SFD (0210-193)54835 Avenida Madero
0210-193
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
652188 2
Date 11 fes- 6`°Y Signature of Contractor
OWNER -BUILDER DECLARATION e~
I hereby' affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 1, 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).
( ) 1, as owner of the property, am exclusively contracting with license
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
O I am exempt under Section B&P.C. for this reason-'
Date f' t"' i7 '-Signature of Owner I r'.: • r....-....-
V.
WORKER'S COMPENSATION DECLAR TION
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:.
Cartier STAU Policy No. 7683w -p1
(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 mannerl 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 3700,01h,e Labor
Code, I shall forthwith comply witlYthose proviso s?
Dates f Applicant
Warning Failure to secure Workers' Corn ie, on 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, indemni
& hold harmless the City of La Quinta, its officers, agents and employee D
2. Any permit issued as a result of this application becomes null and void
work is not ,commenced within 180 days from date of issuance of su
permit, or cessation `of work for 180 days will subject permit to cancellatio
I certify that I have read this application.and state that the above information
correct. I agree to comply with all City, and'State laws relating to the buildi g
construction, and hereby authorize representatives of this City to enter•up• n
the above-mentioned property for inspection poses
ignature (Owner/Agent) - .',nate
-_BUILDING PERMIT PERMIT#
DATE - VALUATION- LOTTRACT
a .r? rsj : • > e rO 1:597 b 331 0 x'"14 U25
JOB SITE APN
ADDRESS
OWNER CONTRACTOR / DESIGNER / ENGINEER
A0.X 621
ki 17xJ SC3iTx
C-4.1 32501 k4.b"ERSIDE, CAL 92501
}
(760,399-1413 31 RA
USE OF PERMIT
SM :• 37$5 r.(?,'FT. WO IZNG 1?4:;PMIT CvEU rmt (ttdlude %vAr.,
gaol 0 span Mopwroto df e way aWoavh Feral* is a etaE d
tio-ou(o the Puhk Oepatoneta .
r„
TRAM i coNn-au i ow " rte; 95. 0 3F ,
P011CHIPAT16 ). ts4 R0 Sig
L?AR AOXV1 °A1t1'ORT 525.011 3t
EMMATYD COW OF MRS'I'. U4":1,10N
11Wss3, .70
COWTROCT10A FEE
I01,v000418-000
$874.00
KIM + 14FICK ME
101_000_4139_318
VW.43
;P?z 1yy Epplt O'Si`,F;•
1 3tg3 •/.1 (18
-a 250,00
Y y
1"J19C..J . ' NICAf..l•IM
{01.000ry {
101,000-421-000
7. q.A.1 ,00 3-4 1 -000
M1 CTIRUCAL FU
101.000.421,00 3
d141iM'
PLIL`P48INQ FLY
101-0011-i19-000
ST:R aRG }bIOTIO14 ME -R1 SID
101-000-24-1-000
MAWIG FL1a'
1 tl1 1fi0M # 3 OCrij
$f .Of!
DEVELOPER IMPAC ' FIR
PRECISM PLAN
161-000-,441-345
$,100.00
5XIS 1 RZ4-..AtD)5
".°
4,7.50100
DEC 0 91001 . D
OF LA QUINTA
'.1" YM :PXPZWf FERES' DIA NOW I $4,31ML20
s3
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
— 0
Underground Ducts
Forms & Footings
it 4
Ducts
Slab GradeReturnAir
Steel
Combustion Air
Roof Deck
f 13, O
Exhaust Fans
O.K. to Wrap
—/ 6�? L!/
F.A.U.
Framing
— d
Compressor
Insulation
% 03
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final �!!(
BLOCKWALL APPROVALS
Final
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
—la -0
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
Pool Cover
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 — 03
Final
Utility Notice (Perm)
COMMENTS:
Building
AArfrana I;A-, 9itI;
a "
4P . 80X.1504
78.495 CALLE TAMPICO
mala Madero La2u.iltittrA QUINTA, CALIFORNIA 92253
C ►tit I
pa d -den Cvana e6A gn a eJe . ne G
Address 21
new. S.iftate F FA ,R2aid.
City
R,i,velr.6.tde
Zip
92502
Tel
9b9788,,
_
678.0:
Contractor I '
t
Pau,eden Evgna
Alter ❑ Repair ❑ Demolition ❑
Addres§ P 0' 00X 621
City
Zlp
Tel..
Rivex6,i:de
92502
909 7884780
FINAL DATE
State Lic.
8•Classif. 6521-88 B• HIC`
Cty
Lic. # 0624`6
Plan "Chk. Dep.
Arch., Engr., Sf2.4 L2YlC(1
P`
Plan Chk. Bal.
Designer
Const.
Address
Te
y60
My Zip State
La 2u.i.nxa 1 92253 I.Lic. a
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 am licensed under provisions of Chapter.8 (commence
7000) of Olvlslon 3 of the Business and•Professlons Code, and my;lloenbe le
effect.
OWNER•SULLOERDECLARATION '
I hereby affirm that I am exempt from the Contractor -a License Law for t a following
reason: (Sec. 7031. s; Business and Professions Code: Any city, or; county whic j requires a
Permit to construct, alter, Improve, demolish, or repalr'any structure,. prior to 'Ile seance also
requires me applicapt for such. permit to file a signed statement that,he;ls.licensa pursuanhto
the provisions of the Contractor's License Law, Chspror.g (commencing with Sea )n'7000) of
Division 3'of the Business and Professions. Code. or fhet.he Is exempt therefrom, no the basis.
for 'me alleged exemption.' Any violation of Section 7031.8 by Any ftant or a permit
cts Me
l 8as owner he property, r y employees
ant to a civilpanally of not with wages as than live hundred their able compensation, will
do the work, and the structure Is not Intended or offered for sale.' (Sec. 7044, Bulsnass and
Professions Code: The Contractor's License Law does not apply to an owner of properly who
builds or Improves thereon and who does such work himself or .through .his own employees,
.provided that such lomprovements are not Intended or offered for. sale. If, however,[ the building
or Improvement Is sold - within one year of completion, the owner builder will havi the Durden
ot.proving that he did not build or Improve for the purpose of sale.) -
1'1 I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The -'Ccntracror's License Law
does .not apply to an owner ol,pmparty who builds or Improves thereon, and who contracts Jor
such projects with a contrector(s) licensed pursuant to rite Contractor's License Law.) 33
i7 1 am exempt under See,, R. & P.C. for this reason e
Date Owner
S
WORKERS' COMPENSATION DECLARATION 3
I hereby affirm that ! have a certificate of consent to self -'Insure, or a certificate of
wo
Policy No e a t n l r company
a ce((l lip tt0Y11r. 3800, Labor Code.) .
O Copy Is flled.with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section nand not be completed it Oro permit Is for one hundred dollars (:700) valuation
or lase.) ;
I certify that in the performance Of the work. for which this It is Issued,'I shall not
employ any ppgraon tm.any manner oro as to become auDjecI to the Workere'-Cpmpensallon
laws of California.
Date_ Owner
NOTICE TO APPLICANT. Jf, after making this -canincate of Exemption you .should become
. subject to tho workers' Compensation- provisions of the Labor ;Code, you ;roust forthwith
lc*mply .with such provision or this permit she be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there Is a constructior0ending agency for .the .pertormence of .the
work for which th is Issued. loc. 3A! 7,.Civil Code.)
Lendks Nam
Lenders Address
This Is.a building. permit when property filled out,.signed and validated, and •is_aubject to
expiration It work thereunder Is suspended for 180 days.
.I certify that 1 have read'this application and state' that the above Information Is correct. .
1 afire@, to comply with ajl city and, county -ordinances and state laws relating to'bullding
conatnn tion, and ht;rbD :authorize :repSsgotlatives of @his city to anter sifts above
mentidned prop'erty'fortnspectlon puerpoae`s.
Slgntiture of aliplicanf v ' DateR
Mailing Address
city. State, 71.
veu e. a _ •
r . H.
APPLICATION ONLY
7 (q wIIJ f
BUILDING: TYPE'CONST: % OCC. GRP.
A.P. Number 774-2'64-027-.7
Lepal;Descriptlon Lo
ProJect:Description
new. S.iftate F FA ,R2aid.
Sq. Ft.
Size
No. j No. Dw. 1
Stories Units
NewX] Add•❑
Alter ❑ Repair ❑ Demolition ❑
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop..Line
Side Street Setback from Centerline
Estimated Valuation
FINAL DATE
PERMIT
AMOUNT
Plan "Chk. Dep.
Q.
Plan Chk. Bal.
Validation:
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
tnfrestructure
TOTAL
REMARKS
I
ZONE-
BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop..Line
Side Street Setback from Centerline
Side Setback 4rom.Property Line
FINAL DATE
INSPECTOR
Issued by:
Date Permit
Validated by:
Validation:
WHITE ■'FINANCE` YELLOW a:APPLICANT PINK ■ BUILDING DIVISION
0
0
RC DISTRICT. - PLANNING REVIEW FORM
This form is to be used by CDD staff for review of single family dwellings in the. RC (Cove
Residential) District per Section 9.50.090 of the Zoning Code. Its purpose 'is to determine: - 1)
that the proposed housing design -does not duplicate the same architectural style of any house
within 200 feet of the applicant, and/or 2) if there is a need'for the applicant to file for Master
Design Guidelines. If the applicant does need to file a Master Design Guideline, please transmit
this information to the Building and Safety Department as part of your, correction list. Please
attach additional explanations as necessary.. .
APPLICANT: Paulden Evans Design Center Inc
SITE ADDRESS: 54-835 Avenida Madero ,
APN 774 - 264 - 027-7= CASE NO. 2002-719
LEGAL: LOT 15-V z /GBLOCK Z } `?' UNIT S.C.@V.L.Q.
CHECK AND APPROVED BY: Wally Nesbit DATE: I
Inform the assigned Building plan checker upon your assignment to this case. The CDD
Executive Secretary maintains 'a log book to track applications and assign case numbers.
REQUIRED ITEM
Y
N
COMMENT/CORRECTION
Verify legal and APN information
Consistent -with <MDG on file (as
applicable)
MDG filing required (5 filings
r
since 9/3/98)
Architectural variety within 200.
{
feet of the surrounding area:
Architectural design features
Other Requirements:
6RRroyed by!
D City Council
ommung ev ep,. •,...,.
itials
Use No: !fie .Z : '19 . ,. .....,... «* ►
Exhibit
mmin congiaons .,Zzac, .
Certificatel'of Occup Yanc
Cityof La Quinta
Building and Safety Department'. MOF
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code,
certifying that, at the time of issuance, this structure was in compliance with the various ordinances
of the City -regulating budding construction or use. For the following:
BUILDING ADDRESS:' 54-835 AVENIDA MADERO
Use Classification: SINGLE FAMILY DWELLING • Bldg. Permit No.: 0210-193
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RC
Owner.of Building: PAULDEN EVANS DESIGN INC. Address: P.O. BOX 621.
City:' RIVERSIDE, CA 92501
By: KIRK KIRKLAND
Date: 02-25-2003 -
Building Official
POST IN A CONSPICUOUS PLACE -
FEB -13-2003 06:07 PM
CA
a
P. 02
Bui.l der Cont Pt Telephone Plan Number
HER Rater Telgiphono Sample Group Number
ah 03
Ing Signature ate Sample House Nurricer
Firm; .rC, 4- VSSodlireS' HERS Provider; XC.,%A;04o 7&S
Street Address; 78 12 I' rrDY ClYGL . City/State/Zip; Ly Quip 6'00y 11
Copies to: Builder, HERS Provider
HERS RATER P NCETier EMENT
The house was. inTested ❑ Approved as part of sample teat!ng, but was not tested
As the HERS rater providing diagnostic testing and field verification, I certify that the houses identified on this form
comply with the diagnostic tested compliance requirements as checked on this form.
Distribution system is fully'ducted (i,e., does not use building cavities as plenums or platform returns in lieu
f ducts)
Where cloth backed, rubber adhesive duct tape Is Installed, mastic and drawbends are used In combination
with cloth backed, rubber adhesive duct tape to seal leaks at duct connections,
MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT
Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage)
Measured
Duct PresSUrizatlon Test Results (CFM { 25 Pa) values
Test Leakage Flow in CFM
If fan flow is calculated as 400cfm/ton x number of tons enter
caloulated value here eTp
If fan flow is measured enter measured value here
Leakage Percentage (100 x Test LeaksgelFan Flow) 5
Check Box for Pass or Feil (Passe$% or less) ❑
as Fail
ITHERMOSTATIC EXPANSION VALVE (TXV) or Commission approved equivalent
... M.
0/
Yes ❑ No Thermostatic Expansion Valve (or Commission approved "
equivalent) is installed and Access Is provided for inspection D
Yes Is a pass Pass Fait
❑ MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT
1 0 Yes 0 No ACOA Manual D Oeslgn requirements have been met „
(rater has verified that actual Installation matches values in
CF -1 R and design on plan.
AY
2. C Yes 0 No TXV Is Installed or Fan flow has been verified, If no TXV,
verified fan flow matches design from CF -1 R,
Measured Fan Flow x
0 -
Yes for both 1 and 2 is a Pass Pass Fail
r.t,•t r -•
f ,
9L% AF
'Information
' aidyr .I /r`71 To Build On
15ing/veering Consulting • lbsdng
t
YA u lI rr6A a177,1
REPORT OF FIELD COMPACTION TESTS
_ ,.'. ,
TESTEb FOR: PAULDEN EVANS PROJECT:
PO BOX 621
}
RIVERSIDE; CA 92501
54-835 AVENIDA MADERO
LA QUINTA, CA •
t
DATE: December 05, 2002 OUR REPORT NO.: 073-20341-2
TEST BATA: (1) Medium to coarse grained sand w/ gravel. OPT. MOIST. = 10.0%
+:,.•r¢ .+r Tl !'iii -.'ti's"'!• jt S" i' , . 1{ y.,.. t'` .. , t 9
„c" 4 4 r e•.r , r,n ♦:t t. ... •.t r„ .. SFq rr .
TEST LOCATION: Bui.ldinq pad.
1
NW
corner
2
SW
corner
3
SE
corner
4
NE
corner
MAXIMUM
COMMENTS'
TESfl
"%'y TEST,
SOIL ID
LAB DRY ArWATER
WET
DRY
PERCENT
Spec; 901; Min
NO.
DEPTH
ELEVATION
NUMBER
DENSITY
CONTENT
DENSITY
DENSITY
COMPACTION
1
811
FG
1
128.0
7.3
133.3
124.2
97.0
1 - A
2
811
FG
1
128.0
9.5
135.3
123.6
96.6
1
3
° 8"" (
FG
1
128.0
9.0
129.6
118.9
92.9
1 - A
4
811
FG
1
128.0
9.2
133.9
122.6
95.8
1 - A
l 'r
TEST LOCATION: Bui.ldinq pad.
1
NW
corner
2
SW
corner
3
SE
corner
4
NE
corner
NOTES: TESTS PERFORMED PER ASTM D2922-96 8 ASTM D3017-98 •COMMENTS: 1.FILL MATERIAL A. TEST RESULTS COMPLY WITH SPECIFICATIUNS
DENSITIES SHOWN: Lbs. per cubic fool. 2. CKFILL B. PERCENT COMPACTION DOES NOT COMPLY
WATER CONTENT: Percent of dry weight 3. BASE COURSE WITH SPECIFICATIONS
PERCENT COMPACTION: Based on maximum dry 4. SUBBASE C. RETEST OF PREVIOUS TEST
density obtained on sample Indicated by 5. SOL CEMENT D. MOISTURE IN EXCESS OF SPECIFICATIONS
soil ID number. 8. OT ER E. MOISTURE BELOW SPECIFICATIONS
* (1) ASTM D1557-00 METHOD A I
TEST INSTRUMENT: STANDARD COUNT M: D:
REMARKS: PSI did not monitor the material placement. ADJUSTMENT DATA M: D:
! Respectfully submitted,
TECHNICIAN: Vinnie De Souza Professional Service Industries, Inc.
THESE TEST RESULTS APPLY ONLY TO THE SPECIFIC LOCATIONS NOTED AND MAY NOT REPRESENT ANY OTHER LOCATIONS OR ELEVATIONS. `
REPORTS MAY NOT BE REPRODUCED. EXCEPT IN FULL, WITHOUT WRITTEN PERMISSION BY PROFESSIONAL SERVICE INDUSTRIES, INC. - "-
Professional Service Industries, Inc. • 42-240 Breen Way, Suite C • Palm Desert, CA 92211 • Phone 760/341-5790 • Fax 760/341-5794
PSI A•100.2 (qF
FEB -132003 06:06 PM P.01
CERTIFICATE OF FIELD 'VERIFICATION'AND DIAGNOSTIC TESTING CF -4R
t
6ttitd r Cont ct Telephone Plan Number
i /"
Hca R
or el®phone Sample Group Number
retying Signature ate Sample House Number
Firm:_C' ' Ss'OGicf% HERS Provider:G. /gSSVG/4 %S
".
Street Address` 29&a i': L OV C/YG a City/SletelZip: Ly Qu ih - G/ qZ2•
Copiesto, Builder, HERS Provider
I8NCE STATEMENT
Tno house was: XTested ❑ Approved as part of sample testing, but was not tested
As the HERS rater providing dlagnoetic tasting and held verification, I certify that the hoUeas identified an this form
comtyy with the diagno0c rested compliance requirements as checked on this form.
xDistribution system is fully'ducted (i.e., does not use building Cavities as plenums or platform returns in lieu
, ^f ducts)
XJ Where cloth backed, rubber adhesive duct tape is Installed, mastic and drawbends are used in combination
with cloth backed, rubber adhesive duct tape to seal looks at duct connections.
MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT
Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage) t
j Measured
Duct Pressurization Test Results (CFM Q25 Pa) / values
Test Leakage Flow in CFM
If fen flow is calculated as 400cfmlton x number of tons enter
calculated value here
If fan flow is measured enter measured value here 1
Leakage Parcentage (100 x Test Leakage/Fan Flow)
Check Box for Pass or Fail (Peas=6% or lose) Or ❑ i
Pass Fail
LgL ERMOSTATIC EXPANSION VALVE (TXV) or Commission approved equivalent `
Yes ❑ No Thermostatic Expansion Valve (or Commission approved ,
equivalent) Is Installed and Access Is provided for inspection ❑
Yes Is a pass pass ' Fail
CEJ MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT
1 . CO Yes O No ACCA Manual D Design requirements have been met .
(rater has verified that actual installation matches values In
CF -1 R and design on plan.
2. d Yes D No TXV is installed or Fan flow has been verified. If no TXV,
verified fan flow matches design from CF•I R.
Measured Fan Flow ■ "'
0 ❑
`Yes for both 1 and 2 is a Pass Pass Fai!
lil
6 7, lou3
._.._..._. - .. _ ... . • . s 3,_
/1 . +-slew / : G. 1u :..__ _.___.....___......____ ._...___._ - _ .•
hi
1;i
ly
... .... . ..? I
i,l _
• Q p ESS1pHq
I!I
Exp
! 4_ / c e _ - P , ---ter• . . ; y __._ _ .____......
We
l4
!l
ail
"1