SFD (0212-068)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 Cade, and my License is in full force and effect.
License # Lic. Class Exp. Date
Date Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( I, as owner of the property, or my employees with wages as their sole
,#compensation, will do the work, and the structure is not intended or offered for
sale (Sec. 7044, Business & Professionals Code).
() I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
/Code).
( ) I am exempt under Section B&P.`C. for this reason/,17
Date 5 .. Signature of Owner �
,*•, _.
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
( ) I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
( ) I have and will maintain workers' compensation insurance, as required by
'Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
(This section need not be completed if the permit valuation is for $100.00 or less).
(* I certify that in the performance of the work for which this permit is issued,
I shall not employ any person in any manner so as to become subject to the
workers' compensation laws of California, and agree that if I should become
subject,to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.'
Applicant ) %4-A,a--
u
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
I
ddition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property�for inspection purposes.
Signature (Owner/Agent) ' !'� '+ • Dater 2__ '3
Ir .
BUILDING PERMIT ` PERMI #
off
DATE ( VALUATION '�' ` LOT TRACT
JOB SITE
ADDRESS .52.99 ANTMI.A. hiENDOZA
APN
7720133-009
OWNER
CONTRACTOR / DESIGNER / ENGINEER
)AL O DORAN
OWN '£�'cJBUILDFIZ
72-960 FUD WAXING DF. 01
TIALM DF,13Mr CA 92260
USE OF PERMIT
SINGLY, FAV,0,Y UWEL124G
3431 $.E, SVD. .fYf?, MIT VO&S VOT INC:L.L D1r ftl Drk,:WAIJ,1 OOL OR
DRCV1,7%VAY'JAPPROAt, E
T1 AC"T CONSTRUCTION 1,431,00
PORCH/pArlo 97.00 ZF
0AP.AGFJCA1kP0XT 437,00 81
X517'1lf1:A.17D CONef OF 1:ONSMU6:'1;`ION
bt;„5�T.tif)
CONSTRUCTION BABE 101.000.418.000 9590.00
PLA.W CkiZCK1. PEP, 101-000-439-318 $503,R7
FRE ,ID&POffiT 1014)W-439-318 4250100
1VACHANIC;�'� , FO, 101-000.421-000 $99.00
L.6ECTtUCAL FEE 101- 00,420.000 $103.31
P1.i1X011-110 FSE 101-000-419-000 $136.13
ST1<ONG UOTION R - RU►D 101-000.241.000 $0.85
(1RAcDIN0 PEE 1014"423-000 $15.00
UVE3.cVk,R IMPACT RE $?,401.”
PRECISE PLAN 101-000-441-:34,5 $ t0U.U0
SETA t0TA3., CONSTRUCTION AND 1✓I. AKT CHECK
$3,945-80
- .,. 1"s s T?.t h_J>A1D FIM
4250,00
'
ta,Z;, %Z()
!n1 UAL )?=W TRIES S DAT NOW
D
FEB 0 7 2003
CITY OF LA QUINTA
Rjr/ ,r
By""I
DAT�INALED
INSPECT
t #
INSPECTION RECORD
OPERATION
DATE
INSPECTOR'
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Q lj(
Underground Ducts
Forms & Footings
p
Ducts
SIa3 Grade
��?
J
Return Air
Steel
Combustion Air
Roof Deck
—)gip 3 _
Exhaust Fans
0. K. to Wrap
�_ O
F.A.U.
Framing
_ _
_ PJ3 _
Compressor
Insulation
�Z�
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
C�
Drywall -Int. Lath
Final
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
_
-5
Neater Final
Water Piping
J
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection 3 �� �'�
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS: -
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS`=–If
Temp, Power Pole
Underground Conduit
y
Rough Wiring
Low Voltage Wiring
'
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
i
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
47950 Dune Palms Road
!t BERMUDA DUNES r'
Date 2/3/03 La Quinta f CA 92253 Cn RANCHO MIRAGE b
� INDIAN WELLS 1
No. 24108 (760) 771-8515 �%�., P„AQDESERT �V
10-
IQ
y7
0
Owner Milo A Doran APN # 773-333-009
Address 52900 Avenida Mendoza Jurisdiction La Quinta
City La Quinta Zip 92253 Permit #
Tract # Study Area
Type Single Family Residence 4 No. of Units 1
Lot # No. Street S.F. Lot # No. Street S.F.
Unit 1 52900 Avenida Mendoza 1431 Unit 6
Unit 2 Unit 7
Unit 3 Unit 8 _
Unit 4 Unit 9
Unit 5 Unit 10
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 (spaces that do not contain facilities for Irving, sleeping, cooking, eating or sanitation) or replacement_ mobile
homes. It has been determined that the above-named ownei 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 1,431 S.F. or $3,062.34 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/PDNB - Milo A Doran Check No. 085712
Name on the check Telephone 760-413-2693
Funding Residential '
By Dr. Doris Wilson `
Superintendent r ,
.Fee collected /exempted by Sharon McGilvrey $3,062.34
e Payment'Recd Over/Under
Signature C;
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
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING
01
D
Project Title5�� ���UZ� Dates/ I ��
Project dress Builder Name
Builder Cont ct Telephone Plan Number
57; 3
HERS,Rater
% ZZ D
ifying Signature We
Firm: SC. d',gSS/OG/ C
Street Address: %gyp �O S"d — OKo C�IYG( v
Copies to: Builder, HERS Provider
e Sample Group Number
CF -4R
Sample House Number
HERS Provider: �, /lSiDG/rl%S
City/State/Zip: Ly i/tjlnhraa Cl9 92253
HERS RATER COMPLIANCE STATEMENT
The house was: XTested ❑ 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 form
com 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.
iMINIMUM 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 7_
If fan flow is calculated as 400cfm/ton x number of tons enter .L
calculated value here �D
If fan Flow is measured enter measured value here
Leakage Percentage (100 x Test Leakage/Fan Flow) _. J' �lqU
Check Box for Pass or Fail (Pass=6% or less) ( ❑
Pass Fail
THERMOSTATIC EXPANSION VALVE (TXV) or Commission approved equivalent
gfYes ❑ No Thermostatic Expansion Valve (or Commission approved
equivalent) is installed and Access is provided for inspection
Yes is a pass
❑ MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT
1. ❑ Yes ❑ 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. ❑ Yes ❑ 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 = F
Yes for both 1 and 2 is a Pass
❑ ❑
Pass Fail
Fy„K;<”-i$?b':1b.i�' `• .. • - ..: ".'�:::\.: `.Fi: t•F:•_: v'r.•�aT.-.'c't+.
F.,.�� '^. .� • �. .. ._.,. ...ate. � � :.�. - - `• ..
I ,--e'•?:-�• : ....:.'� -.= "�>"�N-r'� 7..':fir A�`^
:REPORT:OF FIELD..`C0(VIP�kCi"1ON T::E"a-T,
STr --
-
- -
i•OUR'..REPORT NO.: .� U c., LI �• CLIENT: > C `ryy \�"'�"^'•
I':OATEr . F 2 :7 03 PROJECTZ-- 9070 y ✓.r 1.7..r o:z.9`
''NUCLEAR GAUGE INFORMATION AND
DAILY STANDARD
CALIBRATION NUMBERS
VARIATION. PERCENT,+/-
GAUGE ADJUSTMENT
'h VARIATION FROM
':-C.aUBRATION
COUNTS
FROM SHEETS
COMMENTS
NO.
LAST USE
�.. GAUGE TYP RROXLE AMPBELL
MOISTURE:
MOISTURE:
MOISTURE:
MOISTURE:
DENSITY,
MOOEL NO.: J <r 3D
I OENSTI•:
OENSffY:
I DENSITY: 5177:
I DENS(1-Y:
?AOC T OR INFORMATION
SOIL ID R VISUAL CLASSIFICATION OF SOIL I MAX. DRY DENSITY, PCF OPTIMUM MOISTURE. %
COMPACTION MOISTURE GENERAL LOCATION: Q
REQUIREMENTS, % 4� I REQUIREMENTS. %/X
EST
READING
QUOTIENT/
SOIL
TEST
ELEVATION
MOISTURE
WET/DRY
PERCENT
COMMENTS
NO.
PCF
10 NO.
DEPTH, IN
OF TEST
CONTENT,
DENSITY,
COMPACTION
%
PCF
M-
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ATERIAL TES RESULTS COMPLY WITH SPECIFICATIONS
BACXFILL 8 -COMPACTION PERCENTAGE DOES NOT COMPLY WITH SPECIFICATIONS
i BASE .COURSE C - RETEST OF PREVIOUS TEST
4'- SUBBASE O - MOLSTURE IN EXCESS OF SPECIFICATIONS
5 - SOIL CIEMENT E- MOLSTURE BELOW SPECIFICATIONS
�.� 6 - OTHER .
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no- MrtEM F M . - A-
ATERIAL TES RESULTS COMPLY WITH SPECIFICATIONS
BACXFILL 8 -COMPACTION PERCENTAGE DOES NOT COMPLY WITH SPECIFICATIONS
i BASE .COURSE C - RETEST OF PREVIOUS TEST
4'- SUBBASE O - MOLSTURE IN EXCESS OF SPECIFICATIONS
5 - SOIL CIEMENT E- MOLSTURE BELOW SPECIFICATIONS
�.� 6 - OTHER .
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M-
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no- MrtEM F M . - A-
ATERIAL TES RESULTS COMPLY WITH SPECIFICATIONS
BACXFILL 8 -COMPACTION PERCENTAGE DOES NOT COMPLY WITH SPECIFICATIONS
i BASE .COURSE C - RETEST OF PREVIOUS TEST
4'- SUBBASE O - MOLSTURE IN EXCESS OF SPECIFICATIONS
5 - SOIL CIEMENT E- MOLSTURE BELOW SPECIFICATIONS
�.� 6 - OTHER .
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Certificate of Occupancy
City of La Quinta
Building and Safety Department
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 building construction or use. For the following: -
BUILDING ADDRESS:
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of ConstrL
Owner of Building: MILO DORAN
Building Official
52-900 AVENIDA MENDOZA
Bldg. Permit No.: 0212-068
tion: VN Land Use Zone: RC
Address: 72-960 FRED WARING DRIVE, #1
City: PALM DESERT, CA 92260
By: KIRK KIRKLAND
Date: MAY 21, 2003
POST IN A CONSPICUOUS PLACE