9701-056 (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
296566 B 1 1U131/96
. el I . • Gl
Signature of Contractor 'Y) ;, VDatek f 0,L_,
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
sale (Sec. 7044, Business & Professionals Code).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
() I am exempt under Section B&P.C. for this reason
Date ` 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.
(< 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 & policy no. are:
Carrier Policy No.
;if,K,tEiFUND 111.14I.i IA
(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 J
VDate:/' 2 12- n Applicant . .4�'7";i+ I �1ti�
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 relating to the building
construction, and hereby authorize representatives of, this City to enter upon
th .above-mentioned property -for inspection purposes'--
Signature (Owner/Agent) J1 t l art Date f ,7�
BUILDING PERMIT PERM';" CONTROLN
r 970456 4629
DATE „ 1VALUATION SIM/74.60' .LOT TRACT
JOB SITE
ADDRESS 8.1-W i--WENUIt-54
APN 767-320-013
OWNER CONTRACTOR/DESIGNER/ENGINEER
MVIRV E RlE-`VIN EAS- rd{AY.XE CGNI';MUcl'4C' N
£41-345riVENUCs 14 548MO AVE A.L4AkADC)
LA Q0IN A CA 92253 I. A Qt1tZ+l A CA 92253
(619)504.4944 C_RIX 196i
USEOF PERMIT J 1
itMI} i IIIIIIIIIIIIIIIIIIIIIIIII 68
IE
ti2� S ir. tefw►i.�t�'t r�tiiri ku:tla ` �_ _ -- ��—
TRAir-7i'CON311.Z! i0l%-0-14 622,.00 SOF
11+X1*1N1AxEUY(.0,Si OFCONS"t3,TET OIN,
33.774.60
11EIidly#.t" '
PLAN 041iCK FF1', f01-t3f)0.43V_3)dt � 4i1.S;
(70NS'f10X '1':1(3N F OL1 1014W•419-000 5310.50
Nilly 11MI ltt; %LFUE 1X11-060-4"iJA) �35.�►U
11f VkIC,'AI; P' iFa f0E-00(1-4 20 -ON SM017
PLUW_ FU- , 101.4)0-09-00
'3TON(I MOIJ N F11i - RT! t11) 1011 -000 -2 -1( -MO
u
titJfl:�n'i�� 1 C:f)P14� ft1.fC,"I1(aN rlNLi PLAN (314fiCYF-+�:
Sf126.V
t^l `
D
PAID
i"4')'r:i11, 1'1N:i�11�t'!' !'h;d:ti 1)i►►1? n4.14L'
$626.48
JAN 2 2 1997
CITY OF LA QUINT/
RECEIPT
DATE
BY
B
DE D
INSPECTOR
J
%
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 a —
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
Insulation -
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric .
Underground Plbg. 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
O.K. for Finish Plaster
Sewer Lateral >
Pool Cover
Sewer Connection
Encapsulation
• Gas Piping
Gas Test
Appliances
Final
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)
COMMENTS:
-
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
296566 B 10/31/96
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
sale (Sec. 7044, Business & Professionals Code).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
( ) I am exempt under Section , B&P.C. for this reason
Date 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.
( ) 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 & policy no. are:
Carrier Policy No.
STATE FUND 1242713
(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,
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 1his.applicaton agrees to, & shall, indemnity
& 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.
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 relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes. .
Signature (Owner/Agent) Date
BUILDING PERMIT PERMIT97Ol-M c°�46 2.9
DATE VALUATION 533,774.60 LOT TRACT
JOB ADDRESS ` 81-345 AVENUE 34
APN320-013
OWNER CONTRACTOR / DESIGNER / ENGINEER
MERV GRIFFIN EAST VALLEY CONSTRUCTION
81-345 AVENUE 54 54880 AVE. ALVARADO
LA QUINTA CA :92253 LA QUINTA CA 92253
(619)5644844 CBL# 1961
USE OF PERMIT
ADDN I I IIIIIII VIII III VIII IIII 62
622 S.F. ROOM ADDITION IE
TRACT CONSTRUCTION 622.00 SF
ESTIMATED COST OF CONSTRUCTTON
33,774.60
PERAM FEE SUMMARY
PLAN CHECK FEE 1014000439-318 $201.83
CONSTRUCTION FEE 1014000-418-000 $310.50
MECHANICAL FEE 101-000-421-000 $35.00
ELECTRICAL FEE 101-000-420-000 $36.77
PLUMBINO FEE 1014000-4194)00 $39.00
STONG MOTION FEE - RESID 1014000-241-000 $3.38
SUB -'DOTAL CONSTRUCTION AND PLAN CHECK
$626.48
LESS PRE -PAID FEES
$0.00
TOTAL PERMIT FEES DUE NOW
5626.48
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
°
I..--.-..-. ., : Building Permit Application'and Tracking Sheet
Name of Con I tact Person:
U61P
Sq. Ft.: � 9� I
4 Stories:
# Units:
Telephone # of Contact Person: ,05
.
W.
* 9701 r. 4700
rtiiic,aze of Comntiance* Residential (Pace I or �) t;F-1 R
r.,
oleo! TI/IlR
Dot*
L ,
U ti
Budding Permit R
oleo 4ddress
Plan Check r Date
ocu!liontat lor -Au thor
Telephone
Field Check Date
�mpllance Method (Package. Point System or Computer) Climate Zone
cntorcement Agency use Only
1E,,1ERAL INFORMATION
otal Conditioned Floor Area:
ft2
Building Type:
Single Family X_ Addition
Existing-PluS-Addition
:heck one or morel
Multi•Fa
North out / West / All Orientations
=ront Orientation:
(Input o autxt graft and circle one.)
'slumber of Dwelling Units:
loor Construction Type:
Slab / ailed Fi (circle one or both)
BUILDING SHELL INSULATION
Construction
vent InsuR
oical, etc.1
r e Va uien
type
U Vaiuely a�ic.t o2ara ements
Wail ..............
Wail ..............
�.
Roof ............. 3
Root .............
Floor.............
�—
Floor.... .........
_
Slab Edge ....
FENESTRATION
Shading Devices
Fenestration Area Fenestration Interior Exterior
blind. etc.) (shadescreen.
Overhang Framing Type
etc.) veslnol fmalallwaod►►+in i)
Orientation 5f
-Value (railer
Front..... <0-
Front .....
Lett .......
(S_�)
(C.)
Left .......
( )
Rear .....
,,Rear .....
Right.....
r
ry
(I.J)
r r— d 0 4
�
Skylight .......
Skylight .......
THERMAL MASS
Type/Covering Area Thickness
siab/exoosed. lite. etc. (St) (inches Location/Descn tion kitchen, batn. etc.)
Rujud Janumv 11992
u aLi,.4 .w is
Certificate of Compliance:
Residential
(Page 2 of 2) CR-1 R
Project I Itl■
Date
HVAC SYSTEMS
Note Input hyani or combined hydrornc data under, Water Heating Systems,
except Dewgn Heating Load.
Heating Equipment Minimum
Distribution
Type and
Duct or
Type (furnace, heat Efficiency
Location
Piping Thermostat
urna. etc.I IAFUE11-ISPF1
;ductVattic, etc.l
R-Value 7v B
Cooling Equipment Minimum
Type (air conditioner, Efficiency
heat ourno. evaD. coottng (SEER1
WATER HEATING SYSTEMS
Duct
Location
attic, etc.)
Duct
R-Value
l Input
Water Heater Distribution Number RatedkW Ca�nk act
ty
11pe Type in System or 9tuthr) 'gallons)
Thermostat
Tvoe
Configuration
(Soli' or oack4
Energy I
External
Factor or
Tank
Recovery Standby'
Insulation
Efficiency Loss (%I
R-Value
For small gas Store" (raced mout s 75-000 9tWhr). electric reatatance and heat pump water hisatsre, list Energy Factor.
For large gas storage wrier hsstsra crated nlout 2 75.000 Bturh►), lost Rated Input. Recovery Efficiency and Slartdny t.nea-
For instantaneous gee water hastens. It[t Rated Input arse Recovery Efficiency -
SPECIAL FEATURESIREMARKS (Add extra sheets if necessary)
COMPLIANCE STATEMENT
This cenificale of compttance lists the budding features and pertormznce speutrcatipns needea td campry rtinm Tile 24. Parts t and fi, of
the California Cede of Regulations. and the adrrlrntstrative ►egUalions to Implement tnem. This CerlifiC,ate has peen signed by the
Indr+ndual WIM overact deslgn responsibility. When trll5 certificate of Compliance IS Submitted for a single building plan to be Guilt in multiple orientations, any sttaouV feature that IS varied rs indicated in the Special Featuresi Remarks section.
Designer or Owner (pw eusineae A farotaeeion. code)
Name:
Tide/Finrec
Address:
Telephone:
Lic. s:
(signature) (dam)
Enforcement Agency
Name:
Title:
Teleohone:
Documentation Author
Name:
T1derFirm:
Address:
Telaphone:
(signature) (di )
is►gna:unwitamp) (da110)
*TV141-4056
.-r[iYicn a Oi Comaiiancao: aesiden iai (Daae l OT
'I) CF -1 R
oiaat Tltia
oJeCI Addreaa
xurnantation Author Telephone
Date
Budding Permit rt
Plan Check i Date
Field Check i Date
cnlorcoment Agency use uniy
�4-pilancu Aiwhod (package, Point System or Computer)
Clin►ato Zona
aEVIERAL INFORMATION
.otal Conditioned Floor Area:
wilding Type:
:heck one or more)
:vont Orientation:
Vumber of Dwelling Units:
:loor Construction Type:
Q �-- ft
Single Family X_ Addition
Mufti-FPanooff-digrees
Existing -Plus -Addition
Northaut /West / All Orientations
(lnout o and circle one.)
Slab 1al5ed Flo (circle one or both)
WILDING SHELL INSULATION
Slab Edge ....
FENESTRATION
Construction
3omponent
Insulation
Assembly
Location/Comments
typcal. etc.)
type
R -Value_
LI -Value
attic, to garags.
Wall ..............
�( :.
i +2 k:
iZr d/2
Wall ..............
V
�rn0 M 6
Roof .............
.-
—
Roof .............
Floor .............
--�-
Floor..............
fl. Ling�vltT,,
Slab Edge ....
FENESTRATION
Shading Devices
Fenestration Area
Fenestration
Interior Exterior
blind. etc.) {shadescreen, etc.)
overhang Framing Type
er
over ar (rrtHallwa�odMin I)
Orientation sf
U -Value
(roller
Front.....
Front..... 6)
V
�rn0 M 6
Left ....... ( .)
.-
—
Left ....... ( )
Rear..... {--r —
--�-
*Rear ....
Right.....
fl. Ling�vltT,,
Right..... (I,))
►•Skylight .......
Skylight—....
— --
THERMAL MASS
Type/Covering Area Thickness
slablexDosed, We, etc.) (si) Qnchesj LocatiowDescription kitchen, batn, etc.)
Ac
RvAaad January 1992
Certificate of Compliance: Residential (Page 2 of 2) CF -1 R
Project rills
riot -
HVAC SYSTEMS
Extemat
Tank Factor or
Tank
Capacity Recovery Standby'
Note: Input hyyornc or combined hydmnic data under Water Heating Systems, except Design
Heating Load.
FI -Value
Distributio
Heating Equipment
Minimum
Type and
Duct Duct or
Type (furnace, heat
Efficiency
Location
Piping
Thermostat
umo. etc.l
i'
fAFl E/HSPF)
Iductatrattic, etc.I
R -Valine
Type
LJaY
JW tll
1
Cooling Equipment
Minimum
Duct
Type (air c ondnioner.
Efficiency
Location
Duct
Thermostat
haat rnI3. evao. =1011nq)
(SEER)
iattic. etc.)
R -Valine
7vpe
WATER HEATING SYSTEMS
Water HeaterDistribution Number Input(kWT $ T e in System or 84umn
Configuration
(scall' or aacka
Energy'
Extemat
Tank Factor or
Tank
Capacity Recovery Standby'
Insulation
[ allons) Efficiency Loss %)
FI -Value
For stns" gsa slots" (rated inaur 5 75.000 ShAr), electric resistance and haat pump tunes hestars, list Energy Factor.
For terga gas storage Willer heslerte Irated snout 2 75.000 eiu/hrl. list Rated Input. Recovery Efficiency and Standby Lose.
For instentensous 9118 +eats* hestsrs. list Rated Input and Recovery E
ftsrrcy..
SPECIAL FEATURES/REMARKS (Add extra sheets if necessary)
COMPLIANCE STATEMENT
This certlfceate of compliance lists the b'ik'ing features and perform2rlce specaficatlons neecm 44 comDlly wail Title 24. Parts i and 6, of
the Cali(omla Code at Reguialions. and the administrative regulations la Implement them. This cenlhcate has been signed by the
indzrnddual Wlh overall design reswrisaxiity. When this crenifiuie of oomplianoe Is submitted for a suigle txaildirig plan to be 4auli4 Ili mullilale
orientations, any sitac2utg tealure that is vaned Is IndicatID0 In the Spectal FeaturevRemarks section.
Designer or Owner (per sueinesa al, pretaesion11 code)
Name:
TiMNFinec
Address:
Telephone:
tic. s•
(signature) 011111110)
Enforcement Agency
Name:
Title:
Telephone:
(signatunsrstamp) (411111ille)
Documentation Author
Name:
TtrlerF0m:
Address:
Telephone:
(signature)
(dwo)
w