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0206-138 (SFD)LICENSED CONTRACTOR DECLARATION hereby affirm under penalty of perjury that I am licensed under provisions of a i 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. Da e t . t/Date ` j ;r — Signature of Contractor s 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). ( ) 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 Date Signature of Owner WORKER'S COMPENSATION DECLARATION 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 ( ) 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 STATE I D Policy No. 154:293'7-01 f :i (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.,l should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those,provisions. Date: Applicant 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. ,q 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 pursuanttto 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 voidVIif• 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.,+N; I certify that I have read this application and state that the above information is i1 correct. I agree to comply with all City, and State laws relating to the building ti construction, and hereby authorize representatives,ofjthis City to enter upon the above-mentioned property for inspection purposes.' 'Signature (Owner/Agent)- r^�.. + - Date B BUILDING PERMIT PERMIT# 0206-13e DATE VALUATION � � y � � LOT3 6 TRACT PALK 307 JOB SITE �,�1 ADDRESS 54-6f0 AEDA. C.AR.IMINZA APN 774-27.5-009 OWNER CONTRACTOR / DESIGNER / EN (NEER l':Oit.ORMMIT1 RPRlSF0 WPOly°EL CoNgr UC14110H PO BOX 389. 78-150 CAUS TEMPiu0 STMT -042,3.0 LA QUINT'A " CA 9.2P.53 3. k QT:fWTA CA 512253 ('760)5CYI- 604 Cr -UP 22151 USE OF PERMIT 3F'D - LAP 1.6, AeRli�: TUD KAST'Ji l PERM'.(T DO&S NC.7'.f 174it: IM! POOL, SPA OP. DRNEWAY APPROACH . 1ACT CONSTRUCTION 1,PA6,00 I'M C1AidAMCeAIRPORT 504.00 Sir S Fr.'WOOD PENCE �l14,0� LF :ESUMAMMSr"rOF C01t4.i°�T'.I'�'.T3("nox 1:11101620 PMW1.1 L JLT 1r` 1MAWIty CONSTRUCTION FE1 101.000-419-000 $691:64 PLA14 CHECK PRIE 102.,000.,439-318 $56t.0 i PF9DEPORSIT 101.000.439,.-318 4210,00 11lMVifi.NIC.AL FE -9 101-000-X4254X0 $6,100 ELECTRICAL IC,AL FEE 101 -000-4zo.000 `1123,19 P1,UMS1140 F9F. V IS.00 STif.ONc r TincYCION S+}:X+' .'r•tfISID 101.,000-243-000 $11,18 f;41i.M140 FE, LIP $2a.00 DWELO.PER IMPACT ME, $2,40$,09 1'i=1SEPLA14 $�32-[tf;t) •tdl-3�S �1f}O.f10 � 01JR-1'0TAF C.7NSTR.i.3G'T'iON AWD X�W CIMC .,03,3.94 r.. M 1'1 -PAITy I- 3 PQ 4230. W, ,��i�_ 1,•h 1tf�� CITY OF LA dUINTA FINANCEDEFM 1� RECEIPT DATE BY DATE FINALED INSPECTOR f c�. 'u, INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING- APPROVALS MECHANICAL APPROVALS Set Backs 7a - x?ef-- - Forms & Footings / Underground Ducts Ducts Slab Grade v 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 Wail Insulation Condensate Lines Party Wall Firewall Exterior Lath / Drywall - Int. Lath Final Final O 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 _(%3 pZ� Heater Final Plumbing Final Water Piping Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection /(�_� �, Encapsulation Gas Piping _ Gas Test Appliances Final COMMENTS: Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole — - d 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) rTwit 0 Cl/ P.O. BOX 1504 Address , _ UINT CALLE CALIFORNIATAMPIO Address_ —1 cr•� ,r• Zq LA QUINTA, ORNIA 92253 Owner — , Address \J ` U �� r -S% `1 CityZip Tel. Contractor Cd f ci rte. Address � � 1 O� State Lic. \, , City Li ' & Classif. ��y l �` C. # �a Arch., Engr., t Designer Address Tel. City Zip State %� I Lic. # 1 am tic Sed ng /revisions of Chapter 9 (colTlptenc the B ness ¢Q PP//ofessions Code, and my licenV is QhaI.;1.,?e1.1empt Wfrom th DECLARATION I hereby aflir Irom the Contractor's License Law for the following reason: (Sec. 70nd ProlessionsCotle: Any city or county which requires a permit to construcprove, demolish, or repair any structure, prior to'Its issuance alsorequires the applicsuh permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Lew, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Cotle, 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 subjecls the applicant to a civil penalty of not more than five hundred dollars ($500). 1: 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.) I 1 I, as owner of the property, am exclusively contracting with licensed contractors to con- struct the projec 1. (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of properly who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) I'I I am exempt under Sec. B. & 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 rl Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed it the permit is for one hundred dollars ($100) valuation or less.) 1 certify that in the performance of Ing 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, atter 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 parmif 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 slate 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 sof this city to enter the above- mentioned property for inspection purposes. Signature of applicant Dale Mailing Address City, State, Zip APPLICATION ONLY . 110 �O BUILDING: TYPE'CONST. i� OCC�. GRP. A.P. Number _1�_ �l� .?V0 c Legal Description\—A VV_ '�-0-7 Project Description z - 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 t Validation: WHITE = FINANCE YELLOW = APPLICANT PINK= BUILDING DIVISION q.t No. \ Size �1 Stories \ No. Dw. Units New .JR Add ❑ Alter ❑ Repair ❑ Demolition p Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure 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 t Validation: WHITE = FINANCE YELLOW = APPLICANT PINK= BUILDING DIVISION I A JRC DISTRICT - PLANNING REVIEW FORM This form is to be used by CDD staff for review of single family dwellings in the RC (Cove Residential) District per Section 9.'50.090 of the Zoning Code. Its purpose is to determine: 1) that the proposed house design does not duplicate the same architectural style of any house within 200 feet of the applicant, and/or 2) if there is a need for the applicant to file for Master Design Guidelines. If the applicant does need to file a Master Design Guideline, please transmitted this information to the Building and Safety Department as part of your correction list. please attach additional explanations as necessary. APPLICANT... . SITE .ADDRESS Coronel Ent. APN 774 _ 275 - 009 LEGAL: LOT 16 54-680 Carranza CASE NO.: 2002-662 BLOCK 307 UNIT CHECK AND APPROVED BY.: Greg Trousdell DATE: S.C.@V.L.Q. Inform the assigned ' Building plan checker upon your assignment to this case. The CDD Executive Secretary maintains a log book to track applications and assign case numbers. REQUIRED ITEM Y N COMMENT/CORRECTION Verify legal and APN information Consistent with MDG on file .(as applicable MDG filing required (5 filings since 9/3/98) e# e Architectural variety within 200 feet of the surrounding area:. to P an I10� ° Mateka` as C h� Architectural design featu C° o• o, 0 too C/ �' �� , �U� �U/N j 4 1t C ,10 :)ndrt ns r�®l�� �rrr�,� Other Requirements: r r 2 A !-L17b.J G 7 : Y7 r 1.1 INSTALLATION CERTIFICATE CF -6R Ll - Od /y1rW,n 71-P) G e? Site Address Permit Number DUCT LEAKAGE AND DESIGN DIAGNOSTICS DUCT LEAKAGE REDUCTION Pressurization Test Results (CFM @ 25 PA) Test Leakage (CFM) �� Fan Flow f (Fan Flow is Calculated as 400 cfm/ton x number of tons, or as 21,7 x Heating Capacity in Thousands of Btu/hr, enter calculated value here '*G9 If fan flow is measured, enter measured value here Leakage Fraction = Test Leakage/(Measured or Calculated Fan Flow) = a' Pass if leakage fraction 5 0,06 ❑ [] Pass Fail ❑ For AEROSOL TYPE SEALANTS ONLY - The following diagnostic testing was completed: Duct Fan Pressurization at rough -in measured leakage (CFM) CHECK AFTER FIINI•SHING WALL:. ❑ Yes ❑ No ❑ Pressure pan test or House pressurization test j ❑ Yes ❑ No ❑ Visual Inspection of Duct Connections ❑ ❑ Pass Fail THERMOSTATIC EXPANSION VALVE (TXV eyes ❑ No Thermostatic Expansion Valve (or Commission approved equivalent) is installed and Access is provided for inspection A ❑ Yes is a pass Pass Fail ❑ DUCT DESIGN ❑ Yes ❑ No ACCA Manual D Design calculations have been completed, Duct Design is on the plans and duct installation matches plans. 2• ❑ Yes ❑ No TXV is installed or Fan flow has been verified, If no TXV, verified fan flow matches design from CF -IR. Measured Fan Flow ❑ ❑ Yes for both 1 and 2 is a Pass Pass Fall J6 1, the undersigned, verify that the above diagnostic test results and the work I performed associated with the test(s) is in conformance with the requirements for compliance credit. (The builder shall provide the HERS provider a.copy of the CF -6R signed by the builder employees or sub -contractors certifying that diagnostic testing and installation meet the requirements for compliance credit.] Aaw n%4— �14,o3 'Pests gnature, Date Installing Subcontractor (Co. Name) OR Performed General Contractor (Co. Name) COPY TO: Building Department HERS Provider (if applicable) Building Owner at Occupancy Certificate of Occupancy City of La Quinta Building and Safety Department This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code, certifying that, at the time of issuance,. this structure was in compliance with the various ordinances of the City regulating building construction or use. For the following; BUILDING ADDRESS: Use Classification: SFD 54-680 AVENIDA CARRANZA Occupancy Group: R3 Type of Construction: Owner of Building: CORONEL ENTERPRISES Building Official Bldg. Permit No.: 0206-138 VN Land Use Zone: RC Address: 78-150 CALLE TAMPICO STE 230 City:. LA QUINTA CA 92253 By: KIRK KIRKLAND Date: 1-24-03 POST IN A CONSPICUOUS PLACE