SFD (0312-080)LICENSED CONTRACTOR DECLARATION
U) I hereby affirm under penalty of perjury that I am licensed under provisions of
I— Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
04 W Professionals Code, and my License is in full force and effect.
O =) M License # Lic. Class Exp. Date
LLJ ` ,82324 B M'C " .� t113J 3.J2t'
Z r- Dater) Signature of Contractor
r o OWNER -BUILDER DECLARATION
W Wca
I hereby affirm under penalty of perjury that I am exempt from'the Contractor's
~ N License Law for the following reason:
Z_ ( ) 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
LO
O N Date Signature of Owner
rn
Q WORKER'S COMPENSATION DECLARATIONCL w
'
5, 2 Z I hereby affirm under penalty of perjury one of the following. declarations:
n F2 p (.) 1 have and will maintain a certificate of consent to self insure for workers'
K W tt compensation, as provided for by Section 3700 of .the Labor Code, for the
nJ Q performance of the work for which this permit is issued.
Q U ( ) I have and will maintain workers' compensation insurance, as required by
CJ' Q Section 3700 of the Labor Code, for the performance of the work for, which this
L rn F- permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier FUND: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 sha I forthwith comply with those pr• Islons.
Date: Applicant /o-�_ .,-�
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 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.. j '" �•
gent)
Signature (Owner/A
1 G- x'/14- Date4.1
7
BUILDING PERMITPERMIT#'
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DATE VALUATION LOT.. TRACT
13, bilk 2108
JOB SITE
ADDRESS f* a
APN •r
OWNER
CONTRACTOR/DESIGNER/EN 61NEER '
1P0'd�:'�'t,R.'MTA C - _1SSQC1.AXFO WC
PACTC HOMES .
PEa B0X 134 -
77564-"A CbC1T1'NIMY (. LUB I)I2 M Sli:i1S 11'
i•.,G4 QmNv, CA 92253
PAL�+3. DEWiRT CA 9221 '{
( 760)408-3495 CBI* 2953 .
t
,USE OF PERMIT
1314 SY, SFD P1�RMYf ONLY, )�'F1?:MfT DOES dOT'J.Ttt'LUDE BLO X
I
WALL" POOLISPA OR DRIVEWAY APPR 3.A.CH;' 1043 CDC.
TRACT CONSTRUCTION yF
r PORCH1PATJO ,, 1.?6.0f)
6ARAGLYC,.WORT $36,00 OF
. EsnuA .�•�.%, COsT ov, commucriox
q5101 06161D .
3.11,11ME' i= SUMMAgY
CON IRUCTION FEE ', 101.000.418-009 $621,30
PLAU CNECZ JiE ` 101-(i£3i 3 ?-31 3 $512.99
FE1•;'17 POS1'f S:0'ilfJQO-�. -3.1R . ' -.4250,00
.
NIPCJ1,f NHCA I, ?Fit 1,01-000-:421-000 $X50
&LEC9.'13CA FRE $112,21
i�i,UkA"D�4AdCi !<i�W :i 01. -t? O-41.9-000
8 T RO;P1t2 MOTION FEE .101.000,241-000
O. . L317N0 FEE 1.�4 ��U£k�23at?CJ0 $0.30
DEVELOPER IMPACT FEE.
PRECISE PLAN I-01-000--441-:34..
17fs-'1'C�"r.C�Nk'T�ttr1C',Apd11)5 t&tt
$3,938.46.
0.F.
QTAL.)'= T 1%'ES 1 HOW
JAIV.05 2904
.
OF//aa Sys L
A CQIJ�ixjt
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FINARICED[
RECEIPT
DATE
BY
DAT NALED
INSPEC R
INSPECTION'RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
_ Q
Underground Ducts
Forms & Footings
Ducts "
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
l
Compressor
Insulation
L
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
_
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
OX for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
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
Final
Utility Notice (Perm) 6— ((• oti/
COMMENTS:
_
CERTIFICATE OE COMPLIANCE
Desert Sands Unified School District
47950 Dune Palms Road ¢ BERMUDA DUNES .
Date 1/5/04 La Quinta CA 92253 rn RANCHO MIRAGE d
�. INDIAN WELLS '+r
No. 25325. (760) 771-8515 �� PALM LA QUINTAT y
�INDIO y7�
Q
Owner Power Finance Associates Inc APN # 774-061-012
Address PO Box 134 Jurisdiction La Quinta
City La Quinta Zip 92253 Permit # 0312-080
Tract # blk 208 Study Area
Type Single Family Residence No. of Units 1
Lot # No. Street S.F. Lot # No. Street S.F.,
Unit 1 13 77595 Calle Monterey 1514 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 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
V
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 1,514 S.F. or $3,239.96• 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 CCNalley Independent Bank - Dick Scott Check No. 297799
Name on the check Telephone 760/408.3495
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted b aeon cGilvrey Payment Recd $o.oa .
` $3,239.96 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
JUL-'02-2004 07:10 AM P.01
CERTIFICATE'OE FIELI) VERIFICATION ANO DIAGNOSTIC TESTING CF -4R
Project T ale, - Cat
?rois:I Add�ss ` BUllder Narne
3ulldef p , t *elepnone Plan Number '.
• HeRS Qataf.
of phone �^ Sample Group Number T
ifying Signature atd; Sample house Number
F rm;' J~G..�,�ISS°OGr�J"gs CHieRS Provider TG.4-/7f�OG/GTS
Saga; Address' C1Y
City/Stawe/zlp:
Copies to: Builder; -HERS Provider —
HE RATER'CgMP616NCE STATEMENT
Tne house was: Tested Approved as part of sample testing, but was not tested
As the HERS rotor providing diagnostic testing and field verification, I certify that the houses identified on this rorm
comZy witn`the dlagnostic tested compliance requirements as checked on this foram.
Distribution system is fully ducted (i.e., does not use building cavities as plenums -or platform returns in lieu -
��c' ducts) .
u°1 '"_here cloth backed, rubber adhesive duct tape Is installed, mastic and d?awbands are used in cmoination
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 Press �,rization Test Results (CFM'Q 25 Pa) values -
Test Laakage Flow, in CFM /,
_--I fagil.ow is=calculated'as,4boC fon.-x number of fcins
_. calcuiated.valua here:
If:fan+low Is•measured enter measured value here
Leakage percentage (100 x Testleakage/Fan Flow) =: "T
Check Bcx for Pass or Fail (pass=6�6 or less)
F7ass Fail
1,tTHERMOSTATIC EXPANSION VALVE (TXV).or Commission approved equivalent
es No, Thermostatic Expansion Va!ve (or Commission approved -
equivalent) is installed and Access is provided !or inspection
Yes Is a pass Pass Fail
❑ MINIMUM REQUIREMENTS FOR DUCT
DESIGPI,COMPLiANCE CREDIT
O Yes No ACCA Manual ODesign'requirements have been mel /
(Wer has veriflec thetactuai Installation matches values'in
CF.1.R and design on.plan,
2. D Yes O No TXV is lnstal ed -on Fan flow has been Verified. If ne TXV;
verified fan flow matches design from CF -1 R.
Measured Fan Flow:
Yes for both,1 and 2'is a Pass Pans Fail
cei4-4 � Qum-
78-105,
CALLE ESTADO - LA QUINTA; CALIFORNIA 92253 (619) 564-2246
January 15, 1991
Riverside County Assessor's Office,
46-20.9 Oasis Street
Indio, CA 92201,
Dear Sir.:
Please be advised that 53-245'Eisenhower Drive, Parcel Number
774-055-022, has been changed. The corrected address is 77=660
Calle Monterey. (Please see copy of enclosed..permit card.) The
change was due to 'the fact that the house was repositioned during
building and now faces Monterey.
Should you have.any questions,,.pl.ease do not hesitate to contact.
me.
Sincerely,
BUILDING AND SAFETY
Tom Hartung
Director of Building and Safety
TH/lc
enc..
MAILING ADDRESS P:O: BOX 1504 LA QUINTA, CALIFORNIA 92253
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MAIL TAX STATEMENTS To SPACE ABOVE THIS LINE FOR RECORDER'S USE
Namc
Street Same as:.above
:ware,.
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state
Gaunt Deed
THIS FORM -FURNISHED BY UNITED TITLE COMPANY n
f1.I. o5S 07-7--i.,
The undersigned grantors) declare(s):
Documentary transfer tax is S `� s
( ), computed on full value of property conveyed, or
( ) computed -on full value less value of liens and encumbrances remaining at time of sale.
( ) Unincorporated area: ( )t-) City of LA Qo+ N-rA and
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
1.
(� KENNARD E. GOLDSMITH., JR. AND PATRICIA S. GOLDSMITH, husband and'•::wife
as joint tenants
00 hereby GRANT(S] to
(y) DOMENIC RATTO, a. single man
the. following described real property in the C, i -��� o Lf1 Q UirN TA
-County of Riverside , State -of California:
Lot 12; block :209 Unit 20 of. Santa Carme.lita at Vale La
Quint as per map . recorded iii book 19 t,�a e - 38 of, -siaid ,:coun.ty.
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Dated
March 29, 1988��.
K rd E. Goldsmith, Jr.
STATE OFCAIJF0t3A11 eies SS. Patricia S. Goldsmithe
COUNTY OF L g
On April 6 ,, 1988 before me, the under-
sned, a Notary -Public in and for said State, personally appeared
Kennard E. Goldsmith Jr*
personally known
u) me or proved to me on the basis of satisfactory evidence to be the ; • (/ / `p
person _ whose name 1 S subscribed a, the within instru•{M „' 1
4+4s� I '.0 C �• a.
merit and uwlydRed that he executed the same.
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Signatu LA -1 -OL
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Yoich' Kawamura,'
Name (Typed or Printed) (Ttiis area for official notarial seal)
Title Order No. Escrow or Loan No. ,
11'1-1)22t5;x5l MAIL TAX STATEMENTS AS DIRECTED ABOVE
RF.{•ORDINC REQUESTED BY
U"i,IEJil T. i Co.
•
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AND W111EN RECORDED MAIL TO
Dominic Ratto'
Strrrt
9131. Hall Rd.
K
Downey, Ca. 90241
Cit
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MAIL TAX STATEMENTS To SPACE ABOVE THIS LINE FOR RECORDER'S USE
Namc
Street Same as:.above
:ware,.
Cite x
state
Gaunt Deed
THIS FORM -FURNISHED BY UNITED TITLE COMPANY n
f1.I. o5S 07-7--i.,
The undersigned grantors) declare(s):
Documentary transfer tax is S `� s
( ), computed on full value of property conveyed, or
( ) computed -on full value less value of liens and encumbrances remaining at time of sale.
( ) Unincorporated area: ( )t-) City of LA Qo+ N-rA and
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
1.
(� KENNARD E. GOLDSMITH., JR. AND PATRICIA S. GOLDSMITH, husband and'•::wife
as joint tenants
00 hereby GRANT(S] to
(y) DOMENIC RATTO, a. single man
the. following described real property in the C, i -��� o Lf1 Q UirN TA
-County of Riverside , State -of California:
Lot 12; block :209 Unit 20 of. Santa Carme.lita at Vale La
Quint as per map . recorded iii book 19 t,�a e - 38 of, -siaid ,:coun.ty.
. c
Dated
March 29, 1988��.
K rd E. Goldsmith, Jr.
STATE OFCAIJF0t3A11 eies SS. Patricia S. Goldsmithe
COUNTY OF L g
On April 6 ,, 1988 before me, the under-
sned, a Notary -Public in and for said State, personally appeared
Kennard E. Goldsmith Jr*
personally known
u) me or proved to me on the basis of satisfactory evidence to be the ; • (/ / `p
person _ whose name 1 S subscribed a, the within instru•{M „' 1
4+4s� I '.0 C �• a.
merit and uwlydRed that he executed the same.
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Signatu LA -1 -OL
,
Yoich' Kawamura,'
Name (Typed or Printed) (Ttiis area for official notarial seal)
Title Order No. Escrow or Loan No. ,
11'1-1)22t5;x5l MAIL TAX STATEMENTS AS DIRECTED ABOVE
OF R�
OFFICE OF LEON SPAUGY
p COMMISSIONER
s AGRICULTURAL�1CO.MNiISSIONER ,ARIES 0 WALLACE .
O AND AS55'A�f fOW�11SSI0%EP.
WEIGH1 S & MEASURES CLEMENT BENVENISTE ,
SEALER
} 49=613 Ilwy 86, Suite II -12.
�. ,.•' 'Coachella, CA 92236
qry �Sq 619-342-8291
DATE / Y q . CASE NO. -/Q 6"n S 071 Y0
DEVELOPER'S NAME-
ADDRESS:
AME:ADDRESSs 71 33
TELEPHONE: (2/3) horn,
Dear Developer:
After reviewing your landscaping plans, all plant material listed is not in
violation of quarantine laws governing the Coachella Valley. If substitutions
do occur and they differ fran plalit material listed, this office must .be notified
immediately.
Thank -you for protecting and preserving the Coachella Valley's pest -free environment.
Agricultural CaTmissio a & Office
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Buena Engineers, Inc.
79-811 Country Club Drive, Suite 4
Bermuda Dunes, CA 92201 • (619) 345-1588 / 328-9131
Client
Client
Client Phone
DATE
TEST LOCATION
IJOB NO.
/-6— C)
FIELD TESTING
7' /cxf2
PROJECT
DRY
DENSITY
IbsJCu. h.
.:: �3 c-2
LOCATION
OPTIMUM
MOISTURE
CONTENT
%
ZA
CONTRACTOR
OWNER
WEATHER
TEMP. o at AM
at PM
PRESENT AT SITE
TEST
NUMBER
TEST LOCATION
LOT
NO.
ELEVATION
FIELD TESTING
REFERENCE CURVE
MOISTURE
CONTENT
%
DRY
DENSITY
IbsJCu. h.
MAXIMUM
DRY
DENSITY
%
MAXIMUM
DRY
DENSITY
IbsJcu.ft.
OPTIMUM
MOISTURE
CONTENT
%
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REMAR�i<S�
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CLIENT REPRESENTATIVE SIGNATURE
FIELD REPORT
TT%A1' IJV2'�'
I TECHNICIANS SIGNATURE
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1 Cedifica tea, bf-Occqpanc
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OF :, Building. & Safety Department.
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This Certificate, is issued pursuant to the requirements of Section 109 of the California Building
c
Code, certifying that, at" the - time"- of issuance, structure was in compliance with the
.this
provisions of the Building. Code :_and the various ordinances of the City .regulating building
construction and/or use.
BUILDING ADDRESS: 77 CALLS MONTEREY
Use classification: SINGLE FAMILY. DWELLING , . ' x • `. Building Permit No.: 0312-080
Occupancy Group: R3 Type of Construction: VN Land Use Zone: RC
_ Owner of Building: POWER FINANCE ASSOCIATES' Address: P.O. BOX 134
City, ST, ZIP: -LA QUINTA, CA 92253
' By: KIRK KIRKLAND
Date: JULY 13, 2004
Building Official -
#' POST INA CONSPICUOUS PLACE
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