9710-071 (AR) LICENSED CONTRACTOR DECLARATION BUILDING PERMITPERMIT# CONTROL#
co a 14reby affirm under penalty of perjury that I am licensed under provisions of *11*472 O
H, _Chapter 9 (commencing with Section 7000) of Division 3 of the Business and DATE � VALUATIONS Lor TRACT
U) ��. Professionals Code,and my License is in full force and effect.
License# Lic.Class Exp.Date
r- _� JOB SITE APN
I Lud r 442118 tv'W" ADDRESS 44M A"VILA DRIVE "6-2
ZO ate 1+}i /a co ) �► Signature of Contractor— � _�._ OWNER CONTRACTOR/DESIGNER/ENGINEER
r 0 t OWNER-BUILDER DECLARATION STANLEY H&4L'1.[.?�S,NE SfAt!FFER T.A. K1�7°"'dt~M CONS►`;'.C0
J U ///i �4 81AVILA DR 773;0 C'A1.LE ARROBA
W w I hereby affirm under penalty of perjury that I am exempt from the Contractors
~ U) License Law for the following reason: I,A QAAKFA ('A 92253 [,A(AANTA ('A Q2253
Z_ ( ) I, as owner of the property, or my employees with wages as their sole Ic441'S(S4- (1 ('1T.lI
compensation,will do the work,and the structure is not intended or offered for
sale(Sec.7044,Business&Professionals Code). USE OF PERMIT
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals ADDN
Code).
M () I am exempt under Section B&P.C.for this reasons S+. AllUtli(.)iv TO U:1Sitvc3[s t 1CiikiN.
LO
N Date Signature of Owner
O.C)
Q WORKER'S COMPENSATION DECLARATION
C:) Z I hereby affirm under penalty of perjury one of the following declarations:
110
p O I have and will maintain a certificate of consent to self-insure for workers' C'U:STUM C(NSiR f ON 4$.00'x'
X W"LL compensation, as provided for by Section 3700 of the Labor Code, for the
O � Q performance of the work for which this permit is issued.
m Q C) ( I have and will maintain workers'compensation insurance,as required by
OU Q Section 3700 of the Labor Code, for the performance of the work for which this
a � Z permit is issued. My workers' compensation insurance carrier & policy no. are: I
Carrier Policy No.
obO STATi:I•VNij Z-*Xytl3IQI.,11 T..STUB!�.iTEDC &TCts'C€NSTRUC'tTON, 3719.20
J
(This section need not be completed if the permit valuation is for$100.00 or less). PC, Y
R 1i FIC Si�:Il�1t R I
O I certify that in the performance of the work for which this permit is issued, PILAN(:hlf+,('K F-W i0I4XKl4.W-318 U0 515 f
I shallmot employ any person in any manner so as to become subject to the "W41 RIR!'f" )mid 101Alf"I R4W.
workers' compensation laws of California, and agree that if I should become
1'L.i.► 03iNC; 101-004-1� 000 $21.00 1
supject to the workers'compensation provisions of Section 3700 of the Labor 1
C6de, I shall forthwith comply with those provisions:f �'RONU WIrTION FEK-ft,3U.1 101.000-241-OW �V
� ,
ate:i r 1 Applicant J1- �
Warning: Failure to secure Workers' coverage lawful and
shall subject an employer to criminal penalties and civil fints,up to$100,000,In I
addition to the cost of compensation,damages as provided for in Section 3706 it
' of the Labor Code,interest and attorney's fees. I
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. s I
. 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 SZ tF3- P11,(''ON9MIR`"C ON ANC?PLAN('11 WK $I?i 4S
& hold harmless the City of La Quinta, its officers, agents and employees. 1(3 LE&S PRE PAID FEES $000
OCT
2.Any permit issued as a result of this application becomes null and void if 16 97 i
work Is not commenced within 180 days from date of issuance of such Pr.Rm,ri,raps sir Now $1Li.45
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 � � '9'�+ IIIIIIIIVIIIIIIVIIIIIII correct. I agree to comply with all City, and State laws relating to the building C Y
07
cop.struction, and hereby authorize representatives of this City to enter upon IE
t e above-mentioned property for inspection purposes.
„(j RECEIPT DATE BY DA E FIAE E
t
INSPECTOR
Signature (Owner/Agent) Date t1: t S
- db �� �,.
INSPECTION RECORD
OPERATION DATE 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
0.K.to Wrap F.A.U.
Framing Compressor
Insulation Vents
Fireplace P.L. f IGrills
Fireplace T.O. Fans&Controls
Party Wall Insulation Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall-Int.Lath
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 APPRO ALS Gas Test
Electric Final
Waste Lines / Heater Final
Water Piping Plumbing Final
Plumbing Top Out Equipment Enclosure
Shower Pans O.K.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)
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SUBJECT TO INS ': ,.: ' :9 f i:y v`•`'iy
AND ALL APE'I
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-rtifioare of Comniiancr: Residenbal (Pace or CF-1 R
Date
*eq!Title f� \
oject Address V O Budding Permit 0
`_ky n (1,a Plan ChDate
xumentatlon Author Telephone
Field Check r Gate
� r wz .e Enforcement Agency use Only
imp anti ce Method(Package. oint System or computer) ■■■■■�■-
1ENERAL INFORMATION i DA
otal Conditioned Floor Area: ` V /
'uilding Type: Single Family ✓ Addition
:heck one or morel Multi-Family Existing-Plus-Addition
=rout Orientation: North/ East/ South/West/ All Orientations
(Input orientation to degrees and circle one.)
Number of Dwelling Units:
:Ioor Construction Type: SI Raised Floor (circle one or both)
WILDING SHELL INSULATION
Construction
:;omponent Insulation Assembly LocatiorvComments
'j- R-Value LI-Value attic.to garage.WiCal.etc.)
Wall..............
Wall..............
Roof.............
1 V
Roof .............
Floor.............
Floor.............
Stab Edge ....
FENESTRATION Shading Devices
Fenestration Area Fenestration Interior
Exterior Overhang Framing Type
Orientation (sf) U-Value (roller blind.etc.) (shadescreen, etc.) tyas/noi (metaUwoodN'^Y1)
Front..... ( ) -
Left....... ( )
Left....... ( )
Rear..... ( )
Rear..... (. )
Right..... ( )
Right..:..
Skylight .......
Skylight....... -
THERMAL MASS
Type/Covering Area Thickness
slab/exposed.tile.etc. (sf) (inches Location/Description kitchen.batn.etc.)
Rm�iied■laM+�to42 � .
Certificate of Compliance: Residential .(Page 2 of 2) CF-1 R
t
Project Title
Date
�D
HVAC SYSTEMS
Note: Input hygronlc or comolnad hydramc data uta Water Heating Systems,except Design Heating load,
Distribution
Heating Equipment Minimum Type and Duct or
Type (furnace,heat Efficiency Location Piping Thermostat
pumo,etc.I (AFUE/HSPF) (ducts/attic etc ) R Value Type
`LXlS'f � zwNe,N
Cooling Equipment Minimum Duct
Type (air conditioner, Efficiency Location Duct Thermostat Configuration
heat Pump. evao.coolina) (SEER) (attic,etc.) R-Value Tvpe
(split or package)
WATER HEATING SYSTEMS
Energy' External
RatedTank Factor or Tank _
Water Heater Distribution Number Input(kW Capaclty Recovery Standby' Insulation
TYpe Type in System or BtWhr) (gallons) Efficiency Loss(%) R Value
1. For am"pas slerepe(rated wwut S 75.000 BUft).electric resistance and heat Pump water heaters,list EnergyactorF .
For large cess atorepe water heaters baud Inout a 75.000 Bturh).Inst Rated Input,Rsoovery Effie( my Loss.
For Instantaneous pas watsr•hesters,list Rated Input and Recovery Efficiency. Efficiency and Stan
SPECIAL FEATURES/REMARKS (Add extra sheets if necessary)
COMPLIANCE STATEMENT
This certificate of compliance lists the building teattxes am pertorma=speoticacons needed to comply with Title 24,Parts 1 and 6.of
the California Code of Regwatons,and the adnnlstrapve reguiatons to Implement them. This certificate has beensigned by the
l�ividtlal Math overall design responslbt6ty. When flus certlticate of complance s u brmited for a single building plan to be built in mUtioe
in
oriarttatlons,any madN teams that Is vaned a akated In the Speaai FeattxeslRemarks section.
Designer or Owner(per austneaa a p►erleeslens coda) Documentation Author
Name: Owl Nanta:
TiderFlnn: ^.►Ot .kr'M( v= y C-Mr
Titt.IFw"
Address: —.-11 `''U /�✓����*s Aditss: -
Tebphone: S-44 (Go
s:
Lie. Tcrpltone'
l
(spni►an) (date) (si(ptaar (�)
Enforcement Agency
Nance:
Tide:
pig":
Tsleowe:
(slgnaRmstamp) (�)
Villa la Quinta Homeowners Association
P. 0. Box 15 • La Quinta, California 92253
October 13, 1997
BUILDING DEPARTMENT
City of La Quinta
La Quinta CA 92253
RE: Stan Stauffer
49688 Avila Drive
Ladies and Gentlemen:
The Architectural Committee of Villa La Quinta has approved the remodeling of
the above referenced residence.
These improvements meet the specifications as stated in our CC&Rs.
Yours truly,
4Le-�
BRENT BOURDEAU
Chairman _
Desert Sands Unified School District
Notice: 82-879 Highway 111 IIIIIIIIIIIIIIIIIIIIIIIII 08 ,,W
Indio, CA 92201 )E
Document Cannot Be Duplicated 619-775-3500
CERTIFICATE OF COMPLIANCE
Date 10/15/97 APN# 646-270-008
No. 16163 Jurisdiction La Quinta
Owner Name Stanley H & Madeline Stauffer Permit#
No. 49688 Street Avila Dr. Log#
City La Quinta Zip 92253 Study Area
Tract# Lot# Square Footage 48
Type of Development Residential Addition No. of Units 1
Comments addition to kitchen
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 48 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
Fees Paid By n/a ,Telephone 564-4660
Name on the check f
By Dr. Doris Wilson r
Superintendent r
1
Fee collected/exempted by Pauline Pearson Exemptd:`d0
DCheck No. n/a
Signature 1.r Ant
F
OTICE: Pursuant of Assembly Bill 3081(CHAP 549,STATS.1996)this will serve to notify you that the 90-day approval period in which you may protest the fees or other payment identified
ove will begin to run from the date on which the building or installation permit for this project is sssued or on which they are paid to the District(s)or to another public entity authorized to
llect them on the Dislrict('s)(s')behalf,whichever is earlier.
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