SFD (0310-175)r
LICENSED CONTRACTOR DECLARATION
.1 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
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 intehd_ ed 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.rfor this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
O 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 gTATR F(INI) Policy No. IpSO4�fa-ii2
(-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 prdvision� s o_ f Section 3700 of the Labor
Code rl.shall- orth ith comply with I ose: ro -,, A Z
Date` 6 'Applicant - �" ; FV
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
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' onhis
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 authrize representatives of this City to enter upon
the above-mentioned property for in pection purposes.
Signature (Owner/Agent) "�" ' Date
BUILDING PERMIT PERMIT#
DATE ¢ ti VALUATION N. LOT �tA.' TRACT
JOB SITE
ADDRESS r`�— 'est% CALL
APN 1
OWNER
CONTRACTOR/ DESIGNER/ EN INEER
PA TIL d7EV0.
'PAVI, G. D]'110 :COY-Jk ROD xalW1,0PU' ;
S) -713 k;PNY 11-1
8.1-71 s Yid Y 111
INDIO CA 92201
WD10 CA _92:01
(760),324-8515 CaLff 1311
USE OF PERMIT
8I24QIE FPJ4LY DWh P MG
17063 SY117D PERM 1,T 1;7ORS NEST INC dal0Z1:1.1:OC.`i.WA.I 1, POCI SPA OR
MVEWAV APPkOACK 75Bb RUNUCED IEEE FOR M1.iI1' IP1.9 t LASS. OF
SAME TYPE.
'I'%kCT CONSTRUCTIOIN I, 9:s,a1i Sr?
QARA(3VCARPOIaT ;F
C01491TRUCTION FEE. ,, 101'iOCOO-418.000 Std kso
PLAN CHEK;IFE itJi-t2G�-439�31� �153.5imu-v/I '
y{'
ya..rrL D. �ifiIT 101,,00 -439.318. ,104
MECHANICAL FEE 1.01-(3£ 07+121-000 1.52.50
BLECTPJC.AL FEE 101i.0004-20-000 $111.09
FLUMNINO F'WE, POI-obo-419-0w . SHO, 00
OTRO140 MIYFI014117-19 -QUID 101-000-241-000 $J0.15"
OI I aIN 1.61-eft-423-00ta
Di J, YELOPER IMPACT FEF
PUCISE PLAN l01-000-449.345 ' 9610tl:tJ�t .
,� ;pp . . �• . .. . ,
yy AA�� �sy- rye,. ^�7y]��.P Ty
2 ,y�r9 M
LEOS 'FRE-lFA1D r -W.3.
4250.00
`�' K I!!�T3`:7?"1 S:i�0rR: vg0W
$3,347,76
OCT 2 3 1003
CITY OF LA QUINTA
LFINANCE DEPT.
RECEIPT
DATE ti [t
BY
DAT INALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
, DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
A
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
' O.K 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
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
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
L
Encapsulation
Gas Piping
Gas Test
Appliances
o�
Final
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
Final
Utility Notice (Perm)
Date
10/22/03
No.
25121
Owner
Paul Delio
Address
81715 Highway 111
City
Indioi Zip 92201
Tract #
Type
Single Family Residence
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
47950 Dune Palms Road
La Quinta, CA 92253
(760) 771-8515
Lot # No. Street
Unit 1 11 77240 Calle Monterey
Unit 2
Unit 3
Unit 4
Unit 5
APN #
Jurisdiction
Permit #
Study Area
No. of Units
S.F. Lot # No.
1703 Unit 6
Unit 7
Unit 8
Unit 9
Unit 10
Comments Certs #25121 and 25122 used for CC#297831 in the amount of $7,288.84.
'S�1Ft�DsC"
Q�BERMUDA DUNES r
Cn RANCHO MIRAGE
�+ INDIAN WELLS
PALM DESERT y
LA QUINTA
4Q,
INDIO
Oy✓
O J
774-032-019
La Quinta
0310-175
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 1,703 S.F. or $3,644.42 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/Valley Independent Bank Paul Delio Check No. 297831
Name on the check Telephone 760/324.8515
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Sharon MCGilvrey Payment Recd
$3,644.42 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
• f w
• CHARLES B."' GARLAND
c119M Architecture, Interiors, Space and Land Planning
Structural Calculations
26 March 2004
The City of La Quinta
Department of Building and Safety , r
78.495 Calle Tampico
La Quinta, CA 92253
Project: Single Family Residence for: i
P. G. D.
77-240 Calle Monterey
La Quinta, CA
Regarding: Project .Observation
To Whom it May Concern,
On this date I visited' the noted project site to perform code required structural observations. At
the time I noted only minor issues that were resolved'at the time of my visit. `
Therefore, in light of the record construction documents I hereby certify that the noted
single family residence, is in substantial conformance with design intent of said record
construction documents and is hereby declared ready to wrap. .
If you have any further questions regarding this project please do not hesitate in contacting me.
Sincerely,
i
ED ASC ,
S D.
Charles D. Garland U No. C11991 '
10/31/2005
Architect q u
� EXP. DATE
01 V
• s
74-854 Velie Way, Suite 5 ❑ Palm Desert, CA 92260 ❑ Phone: (760) 340.3528 ❑ Facsimile: (760) 340.3728
y" Architecture, Interiors, Space and Land Planning
' Structural Calculations
12 August 2003 }
The City of La. Quinta
Department of Building and, Safety `.
78-495 Calle Tampico
,
La Quinta, CA 92253
Project: _ A Single Family Residence for-..,,
PGD
77-240 .Calle Monterey
La Quinta, California
Regarding: Truss Calculations
To Whom it May Concern,
I have been supplied -with truss calculations-prepared by Trussworks of Thermal," California for the
project noted above. Upon' review of the truss calculation' package, and in light of the structural
design documents, • I find them to be in substantial conformance with the structural design intent
as documented in the structural calculations prepared by my firm for the noted project.
If you have any questions or comments regarding these issues or any other issue please do not
hesitate in contacting my firm.
Sin r ZER�D
ov
Charle D. Garland
Architect .
74.854 Velie Way, Suite 5 o Palm Desert, CA 92260 ❑ Phone: (760) 340.3528 ❑ Facsimile: (760) 340.3728 .
1
1
• -r
CERTIFICATE OF FIELD VERIFICATION'AND DIAGNOSTIC TESTING CF -4R
d
Project Title� Date
Project res Builder Name .
Builder Cont ct Telephone Plan Number
HERS Rater Tele hone Sample Group Number
ifying Signature D to Sample House Number
..Firm: 'j-6. �SSOG/ eS C HERS Provider.
�oG/� S
Street -Address: 78tg0.�"W:FaY1 Ga. &6, City/State/Zip: LR (Y�l/vJ/a
Copies to: Builder, HERS Provider
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
co25My with the diagnostic tested compliance requirements as checked on this form.
El 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.
� r "'
Imo -"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% orless) ❑
Pass Fail
14THERMOSTATIC EXPANSION VALVE (TXV) or Commission approved equivalent
[Xes ❑ No . Thermostatic Expansion Valve. (or Commission approved
equivalent) is installed and Access is provided for inspection ❑
Yes is.a pass Pass Fail
❑ MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT
1. O Yes' 0 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. O Yes O No, s TXV i installed or Fan flow has been verified. If no TXV, . .
verified fan flow matches design from CF -1 R.
Measured Fan Flow =
O O
Yes for both 1 and.2 is a.Pass Pass Fail
f
Certificate of QcdupancY
OF 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: 77-240 CALLE MONTEREY
Use classification: SFD Building Permit N60310-175
Occupancy Group:.R3 Type, of Construction: VN Land Use Zone RC
Owner of Building: PAUL DELIO Address: 81-715 HWY 111
City, ST, ZIP: INDIO CA 9.2201
l By: KIRK KIRKLAND
Date.: 6-23-04
Building Official
POST IN.A CONSPICUOUS PLACE