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RER (04-7029) + PLBG (08494) + BLCK (08493) + RPL (08481)
54700 Avenida Madero 04-7029 08494 08493 08481 T44f 4 4 Q" K 1504 ,ALLE TAMPICO TA, CALIFORNIA 92253 BUILDING PERMIT BUILDING & SAFETY DEPARTMENT _ (760).777-7012 F -AX (760) 777-7011 INSPECTION REQUESTS (760) 777-7153 v' gib% App lcation Number 04-00007029 Date 11/01/04 ropety Address . . . . . . `.54700 AVENIDA MADERO _PN: 774-262-010-15 -000000- Application description REMODEL - RESIDENTIAL Property Zoning . . . . . . . COVE RESIDENTIAL Application valuation . . . . 4443 Owner Contractor GRIER ERIK ------------------------- SIPOVAC CONSTRUCTION, INC. 54700 AVENIDA MADOERO 72651 THOEDORA LANE LA QUINTA CA 92253 PALM DESERT CA 92260 (760) 809-7538 WCC: EXEMPT WC: EXEMPT 09/30/05 CSLB: 581636 06/30/06 CCC: B Other struct info . . . . CODE -----------------------------------------------------------=---------------- EDITION 2001 Permit . . . . . . BUILDING PERMIT Additional desc Permit Fee 72.00 Plan Check Fee 46.80 Issue Date . . Valuation . . . . 4443 Qty Unit Charge Per Extension BASE FEE 45.00 3.00 9.0000 THOU BLDG 2,001-25,000 ---------------------------------------------- 27.00 Special Notes and Comments ----------------------------- CHANGE OUT OF EXISTING WINDOWS TO NEW WINDOWS PER ENERGY CALCS/150 LF 6' BLOCK WALL ALONG REAR & SIDE P/L. 32 LF 5' BLOCK WALL IN FRONT. ALL WALLS PER CITY STANDARD. ---------------------------------------------------------------------------- Other Fees . . . . . . . . . ENERGY REVIEW FEE 4.68 Fee summary Charged Paid Credited Due ---------- Permit Fee Total 72.00 ---------- ---------- .00 .00 ---------- 72.00 P1an.Check Total 46.80 .00 .00 46.80 Other Fee Total 4.68 .00 .00 4.68 Grand Total 123.48 .00 .00 123.48 P.O. BOX 1504 • ,G` 78-495 CALLE TAMPICD LA QUINTA, CALIFORNIA 92253 4 BUILDING & SAFETY DEPARTMENT Application Number: y Applicant: Applicant's Mailing Address: VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: Architect or Engineer: Architect or Engineer's Address: Lic. No.. BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S 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-L-icens is in full force and effect. _ L C81 nse Class %= i 6>3 6' - - Licen_se_- oa t,_Xl Contract OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' 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 Contractors' 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).): U 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 or 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.). U I, 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.). U I am exempt under Sec. , BA P.C. for this reason Date Owner. WORKERS' 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 Policy Number _ 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. WARNING: FAILURE TO SECURE 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. 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 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, indemnity and hold harmless the City of La Ouinta, 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 this county to enter upon the above-menf d property for inspection purposes. Da Signature (Applicant or Agent): FROM : GRIER FAX NO. : 9495899367 Jul. 24 2004 08:18AM P1 YRT:PAREE, BY: D?= rlcriu' Benton AP Q l ".O MORTGAGE Corklan Drive jacksorville, FL 3225^6 RETURN TO 'I'12Ur3I10R: Eric Grier Dawn Grier 4 Viz Fund PC_'10 Sta Marg,CA,52638,3SO4 f.0an Nu. 06234227SI DOC " zaea- ! rar 7 04/29/2003 0a:A0A Fee 16.00 Pape t of 1 Recorded in OfflClal Reco da County of Riverelde Gary L. Orsa Assessor, County Clerk- 8 Reeardrlr lII Il I!!! t t I l I ll f Ilal lfll 1 . lll lll l SUBSTITU'I1ON OF TR.USTRE AND FULL PECONVEYANCE R 0 f Whereas, tl..e undersigned is the beneficiary under the Deed of ►+"' Trust dezcribed as follcwa : t-.---•` Ur'i irial trustor: ERIX GRIER A:qD DAWN GRIER Ociain3'_ 1'rt)stee. FIDELITY NATICKAL TITLE COMPANY Original Beneficiary: ASN P"O MORTGAGE GROUP INC ?aid In full date: 04-02-03 Original Principal, Amount: $ 120,000 Date Executed; 05-10-2002 uocLumoT17. NuTber: 2002 -?.'131742 Dine kecr,rdcd: 05-14•-2002 Recorded ir. RIVERSIDE County, Calitr..rnia Whereas, trc undersianed, as the present beneficiary(s) under said Deed of Trust desires to Substitute a new Trustee under said Deed of. Trust in place and stead of said original Trustee, now therptore., the under signets hereby substitutes 1-imself (themselves) as trustoo. nnde.r said 'One -d of TrusL and does hereby reconvey, without warranty, Lo LILL- person or percars legally Entitled thereto, t1e estate now held by trim ( her) =herr under. ABN AMRO MORTGAGE GROUP, INC. By: Z Z ULA CLA DA . AssiSL'ant Vice Presi tut .tape of Florida)ss / County of Duval) % .jn Ari ] 1.0, 2003 before mc, the undersigned, personally came the above named PP.ULA CLAIRDAY, Assistant vice President known to me to be the peroon who executed the above irstnimert. for 1%9N A.MR0 Mortgage Group, Inc. and acknowledged th.2t s/he executed tiie,.bFlme for the intens and purposes therein mentioned. fN my hand an t i ial seal CHM11NA L ^1:WE jfC fa LRE73 012 P3H % ` . i. - ; f HuGX!+'nts1 ElG 1'2Snitiv f 1.2006 c mmiss an d r1 +Mn ' r.,.:.•' 3:,rrtaCBV lcriar.ltNctuti, ssr.. FROM : GRIER .lulu 23. 20,04 Rc: drier Residence 54-700 Avenida Madero La Quinta, C:A 9225; To whom it may concern, FAX NO. : 9495899367 WORK AUTHORIZATION Jul. 24 2004 08:17AM P1 I hereby authorize Sipovac Construction, Inc. to petfonn the fo.lJowinb construction at my residence at 54-700 Avenida Madero. • Demo all exterior windows and sliding doors • Install all exterior windows and sliding doors • Repair, drywall around all windows (interior) • Repair and stucco exterior of residence • Demo front wall • Build five; -foot cinderblock wall in front of residence with archway entry and wooden gate creating a courtyard arca • Stucco front wall to match exterior of residence Requested Start Datc: 8/l/2004 Requested I ;nd Date: 10/31 /2004 The tasks will be performed in accordance with this Work Authorisation and the provisions of the Contract. (:ontract and estimate for work Pending approval by owner. Approvals: h UvialE:r - Erik Grier Contractor Project Manager Bob Sipovac TITLE 24 REPORT Title 24 Report for: Grier Residence 54700 Madero La Quinta, Ca 92254 Project Designer: Sipovac Construction Inc. 72651 Theodora Ln. Palm Desert, Ca 92260 760-567-2347 Report Prepared By: Sipovac Construction Inc. Sipovac Construction 72651 Theodora Lane Palm Desert, CA 92260 (760) 779-0790 CITY OF LA QUINTA BUILDING & SAFEW DEPT. APPROVED Job Number: FOR CONSTRUc-noN 452004 DA .O BY Date: 11/1/2004 The EnergyPro computer program has been used to perform the calculations summarized in this compliance report. This program has approval.and is authorized by the California Energy Commission for use with both the Residential and Nonresidential 2001 Building Energy Efficiency Standards. This program developed by EnergySoft, LLC (415) 883-5900. EnergyPro 3.1 By EnergySort Job Number. 452004 User Number. 5289 1 TABLE OF CONTENTS I Cover Page Table of Contents Form CF -1 R Certificate of Compliance Form MF -1 R Mandatory Measures Checklist Form C -2R Computer Method Summary 1 2 3 6 8 I EnergyPro 3.1 By EnergySoft Job Number. 452004 User Number. 5289 1 Certificate of Compliance: Residential (Part 1 of 2) CF -1 R Grier Residence 11/1/2004 Project Title Date 54700 Madero La Quinta Project Address Building Permit # Sipovac Construction (760) 779-0790 Plan Check / Date Documentation Author Telephone Computer Performance 15 Field Check / Date Compliance Method (Package or Computer) Climate Zone Enforcement Agency Use Only GENERAL INFORMATION Total Conditioned Floor Area: 1,700 ft2 Average Ceiling Height: 8.0 ft Total Conditioned Slab Area: 1,700 ft2 Building Type: (check one or more) © Single Family Detached ❑Addition ❑ Single Family Attached ❑ Existing Building ❑ Multi -Family ❑ Existing Plus Addition Front Orientation: (West) 270 deg Floor Construction Type: ® Slab Floor Number of Dwelling Units: 1.00 Number of Stories: , 1 ❑ Raised Floor Component R-19 Wall (W.19.2x6.16) Solid Wood Door R-38 Roof (R.38.2x4.24) Slab On Grade Slab On Grade FENESTRATION Frame Type Const. Assembly U -Value Location/Comments (attic, garage, typical, etc.) Wood 0.065 Exterior Wall None 0.387 Exterior Door Wood 0.024 Exterior Roof n/a 0.756 Covered Slab w/R-0.0 Perimeter Insulation n/a 0.756 Exposed Slab w/R-0.0 Perimeter Insulation Shadina Devices Type Orientation Area Fenestration Exterior Overhang Side Fins SF U -Factor SHGC Shading Yes / No Yes / No Front (West) 32.0 0.33 0.33 Bug Screen ❑ X❑ ❑ X❑ Front (West) 18.0 0.35 0.30 Bug Screen ❑X❑ ❑X❑ Rear (East) 56.0 0.35 0.33 Bug Screen ❑X❑ ❑ x❑ Left (North) 16.0 0.38 0.28 Bug Screen ❑ x❑ ❑ x❑ Rear (East) 16.0 0.35 0.30 Bug Screen ❑ X❑ ❑ 0 Rear (East) 4.0 0.38 0.28 Bug Screen ❑ 0 ❑ 0 Left (North) 35.0 0.35 0.33 Bug Screen ❑ 0 ❑X❑ Right (South) 48.0 0.38 0.28 Bug Screen ❑x❑ ❑X❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ Run Initiation Time: 11/0110410:07:39 Run Code: 1099332459 EnergyPro 3.1 By EnergySoft User Number. 5289 Job Number. 452004 Page: 3 of 11 Certificate of Compliance: Residential (Part 2 of 2) CF -1 R Grier Residence 11/1/2004 Project Title Date HVAC SYSTEMS Note: Input Hydronic or Combined Hydronlc data under Water Heating Systems, except Design Heating Load. Distribution Heating Equipment Minimum Type and Duct or Type (fumace, heat Efficiency Location Piping Thermostat Location / pump, etc.) (AFUE/HSPF)(ducts, attic, etc.) R -Value Type Comments Central Fiirnara 80% AFUE Duds in Attic 4.2 Setback HVAC 1 Cooling Equipment Minimum Duct Type (air conditioner, Efficiency Location Duct Thermostat Location / heat pump, evap. cooling) (SEER) (attic, etc.) R -Value Type Comments Split Air Conditioner 12.0 SEER Duds in Attic 42 Setback WATER HEATING SYSTEMS Rated 1 Tank Energy Fact! 1 External Water Heater Water Heater Distribution # in Input Cap. or Recovery Standby Tank Insul. System Name Type Type Syst. Btu/hr (gal) Efficiency Loss (%) R -Value Standard Gas 50 gal or Less Small Gas Standard 1- 40"000 so 0.52 n/a 12 1 For small gas storage (rated inputs of less than or equal to 75,000 Btu/hr), electric resistance and heat pump water heaters, list energy factor. For large gas storage water heaters (rated input of greater than 75,000 Btu/hr), list Rated Input, Recovery Efficiency and Standby Loss. For instantaneous gas water heaters, list Rated Input and Recovery Efficiency. REMARKS 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 California Code of Regulations, and the administrative regulations to implement them. This certificate has been signed by the individual with overall design responsibility. The undersigned recognize that compliance using duct sealing and TXV's requires installer testing and certification and field verification by an approved HERS rater. Designer or Owner (per Business & Professions Code) Documentation Author Name: Name: Sipovac Construction Inc. Title/Firm: Sipovac Construction Inc. Title/Firm: Sipovac Construction Address: 72651 Theodora Ln: Address: 72651 Theodora Lane Palm Desert, Ca 92260 Palm Desert, CA 92260 Telephone: 760-567-2347 Telephone: (760) 779-0790 Lic. #: es, L— 1,1 b - 0 (sign t ((dale) (signature) (gate Enforcement Agency Name: Title/Firm: _ Address: Telephone: (signature/stamp) (date) Run Initiation Time: 11101/04 MM39 Run Code: 1099332459 1 EnergyPro 3.1 By EnergySoft User Number. 5289 Job Number. 452004 PageA of 11 Certificate of Compliance: Residential (Addendum) CF -1 R Grier Residence 11/1/2004 Project Title Date Special Features and Modeling Assumptions The local enforcement agency should pay special attention to the items specified in this checklist. These items require special written justification and documentation, and special verification to be used with the performance approach. The local enforcement agency determines the adequacy of the justification, and may reject a building or design that otherwise complies based on the adequacy of the special justification and documentation submitted. I Plan Field The DHW Svstem "Standard Gas 50 pal or Less" Enerpv Factor = 0.525. An EF below 0.58 requires an R-12 External Blanket. HERS Required Verification These features must be confirmed and/or tested by a certified HERS rater under the supervision of a CEC approved HERS JI VVIUal. Ila nG IaLal IIIuAI uubUIIICIIL UIC IICW •CIIIILAUVII a11U umvesubuL4 Laauiij u1 UICSC UIC45uLC5 VII a Iuma Lor -on. I Plan I Field Run Initiation Time: 11/01/0410:07:39 Run Code: 1099332459 EnergyPro 3.1 By EnergySoft User Number. 5289 Job Number. 452004 Page:5 of 11 Mandatory Measures Checklist: Residential (Page 1 of 2) MF -1 R NOTE: Lowrise residential buildings subject to the Standards must contain these measures regardless of the compliance approach used. Items marked with an asterisk (*) may be superseded by more stringent compliance requirements listed on the Certificate of Compliance. When this checklist is incorporated into the permit documents, the features noted shall be considered by all parties as minimum component performance specifications for the mandatory measures whether they are shown elsewhere in the documents or on this checklist only. DESCRIPTION Instructions: Check or initial applicable boxes or enter NIA if not applicable. DESIGNER ENFORCEMENT Building Envelope Measures 1150(,): Minimum R-19 ceiling insulation. ❑ §150(b): Loose fill insulation manufacturer's labeled R -Value. * § 150(c): Minimum R-13 wall insulation in wood framed walls or equivalent U -value in metal frame walls (does not apply to exterior mass walls). E] *§150(d): Minimum R-13 raised floor insulation in framed floors or equivalent ❑§ 150(1): Slab edge insulation - water absorption rate no greater than 0.3%, water vapor transmission rate no greater than 2.0 permfinch. 6118: Insulation specified or installed meets insulation quality standards. Indicate type and form. ® §116-17: Fenestration Products, Exterior Doors and Infiltration/Exfiltration Controls 1. Doors and windows between conditioned and unconditioned spaces designed to limit air leakage. 2. Fenestration products (except field fabricated) have label with certified U -Factor, certified Solar Heat Gain Coefficient (SHGC), and infiltration certification. 3. Exterior doors and windows weatherstripped; all joints and penetrations caulked and sealed. §150(8): Vapor barriers mandatory in Climate Zones 14 and 16 only. ❑ § 150(0: Special infiltration barrier installed to comply with Section 151 meets Commission quality standards. ❑ §150(e): Installation of Fireplaces, Decorative Gas Appliances and Gas Logs. 1. Masonry and factory -built fireplaces have: a. Closeable metal or glass door b. Outside air intake with damper and control C. Flue damper and control 2. No continuous burning gas pilots allowed. Space Conditioning, Water Heating and Plumbing System Measures ❑ §110-13: HVAC equipment, water heaters, showerheads and faucets certified by the Commission. §150(h): Heating and/or cooling loads calculated in accordance with ASHRAE, SMACNA or ACCA. ❑ §150(i): Setback thermostat on all applicable heating and/or cooling systems. ❑ §1500: Pipe and Tank Insulation 1. Storage gas water heaters rated with an Energy Factor less than 0.58 must be externally wrapped with insulation having an installed thermal resistance of R-12 or greater. 2. First 5 feet of pipes closest to water heater tank, non -recirculating systems, insulated (R-4 or greater) 3. Bads -up tanks for solar system, unfired storage tanks, or other indirect hot water tanks have R-12 external insulation or RA6 combined intemal/extemal insulation. 4. All buried or exposed piping insulated in recirculating sections of hot water systems. 5. Cooling system piping below 55 degrees F. insulated. 6. Piping insulating between heating source and indirect hot water tank. EnergyPro 3.1 By EnergySoft User Number. 5289 Job Number. 452004 Page:6 of 11 Mandatory Measures Checklist: Residential (Page 2 of 2) MF -1 R NOTE: Lowrise residential buildings subject to the Standards must contain these measures regardless of the compliance approach used. Items marked with an asterisk (') may be superseded by more stringent compliance requirements listed on the Certificate of Compliance. When this checklist is incorporated into the permit documents, the features noted shall be considered by all parties as minimum component performance specifications for the mandatory measures whether they are shown elsewhere in the documents or on this checklist only. DESCRIPTION Instructions: Check or initial applicable boxes or enter NIA if not applicable. DESIGNER ENFORCEMENT Space Conditioning, Water Heating and Plumbing System Measures: (continued) ❑ '§ 150(m): Ducts and Fans 1. All ducts and plenums installed, sealed and insulated to meet the requirements of the 1998 CMC Sections 601, 603, 604 and Standard 6-3; ducts insulated to a minimum installed level of R-4.2 or enclosed entirely in conditioned space. Openings shall be sealed with mastic, tape, aerosol sealant, or other duct -closure system that meets the applicable requirements of UI -181, UL181A, or UL181B. If mastic or tape is used to seal openings greater than 1/4 inch, the combination of mastic and either mesh or tape shall be used. Building cavities shall not be used for conveying conditioned air. Joints and seams of duct systems and their components shall not be sealed with doth back rubber adhesive duct tapes unless such tape is used in combination with mastic and drawbands. 2. Building cavities, support platforms for air handlers, and plenums defined or constructed with materials other than sealed sheet metal, duct board or flexible duct shall not be used for conveying conditioned air. Building cavities and support platforms may contain ducts. Ducts installed in cavities and support platforms shall not be compressed to cause reductions in the cross-sectional area of the ducts. 3. Joints and seams of dud systems and their oomponents shall not be sealed with doth back rubber adhesive dud tapes unless such a tape is used in combination with mastic and drawbands. 4. Exhaust fan systems have back draft or automatic dampers. 5. Gravity ventilation systems serving conditioned space have eitherautomatic or readily accessible, manually operated dampers. 6. Protection of Insulation. Insulation shall be protected from damage, including that due to sunlight, moisture, equipment maintenance, and wind but not limited to the following: Insulation exposed to weather shall be suitable for outdoor service e.g., protected by aluminum, sheet metal, painted canvas, or plastic cover. Cellular foam insulation shall be protected as above or painted with a coating that is water retardant and provides shielding from solar radiation that can cause degradation of the material. ❑ § 114: Pool and Spa Heating Systems and Equipment 1. Certified with 78% thermal efficiency, on-off switch, weatherproof operating instructions, no electric resistance heating, and no pilot 2. System is installed with at least 36" of pipe between filter and heater for future solar, cover for outdoor pools or spas. a. At least 36" of pipe between filter and heater for future solar heating. b. Cover for outdoor pools or outdoor spas. 3. Pool system has directional inlets and a circulation pump time switch. ❑ §115: Gas fired central furnaces, pool heaters, spa heaters or household cooking appliances have no continuously burning pilot light (Exception: Non -electrical cooking appliances with pilot < 150 Btu/hr) ❑§118 (f): Cool Roof material meet specified criteria Lighting Measures ❑ §150(k)1: Luminaires for general lighting in kitchens shall have lamps with an efficacy 40 lumens/watt or greater for general lighting in kitchens. This general lighting shall be controlled by a switch on a readily accessible lighting control panel at an entrance to the kitchen. ❑§150(k)2: Rooms with a shower or bathtub must have either at least one luminaire with lamps with an efficacy of 40 Iumenstwatt or greater switched at the entrance to the room or one of the alternative to this requirement allowed in Section 150(k)2.; and recessed ceiling fixtures are IC (insulation cover) approved. 3.1 By EnergySoft User Number. 5289 Job Number. 452004 Page:7 o11 Computer Method Summary (Part 1 of 3) C -2R (,.riff Residence Project Title 11/1/2004 Date .34700 Madem a_QDinta Project Address Building Permit # Sinovac Construction (760) 779-0790 Do umentation Author Telephone Plan Check/Date Qlampl ltp_r Parformgnce Compliance Method (Package or Computer) 15 Climate Zone Field Check/Date Source Energy Use Standard Proposed Compliance (kBtu/sf-yr) Design Design Margin Space Heating 0.82 0.36 0.46 Space Cooling 32.07 30.86 1.21 Domestic Hot Water 14.48 14.48 0.00 Totals 47.37 45.69 1.68 Total Conditioned Floor Area: 1,700 ft Floor Construction Type: ❑ Raised Floor ❑X Slab Floor Building Type: Single Fam Detached Building Front Orientation: (West) 270 deg Total Fenestration Area: 13.2% Number of Dwelling Units: 1.00 Total Conditioned Volume: 13,600 ft 3 Number of Stories: 1 Total Conditioned Slab Area: 1,700 ft 2 BUILDING ZONE INFORMATION # of Thermostat Vent Zone Name Floor Area Volume Units Zone Type Type Hgt. Area HVAC 1 1,700 111 An0 1.00 CnnditinnPri Setback 2 _n1a Solar OPAQUE SURFACES Act. Gains Type Area U -Fac. AZm. Tilt Y / N Wall 97 0.065 270 90 Door 21 0.387 270 9.0 Wall 92 0.065 9.0_ gn Wall _312 0.065 0 90 Rnnf 750 0.024 0 0 Wall 140 0.065 go go Wall 176 0.065 180 90 Wall 141 0.065 0 90_ Roof 450 0.024 f a Wall 148 0.065 18.0_ 90 Roof 500 0.024 -0 0 Form 3 Reference Location / Comments EnergyPro 3.1 By Enemy oft User Number. 5289 Job Number. 452004 Page:B of 11 Computer Method Summary (Part 2 of 3) C -2R Grier Residence 11/1/2004 Project Title Date FENESTRATION SURFACES U- Act. Glazing Type Location/ # Tvpe Area Factor SHGC Azm. Tilt Comments J- Window Front es ) 2 Window Front (West) 3 Window Front (West) 4 Window Rear (East) 5 Window Left (North) 6 Window Rear (East) 7 Window Rear (East) 8 Window Rear (East) ' 9 Window Left (North) 10 Window Right (South) 0.380 Window Right (South) 16.0_ _0330 -0_33 270 _9t2 p9Lble1VON Met fear 3 20NE 1 16.0 0.330 0.33 270 90 Double NON Metal Clear 3 ZONE 1 18.0 0.350 0.30 270 90 Double NON Metal Clear 2 ZONE 1 56.0 0.350 0.33 90 90 Double NON Metal Clear 1 ZONE 1 16.0 0.380 0.28 0 90 Double NON Metal Clear ZONE 1 8.0 0.350 0.30 90 90 Double NON Metal Clear 2 ZONE 1 8.0 0.350 0.30 90 90 Double NON Metal Clear 2 ZONE 1 4.0 0.380 0.28 90 90 Double NON Metal Clear ZONE 1 35.0 0,350 0.33 0 90 Double NON Metal Clear 1 ZONE 1 24.0 0.380 0.28 180 , 90 Double NON Metal Clear ZONE 1 24.0 0.380 0.28 180 90 Double NON Metal Clear ZONE 1 • INTERIOR AND EXTERIOR SHADING # Exterior Shade Type SHGC -i-Bug • Screen 0.76 2 Bug Screen 0.76 3 Bug Screen 0.76 • 4 Bug Screen 0.76 5 Bup Screen 0.76 6 Bug Screen 0.76 7 Bug Screen 0.76 8 Bug Screen 0.76 9 Bug Screen 0.76 10 Bug Screen 0.76 11 Bug Screen 0.76 Overhang Len. Hgt. LExt. REM. Left Fin Dist. Len. Right Fin Dist. Len. Hgt. EnergyPro 3.1 By EnergySoft User Number. 5289 Job Number. 452004 Pace:9 of 11 Computer Method Summary (Part 3 of 3) 1 C -2R Grier Residence 11/1/2004 Project Title Date THERMAL MASS FOR HIGH MASS DESIGN Area Thick. Heat Inside Location Type (sf) (in.) Cap. Cond. Form 3 Reference R -Val. Comments PERIMETER LOSSES F2 Insulation Type Length Factor R -Val. Depth Location / Comments HVAC SYSTEMS Heating Equipment Minimum Distribution Type Type (furnace, heat Efficiency and Location Duct Thermostat Location / pump, etc.) (AFUE/HSPF)(ducts/attic, etc.) R -Value Type Comments Central Fumace 80%AFUE Ducts in Attic 4.2 Setback HVAC 1 Hydronic Piping pipe Pipe Insul. System Name Length Diameter Thick. Cooling Equipment Minimum Duct Type (air conditioner, Efficiency Location Duct Thermostat Location / heat pump, evap. cooling) (SEER) (attic, etc) R -Value Type Comments Split Air Conditioner 12.0 SEER Ducts in Attic 4.2 Setback HVAC 1 WATER HEATING SYSTEMS Ratedl Tank Energy Fact! 1 Tank Insul. Water Heater Water Heater Distribution # in Input Cap. or Recovery Standby R -Value System Name Type Type Syst. (Btu/hr) (gal) Efficiency Loss M Ext. Standard Gas 50 gal or Less Small Gas Standard 1 40,000 50 0.52 n/a 12 1 For small gas storage (rated input — 75000 Btu/hr), electric resistance and heat pump water heaters, list energy factor. For large gas storage water heaters (rated input > 75000 Btu/hr), list Rated Input, Recovery Efficiency and Standby Loss. For instantaneous gas water heaters, list Rated Input, and Recovery Efficiency. REMARKS Run Initiation Time: 11/01/0410:07:39 Run Code: 1099332459 EnergyPro 3.1 By EnergySoft User Number. 5289 Job Number: 452004 Page:10 of 11 Computer Method Summary (Addendum) C -2R Grier Residence 11/1/2004 Project Title Date Special Features and Modeling Assumptions The local enforcement agency should pay special attention to the items specified in this checklist. These items require special • written justification and documentation, and special verification to be used with the performance approach. The local enforcement aaencv determines the adeauacv of the justification, and may reject a building or design that otherwise complies based on the adequacy of the special justification and documentation submitted. I Plan Field The DHW Svstem "Standard Gas 50 qal or Less" Energy Factor = 0.525. An EF below 0.58 requires an R-12 External Blanket. HERS Required Verification These features must be confirmed and/or tested by a certified HERS rater under the supervision of a CEC approved HERS provider. The HERS rater must document the field verification and diagnostic testing of these measures on a form CF -611. Plan Field Run Initiation Time: 11101/0410:07:39 Run Code: 1099332459 EnergyPro 3.1 By EnergySoft User Number. 5289 Job Number. 452004 Page:11 of 11 Building Address Owner Mailing Address City 4111 Contractor' Address 4 P.O. BOX 1504 78-105 CALLE ESTADO 54-700 MAnFRo LA QUINTA, CALIFORNIA 92253 City lZip I Tel. State Lic.I City & Classif. rJ2,10A,7 n Lic. # Arch., Engr., Designer Address I Tel. CityI Zip I State I Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I em licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. SIGNATURE DATE 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, 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 that. he 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). ❑ 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 of proving that he did not build or improve for the purpose of sale.) ❑ I, 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._ ) ❑ I am exemp and r Sec. B F°8 P.C. f r thjs leas n fcJ . Date & ner .► .f IVf + (F --✓ WORKER'S' 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.) Policy No. Company ❑ Copy is filed with the city. 0 Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATIONINSURANCE (This section need not be completed it the permit is for one hundred dollars (8100) 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 Address City, State, Zip No. 08494 BUILDING: TYPE CONST. OCC. GRP. A.P. Number Legal Description Project Description SEWER i V + c M.i Sq. Ft. Size No. No. Dw. Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS vi inn - A"Cr 047-13 1-00 40 IV 4 1 1t3 f HL. I SV a Vtf ;4M 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. SQ. FT. @ $ 2ND FL. SQ. FT. @ POR. SQ. FT. @ GAR. SQ. FT, @ CAR P. SQ. FT. @ WALL SO. FT. @ SQ 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 BONDING FLOOR DRAIN MECHANICAL FEES FORMS WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH) GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APPJEQUIP. 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. SQ. FT. @ c BATH TUB SQ. FT. @ c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID @ 11/4 c SEWAGE DISPOSAL SQ.FT.GAR @ 3/ac HOUSE SEWER REMARKS: GAS PIPING PERMIT FEE MIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE LPL.CK.!FEECONST. 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 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. 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 :d a COACHELLA VALLEY WATER DISTRICT CASH RECEIPT DETAIL Received From: if r ! r i f Address: SG - L Account No.//,74 =''111411610Lot(s) Service Address Meter(s) v 4ervice(s) / SO -Ga ❑ Backflow(s) ❑ House Lateral(s) ❑ DetectorCheck(s) ❑ Meter Surcharge r / Sanitation Capacity Charge ❑ W.S.B.F.C. ❑ Temporary Construction Meter n Turn nn charm ❑ Uncollected Account -Nam ❑ Inspection Fee -Tract - Fee - ❑ Plan Check Fees Water I Sewer - Tract - ❑ Bond Payment - A.D. - Bond Assm ❑ Customer Deposit_ ❑ Other v Remarks: N! :,P- - 5 7 U TOTAL $ 7/L/ EI Copy to: L., l Cash ' // Water Service ` AA Check 7 Y2 \4 Money Cashier , / , Order CVWD-438 (11189) Building Address Owner Mailing Address T4hf 4 4 Qgb& P.O. BOX 1504 N o . 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 BUILDING: TYPE CONST. OCC. GRP. City Izip IT Contractor Address Zip j Tela State Lic.I City & Classif. »ls'70f1'7 ID Lic. # Arch., Engr., Designer Address Tel. CityI Zip I State I Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. SIGNATURE DATE 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, 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 that. he 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). ❑ 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 of proving that he did not build or improve for the purpose of sale.) ❑ I, 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.) ❑ 1 am axem t under Seca. & P.C. for this reason ! // Date 1Z f 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.) Policy No. Company O Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed i1 the permit is for one hundred dollars ($100) valuation or less.) I certify that in the performance of Ing 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. Dale 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 Ihereby 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 P. Number al Description 08498 Project Description 60 GAR—DC- bi NAM-1-100-ti-1-14—CAR. Sq. Ft. No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT I w ^ AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. 21 Grading Driveway Enc. Infrastructure TOTAL REMARKS 0,05% $Wfk.l-`r „ 10 vravf; 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. SQ. FT. ® $ 2ND FL. SQ. FT. FOR. SQ. FT. ® GAR. SO. FT. ® CAR P. SQ. FT. WALL SO. FT. ® SQ 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 ROCK STORAGE GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY AIR HANDLING UNIT CFM OTHER APPJEQUIP. 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. SQ. FT. ® c BATH TUB WATER SYSTEM SQ. Ff. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/. c SEWAGE DISPOSAL SO.FT.GAR ® 3/ac HOUSE SEWER FINAL INSP. GAS PIPING PERMIT FEE MIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE EPL.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 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. FRAMING FINAL INSP. ROOFING ! /" /fe REMARKS: VENTILATION FIRE ZONE ROOFINGFIREPLACE SPARK SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL P.O. BOX 1504 No. 08481 Building 78-105 CALLE ESTADO Address 54-700 I►iA1 HRO LA QUINTA, CALIFORNIA 92253 Owner CUDDFHT Mailing Address SAME City LA QUINTAS Contractor F & F POOL Address BUILDING: TYPE CONST. OCC: GRP. A.P. Number Zip Tel. k 92.253 347-3145 Legal Description Project Description MOD (no Fins or heAtar) City Zip Tela . Zbit3Ff<i CA 92201 345— State 6 —State Lic. City & Classif. 0538476807 Lic. # Arch., Engr., Designer Address Tel. City Zip State Lic. # LICENSED CONTRACTOR'%DECLARATION I hereby affirm that I am licensedynder p&ssmn of ChapteC9(commencing with Sectio 7000) of DivisiarrS-Gltbe 3uetntilgs and Pro cions Code, and my license is in full force rind_/ —OWNER -BUILDER ITECLARATION % E I hereby affirm that I am exempt from the Contractor's License Law for l e 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). ❑ 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 of proving that he did not build or improve for the purpose of sale.) ❑ 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.) ❑ 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.) . Policy No. Company O Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION 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 thg 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 Address City, State, Zip Sq: Ft. No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ m ; i Estimated Valuation $8.000.00 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. 99.00 Mech. Electrical. Plumbing 21.00 S.M.I. .55 Grading Driveway Eno, Infrastructure TOTAL $329.21 REMARKS 40 x. a .: 'E•!i "' ...-. .0 ..., 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. SQ. FT. ® $ 2ND FL. ` SQ. FT. POR. SQ. FT. ® GAR. SQ, FT. ® CAR P. SQ. FT. WALL SQ. FT. ® SQ 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, TEM/PERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER. B.T.U. SO. FT. ® c BATH TUB BOND BEAM SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 1% c SEWAGE DISPOSAL LUMBER GR. SQ.FT.GAR ® V4c HOUSE SEWER FRAMING 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 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 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. FRAMING FINAL INSP. ROOFING /I ✓01 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