The URL can be used to link to this page

0303-018 (SFD)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 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). �) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business & Professionals Code). % 00 () I am exempt under Section B&P.C. fpr this reason/ :f% Date 'E= - rfb Signature of Owner f. �. n� 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 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 shall not employ any person in any manner so as to become, subject to the workers' compensation laws of California, -and agree that ifA should become subject to the workers' compensation/provisions of Section 3700, bf the Labor Code, I shall forthwith comply with thoser5ovisions.. r . �• J 'Date: Applicant— Warning: pplicant Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided, for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his -application. 1. Each person upon whose behalf this application is made & each person at / whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws%relating to the building . construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for;inspection purposes;: ,,�/��' ��'f Date l� Signature (Owner/Agent) K: BUILDING PERMIT PERMIT#aA�YL ?j.L'}� DATE ,fir 33 VALUATION ."�'J�� LOT TRACTJOB SITE ADDRESS 17-420 �:is�' X i;taa�'w�,ryLL. VA APN 774 •,x 2�'�E I'D OWNER CONTRACTOR/DESIGNER/EN INEER PAM DESETer CA 92260 ang. USE OF PERMIT t3}:AIGI1 FAMILYDVl 1.DTCI LL&P -5 ijP AJ � A a6. Y X,:JYtll �.F '-i N.: F1'!4..a,r],15#t• 5.V1-fr-w-d'f'.! al -.ti . qPA. OR tAWMAY APPRO,r CH TRAOT r ONS7 NUC' PON 1,319A Sty PORC&'iIP.ATIO 169.441 ;k�t.g' Irl,?tF�LTEl Al 4'f � '"t' S:� n0 ST CONSTRUCC'T1014 FES 101.0 0.41.k3'•000 14t k�L:i�+f C;HLj.Ch Ft'S 101.C1)Q-41".1119 :11 3.?..... FEE VVC>S1T 101-r,4;�t-43;a-31 ,S R3.,3>?C:1 f;1r5,.1aFrs 0.00 S1 'r': t' PLUM M'NO -{?4101-11.3 911.00)0 1A '11.1 V, STRONO MOTION ME - RtSfl) 01 -M-241 -003 t= ^.:?C1u�a 1P$,atl'PI lfJ�-'!°�{)<��+4� a �:i� � '�i.t�•;c.:ti4 �.��• 4 (� 1 r41p9 2 1•V,i% 'a!',f'�'j pKj� M Va�ni�o�/`yL�1��i.J.:. •N�`..�A'J �.l�dwl h.I.1L �4%�•J�1d�i� i ��2't{�; �WA..i+��4w.{�: U710 PTIM11-11AIL �111q;lj 4250,00 I,D�`�'tL 1:IT:,�J1t'�I`I.' Il'".KIMS �TTE N 0W APR 2 8 1003 CITY OF LA QUINTA,y FIN NCE DEPT. RECEIPT DTE, {.r B) f DAT FINALED INSP O r• INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR - BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts ' Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K. to Wrap to F.A.U. Framing 67 - 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 G 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 - Q 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 Appliances Final COMMENTS: Final 0.1 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) 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 1,519 S.F. or $3,250.66 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. 115327 Name on the check Telephone 949/378-2099 Funding Residential By Dr. Doris Wilson Superintendent Fee collected /exempted by Signature ron McGilvrey $3,250.66 $0.00 Payment Recd Over/Under 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 CERTIFICATE OF COMPLIANCE J Fisc Desert Sands Unified School District 47950 Dune Palms Road �qe Cc) ¢ ER Date 4/28/03 La Quinta f CA 92253 RAN AN WELLSMIRAGd HO � '�+ INDIAN WELLS No. 24370 (760) 771-8515 PALM DESERT LAQUINTAy �INDIO yr-� J O Owner Roper Morris APN # 774-125-010 Address 74-800 Sheryl Ave #11-1 Jurisdiction La Quinta City Palm Desert Zip 92260 Permit # 0303-018 Tract # BLK228-U-22 Study Area Type Single Family Residence No. of Units 1 Lot # No. Street S.F. Lot # No. Street S.F. Unit 1 12 77720 Calle Arroba 1519 Unit 6 Unit 2 Unit 7 Unit 3 Unit 8 Unit 4 Unit 9 Unit 5 Unit 10 Comments Both Cert 24369 and 24370 used for CC #115327 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 1,519 S.F. or $3,250.66 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. 115327 Name on the check Telephone 949/378-2099 Funding Residential By Dr. Doris Wilson Superintendent Fee collected /exempted by Signature ron McGilvrey $3,250.66 $0.00 Payment Recd Over/Under 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 Certificate of Occupancy G OFT1Building & 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: 77-720 CALLE ARROBA Use classification: SFD Building Permit No. 0308-018 Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RC Owner of Building: ROPER MORRIS Address: 74-800 SHERYL AVE. #11-1 City, ST, ZIP: PALM DESERT CA —b By: KIRK KIRKLAND Date: 8-28-03 Building Official POST IN A CONSPICUOUS PLACE • .........veva aa,naavil AIuL ulAunjL*&It; -1'r:S'1'1lNU CF -4111 clk A.✓PZ* I S Da PZ* �x v LLC_ auttaer'Cont t Telephone Plan Number H RS Ater Tel Ons Samp a Group Number A rfy-inti Slpnature to Sample House Number irm S. . •d" f HERS Provider:G_�i�fSeG�IrS Street Address: % City/Statemp! Copies to; guilder, HERS Irovider MRS RATES O AN_ C� E STATEMENT The house was Iff Tested ❑ Approved as part of $ample testing, but was not tested As the HERS rotor providin diagnostic testing and field verification, 1 certify the the houses identified on this form comyty with'the diagnostic sated compliance requirements as checked on thl$ �orm. ['� Distribution'system Is fully'ducted (i.e., does not use bullding oavltles is plenums or platform retu(ns in lieu f 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. {O MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage) Measured Duct Pressurization Test Results (CFM (M 26 Pe) values Test Leakage Flow In CFM / p If fan flow is calculated as 400cfmitch x number of tons enter calculated value here If fan flow Is measured enter measured value here r - Leakage Percentage (100 x Test Leakage(Fan Flow) a 6/1 Check Box for Pass or Fall (Pass■ft or less) ❑ P833 Fail I ((THERMOSTATIC EXPANSION VALVE (TXV) or Commission sporoved eauivslant Yes ❑ No Thermostatic Expansion Volvo (or Commission approved equivalent) Is Installed and Access Is provided for Inspection ❑ Yee is a peas Pass Fell ❑ MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT t . ❑ Yes 0 No , ACCA Manual D Design requirements have been met (rater has verified that actual Installation matches values In CF•1 R end design on plan. 2. O Yes 0 No TXV is installed or Fan flow has been verified. If no TXV, A/M verified fan flow matches design from CF -1 R. Measured Fan Flow a Yes for both 1 and 2 is a Pass Pass Fail