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RPL (11328) + SFD (10518)53545 Avenida Madero 11328 10518 Building Address 53-545 Madero Owner David driller Mailing Address P. O.' Box 722 City La Quinta Zip 92253 Contractor Pacific Traces Address same as above City lZip State Lia & Classif. B425381 Arch., Engr., Designer Address City lZip 444 P.O. BOX 1504! No. 11328 7&105 CALLE ESTADO t jj LA QUINTA, CALIFORNIA 92253 Tel. ' . 564-'823' Tel.: z City Y ' Lic. #.-' 1955 BUILDING: TYPE CONST. OCC: GRP. A.P. Number Legal Description Project Description POOL O"INLY ' Sq. Ft Size . New: ❑. Tel. f; State Lic. # ' 9 (commencing with Section my license is in full•force and t OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a Permit to construct, after, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to rile a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis for the alleged exemption.. Any violation of Section 7031.5 by 'anyapplicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). O 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, Buisness and Professions Code: The Contractor's License Law does not apply to an owner of property. who builds or improves thereon and who does such work himself or through his own employees, provided that such 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 or proving that he did not build or improve for the purpose of sale.) O 1, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. -(Sec. 7044. Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) O 1 am exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Pol icy. No. Company upCopy is filed with the city. O Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COM PENSATION. INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) valuation 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 Date Owner NOTICE TO APPLICANT: If, alter making this Certificate of Exemption you should become subject to the Workers' Compensation provisions of the Labor' Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Lender's Name Lender's Address 'This is a building permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. 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 this city to enter the above-. mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip No. Stories No. Dw. Units Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated. Valuation 8,000 PERMIT AMOUNT Plan Chk. Dep. - Plan Chk.. Bal. 64.35 Const. - 99.00 Mech. 21X00 Electrical 30.00 Plumbing 24.00 S.M.I. ..80 Grading Driveway Enc. Infrastructure TOTAL X39.5 REMARKS'TC.!.';i»i.'i ZONE: BY: Minimum Setback Distances: Front Setback.from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO, ELECTRICAL FEES NO. PLUMBING IST FL. SQ. FT. ® $ 2ND FL. SQ. FT. POR. Sp, FT, ® GAR. SO. FT. ® CAR P. SQ. FT. WALL SQ. FT. ® Sp FT ® ESTIMATED CONSTRUCTION VALUATION $ UNITS s 'r MOBILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN. URINAL WATER PIPING NOTE: Not to be used as property tax valuation ROUGH PLUMB. BONDING FLOOR DRAIN MECHANICAL FEES FORMS WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(AUTO)(DIS H) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APPJEQUIP. LAUNDRYTRAY AIR HANDLING UNIT CFM GAS (FINAL) TEMP. POLE KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET COMPRESSOR HP POLE, TEMIPERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER. B.T.U. SO. FT. ® c BATH TUB FINAL INSP. 6 SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 1//a c SEWAGE DISPOSAL SQ.FT.GAR ® V4c HOUSE SEWER VENTILATION GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK GROUND PLUMBING lUNDERGROUND -7l3 A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING. DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ _$ LUMBER GR. FINAL INSP. 6 FRAMING FINAL INSP. 6 %/1 a1 CL /``'' ROOFING /) 1A L/ / v s( w .,1 ga. Lq 146--- y ' REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTIOryy —2,)— c ( v CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL 'Ay: a' P.O, BOX 1504 _ N o . 10518 BuIldin' 1- ,, " 78.105 CALLE ESTADO Address 3 -55=LA QUINTA, CALIFORNIA 92253 Owner . :. . David miller Mailing BUILDING: ..TYPE CONST: OCC; GRP.. Address* P. g,' fox _ 72? A.P, Number 774-102--014 a City ZIP Tel• Tact 2 Block 194 La Cliii 3W 32253 564-y5823" LegalDescrlptlon Contractor Protect Description Pacific Trades Address City ZIP Tel.' State Lic. City & Ciasalf. 8425381 Llc. q 1955 Sq. Ft, 1372 No, No, Dw. Arch., Engr,, Size '-Stories* - Units Designer New ❑ Add ❑ Alter ❑ Repair ❑ 'Demolition ❑ Addreas Tei. Permit doe.& not' .i n* clude block %yall>, ok City ZIP State pool LIc, q , LICENSED CONTRACTOR'S DECLARATION ereby affirm the iPam licensed under provisions of Chapter 9 (oommeno ri g wlth.8eotlon Moo) o(\DlYlel n 3 o tho'Buelncaas and Prorofe'sssions Coda' end my Iloanes le full }oke and .+, 6},;\3 .•u.'!- ", / ter• I .. Ci' r '+' OWNER•BUILDER DECLARATION' Estimated ValUatlon ' I hereby affirm that I am oxompt from the ContraotoPe License Law for the following x 6 4 raason; (Seo. 703 f,6 Business and Professions Code: Any city or. county which 'requires a permit to oonetruct atter, Improve, dam011&h, Or repair any structure, odor to he Issuance also AMOUNT requlros the appllcent for such permit to file a signed statement that he Is ucansed.purauant to PERMIT fits*. provialons of the Contractor's License Low, Chapter 9 (Commencing with Section 7000) of Wvision 3 of the Business and Profession& Code, or that. he is exempt therefrom, and the basis ,for the alleged exemption. -Any violation. of Section 7031.6 by 'eny Iloant for a permit. Plan Chk Dep'. psi . igo subjects the applicant to a.clvll ponafly of not more than five hundred dollars* (S gO). ®. l as owner of the property, or my am loyeea wlth wages'as their sole compensation, will Pian Chk Bal, e 2 5 2,. 2 8 -do the work and the structure is not Intended or of}ored.forsale. fSec. 7044,.8u1snO88 and Profession& Coda: The Contractor's License Low does not apply to an owner of property who Const. , 558.501 builds or Improves thereon and who does such work himeell or through his own employees, provided that' such Improvements are not Intended or offered for sale, If, however, the building MSCh, } ,4 141, • 9 "(10 orImprovement le Gold within one Yost Of Completion, the ownor•builder will have the burden,, ti .' 2 A 0 of proving that h0 did not build or improve for the purpose of Bala,) Electrical ® I, as owner of the`propertYY, am exclusively contracting with licensed.contractors.to con•: Plumbing j .41 p6 etruot the project. (Seo, 7044, Suelnees end Profession& Code: The Contractor's LlcansO Law does not apply to an owner of proporfy,who build& or Improves thereon, and who contracts•for S•M.I. '•R+ 20 such projects with a contraotor(G) licensed pursuant to the Contractor's License Low.) Grading 20 . t ^y ® 1 am exempt under Sec. B, & P.O. for this reason Driveway Enc, 20.00 Date owner Infrastructure 1901.45 WORKERS' COMPENSATION DECLARATION ' ,c I hereby affirm that I have a certificate -o} consent to self•Insuro ore certificate of Workar's'Compensation Insurance, or -a certified copy thereof (Seo- 39066 Labor Coda:) Policy No, Company . Ut? } °r t}+ 4 , s` '- L"-74 Copy Is tiled with the city, .® Certified copy Is hereby furnished, TOTAL _ .3222.23 2972.23 CERTIFICATE OF EXEMPTION FROM - REMARKS WORKERS' COMPENSATION INSURANCE r —` ",Is &action need not be completed If the permit /a for one hundiod dollars .(5100) valuation or loss.) I certify that In the performance of the work for which this permit Is Issued, I shall not employ anyparson In any manner eo as to become subject to'the Workers' Compensation Laws of California, Dat Oe NOTICE TO APPLICANT r It, 'after making this Certificate of Exemption you . should: become ZONE:, BY, subject 'to the Workers' • Compensation • provisions of the Labor Code, you must forthwith Comply with ouch provisions Of this permit Shell be doomed revoked. Minimum Setback Distancew. Front Setback from Center Line Rear Setback from Rear Proji. Line CONSTRUCTION LENDING AGENCY. - Side Street Setback from Center Line Ihereby affirm that there Is a construction lending.agency for the performance of the work }or which this permit to Issued. (Soo. 3097, Civil Coda.) Side Setback from Property Line - Lender's Name . +c• '- , Lender's Address t This Is a'building permit when properly filled out, signed and validated, and is subject to FINAL DATE INSPECTOR expiration It work thereunder Is suspended for 160 days. = > I oertlfY that I have road this application and state that the above Information Is correct, Issued b Date zn Permit Pet agree yo comply with all city and county ordlnanoee and state laws relating to building y' construction, and hereby authorize representatives of -this city to enter the -above, mentioned property for Inspection purposes. Validated by: Signature of appllcant Data, Malling Address Validation: City, state, Zip CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ 2ND FL. S0. FT. POR. SO. FT. ® GAR. SO. FT. ® CAR P. SO. FT. WALL SO. FT. ® SO, FT ® ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN. URINAL WATER PIPING NOTE: Not to be used as property tax valuation ROUGH PLUMB. FLOOR DRAIN MECHANICAL FEES HEATING (ROUGH) WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER DUCT WORK GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED GAS (ROUGH) LAUNDRY TRAY AIR HANDLING UNIT CFM HEATING (FINAL) KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET COMPRESSOR HP POLE,TEMIPERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER. B.T.U. SO. FT. ®c BATH TUB BOND BEAM SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® I'A c SEWAGE DISPOSAL LUMBER GR. SO.FT.GAR ® 3/ac HOUSE SEWER r 'n FRAMING N/ FINAL INSP. GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK K l , j 0 [ f — GROUND PLUMBING NDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS a SEWER OR SEPTIC TANK ROUGH WIRING. DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE v GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM $ GRADING cu,yd. plus x$ =$ LUMBER GR. FINAL INSP. / / % r 'n FRAMING N/ FINAL INSP. ^ / ROOFING OOOYYY -Oc C To Vj l -Q/ REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL HI G 3/V7.2– MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION- CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL TA. _ P.O. BOX 1504 APPLICATION ONLY Building M p 7&105 CALLE ESTADO Address - LA QUINTA, CALIFORNIA 92253 Owner Mailing Address City L l Address S41 City BUILDING: TYPE CONST. OCG: GRP. A.P.,Nuniber Zip Tel. Legal Description Project Description State Lic. & Classif. Q Arch., Engr.; Designer Address City Zip 1 LICENSED CONTRACTOR'S I hereb affirm h@ alit licensed ynder provi ns 7000)1of is'on df€ BusineSss and Professt5ns 1 effect , v Lic. # Tel. State Lic. # CATION er 9 (commencing with Section a license is in full force and OWNER -BUILDER DECLARATION I hereby affirm t,at I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure: prior to its issuance also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, or thathe 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). IJ 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, Buisness and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon and who does such work himself or through his own employees, Provided that such improvements are not intended or offered for sale. If, however, the building orimprovement is sold within one year of completion, the owner -builder will have the burden or proving that he did not build or improve for the purpose of sale.) f -I 1, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractors) licensed pursuant to the Contractor's License Law.) - t7 I am exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION hereby affirm that I have a certificate of consent to self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATIONINSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) valuation 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. Date Owner NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Lender's Name Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. - 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 this city to enter the above-. mentioned property for inspection purposes. Signature of applicant -Date- Mailing ateMailing Address City, State, Zip BUILDING DIVISION ZONE: BY: Minimum Setback Distances: Sq. Ft. Size No. No. Dw. Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Estimated Valuation Validation: PERMIT AMOUNT Plan Chk. Dep. _ Plan Chk. Bal. Const. Mach. Electrical "d Plumbing S.M.I. Grading Driveway Enc. rlfrastructure .. TOTAL f a r f r4 —(NA -99 4 Q, REMARKS io "C SM 114611AL 1 275.00 ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SO. FT. @.- $ 2ND FL. SO. FT. {t2 POR. SO. FT. @ GAR. SO, FT. @ CAR P. I SD. FT. WALL SO. FT. SO, FT. ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN URINAL WATER PIPING NOTE: Not to be used as property tax valuation J FLOOR DRAIN MECHANICAL FEES FORMS WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTO)-(DISH) i APPLIANCE DRYER GAS (ROUGH) GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APPJEOUIP. LAUNDRY TRAY AIR HANDLING UNIT CFM TEMP. POLE KITCHEN SINK ABSORPTION SYSTEM. B.T.U. TEMP USE PERMIT SVC WATER CLOSET COMPRESSOR HP POLE, TEM/PERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO. FT. @ c BATH TUB SO. FT. @ c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID @ 11,/. c SEWAGE DISPOSAL SO.FT.GAR @ ?Ac HOUSE SEWER REMARKS: VENTILATION GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE_._ SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BONO BEAM WATER SYSTEM GRADING Cu. yd. $ plus x$ =$ LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL DESERT SANDS UNIFIED SCHOOL DISTRICT 82-879 Highway 111 NOTICE: Indio, CA 92201 Document Cannot Be. Duplicated (619) 347-8631 Date 1/30/92 Type of Permit I La QuinE No. 11152 Permit # Owner Name David Miller Log # No. 53545 street Madero I city La Quinta zip 92253 Study Area 111 APN # Tract # Lot # Square Footage 11372 Type of Development Single Family Residence No. of units 0 Comments 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: EXEMPTION NOT APPLICABLE This certifies that school facility fees unposed pursuant to Government Code 53080 in the amount of1.58 XF537-21 or $ 2,167.76 ' have been paid to D.S.0 S.D. 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 David Miller Tele hoae . "tw Name on the check 3 , By James E. Lively Assistant Superintendent, Business Services Fee collected /exempted by Vickie J. Durrett Signature ; ucJ e Check No. 1356 Collector: Attach a copy of county or city plan check application form to district copy for all waivers. Embossed Original Building DeptJApplicant Copy - Applicant/Receipt Copy - Accounting ( J44 Payment Received•,' Check No. 1356 Collector: Attach a copy of county or city plan check application form to district copy for all waivers. Embossed Original Building DeptJApplicant Copy - Applicant/Receipt Copy - Accounting m ' . COACHELLA VALLEY WATER DISTRICT ' : `•r . 17? - CASH RECEIPT DETAIL - _ V LtJ Q `j 6 7— / S S ' • Date: • - Received From: -Th I I J " C i' b % C ? f' fL% /1? t -7c Edi Address: 1 I` M4 Account No. I , Q. Lot(s) ' Tract SC _ Service Address "' S Vf 4t 1A Y 2 G.A. Code $ oa,406ter(s) _ ' i1 ❑ Backflow(s) ❑ House Lateral(s) ❑ DetectorCheck(s) r ❑ Meter Surcharge ccs tp 6anitation Capacity Charge b 6 ❑ W.S.B.F.C. ❑ Temporary Construction Meter ❑ Turn on Charge ❑ Uncollected Account - Name ❑ Inspection Fee - Tract - Fee- ❑ Plan Check Fees Water 1 Sewer. - Tract - O Bond Payment - A.D. - Bond , Assmt. ❑, Customer Deposit O Other , • a , TOTAL. $ — Remarks:' L4, ❑ Copy to: _ t Cash , Check x: Water Service v, Cashie -. Money Order CMD -438,01189) a ' OFFICE OF 4i .:f,. AGRICULTURAL COMMISSIONER AND WEIGHTS & ME ASURES CALVIN C. KAMINSKAS JAMES O. WALLACE 4080 LEMON STREET. ROOM 19 Asslstonl Commlsslonor AgrIcullwol commissionerBENVENIST,E. RIVERSIDE, CALIFORNIA 925011CLEMENT . soolof olloclor of Welghli &.1A90'sules (714) 787 -2561 49613 Highway 86, . Suite B12 Coachella, Ca. 92236 (619).,342-15291 DATE -7, 22, CASE ND., it. -"TS T, DEVELOPER."S NW CA C VCA d -e S Nj ADDRESS: x C., CA —L cj il TELEPHONE: ((o tck 5(09 5 8 a_3 I ENERGY CONSULTING GROUP Indian Hills Dox 34F I Mountain Center, CA 92361 Lir 473969 The following are some explanatory notes concerning the enclosed forms: C2R The compliance margin is a positivenumber--the building; as described in these reports, complies with the California Energy Commission requirements. CF71R Page 2 should be signed by the building designer and owner. Please note -any remarks that may appear,' in the ."Special Peatiires/Remarks" section. These components are required standards for your build- ing. Also, the brand name and model number of the furnace, air conditioning and hot water systems you plan to install should be entered. MF -1R Lists the '-mandatory items required by the California Energy Commission. This form needs to be completed by the builder or owner.. HVAC SIZING calculations are) used.to indicate the basic heating and air conditioning requirements (Btu) for your particular building. .Please note. that this is. a guideline and the person.selecting this equipment needs to consider all factors.involved (such as air flow restrictions, safety margins, etc.) when making these choices Please contact us if you have any questions. concerning this,compliance.package Thank V" :ERTIFICATE OF COMPLIANCE: RESIDENTIAL Page., -1 CF-1R ---------=----------------------------------=-------------------=-=----=-----= '3roject Title.'......... DAVE MILLER Date. .......-10/17/91 2.r0ject Address........ --------------------- )odumentation Author... W J FINNELL #473969 Building.Perm.i.t # ; :'-ompany....... .......... ENERGY CONSULTING GROUP ' Telephone .. .... 1-800-262-9966 p ; Plan Check / Date omp.liince Method— .... MICROPAS3 by Enercomp, Inc. ; Field Check/ Date Climate Zone........... 15 --,------------------- ---------------- MICROPAS3 v3.11 File-DMILLER Wth-CTZ15 Program-FORM CF-1R ; User#-MP1325 User-ENERGY CONSULTING GROUP Run-DAVE MILLER ; - GENERAL INFORMATION Conditioned Floor Area..... 1372 sf Building Type:. .......... Si'ngle Family Detached Building Front Orientation. Front Facing 90 deg (E) Number of Dwelling Units... Number of Stories. ...... 1 Floor Construction Type.... Slab On Grade (Package D) Infiltration Control....... Standard BUILDING SHELL INSULATION ------------------------- Component Insu1 Type R-value Location/Comments . ----- ---19 OUTSIDE., GARAGE------ W811R -------------------. . Roof R=38 ATTIC € Door R-0. OUTSIDE, GARAGE S1abEdge R-0 TO OUTSIDE, TO GARAGE GLAZING Glazing Area # of Interior Exterior Framing Orientation (sf) Panes Shading Shading Overhang. Type Window Front (E) 20.0 2 drapes 50% bug scrn None Metal 'Window Left (S) 33:0 2 drapes bug scrn None Metal ':Window Back (W) 14.0 2 drapes 50% bug scrn None Metal Window Right (N) 36.0 2 drapes 50% bug scrn None Meta•1. THERMAL MASS ------------ Area Thickness Hard Surfaced/ Type (sf) (in) Exposed Location/Comments SlabOnGrade. 580 3.5 Yes ENTRY/KITCHEN/BATHS S1abOnGrade 792 3.5 No REST OF HOUSE " InteriorHorz 42 1.0 Yes TILE: KITCHEN/BATHS CERTIFICATE OF COMPLIANCE: RESIDENTIAL Page 2` CF -1R Pro,}ect Title.......... DAVE MILL'ER____________________________ ___ Date ___ _______• 10/17/91 ---------------- --------------- i MICROPAS3 v3:11 File-DMILLER Wth-CTZ15 Program -FORM CF -114 User#-MP1325 User-ENERGY•CONSULTING GROUP Run -DAVE MILLER ---"--.------------------------------------- ".. ASSUMED HVAC SYSTEMS --------------------- Assumed Duct Duct AssumedSystemEfficiency Location R -value Gas 0.800 SE Attic - - - - -- -- R -S---- AirCond ..9.00 SEER Attic R-5 ACTUAL HVAC SYSTEMS ------------------- Actual Output Manufacturer and Model #" Actual _(Btuh)_ (or -System---Efficiency approved equal) Heating - - -------------------------- . Cooling. . Cooling Coil PECMaximum output for Gas Central Furnaces: 108000 Btuh' WATER HEATING SYSTEMS • ----------- Tank R-12 or • # of Vol Greater Manufacturer and -Model # System Type Heat (gal) Blanket (or Energy -------------------- ---- -approved -equal)-" - --- Storage, Electric 1 36 Yes SEARS POWER MISER -Credits Recovery SPECIAL FEATURES/REMARKS ------------------------ i. - y CERTIFICATE OF COMPLIANCE: RESIDENTIAL.. Page 3 C Project Title........ DAVE MILLER_______________________________________= -__-====MICROPAS3 v3 11 Fi_________Date------___10/1 le-DMILLER' Wth-CTZ15 Program -FORM CF -1R User#-MP1325 User -ENERGY CONSULTING GROUP Run -DAVE MILLER ------------------------ ------------------------ ----------------- COMPLIANCE STATEMENT -------------------- This certificate'of compliance lists the building features.and spec i f i cat ions . needed to comply with Title 24 , Chapter 2-53 and ormancperf Chapter 2, tle .20;rce 1 of the California'Administrative code This certificate has been signed by the individual with overall desig :responsibility and the building owner, who shall retain a copy of it :an transmit the certificate to any subsequent f• this certificate of compliance is submitted uforaaesingle hbuildin planhe be built in multiple orientations, all building conservation building plan which vary are indicated .in the.Special Features/Remarks section. DESIGNER OWNER Name.... -Company..' Name*... . Address. Company.. Address. "Phone... Phone. Y License. q :Signed Signed 1 (date) b (date DOCUMENTATION AUTHOR Name..... W J-FINNELL #473969 Company. ENERGY CONSULTING GROUP. Address. 34F INDIAN HILLS - MTN CENTER, CA 92361 Phone... 1-800-262-9966 Signed (date) Name . Title.. Agency . . Phone.. Signed ENFORCEMENT AGENCY: (date). ` O MANDATORY. MEASURES CHECKLIST: RESIDENTIAL Page:1. Project Title. DAVE MILLER Project Address........ Date ... 10, ------------- Documentation Author. ' Company •• W J FINNELL #473969 ; B p y•••••• •••••• . ENERGY CONSULTING GROUP uilding Perm' Telephone. .. 1-800-262-9966 ' ....... Plan Check Compliance Method...... MICROPAS3 by Enercomp, Inc.Climate Zone. 15, , Field Check/ C -------------- MICROPAS3 v3.11==File-DMILL________________-__--__---_-"----- ER Wth-CTZ15 Program -FORM MF -1R User#-MP1325 User- s -------CONSULTING GROUP Run -DAVE MILLER - ° Lowrise residential buildings subject to the Standards must measures regardless of the compliance a contain asterisk (*) may be superseded by more stringent compliance Itemrequirements s marked I on the Certificate of Compliance. When this checklist is incorporated int permit documents, the features noted shall be considered by all pantie binding minimum component performance specifications for the mandatory mea whether they are shown elsewhere in the documents or on this checklist onl' BUILDING ENVELOPE MEASURES ----------- --------------- Design- Enfi i e m4 * 2-5352(a): Minimum ceiling insulation R-19 weighted average. 2 -5352(b): -.Loose fill insulation manufacturers labeled R -Value. * 2-5352(c): Minimum wall insulation in framed walls R-11 weighted average (does.not apply to exterior mass walls,). 2-5352(k): Slab edge.insulation - water absorption rate.'no greater than 0.3%, water vapor transmission rate no 3 -greater than 2.0 perm/inch. 2-531,1: Insulation specified or installed meets CEC quality standards. Indicate type and form. t 2-5352(f): Vapor barriers mandatory in Climate Zones 14 and 16. 2-5317: Infiltration/Exfiltration Controls a. Doors and windows between conditioned and unconditioned spaces designed to limit air leakage. b. Doors and windows certified' C.. Doors and windows weatherstripped; all penetrations caulked and sealed. points and 2-5352.(e): Special infiltrationbarrier installed to comply with Sec. 2-5351 meets CEC quality standards. 275352(d): Installation of Fireplaces 1. Masonry and factory -built. fireplaces have: a. Tight fitting, closeable metal or glass door, b. Outside air intake with damper and control c. Flue damper and control 2. No continuous b'urnina aac nil„+- ..,,-.._ MANDATORY MEASURES CHECKLIST: RESIDENT.I.ALPage 2 MF-. Project Title.......... DAVE MILLER__________________________________________= ____________________________________________ Date........ 10/17/.`• _ _ MICROPAS3 v3.11 File-DMILLER Wth-CTZ15 Program-FORM MF-?R User#-MP1325 User-ENERGY CONSULTING GROUP Run-DAVE MILLER ------------------------------------------------.-------------------------- - HVAC AND PLUMBING SYSTEM MEASURES Design- _er Enforcce 2=535.2.. (g) and 2-5303: Space conditioning equipment sizing: menu . .attach calculations. " .2-5352(h.) and 2-5315: Setback thermostat on all applicable heating systems." *-2-5316(a):, Ducts constructed, installed and insulated per Chapter 10, 1976 UMC. 2-5316(b): Exhaust systems have damper controls. 2-;5314(c): Gas-fired space heating equipment has intermittent ignition devices. 2-5314: HVAC equipment, water heaters, showerheads and ...faucets certified by the CEC. 2-5352(i): Water heater insulation blanket (R-12 or greater) fore storage and backup tanks for solar water heating systems (first 5 feet of pipes closest to tank insulated to.R-3 or greater). :2-5.312(Exception 1): Pipe insulation on steam and. steam condensate return and recirculating piping. " 2-53.18(d): Swimming Pool Heating 1 .. System has a. On/off switch on heater. b. Weatherproof instruction plate on heater. ,,. c- Plumbed to allow for solar. { 2.. 75 percent thermal efficiency. 3. Pool cover. f: 4.-Time clock. :. '5. 'Directional water inlet. LIGHTING AND APPLIANCE MEASURES ------------------------- Design- Enforce- 2-5352 er (j): Lighting - 25 lumens/watt or greater"for ment` general .lighting in kitchens and bathrooms. 2-5314(c): Gas fired appliances equipped with intermittent ignition devices . 2-5314"(a): Refrigerators, refrigerator-freezers, freezers and fluorescent lamp ballasts certified by the CEC. COMPUTER METHOD SUMMARY Page 1 "s >s, C --2R. • Pro'jOct _________________________j Title .......:.« _________________ - ----__ DAVE MILLER Project Date. Address..... " " "' 10/17/91 «„ -- -----' Documentation Author' ., W J F. ------------- INNELL #473969 ; Building fR Permit Company ....... Telephone.. :.......... ENERGY CONSULTING GROUP ' ........... 1-800-262-9966 Plan Check / Dat.e ; Compliance Climate Method....... MICROPAS3 by Enercomp,,Inc.' ; Field Check/ D ' Zone..... ate' ...« 15 MICROPAS3 v3.11-___________________________._____= ,•,•,.:. File-DMILLER Wth CTZ15 Program-F.ORM C -2R --«--------------------------------------------.---=-----------------.---------- User#-MP1325 -User-ENERGY CONSULTING GROUP Run -DAVE MILLER - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - _ MICROPAS3 ENERGY USE SUMMARY = ' Ener gy Use Standard. Proposed Compliance (kBtu/sf-yr) _ ' _ - Design Desi Design Margin ----------------------- _ - 7-7 - ---------_-, Space Heating .......---7-25-- ---47i" 2:54 '• = Space Cooling.......`.... 51.44 42:65 8:.79 - , .r ;,k. ^- = _ Water Heating ...... 13.63 19.7.1 -6 08. _r. ... .. --67-07- ---5-:25 «r = Notal 72.32 = •-In" _ *** Building complies with Computer.Performance--------------- GENERAL -INFORMATION- INFORMATION'-----------_- ------------------- Conditioned Conditioned F,loo.r'Area. 1372 sf ' Building Type..:........, Single Family Detached Building Front Orientation. Front Facing- 9'0 deg (E) ' Y. Number:of-Dwelling Units... 1 ' Number of Building Stories. Weather Data Type.'......... ReducedYear i kiY Floor Construction .TYpe••..•. Slab On Grade'(Package D) .• Number of Building Zones. 1- Conditioned Volume..,., 12348 cf x _Footprint .Area ... `:..... 137 f Slab -On -Grade Area.T.`.. , 13724 sf, Glazing Percentage......... 7.5 % of FA 3' i Average'Ceiling Height...., 9 ft. BUILDING ZONE INFORMATION -.-- 'one' Type ' Floor - # - of Vent Cond- Area, Volume Dwell Thermostat Height Vent Spec i a 1 Area'"'. 3' •------ ------ i t i oned (sf) (cf) Units is Type (ft) ------- --- (sf) !OUSE - -- -- - ,_-----------?-..------------ --------------- F Residence` Yes 1'372 12348 Setback 2.0. n/a . a )MPU.TER- METHOD SUMMARY Page 2 C -2R + "0.J`e.pt Title. ____________________________________________________-- .., ---- DAVE MILLER_______________________ Date=========10/17/91 MICROPAS3 v3.11 File-DMILLER Wth-CTZ15. Program=FORM C -2R ------------------- User#=MP1325 User -ENERGY CONSULTING GROUP Run: --DAVE MILLER ' I ----------------------- -------------------- ---------- - -OPAQUE OPAQUE SURFACES arface Area (sf) U- Insul Act, Solar Location/ value R-val Azmth Tilt Gains Comments - ----- Form'3 Reference. )USE ---- --------------------- -----------.-- Wall 116 0.065 R-19 90 90 Yes OUTSIDE None '. Wall 160 0-.065 R-19 90- 90 No GARAGE None 3 Wall 255 0.065 R-19 180 90 Yes OUTSIDE None I.Wa11 152 0.065 R-19 180 90 No GARAGE None >'.Wal1 282 0.065 R-19 -270 90 Yes OUTSIDE None .Wall ' Roof 404 0.065 R-19 0 90 Yes OUTSIDE None 1372 0.029 R-38 0 0' Yes ATTIC None Door 33 0.330 R-0 90 90 Yes OUTSIDE None. D.00r- 18. 0.330 R-0 90 90 No GARAGE None.. PERIMETER LOSSES ----- Length F2 Insu1 Surface -(ft)- Factor R.-val Location/Comments ----- HOUSE----- ---.---- ----------------= _ 10 S1abEdge 411 0.900 R-0 TO OUTSIDE 11 SlabEdge 118 0.720 R-0 TO OUTSIDE 12 S1abEdge 30 0..550 R-0 TO GARAGE 13 S1abEdge 13 0.500 R-0 TO GARAGE :- GLAZING SURFACES ----------------- " Area # SC of Frame Open U- Act Glass Interior Shade SC els+, rface--_- . (sf) Panes Type Type value Azmth Tilt Only ----- ----- ------------ Type Shade 3 USE.. - - - - - - - - - - - - - - - - - - - - - - - ---------- - V ----- Window 20..0 2 Metal Slider 0.65 90 90 0.77 drapes ,a. 0.66 .Window 33.0 2 Metal. Slider 0.65 180 90 0.77 drapes 0.66 Window 14.0 2 Metal Slider 0.65 '270 90 0.77 drapes 0..66 ..Window. 36.0 2 Metal Slider 0.65 0 90 .0.77 drapes 0.66 EXTERIOR SHADING ------------- • Area Shading SC of Surface .(sf) Type Ext Shade ------------ ----------- --------- HOUSE 1 Window 20.0 50% bug scrn 0.84 2 Window 33.0 509 bug scrn 0.84 3 Window 14.0 50% bug scrn 0.84 4 Window 36.0 50% bug scrn 0.84 y OMPUTER -METHOD -SUMMARY _________________________________ Page C -2R r7ect Title....... _______________ ..DAVE MILLER ------=---=--=-------------- -3--_-----_ Date.... 10/17/91 MI.CROPAS3 v3.11 File-DMILLER Wth-CTZ15 Program -FORM C -2R ; User#-MP1325 User -ENERGY CONSULTING GROUP Run -DAVE MILLER ' ---.-------------.------------------------------------------------ ----------- THERMAL MASS Area Thick Heat Conduct- Surface ass -Type_----- _(sf)- (in)- -Cap- _ivity_R_value_ OUSE- - -Location/Comments --------------- 1 SlaI50nGrade 2 S1abOnGrade 580 792 3.5 28.0 0.98 R-0.0 ENTRY/KITCHEN/BATHS 3 InteriorHorz 42 3.5 28.0 0.98 R-2.0' 1.0 24.0 0.67 REST OF HOUSE R-0.0 TILE: KITCHEN/BATHS HVAC SYSTEMS System --------------- Type Minimum Duct Efficiency ------------ -.-Location Duct Duct R -value Efficiency .: HOUSE- --------- ------- ---------- ._ Gas AirCond 0.800 'SE Attic. R-5 0.828 9.00 SEER Attic R-.5 0.818 WATER HEATING SYSTEMS -------- ,. istem # of Capa- city. ----- ---- R-12 or -- -- Greater Effic- Standby Input Pilot Size ape-- •-_- Heat (,gal) Blanket_-iency---- Loss (Btuh) Credits D' Forage __ -._Rating--- - ----------------- :lectric 1 36 Yes 0.99 RE .9% 5.5 kW n/a R•ecovery - SPECIAL FEATURES/REMARKS; ---- --------------- - - - -- 4 k, WATER HEATING -J====-----=------------------------- Page 1 DHW Project Title...... DAVE MILLER____________________________________________ Project Address......... Date..... 10/17/91 ---------------------- Documentation Author... W J FINNELL #47396 ' Com an 9 ; Building Permit # ' p y•'•••••••••••••. ENERGY CONSULTING GROUP ' Telephone...:........... .1-80.0-262-9966 . Plan Check / Date compliance Method...... MICROPAS3 by Enercomp, Inc. ' Climate..Zone........... 15 Field Check/ Date MICROPAS3 v3.11 File-DMILLER Wth-CTZ15------------ Program-WATER HE User#-MP1325 User- ATING ENERGY CONSULTING GROUP Run -DAVE MILLER ----------------------------------------------------------------------- ----i WORKSHEET ONE: STORAGE GAS OR STORAGE ELECTRIC A. EQUIPMENT DATA -- 1. Water heater type Storage., 2. Manufacturer. :.,.,,• 9 , Electric 3. Model SEARS POWER MISER number.. 4. Ignition device .• '.... n/a 5.'Tank volume. ... 36 gal 6. Recovery efficiency....: •99 7. Standby loss:......,., percent x 0.01 8. Rated Input ..... '009 percent/hour x 0.01 " '•• 18771.5 Btu/hr 9. Number of Heaters....... 1 10 Insulation Jacket...:. . .. Yes B. OPERATING DATA ----------- Climate Zone............. 15---- . 2. Water heating budget. 18700 kBtu 3. Tank set temp• /yr/unit .. 4. Water ........ 140 F main temp. 70 F 5. Daily hot water load.... 50 gal 6. Ambient air temp........ 72.6 F 7. Adj. Standby Losses..... .0072 8. No. dwelling.units...... 1 9. Pump power....... 0 Watts. (0 Watts controller) 10.Pumping energy ,•,•,,, 0 Watt- hr/yr (24 hr per day) C_ -WATER HEATING ENERGY CREDITS -1. '---------- Credit Name. Recovery----- 2. Annual savings.......... 2805 kBtu/yr/unit D. ANNUAL WATER HEATING -ENERGY- ---------------- EATING ENERGY ----------------=-------- 1. Recovery load2. Recover energy10539 kBtu/yr Recovery 3: Standby loss energy ,,•• 7813 kBtu/yr 4.. Pumping 'energy.,• 1203 kBtu/yr 5. Total energy ,•,,,• 0 kBtu/yr-source _6. Comparison.. . "'• 27045 kBtu/yr/unit source 7. Points.... •••''''' -8345, kBtu/yr/unit-source 8• Water HeatingEner -12 (DS x B8 gy Use 19.71 kBtu/yr/sf ) /- 1372 sf HVAC SIZING Page 1 HV Froject.Title. ......... DAVE MILLER -------------------=----------------___ Project. Address........ Date . '''••• 10/17/ -------- Documentation Author... W J FINNELL #473969 Building Permit # Company ................ ENERGY CONSULTING GROUP Telephone .............. 1-800-262-9966 Plan Check / Date , Compliance Method....... MICROPAS3 by Enercomp, Inc. ; Field Check/ Date Climate Zone.......:... 15 ' MICROPAS3 x3.11. File-DMILLER Wth-CTZ15 Pro r g am -HVAC SIZING ----User#-MP1325 User -'ENERGY CONSULTING GROUP Run -DAVE MILLER GENERAL INFORMATION ------------------- Floor Area.............. . 1372 sf Volume. 12348 cf Front Orientation.......... Front Facing 90 deg (E) Sizing Location............ INDIO Latitude ................... 33.7 degrees Winter Outside Design...... 29 F Winter Inside Design....... 70 F Summer Outside Design...... 112 F Summer Inside Design........ 78 F SummerRange ............... 30-F Shading Used ............:.. No Latent Load Fraction........ 0.20 HEATING AND COOLING LOAD SUMMARY Heating Cooling Description---------------------- (Btuh)--- ---- (Btuh) F Opaque Conduction and Solar...... 11909 5333 Glazing Conduction.... 2745 2276 Glazing Solar.......:......... ., n/a 3140 Infiltration .................... 7281 4315 Internal Gain .................... n/a 2550 Ducts .......................... 2194 1761 Sensible L.oad.................... 24129 19376 Latent Load ............. ...... n/a 3875 --- Total Load 24129. 23251--- Note: The loads shown are only one of the criteria affecting the selection of HVAC equipment. Other relevant design factors such as air flow requirements, outdoor design temperatures, coil sizing, availability of equipment, oversizing safety margin, etc., must also be considered. It 'is the HVAC designer's responsibility to consider all factors when selecting the HVAC equipment. CEC Maximum output for gas central furnaces only (area weighted SE): 45000 + (100.0 x (0.800 - 0.7.1) x 7000) = 108000 Stuh