05-1905 (RPL)79805 Ambassador Cir
05-1905
R.O. BOX 1504 -_-
7i-'495
-
78-'495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
05-00001905
IIIIIIIIIIIIIIIIIIIIIIIII
13IE
APN:
604-520-015-15 -24197
Application description:
POOL - RESIDENTIAL
Application Number:
05-00001905
Property Address:
79805 AMBASSADOR CIR
APN:
604-520-015-15 -24197
Application description:
POOL - RESIDENTIAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
27380
Tit!t 4 4 Q"
Applicant: Engineer:
iJ Y 4
O
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
-----------------='---Iv ---- ---------------------
1 H -__-
LIC El ONTRACTOR'S DECLARATION
I hereby affirm under penalty of p ry that
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`Cla ss: C53 License No.: 238947
/ate:J--0I —'W SContractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's 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 Contractor's 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).:
(_ 1 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 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.).
(_ 1 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.).
(_ 1 I am exempt under Sec. , B.&P.C. for this reason
Date:
Owner:
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:
LQPERMIT
Owner:
TERRI ANDERSON
79805 AMBASSADOR CIR
LA QUINTA, CA 92253
(760)772-4824
Contractor:
MASTER POOLS AND SPAS
73555 HIGHWAY 111
PALM DESERT, CA 92260
(760)346-6115
Lic. No.: 238947
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/18/05
-----------------------------------------------
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 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 STATE FUND Policy Number 0460014573
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.
D :t'/ _ Applicant:[ /
WARNING: FAILURE TO SEC, 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.
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 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 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 county ordinances and state laws relating to building construction, and hereby authorize representatives
of thi County to enter upon the above-mentioned pro e ty for i%spection urposes.
ate:.S M-6rSignature (Applicant or Age
Application Number . . . . . 05-00001905
Permit . . .
BLDG POOL PERMIT
Additional desc .
Permit Fee . . . .
271.50
Plan Check
Fee
176.48
Issue Date . . . .
Valuation
. . .
. 27380
Expiration Date . .
11/14/05
Qty' Unit Charge
Per
Extension
BASE FEE
252.00
3.00 6.5000
----------------------------------------------------------7-----------------
THOU BLDG 25,001-50,000
19.50
Permit . . .
MECH POOL
Additional desc .
Permit Fee . . . . .
26.00
Plan Check
Fee
6.50
Issue Date . . . .
Valuation
. . .
. 0
Expiration Date
11/14/05
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 11.0000
J---------------------------------------------------'-------------------------
EA MECH FURNACE
>100K
11.00
Permit . . .
ELEC POOL PERMIT -RES
Additional desc .
Permit Fee . . . .
45.00
Plan`Check
Fee
11.25
Issue Date . . .
Valuation
. . .
. 0
Expiration Date..
11/14/05
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 30.0000
----------------------------------------------------------------------------
EA ELEC PRIVATE
SWIMMING
POOL
30.00
Permit . . .
PLUMBING
Additional desc .
Permit Fee . . . .
33.00
Plan Check
Fee
8.25
Issue Date . . . .
Valuation
. . .
. 0
_Expiration Date
11/14/05 '
Qty Unit Charge
Per
Extension
BASE.FEE
15.00
2.00 6.0000
EA PLB FIXTURE
12.00
1.00 3.0000
EA PLB WATER INST/ALT/REP
3.00
1.00 3.0000
EA PLB GAS PIPE
1-4 OUTLETS
3.00
--------------------------------------------------------------
Special Notes and Comments
---------------
POOL & SPA ONLY. ALARMS/BARRIERS SHALL
BE IN PLACE PRIOR TO
PRE -PLASTER
INSPECTION. EQUIPMENT
ENCLOSURE NOT
LQPERAIIT - _
Application
Number
. . . . .
05-00001905
----------------------------------------------------------------------------
Special Notes
and Comments
INCLUDED IN
PERMIT.
Fee summary
-----------------
Charged
----------
Paid
----------
Credited
---------=
Due
Permit Fee
Total
375.50
.00
----------
.00
375.50
Plan Check
Total
202.48
.00
.00
202.48
Grand Total
577.98
.00
.00
577.98
0
LQPERMIT
4
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y : SPILLYVAY--*
LANDSCAPE s FURNITIJIM
POR UjiYTRATION ONLY
NOT INCLUDED IN CONTRACT
HITS MASTM POOLS i SPAS
I`
'` P2NGE BY OMM
I
t: POOL AREA. SM S.P.
POOL PER, 72 L.F.
FORM, 80 L.F.
90D ;I
SPA AREA, 28 SP. {
SPA PER. A L.P.
FORM. 26 LP.
6REY SALT I: •
CONCRETE {
500 Sr.
bATE BY OANER
--- is
i EXIS ,IN& =K CITY OF LA Cil! I NTA
-!TO fwa4AIN----- -- __SPILDING & SAFETY D PT.
A RE -INSPECTION FrEE OF $30
WILL BE CHARGED IF THE APPROVED
PLANS AND JOB CARD ARE NOT ON
THE SITE FOR A SCHEDULED
INSPECTION.
___ NO EXCEPTIONS!
SAI°%BY %/lm
IIIIIII VIII III VIII IIII 15
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INSULATION CERTIFICATE
This is to. -certify that insulation.has been installed in conformance with the current energy
,1regulation, California Administrative Code, Title 24, State of California, in the building located at:
79-805 Ambassador Circle, Lot 15, La Quinta, California
CEILINGS:
TYPE: BLOW MANUFACTURER: Certainteed Thickness: R-38
WALLS:
TYPE: BATTS MANUFACTURER: Certainteed Thickness: R-13
GENERAL CONTRACTOR: CENTURY CROWELL COMMUNITIES LICENSE #
BY: TITLE: y'
to
PARAGON SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072
BY- TITLE: ADMINISTRATIVE ASSISTANT DATE: 11/26/2002
09/30/2013 23:44 FAX
2009
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INSULATION CERTIFIC&TS
This is to certify that insulation has been installed in conformance with the current energy
State Caiwornia, in the building IOcat®d at'
;
regulation, Califomia Administrative Code, Tito 24, of
79-805 Ambassador Circle, Lot 15, La Guinta, California
CEILINGS,
TYPE: BLOW MANUFACTURER: Certalnteed Thickness: R-38
r
WALtS='`
TYPE: BATTS MANUFACTURER: Certalnteed Thickness: R-13
GENERAL CONTRACTOR: CENTURY CROWELL COMMUNITIES LICENSE #BY,
, TITLE:
BUILDING PRODUCTS, A MASCO COMPANY LICENSE #632072
PARAGON SCHMID
TITLE: ADMINISTRATIVE ASSISTANT DATE: 11126/2002
Y:
Y .
r!
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page 1 of 7) CF -4R
Prdject Title /
Probe t Address
Joe re"06IkiSo
Builder Contact
<I
HERS aw i
P I TLA (,2JL I t T
C o )7%2- 3 I
Telephone
Telephon
t"A4K G/3ZcDL
Certifying Signature Date
Firm: P6 Ise 2T E kI EQ.. ,(
Street Address: j c).Epx(o
Copies to: Builder, HERS Provider
5FT D ►' 1 /o
Date
ido
Builder amT e
58 FLt4,KI 3A
e Plan Number
e Sample Group Number
l.o T # 15 79•.005 Am &assapoop-
Sample House Number
HERS Provider: L°, I -I E . F- (Z, s.
Ciry/State/Zip: A Icn tlo f 11iQA G C°A•° 7o
HERS RATER COMPLIANCE STATEMENT
The house was: 11 Tested 2-"Approved
Approved as part of sample testing, but was not tested
As (lie HERS rater providing diagnostic testing and field verification, I certify that the houses identified on this form comply
ith the diagnostic tested compliance requirements as checked on this form.
❑ The installer has provided a copy of CF -6R (Installation Certificate.
❑ Distribution system is fully ducted (i.e., does not use building cavities as plenums or platform returns in lieu of ducts)
❑
Where cloth backed, rubber adhesive duct tape is installed, mastic and drawbands are used in combination with cloth
backed. rubber adhesive duct tape to seal leaks 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
If fan flow is calculated as 400cfm/ton x number of tons enter calculated
value here
If fan flow is measured enter measured value here
Leakage Percentage (100 x Test Leakage/Fan Flow) _
Check Box for Pass or Fail (Pass=6%or less) ❑ ❑
Pass Fail
❑ THERMOSTATIC EXPANSION VALVE (TX
❑ Yes ❑ No Thermostatic Expansion Valve is installed and Access is
provided for inspection ❑ ❑
Yes is a pass Pass Fail
❑ 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 -I R and
design on plan.
- ❑ Yes ❑ No TXV is installed or Fan flow has been verified. If no TXV,
verified fan flow matches design from CF - IR.
Measured Fan Flow =
❑ ❑
Yes for both I and 2 is a Pass Pass Fail
Compliance Forms August 2001 A-16