location/Comments
typical, etc.)
Type R -Value
U -Value attic. to garage.
Wall ..............
Wall ..............
Roof ............. -�
165
Roof .......:......
Right...... ( ) 4�'6
Floor.............
Floor..............
Stab Edge.....'
Skylight ........
FENESTRATION
Shading Devices
Fenestration Area
Fenestration
LI -Value
Interior Exterior
(roller blind, etc.) (shadescreen, etc.)
Orientation (sf)
Front..... ( ) �'o ii5b
2115
FFront.....
Left ....... ( )
Left ....... ( )
Rear.....
Rear ..... ( )
Oa
Right...:. ( ) �O
165
Right...... ( ) 4�'6
t� bs• .
Skylight :......
Skylight ........
THERMAL MASS
Overhang. Framing Type
(ues/no) 'rrietal/wood/vin I)
SFS
aur -�cm (60A8,0
t
Type/Covering Area Thickness
slab/exposed. tile, etc. (sf) . inches Location/Descni tion kitchen, bath, etc.).
Revised January 1992
Certificate of Compliance: Residential
(Page 2 of 2)
Project Title , _ ! l t�
-Date
CF -1:R
HVAC SYSTEMS
Note: Input hyctrornc or combined hydrornc data under Water Heating Systems, except Design Heating Load.
Distribution
Heating Equipment Minimum Type and Duct or
Type (furnace, heat Efficiency Location Pipingumo. ec:
Thermostat
) (ducs/attic, etc.) Raue
Cooling Equipment. Minimum Duct
Type (aircottddioner, Efficiency Location Duct Thermostat Configuration
heat pumo. evag. coolina) (SEER) ation
R) (attic etc) ' R Value Tvpe (stills or ration l
1Cv_l a e,.a
WATER HEATING SYSTEMS
Energy External
Rated f Tank Factor or Tank
Wate? Heater " Distribution Number . Input (kW Capacity Recovery Standbys Insulation
T e T e in S stem or Bt.um) (gallons) Efficiency Loss. %) R -Value
I. For small gas storage (rated input s 75.000 Stu/hr), electric resistance and hast pump wafer heaters, list Energy Factor.
For large gas storage water heaters Irated input a 75,000 Whir). list Rated Input. Recovery Efficiency and Standby Loss.
For Instantaneous gas water heaters,- list Rated Input and Recovery Efficiency.
SPECIAL FEATURES/REMARKS (Add extra sheets if necessary)
COMPLIANCE STATEMENT
This certificate of compliance lists the building features and performance specifications needed to comply with Title'24. Parts 1 and 6. of
the Califomla 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 fora single building plan to be built in multiple
orientations, any shading feature that is varied is indicated In the Special FeatureslRemarks section.
n r r
Designer ner ) Documentation Author
u n•i,a 6 Pcotsaslons Code .
Name: "
TidWFirm: D
Name:
ride/Firm:
Address: 74 —QZa T:7'(r5
Address:
Telephone: (&\ I — (1 S^ 71-3>
Lie. a
g Telephone::
(signature)
(fie) (signature)
(dale)
Enforcement Agency
Name:
Tide:
Agency:
Telephone:
(signal irtustamp) (dace) .
ftWeed January 1992 .