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0403-312 (SFD)M LO N O� U CL Q LO a 0 LL O�Q, co D d rn H "t•Z o0 5 •J 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 702324 I.3wc � � 0813Irrz(, . Date �'i Signature of Contractor e"'�. �t•_, - 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, Busine3 & Professionals Code). A i ( ) • I,,,as owner of the jproperty, am exclusively contracting with licensed contractors "to construct, the: project (Sec. 7044, Business & Professionals Code). V V � O I am exempt under Sectlonl , B&P.C. for this reason Date $gnature of Owner WORKER'6 COMPENSATION DECLARATION • / P I hereby affirm under j�nglty) of perjury one of the following declarations: () I have and will maiWtafna•certificate of consent to self -insure for workers' compensation, as provider 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 „TATE WND . Policy No. 1S763"_02 (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 S etionr3700 of the Labor Code, I shalftrthwith comply with those' provisions, .-'bate: -7- !( 3. Applicant I , 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 purposytes. G- Signature (Owner/Agent) ),/I, -i l Dat PERMIT # BUILDING PERMIT' Ma -312 DATE '? „ ! VALUATION SZX318M.1.0 LOT LCAT 5 TRACT �� 2157V % JOB SITE ADDRESS �.I ^w �..�J d/'y� .IST � CiR`R.. ,7A APN 774—.242--915 77564 A GCQWn.tY CLUB D"rtIT , 001! :131: I 1 Ptt 3d1 i3FSIIMT i CA 92211 r, USE OF PERMIT 02 CONTRACTOR/DESIGNER/ENGINEER PAC PW :#1'.OR4133 PALM PESERI Cly 922.71 (760)408.3495 u'BIX. 2953 10 1913 S_ , SVD PERilSIT DOES 14 dOT IriL,L.L:DY, BLOCK WALL, POOLJSPA � TRACTC.0NOT UCj-00'4 1,9ig.6J OF . I•�Ltl:.s:tt/,PR7'IO �r-- 19.QU 51t GARAGE/CARPORT 480,0;1 SC .�, EYMWCE.D COST Cala' C:OMMUMON 1.13,600,10 • ig7 Wda I rkm 10U'Ry CC),> STPUCTION ",E 101.000.418.000 $689,50 PLAN CHF—CK FEE 101-0100-4341-318 FEE, DEPOSIT 4250100 th&Cflt.NICAL ME 101-000-421-000 $47.00 ELEC"TRIOAL FEE 101-000.420.000 3125.23 PILU1l3NING YEE 101-000-419-000 $124.00 STROIN© MOTION FEE - TiESID 101.000-241.000 516.30 ORA.LiI`1•Pt31`EI1 101-000-423•-000 $15.00 DEVEb OPE, IMPACT FE'.E 52�fiS,00 PJft ti:C.1SB 1"LKN 101-000-4-11-34:5 $100.00 gU B-1170 ATC " " `Ly�C�3� AIM 11 -AM Ck3.: CK $4,082.4 5 a o .FE T0 -$250.00 R MAR 312004 CITY OF LA Q111NTA FINANCE DEPT• RECEIPT DATE. 2 r BY� �j DATE FINALED INSPECT INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs - (j Underground Ducts Forms & Footings Ducts Slab Grade ( Return Air Steel Combustion Air Roof Deck .-7-7,01-1 Exhaust Fans 0. K. to Wrap 04 F.A.U. Framing �— v 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 / Z 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 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 Encapsulation Gas Piping Gas Test — /ee Appliances Final Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Vottage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility,Notice (Perm) COMMENTS: Building Address •��� 1� Address Owner TitivI44Q" P.O. BOX 1504 �°'Q���� �%� 78-495 CALLE TAMPICO lam/ Y`+`1 r�"G� \LA QUINTA, CALIFORNIA 92253 L� - Mailing � � V 7� Address 'aa11 �, -� .� � � J�� CityLA �V ivc Z- 2zs-5 Tbit 7,4-q Contractor A, , _ . II Address P 0 NY, t ® 2-i I State Lic. City P— & Classif.j �� Lic. q 02_9, Arch., Engr., ` � A Designer S 111 --Arw) City Zip State Lic. If — 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 the alleged 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 ($500). I': 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 o! sale.) I'i I, as owner of the property, am exclusively contracting with licensed contractors to con- struct the proiact. (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.) 1-1 1 am exempt under Sec. B. 8 P.C. for this reason Date Owner 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 1`7 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 is for one hundred dollars ($100) valuation or less.) I certify that in the performance of thg 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 Owner NOTICE TO APPLICANT: If, after making this CertiScate 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. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Lender's Name Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to expiration it 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 all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter the above- mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip APPLICATION ONLY LDING: TYPE CONST.�OCC. GRP. . Number Z,-01 Oo al Description f� ject Description 3I 9__ Sq. Ft. (ef r- No. I No. Dw. Size 7 Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bat. Const. Mech. Electrical Plumbing S.M.I. Grading JAW Driveway Enc. InfrastructureOL—c—livoF,LA F 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 = BUILDING DEPARTMENT YELLOW = APPLICANT PINK = FINANCE CERTIFICATE OF COMPLIANCE Desert Sands Unified School District zo�cj�o 47950 Dune Palms Road Q BERMUDA DUNES r Date 3/23/04 La umta, CA 92253 RANCHO MIRAGEINDIAN WELLS DESE No. 25725 (760) 771-8515 ��: -PALM LA gUINTaT PINDIO y7ti O Owner Pacific Homes APN # 774-242-015 Address 77564 A Country Club Dr. Suite 113 Jurisdiction Palm Desert City Palm Desert Zip 92211 Permit # 0403-312 Tract # BLK287 Study Area Type Single Family Residence No. of Units 1 Lot # No. Street S.F. Lot # No. Street S.F. Unit 1 5 54325 Avenida'. arranza 1918 Unit 6 Unit 2 Unit 7 Unit 3 Unit,8 Unit 4 Unit 9, Unit 5 Unit 10 Comments d♦ 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 $2.24 X 1,918 S.F. or $4,296.32 have been paid for the property listed above and that building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued. Fees Paid By CC/1 St Bank -Dick Scott Name on the check By Dr. Doris Wilson Superintentl$ti't Check No. 71022 Telephone Funding Residential Fee collected /exempted by Yolanda Garcia Payment Recd $4,296.32 Over/Under Signaftm 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: 1,0i ;Document NOT VALID if Duplicated Embossed Original - Building; Departnient/Applicant Copy - Applicant/Receipt Copy - Accounting Coil Certificate ®f Occupancy T-itf 4 JW_0U09A= GoF9� -Building & Safety Department i 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: 54-325 AVENIDA CARRANZA 4 9 Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0403-312 Occupancy Group: R3 Type of Construction: VN Land Use Zone: RC i Owner of Building: PACIFIC HOMES Address: 77-564 COUNTRY CLUB, STE.. 113 City, ST, ZIP: PALM DESERT, CA 92211 By: KIRK KIRKLAND -Date: NOVEMBER 23, 2004 Building Official POST IN A CONSPICUOUS PLACE NOV-18-200+ 07:07 PM P.02 Firm: `J .0 . 4& ES Street ACcress: !yao �!'4✓Gl©Y� ld�G�a, riamo rravider: CltylState!Zip: CF -0, Ilder Name TAY in Number r mpl® Group Number mple House Number �..' 4� /:;19;5 Copies to: Builder, HERS Provider HIRI RATER C lAN E STAT MENT The house was: Tested C3Approved as part of sample testing, but was not tested 4F As the HERS rater providing diagnostic testing and field verification, I certify that the houses identified on this form comp' with the diagnostic teatsd compliance requirements as checked on this form. Distribution system is f0y ducted (I.e:, does not use building cavities as plenums or platform returns in lieu 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. �44rm-INIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT Duct Diagnostic Leakage 'Testing Results (Maximum 6% Duct Leakage) Measured Duct Pressurization Test Resuits (CFM Q 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 i w Is measured enter measured value here 4 L eakage�Parcentaga (100 x Test Leakage/Fan Flow) T Check Sox for Pass or Fail (Passs,6% or less) ❑ Pass Fail eTHERMOSTATIC EXPANSION VALVE (TXV) or Commissionproved equivalent �es ❑ No Thermostatic Expansion Valve (or Commission approved equivalent) Is Installed and Access is'providad for Inspection � ❑ Yes Is a pass Pass Fail ❑ MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT 1. 0 Yes O No ACCA Manual D Design requ!rem ents,have been met (rater has verified that actual Installatidn,matches values in CF -1 R and deslgn on plan. 2. 0 Yes 0 No TXV is Installed or Fan flow has been vi§dfied. If no TXV, verified fan flow matches design from dF�;1 R. Measured Fan Flow D 0 Yes !cr both 1 and 2 is a Pass Pass Fay!