SFD (001184)PERMIT APPLICATION
City of La Ouinta J
Department of Building and Safety
This permit becomes void if work not commenced within 180 days from date of issuance. OR, if work has been suspended or abandoned for a period of 180 days.
LICENSED CONTRACTORS -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.
License Class Lic. Number
)ate Contractor
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 ot.,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, Business 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 improvemnt is solQwithin 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 exculsively contracting with licensed contractors to construct 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. 'tea' i�. j r8°Attached Gert`ficate).
Date Owner
WORKERS' COMPENSATION DECLARATION: I hereby affirm that l have a certificate of consent to sell -insure, or a
certificate of Workers' Compensation Insurance , or a certified copy thereof (Sec. 3800. Lab. C.).
Policy No. Company
❑ Certified copy is hereby furnished. o,
❑ Certified copy is filed with the City Building Inspection Department or City Department.
Date Applicant
APPLICANT NAME (L, F. MI)Br"L Monir - '
ADDRESS P.O. B= 1040
CITY/COMMUNITY/STATE/ZIILa Quin a, CA 92253
JOB SITE ADDRESS/SPACE 53-705 Axodnida mendow
CIT1(Y�/COMMUI�NIITTY/STAT�E//ZZlia ]�1ta/ CA 92253
89
/4
PiG32
PU21
C�jf,iil�
garc9e C_WPer � P
TWN
PING
SE
S
TRACT
LOT -LU
Plan Cbeck Fee
MOD
SB
Oonst. Fee
TRACT NAME � mie
�ARp+g4'�Ai
OWNER NAME (L, F. MI) .
Lll.
CONTRACTOR -FIRM NAME n2 J
SM • ,
iPi..O.
ADDRESS tea- 2288
L'� I1ll.A] L92202
CITY/COMMUNITY/STATE/Zi p _ . _ -
PHONE 347-7171
6.65
`I-397169
Pltanbing Fee _
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE 6
LICNC 0
USE OF PERMIT RV4 Y tope'
BL
I
ZON
PD 12/14
FSB
SSB
SSB
RSB
OFC
ZONE ORD o
LOT SZ
END
SIDE '
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if
the permit is for one hundred ($100) o, 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 Applicant
NOTICE TOAPPLICANT: 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.
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ •1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, w ill be
made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or
demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2, Art 2, Sec341, Title B.
C.A.C.)
❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of
Industrial Safety, as noted above, unless such person has a permit to do such work from that division.
0 Division of Industrial Safety Permit No.
Date Applicant
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance
of the work foi.which•this permit is issued (Sec. 3097, Civ. C.).
Lender's Name
Lender's Address
I certify that.l 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-mentionedproperty for inspection purposes.
Signature of Applicant or Agent Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that
the information given is correct. I agree to comply with all state laws and county ordinances relating to buidling
construction, and authorize a' representative;of,the City of La Ouinta Department of Building and Safety to enter
uun the periyY whicq ave appfi'ed,�rorrathis-permit for the purpose of making inspections.
S)gnaturg of Applicant or.'Age`J7 Date
Print Applicant/Agent Name
APPUPRMT � 194
1-C TE-U`.i
5• • •
Fencat W cam
1-59sq•
a. or •Li•
-%a. ft. of pur�dn
EM 430
sq. rt. or
garc9e C_WPer � P
•
tech. Pee
22.110
Plan Cbeck Fee
.2.-"w
Oonst. Fee
Aa&"
33 S i070
Elect. Fee
43.13
SMI Fine
6.65
Pltanbing Fee _
50.50
Prop. Dewel. Fee
44500.(000
/96
(2��5p0.000)
PD 12/14
.45
TOTAL • •
FEE
'�P..wt�.0 'L
r /
: , —1� Y/ /"- t_(--.'
VALUATION
BLDG. DEPT.
NO.
OPERATION DATE INSPECTOR
NO.
OPERATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
chis
34
Plenums & Ducts
2A
Slab Grade
35
Furnace Compart.
3
Steel
36
Inlets & Outlets
4
Grout Blocks
37
Combustion Air
5
Bond Beams
38
Compressor
6
Roof Deck
39
Appl. Clearance
7
Framing
40
1 Fire Damper
8
Vents
41
Smoke Detection Device
9
Garage Fire Wall
42
Commercial Hood
10
Fireplace P.L.
❑
43
Final
10A
fireplace T.O.
❑
OP'NO. ADDITIONAL INFORMATION
', O
� � r
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 .Internal Lath/��(�j�_
12A Drywall 1--2 -7/if
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts) 11 1(7e -
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb Q64
16 Water Piping
17 Rough Plumb
18 Vents
19 Sewage Disposal
20 Sewer
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test
25 Final
Tank Pit L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
P/L P/I
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final
N�f1Ep
S
I)eeert ans
dUnified School District
y. BERMUDA DUNES
RANCHO MIRAGE .2 82-879 HIGHWAY 111 O INDIO, CALIFORNIA 92201-5678 • (619) 347-8631
INDIAN WELLS' ti
PALM DESERT a
-P LAOUINTA �. January'17, 1985
p INDIO y
City of La Qunta
Department of Community Development
78-105 Calle Estado
La Qui-nta, CAA2253
Re 53-705 Aveni.da.Mendoza
Gentlemen:
The developer of the above referenced home
has miti''gated its impacts on our overcrowded schools'by payment
of the amount of $628 per unit' to be' applfed to the cost of
district educational facilities made necessary by suchnew
development.
Sincerely
.John D. Brooks
Assistant Supe.rintende.nt
Business Services
'JDB/crm
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RIVERSIDE COUNTY DEPARTMENT OF HEALTH
PERMIT APPLICATION FOR A SUBSURFACE DISPOSAL SYSTEM
Applicant: Submit this form with three copies of a scaled plot plan drawn to county specifications required on the
attached check list. A non refundable filing fee of $15 is required when the application is submitted. Check must be
made payable to County of Riverside.
Name
Mailing Address
City
State
Zip Code
Phone
'Property Address
'City or Community
'Legal Description of Property (Lot, Parcel Map, Tract)
`IW (,fk) r% E
, 1Y
`Assessors Parcel No.
Water Serving Property From
Lot size
/I— � 117lC�� ✓ �'T'ic'
S C .� /r^ cG
17
Signature of Applicant Date
"The above information must be verified from Building Application
Staff Use — Do Not Write Below This Line
Initial Date
WQCB Clearance required Yes ❑ No
Soils feasibility report required Yes, D NOD
Detailed boring report required Yes ❑ No [91"
Detailed contour plot required Yes ❑ No LJ"
Comments:
Soils or boring report by Date
Approved by Date
Soils Map Page Soil Type Tract File No. Other
Number of Bedrooms
Septic Tank Size (gallons)
Rate Required
Type of System
New Addition Replacement
Leach line sq. ft. of bottom area trench
Leach bedl�sq.,fi. of b ttom area bed)
Seepage Pit Diameter
Number of Pits
Seepage Pit Depth B.I.
Total Depth of Pit
5' ❑ 6' Q-
1
Location of Systte'm
t-1 ( a J
Additional Requirements
rilAt
A < < +A. a+ t e,a. ;'4
A permit is approved/dfem:i d'for the design of a subsurface disposal system as indicated on the accompanied plot plan
using the requirements set forth in Section B above. A building permit is necessary for the installation of the above
designed system.
! 1�"'� r
J 1 2. - i
Signature of Heelf Official Date
Receipt No. Issued By tc- -7'
r
District: Riverside ❑ Indio
' Hemet ❑ Date V
DISTRIBUTION: WHITE - Office File YELLOW - Applicant PINK - Building Dept. GOLDENROD - Pending File
DOH SAN 122 (Rev 10/82)
CaycLl.La.tir�.p,�M.et.h;od�_
__ 1c).n- td S-�.slte,Fri._�
M I tJI MUM N 1,6.-r10;l�L fz -i F?�>✓ --��
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rl
MECHANICAL SYSTEMS DESIGN
134 SOUTH GLASSELL STREET
ORANGE. CALIFORNIA 92666
(714) SA3-6571
j
1
058:10 RZ _,28/84 VH/dr
Attachment D
Form 2
(Revised 3/84)
Climate Zones 2. 4, 6, and 8-15
COMPLIANCE CHECKLIST
For Low -Rise Residential Buildings
(except hotels and motels)
Step 1: Enter on the form the values for each measure from your building plan
and specifications sheet.
Step 2: Enter points on this page while working through the point system
Building Shell Measure Points
*Total Floor Area . . .' . . . . . .. .�ft2
1. Slab -on -Ground; Perimeter ft.,.Depth � in. R-
2. Raised Floor R -Value.. . . . . . . . . . R-
3. Ceiling Insulation or Construction Assembly R -
Attic, Percent of Roof Over Conditioned Spaceft2
4.- Wall Insulation or Construction Assembly. . . . . . . . R -
Glazing; Total % Floor Area Single Double Triple
S. North -Facing. . % ft2ft2 ft2
6. East -Facing . . . ft2 A&:ft2 ft2
7. South -Facing. •. S ft2 ft2 ft
8. West -Facing . . . E!—F%ft2 ft2 ft2
9. Skylight. . . . S ft ft ft
10. Shading Coefficient
(excluding overhang)
a. East �/ a 42i � SC .
b. South. . ' SC .
c. West . . . . . . . . . . . . . . SC .
d. North. . . . . . . . . . . . . . SC .
e. Skylight .. . . SC . . . . . . . . . . . .
11. Horizontal South Overhang Length. . . . ft . . . . . . . . . . . .
12. Movable Insulation,-% Floor Area.S
dd
13. Infiltration (indicate Standard. MeIjULor _197t
14. Thermal Mass
Exterior Wall Thermal Mass
Area, Heat Capacity, R -Value . . . . . . ft2, HC; R -
Interior Thermal Mass
Area,
Area, Heat Capacity, R -Value . . . . . . . ft2, HC, R-e.Z
HVAC System"
15. Gas Furnace without Refrigeration -Cooling
(Seasonal Efficiency) ... . . . . . . ... . . SE
16. Heat Pump (Energy Efficiency Ratio) . . . . .. . . . . . . SEER
17. Gas Furnace with Refrigeration Cooling
Seasonal Efficiency and Seasonal
Energy Efficiency Ratio. . . . . . . SE SEER
18. Active Solar (Net Solar Fraction, %). . . . . . . . . YNSF
19. Zonally Controlled Electric
Resistance Space Heating . . . . . . . . . . . . . (Yes/No)
Domestic Water Heating**
20, Solar With -Gas Backup (Net Solar Fraction, %) . . . . . . . . . %NSF
21. Other Water Heating (Describe type) -
Point System Compliance Total. . . . . . . . . .
*Checklist items; not a point system measure.
**Attach documentation for efficiencies and. NSF.
HEAT TRANSFER COEFFICIENT Form 3R
PROPOSED CONSTRUCTION ASSEMBLY (eiel)
owner prosect title building permit numoer
Oroje Ct location Checked by
dodurnentation author dale '
Sketch of Construction Assembly List of Construction Components R
(for section between framing members) (from Table 111
3.
.4.
5.
Framing Size 1�5 6.
n_ d
Framing SpacingO.C.
i.
Check one:
8. Inside Surface Air Film (from Table 3-181 ............. �•�I
'< Ceiling/Roof
Floor 9. Outside Surface Air Film (from Table 3.18)...........
Wall
i
Total Thermal Resistance (RT) -
If Wall. check the - tum of the above
aopro Orate weight:
less than 25 Ib/ft2
25 to 40 Ib/ft2 AVERAGE U VALUE OF ASSEMBLY
Brener ;ean 4() ;bih2
I' I qtu/(hr .h2 •eF)
Framing AT from above I
Factor from
Table 3-8 i
Life this U value for hest load
calculation or Code comparison
50
HEAT TRANSFER COEFFICIENT
PROPOSED CONSTRUCTION ASSEMBLY
owner project title
Project location
documentation author date
Sketch of Construction Assembly List of Construction Components R
(for section between framing members) (from Table 3-11
/may S-TI�Go c l
it
Form. 3R
(8/81)
Enforcement Agency Use Only
4.
5.
6.
7.
Check one:
8. Inside Surface Air Film (from Table 3.18) .............
Ceiling/Roof
/ Floor 9. Outside Surface Air Film (from Table 3-18). ...........
Y Wall
Total Thermal Resistance (RT)
If Wall, check the sum of the above
appropriate weight:
Y less than 25 lb/0
25 to 401b/ft2 AVERAGE U VALUE OF ASSEMBLY
greater than 40 Ib/h2
+ =�' '= = 3h'' Stu/(hr •ft2 •oF)
Framing AT from above
Factor from
Table 3.6
Use this U value for host load
calculation or Code comparison
ENGINEER: -r" SHEET:
DATE: OF
SOLAR
ME
ME
PROJECT: +l.c� �'ol-�►'�5o r�5�.
SHEET:
ENGINEER: �� �
DATE:
OF
Zc.)nc:
['lour:
F't2
Volume:
Ft3
Tilt-e:
SUMPiARY L 0 A D S
COOLING;
BTU/11R
11EATING:
rAT.A
SENSIBLE
L1Tmgr
I B11U/11 R
CMAZrN
WALLS
S�
111
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� 15a
I� 210 0
r'IZOR
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PMPLE
COS
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7MAL
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Cr?t . Sensible
RS1IRo Sensible
Sens. t La t.
VT:21 'IIATION
I71F'ILTRATI01.1
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