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SFD (0304-402)f _ LICENSED CONTRACTOR DECLARATION ' 4*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 #ry (� Lic. Class Exp. Date 7=B��~} ' Dat 00— -, ", iSignature of Contract' ori �! OWNERcBUIL-DER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason: ( ) I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business & Professionals Code). ( ) I, as owner of the property, am..exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business & Professionals Code). ( ) I am exempt under Section , B&P.C. for this reason Date Signature of Owner WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ( ) I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ( ) I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier & policy no. are: Carrier k Ai T Policy No (This section need not be completed if the permit valuation is for $100.00 or less). C )r I certify that in the performance of the work for which this permit is issued, INall 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 shaY forthwith comply with those,provlslons. � Date: Applicant'' Warn ng: Failure to secure Workers Compensation cove age 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 applicator agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is • correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection pu/rposes. Signature (Owner/Agent) (- / +� j D46 �i - BUILDING PERMI PERMIT# DATE VALUATION LOT WYD"02 TRACT y! k 712 .16 JOB SITE ADDRESS SSA. 4C: !ill �N�Y�O E4 s t1 U.2' APN 773-1,43-•B OWNER CONTRACTOR / DESIGNER / ENGINEER RAMY BILLS Y �iC)i+Jl1:.S LEGACY 34-8Xi AV1RMA OBEC6N 47-) 56AAM9,YK U "t28 tAQLY44XCA 9225. . !A QyDrPA CA T¢d+51- (760}564.7320 MR 02063 USE OF PERMIT O ?FAlI'LY'La }sL.d.,.L_+0 191IS.F. W11 PF"IT DT.?MNOT Cly CLUOR K-OCI::'FItALL, P00I; OR DRIVEWAYAPPROACH TRACT CONSTRUCTION 1,1351.00 SF P'ORCF3'7PATIC 4 45.00 SC' CAMOUC.ARP011T 450,00 SF :RGUMATIM COST OF CONSIMUMON 110, ,2.0 PKRUM:b"Er SUAWARY COl+l3TRUCTION FRE 301.001.4189000 $66.00 . PLAN CFIZCK FEZ 201.000-439-318 $364,31 ; FEE DEPOSIT 101.0004,39.3113 4201040 MECHAV41CAI. FEE 101-000.421-000 165.50 Kl<EMiCA L PER 101.000420.000 W2107 PLIUMBINO 1fFIrl 103 -000.419-000 S!`.11O NO MOTION FLM - Mt ID 101.000.24,1.000 OR.rDINO FREI 101-000-423•,0713 $15,00 DIW& 0PER IMPACT FES 32,409,14 PPX.CISE, PLAN 101.000-4+41-345 $IC0.00 MM -TOW, CONSTRUCTION NT) PLPM ClWaic. $4,091.51 IMS 11". -PAID F, "R.30 X DUK NOW 00841.51 MAY 12 2003 CITY OF LA QUINTA FINANCE DEPT. RECEIPT DATE BY D /E�FINN INSPEC R INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs - Underground Ducts Forms & Footings // Ducts Slab Grade C7 -f Return Air Steel 1i3 Combustion Air Roof Deck Exhaust Fans OX to Wrap F.A.U. Framing — Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath O Final f ljci Final - POOLS - SPAS BLOCKWALL APPROVALS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances Final r COMMENTS: final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power (Z{ Final Utility Notice (Perm) CERTIFICATE OF COMPLIANCE Desert Sands Unified School District 47-9,50 Dune Palibs Road Date 5/12/03 - La Quints, CA 92253 No. 24414 (760) 771-8515 Lot # No. Street S.F. Unit 1 16 51690 Avenida Mendoza 1851 Unit 6 Unit 2 Unit 7 Unit 3 Unit 8 Unit 4 Unit 9 Unit 5 Unit 10 Comments APN # Jurisdiction Permit # Study Area No. of Units Lot # No. �eFtEDsc�o -!:C BERMUDA DUNES f:•' rn RANCHO MIRAGE INDIAN WELLS PALM DESERT ,y LA QUINTA tr`- INDIO 1r1 O JJ 773-143-009 La Quinta 0304-402 1 Street S.F. 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 (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile homes. It has been determined that 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 imposed pursuant to Education Code Section 17620 and Government Code 65995 Et Seq. in the amount of $2.14 X 1,851 S.F. or $3,961.14 have been paid 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 CC/EastWest Bank - Sharon Bills Check No. 832000962 Name on the check Telephone 760/880-3446 Funding Residential By Dr. Doris Wilson Superintendent Fee collected /exempted by ShaNn McGilvrey $3,959.00 / �l / v/ /^/ Payment Recd Over/Under Signature NOTICE: Pursuant to Government Code Section 66020(d)(1), this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified above will begin to run from the date on which the building or installation permit for this project is issued, or from the date on which those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier. NOTICE: This Document NOT VALID if Duplicated Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting Owner Randy Bills Address 54-865 Avenida Obregon City La Quinta Zip 92253 Tract # blk 112 Type Single Family Residence Lot # No. Street S.F. Unit 1 16 51690 Avenida Mendoza 1851 Unit 6 Unit 2 Unit 7 Unit 3 Unit 8 Unit 4 Unit 9 Unit 5 Unit 10 Comments APN # Jurisdiction Permit # Study Area No. of Units Lot # No. �eFtEDsc�o -!:C BERMUDA DUNES f:•' rn RANCHO MIRAGE INDIAN WELLS PALM DESERT ,y LA QUINTA tr`- INDIO 1r1 O JJ 773-143-009 La Quinta 0304-402 1 Street S.F. 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 (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile homes. It has been determined that 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 imposed pursuant to Education Code Section 17620 and Government Code 65995 Et Seq. in the amount of $2.14 X 1,851 S.F. or $3,961.14 have been paid 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 CC/EastWest Bank - Sharon Bills Check No. 832000962 Name on the check Telephone 760/880-3446 Funding Residential By Dr. Doris Wilson Superintendent Fee collected /exempted by ShaNn McGilvrey $3,959.00 / �l / v/ /^/ Payment Recd Over/Under Signature NOTICE: Pursuant to Government Code Section 66020(d)(1), this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified above will begin to run from the date on which the building or installation permit for this project is issued, or from the date on which those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier. NOTICE: This Document NOT VALID if Duplicated Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting 1' ,J RC DISTRICT - PLANNING REVIEW FORM V0f� 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: .SITE ADDRESS: Z'I - � �y A P N �%3 /� -' CASE NO.: bQ% LEGAL: LOT _Z! BLOCK //�1- UNIT S.C.@V.L.Q. CHECK AND APPROVED BY: DATE: 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 I N COMMENT/CORRECTION Verify legal and APN information A10.44.1c;wr Consistent with MDG on file las applicable) MDG filing required (5 filings since 9/3/98) J9 Architectural variety within 200 feet of the surrounding area: �S Architectural design features :_.._....... ............ Other Requirements:Reso ^___� el_ O C ty Councll co Initi Is Cas fxhi No.. it /am lug VW"Wluw"a OCT -29-2003 06:55 AM CE VERIFICATION AND D ;P.02 CF -4R 6uildeeNeme/ Plan Number T Sample Group Number Sample House Number Firm: -J -G. fS ritKo rrovlder:�SSUG., Street Address: Z&'vl J City/State/Zip, Zo Ok/hl'a Capes to Budder, HERS Provider HERS RATER COMPLIANCE STATgMENT Tne house was: CprJl Tested ❑ Approved as part of sample testing, but was not tested As the HERS rater providing diagnostic testing and field verification, I certify that the houses identified on this rorm corn ly 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 �of ducts) ' Where cloth backed, rubber adhesive duct tape is installed, mastic and drawbands are used in combination with cloth backed, rubber adhesive duct tape to seal leaks at duct connections. 2J/ MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage) Measured Duct Pressurization Test Results (CFM ® 25 Pa) values Test Leakage Flow in CFM , If fan flow is calculated as 400cfm/ton x number of tons enter calculated value here If fan flow Is measured enter measured value here Leakage Percentage (100 x Test Leakage/Fan Flow) Check Box for Pass or Fail (Pass=6% or less) 2� ❑ Pass Fail THERMOSTATIC EXPANSION VALVE (TXV) or Commission approved equivalent r'J Yes C3 No Thermostatic Expansion Valve (or Commission approved t equivalent) is installed and Access is provided for inspection ❑ Yes Is a pass ass 'Fail ❑ MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT 1 ❑ Yes ❑ No ACOA Manual D Design requirements have been met (rater has verified that actual installation matches values in CF -1 R and design on plan. 2. O Yes ❑ No TXV is Installed or Fan flow has been verified, if no TXV, /l / verified fan flow matches design from CF -1 R. Measured Fan Flow ❑ G Yes for both 1 and 2 is a Pass Pass Fail l/f-(Illi✓` C LL -.(_/1' JO�D Rr�1OHRESr.EtirCs l�—1 �1 l� 1.1 ' ( tJ.__. n`D6AfT 1111111Aiil-f� V WWI UI -.I /1 1 �.__. .. .___ fvv... .___ .. ..� This farm shall be '�' ""'cart it employe s are authorized to wo posted on the job with the Building Inspection Card at ah times in a consPicucu,s ���,e. Y E;::rso;,s ..... _..nn ^r? s?�!s i�st cr thi on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result it) a s- : pp g o19� o a e of work and/or the voidance � o) of building permit For each applicable trade, all information requested below. must be completed by applicant. "On File" is not an acceptable resp( nse. 1 i m 0 uJNI 6C' M State Contractor's License � Workers Compensation Insurance City Business License Trade I Classification Contractor Company Name Classification License Number Exp. Date Carrier Name Policy Rtrtmher Exp. Date License Number Exp. Date (e.g. A, B, C-8) (xxxxxx) (xx/xx/xx) (e.g. State Fund, CalComp) (Forma :Innes) (xx/xxlxx) (`xxxx) (xx/xx/xx) EARTHWORK IC -121 1 ��� ii^I'; y ? fit; , <. i .� 1 C^� ter _;s CONCRETE (C-8) FRAMING IC -51 f .1 �{ ���d J� '�`f L�-T . STRUCT. STEEL (C-51) r ' 1 MASONRY (C-29) PLUMBING (C-36) t`rjF%.G A! �j►-J4`� I G- "3�e �-� .� rl'v2 G.T31-f5 °Lt 11�l.'� t 1 0 6874? . ... -) % U% -I 03 //- ©SIIJ 03 LATH. PLASTER (C-35) �"( `� i �% �2j t ! tx Y."�� (kC-2-0D4-6S ✓ DRYWALL (C-9) , t, �?j Ct• psr 0 /SLG �! L%C� C> s$G3 Hvgc (c -2o) &t 5 s n/ � 22�% -�,�� QZ � - j t a� 0Gq l " /- ELECTRICAL (C-10) 0 ROOFING IC -39) SHEET METAL (C-43) _ FLOORING IC-15) �i4L,?i:.r-!S 1-7 d S"' 31- Nb 4fA Lj J -- ._....._.-.. _....__ �o (p3 55 a3 GLAZING (C-17) INSULATION. (C-2) • 1. J ! G2 6 f (,i Dp 2� 6 -� SEWAGED ISO. IC -42). PAINTING (C-33)r'{'i�'-' t C �'- 1'% k'� �_ Jam. ()C� lV rte?( �'ytf i CERAMIC TILE IC -54) CABINETS IC -61 L t 1 1 I I t it I t FENCING' (CA3) LANDSCAPING (C-271 POOL (C=53) (� --- - i m 0 uJNI 6C' M M' �- C.ertificate of Occupancy G� OFT9� Building & Safety Department This Certificate is issued pursuant to the requirements of Section 109 of the California Building Code, certifying that, at the time of issuance, this structure was in compliance with the provisions of the Building Code and the various ordinances of the City regulating building construction and/or use. BUILDING ADDRESS: 51-690 AVENIDA MENDOZA Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0304-402 Occupancy Group: R3 Type of Construction: VN Land Use Zone: RC Owner of Building: RANDY BILLS Address: 54-865 AVENIDA OBREGON City, ST, ZIP: LA QUINTA, CA 92253 By: KIRK KIRKLAND Date: October 29, 2003 Building Official POST IN A CONSPICUOUS PLACE