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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 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 intended or offered for
sale (Sec. 7044, Business & Professionals Code).
( X 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 s'
Date a+ � ' "t7 Signature of Owner g, —
WORKER'S COMPENSATION DEELARATION
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 is Rall 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 proGisions of Sect! n 337,00 of the Labor
Code, I shall forthwith comply with thse rovisions.h/14�
,¢ate: - x• -°Applicant Y
d � ;✓"
Warning: Failure to secure Workers' Compensation coverage -i Inlawful 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 authorizedr6resentatives�of this'City to enter upon
the above-mentioned property fonspection purposes.
I�Signature (Owner/Agent) ��e�i. f�G �(i� Date,
BUILDING PERMIT PERMIT#
-330
03MLOT
DATE TRACT
VALUATION 1 2"
INLKJOB
SITE
ADDRESS _94-M.�A.VE N�«�a'�. �i5 �a%�
APN 774-211.-W2
OWNER
CONTRACTOR / DESIGNER / EN INEER
RIC:01='3'.bt31'LR17M.
O'WWWRU1- ZER
77-510 0'RMU LME )A
PALM DESERT CA 9.2211
CIX
USE OF PERMIT
1936 S.F. SPD'PERMI'T DOES NOT 111CWDS i3WCK WW, POCLJ'. PA.
OR DRUVI&WA,Y APPF QikC1•I
-------
inn
TRACT CONSTRIXT1014 1,936.00 SF
LC
CT 0 8 2003
PORCH/F' 10.00 9F
GA1i.,s,.O. CARPORT 447,00 OF C
TY OF LA QU{NTA
FINANCE DEPT.
ES'Y'.�f ATED C015T X F C0NSi°ft17K."1;° 01q
4 2:4,139.70
'ONSTRUCTION FEE 101-000-1418.000 092.40
PLAN CHECK FEE $517.33
TE!I�' D POSIT 101.000.439.318 42361.110
MY—CI.11WWAL IrwC 101_000-141.21-000 $59.00
N. ECTRICAi., M, 101-000.420,,000 S12S.20
»I..LTFkI INO F".I: 101-000-419-000 $13o.w
STRONG MOTION FEE - R SID 101.000 -,?,41.1300 $11.11
OPAD114CIFRE - 101.*000-423-400 $13.00
'
DZVX1,01'Eft IMPACT PC,9 $2,40.1.00
PItE1' SE PLAN ifil-43t3ia�4A1-?AS SIDD.oU
LS FIR�� a Ms
4250100
OT ASL PMWT FEES :AW, now
&4^094
RECEIPT
DATE
BY
DAT IN Ep
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
. B
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
_ d
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
�j �J�
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 Piaster
Sewer Lateral
Pool Cover
Sewer Connection
/ o
Encapsulation
Gas Piping
Gas Test
Appliances
_
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 s!
Final
Utility Notice (Perm)
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
47950 Dune Palms Road
Date 10/8/03 La Quinta, CA 92253
No. 25059 (760) 771-8515
Owner Rico. Properties APN #
Address 77-570 Springtime Ln Jurisdiction
City Palm Desert Zip 92260 Permit #
Tract # BLK 285 Study Area
4G''��211EZ1 �o
Q BERMUDA DUNES
RANCHO MIRAGE C7
{�J INDIAN WELLS
PALM DESERT y
LA QUINTA
�INDIO y�
0
774-211-002
La Quinta
Type Single Family Residence No. of Units 1
Lot # No. Street
Unit 1 2 54040 Avenida Carranza
Unit.2
Unit 3
Unit 4
Unit 5
S.F. Lot # No.
1936 Unit 6
Unit 7
Unit 8
Unit 9
Unit 10
Comments Certs #25058 through 25060 used for CC#116332 in the amount of $11,594.52.
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 Irving, 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 1,936 S.F. or $4,143.04 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/South Bay Bank - Roper Morris Check No. 116332
Name on the check Telephone
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by S ron McGilvrey Payment Recd $0.00
$4,143.04 Over/Under
Signature C4,64�.,
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
0-3o5- 01
Building StJ o�
Address Z"
• 4"
P.O. BOX 1504 APPLICATION ONLY
all, 78-495 CALLE TAMPICO
uc��hct Y _
46A QUINTA, CALIFORNIA 92253
p; pvopc,ties ('1US--4i 1110 v✓iSMailin
)
Address -7'-)r 37-7c> SP /i W3 f idtl LM 414e M
City Zip Tel.
7P►1 4?2)6 L ( 760 `V Y85 -
Address
City lZip
State Lic. City
& Classif. I Lic. #
Arch., Engr.,
Designer
Address
CityI Zip I State I
Lic. #
LICENSED CONTRACTOR'S 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.
SIGNATURE DATE
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
thealleged exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars (E500).
l; 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, Buisness 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 improvement is sold within 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.)
as owner of the property, am exclusively contracting with licensed contractors to con•
sitruct 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 th Contractor's License Law.)
17 1 am exempt under Sec. B. 8 P. . I r IN reason
Date i'j Owner JAAA
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
n Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit i for one hundred dollars ($100) valuation
or less.)
I certify that in the perfor nce of hp wor f ich t ermit is issued, I shall not
employ any person in any m r so a bec • s b) o he Workers' Compensation
Laws f C ifornia
Date wner
NOTI TO APPLICANT: If, aA making this Certificate o empfion you should become
subject to the Workers' Compe ation provisions of the Labor Code, you must forthwith
comply with such provisions or this rmit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this per it is iss e . (Se 097, CiviloQde.) {�
Lender's Name 1: I ped"r__
ped _
Lender's Address
This is a building permit wh n properly tilled out, signe and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct.
I agree to comply with II city and county di nce! and state laws relating to building
construction, and her autho ize repre tat es sof this city to enter the above-
mentioned property for i echo poses. Q �I
Signature of a0plicant Date v ` -�
Mailing Address _
City, State, Zip
rn--tIM ` tyuo, co,
LDING: TYPE'CIONST. OCC. GRP.
. Number 79Y '.I// • 00.2. &1 29 B/ooK .2 !S
Legal Description cc
Project Description d
Sq. Ft.No. No. Dw.
Size 1�f 3 to Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
>timated Valuation
PERMIT AMOUNT
Plan Chk. Dep. OO
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading i
Driveway Enc. j
Infrastructure 1 i
TOTAL -- `
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
MAY -14-2004 07:1'1 AM N'bb
projec weap to
V=a4,® % ��t�r72-49
,
Proje Aooress Builder Name
sui;aer i;I Tolephons Plan Number
�im_ e4 r%V 11. 4
KERS,parer / oisghone ompli' roup Number
ify ng Si6na;urs a Ssmp a cues Number
Firm. �T'C d-,�joG�4��. p HERB Provider;
steei�deress: ��LO Bi!�`�rAr� C/YGti, City/StatmRtp: La CA -�13.•
Copes m 80oer, 1, -ERS Provider
HERS &ATER COMPLIANC9 ITA11MINI
Tha house wet: Tested ❑ Approvod as pert of sIBMIDI :test ng, but was not tested
As the HERS rater providing dlognostle testing and Held verltcellon, t cerlty that the houses identified on tnis form
comp,,r w in tris diagncs:ic tested compliance requirements as checked on this form.
1' ,041ribution syste'n Is rul'y ducte.d (Le., does not use bullding csvlttes as plenums or plat'orm returns in lieu
-r c�cts;
where Voth backec, rubber adhesive duct -tape Is Installed, mestlo and drawbands arm used in combination
,v th cloth backed. rubber adhesive duct tape to seal leaks.at.duct connections,
3(Mi.NIMUM REQUIREMENTS FOR DUCT LEAKAGE'REDU.CTION COMPLIANCE CREDIT
Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage)
` Measured
D•Jcr aressurizatronJoil Results (CFM C 25 Pa) values
Toot Leakage Flow in CFM
If fan flow -Ie eCculaled as 400cfrn/ton x number of tons enter.
T Calculated yelu6 here, r�
tf fan flcw is measured enter measured value here
'-as We Percentage (100 x Test LeskagelPen Flow) ■
o
-L.
Check Box for Pass or Fell (Pasaaa% or legs)
❑
rss
Fail
TTHERMOSTATIC EXPANSION VALVE TXV or Commission approved equivalent
Q11/Y
i❑ Thermoste:lc
ass No Expansion Valve (or Commission approved
equivelcnt) is installed and Access is provided for Inspection
❑
Yee Is a pass
❑ MINIMUM
Pass Fail
REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT
t 0 Yes C No ACCA Manuel D Design fequlre Gr1ts have been riot
(refer res verified that actual installetron matches values in
CF•1R and design on plan.
2. 0 Yes ®No TXV is Installed or Fan flow hes been verlfled, n no TXV,
Verlfled fan flow matches design from CF -1 R.
Measured Fan Flow e
Yes for both 1 ant 2 13 a Pass
o El
Pass Fa,l
Certificate of Occupancy
T'Vf 4 4 Q"
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: 54-040 CARRANZA
Use classification: SFD
Occupancy Group: R3 -
Owner of Building: RICO PROPERTIES
Building Off iciai/
Type of Construction: VN
Building Permit No.: 0308-330
Land Use Zone RC
Address77-570 SPRINGTIME LN
City, ST, ZIP: PALM DESERT CA 92211
By: KIRK KIRKLAND
Date: 5-25-04
POST IN A CONSPICUOUS PLACE