9804-091 (SFD)s
r�
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
OtroC�7 13 313iJ9.9
DaRe Signature of Contractor ,�Zl h
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
Ihereby 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 3760 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.
1PTLON ox Fru
(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 shall forthwith comply with those provisions. , , }
pate: G _ ti+,., i�Applicant ` .�1A. P!f
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''� t �
/Signature (Owner/Agent)` !���'°.�� Date
^(" PERMIT# P' : CONTROL#,
BUILOING�PERMIT
�� �
DATE VALUATION LOT TRACT
393,22660 3 1.3,',
_
JOB SITE
ADDRESS
11 31-805 AVEMDA 80810 r:
FAPN
773-161-014
OWNER
CONTRACTOR/DESIGNER/ENGINEER
J. CK CLARK !?N. AJ, "ONT&ACTOR.
JACKCL_jkR: GENERAL CONTR.ACTOR.
i4-.350 AVE.NIDA H.ER_RERA
34-350.A.NTNIDA H.I RRER.A
LA QUINTA CA. 92253
LA QUINTA CA 92253
(760)54.35'13 CBL# 1115
USE OF PERMIT
, FD • HRiWT D09,S NOT 1NCLUEYE 13L OCK WALLS OR PPOL.
PAI
{r MAY
15 1998
•r�AC�t COnr;��14�.ur,T1aN 1, 05.00 S.F
FORC1� PATIO �`F v1TY OF
LA QUlINI ;�
QAR. kGI31C;ARPORT 448:00 SF
.i
6 FT. WOOD F>rNCE 200.00 LI'
ES'l IINIATLe D COQ T O CO ST6i±UC I.GiN
oi,224.411
I'ORMIT FEE S1.Tii'YMARY
CONSTRUCTION FiKE 101 X000 --418-0X,10 $612.50
PIAN C1313CK M 401-000-439-318 :$528.7^
1V1F04ANrCA1, FRE 101-000-421-000 553.50
ISLEC'iWAL FI -X_ 101-000-420-000 $161.14
PLLTNI 31NG F FE 10.1-000419.000 $ 446.50
517tONG MOnGN FEX -.RESID 10.1-000-241-000 $9.32
G.RAD11-40 FEE 101-000-423.000 $20.00
tNkRMiTCtUt,"IVRE FEE 225.000-", -342 $2,036.30
PRrCTSE PLAN 101-0X80-441-345 $25.00
F'EEDEPOSI 101-000439418
SUB- 'O TAL CONMRUC,'T`tON AND PLAN CHECK
$3,59198
LESS PPM:-PA:1D .li r3S
-$250.00
TOTAL i'F..1tMIT & EES DUE NOW
!
$3,344.99
RECEIPT
DATE
BY 7
DATE FINALED
INSPECTOR
;'4
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs lArl A
Underground Ducts
Forms 8 Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck /
Exhaust Fans
O.K. to Wrap i
F.A.U.
Framing
Compressor
Insulation lip
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
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 I
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 ha
Pool Cover
Sewer Connection
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
Final (�
Utility Notice (Perm)
Desert Sands Unified School District
Notice: 82-879 Highway 111
Document Cannot Be Duplicated Indio, CA 92201619-775-3500
CERTIFICATE OF COMPLIANCE
Date 5/13/98
No. 17014 Jurisdiction
Owner NameJack Clark {
No. 51-805 Street Avenida Rubio
City La Quinta zip 92253
APN # 773-161-014
La Quinta
Permit #
Log #
Study Area
Tract # Lot # Square Footage 1,505
Type of Development Single Family Residence No. of units 1
By
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 or replacement mobilehomes.
It has been determined 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 Government Code 53080 in the amount of
1.93 X 1,505 or $ 2,904.65 the property listed above and that building
permits and/or Certificates of Occupancy for this square footage in this proposed project may now be.issu.ed
Fees Paid By Cashier Check/La Jolla Bank/Jack Clark Telephone,;564 35lla- w ::
Name on the check
Dr. Doris Wilson
Superintendent
Fee collected /exempted by
Signature
Juanita Green Payment Received
Collector: Attach a copy of county or city plan check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
RECORDING REQUESTED BY.
ORANGE COAST TITLE COMPACOMPANY
97.6716KC R-158320-1
WHUNL �OL%Rrlgj�S
OD� OWNl)'
JACK CLARK
54-350 Avenida Herrera
La Quinta, CA 92253
29.9047 RECEIVED FOR RECORD
AT 2.00 O'CLOCK
AUG 191997
PAID
cofas
DOC. Trawor Tan R«oraea a County.oal R alba
of Hiveiside Ccunry, CWilarrua
Recorder (\. n
mill. Co. peoo tW Feesfti 1�(C/
SPACE ABOVE THIS LINE FOR RECORDER'S USE
APN: 773 -M -
GRANT DEED 7-,�,�- 0000/7
The undersigned grantor(s) declare s) : J��-�6rj twr' x_0010
Documentary transfer tax is 13.20 .
(XXX) Computed on full value of property conveyed, or .
( ) Computed on full value less liens and "cumbrances remaining at time of sale.
( ) Unincorporated area: (� City of (,i.[.i rL� and
J
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
MOUNT ST. MARY'S COLLEGE
hereby GRANT(S) to
JACK CLARK, JR., A MARRIED MAN AS HIS SOLE AND SEPARATE PROPERTY
J the real property in the City of LA QUINTA, County of Riverside, State of California,
described as:
IBJ LOT 3 IN BLOCK 33 OF SANTA CARMELITA AT VALE LA QUINTA, UNIT NO. 2, AS PER MAP
`.\ RECORDED IN BOOK 18, PAGE 55 OF MAPS, RECORDS OF RIVERSIDE COUNTY, CALIFORNIA
`C
Dated June 23. 1997
State of California
Coun of ,Cos �y4t mss j S.S.
On 2
befo e m ,%&i blt_'
personally appeared
-me (or proved to me on
the basis of satisfactory evidence) to be
the person(a) whose name() is/subscribed
to the within instrument and acknowledged to
me that he/ahe/tdwy executed the same in
his/hoc/theme authorized capacity(ilue), and
that by his/,4ar/tba4x signature (!9 on the.
instrument the person(, or the entity upon
behalf of which tac pe'iSGn(,V7 acted, executed
the instrument.
WITNESS my hand and official seal.
Signatur >
- MAIL TAX STATEIit ' 'S SAME AS ABOVE
MOUNT ST. MARY'S COLLEGE
BY
Name /Same -
BY Lf• P TIVMC67
4iame/T i t 1 e
A.
TORY J MAZIE
Convr4o nfX0
UUA MQ0NC*A*
My Comm. Mor L W04
(This area for official notarial seal)
C
o.n
It is the responsibility of the General Contractor or the Owner/Builder to monitor the sub -contractors t
are on this list are the same persons performing the work. Any changes to this list must be approved
City of La Quinta Department of Building & Safety U[j x to work being performed by • a changed s
contractor. Failure to comply will result in a stoppage of work and/or the. voidance of building permi
TRADE
SUB -CONTRACTOR'S
NAME.
TYPE OF
LICENSE'
STATE `:
CONTRACTOR'S:
LICENSE :
NUMBER'` :.' :. .:..
WORKER'S
COMP. NAME/
NUMBER ON FILE
CITY
BUSINESS
LICENSE
NUMBER/
EXP. DATE
GRADE/
EXCAVATE:*
A FId✓G� C-1 ✓ i KFC
A/C -12
610D05
��y 3 19
STATE Fur►
�a 3013- 9 6
ycl�
-
PIPELINES
C-34
CONCRETE/
FOUNDATIONS::
B0�-��'1`✓
C-8
36b385
Nw3 ��}b3<_C
aS3a,
ASPHALT
A
FRAMING
C�+e Cotit� • u� �vr
B
%3�0�4 oj
STA i G
179&19-9 �� zo 7
i i -•� - '
STEEL/
STRUCTURAL
C-51
MASONRY
C-29
PLUMBING �
M. Cmc l v i � Plu,hbi r�c�
C-36
515r3�}�1 r . -; i �
-STATE Fw v
1317
LATHING
C-26
DRYWALL
•
C-9
13108 � • : � -`t �
y°L DEQ
NvJc 1"Mi`N-ItaO 9-!, •'i
4-c44
PLASTERING
CrAi Vi1rt$ 1''lA,ievi•d.
C-36
6014 49A
14WC,
I $S�
HVAC
J�- 4 -Lie- deal a" 4C-
C-20
E•
a`168 , l''
CLAicfslDv!(� itT' ll
�lti
ELECTRICAL
IL+tiL��S ��y�[
C-10eI13
EXEMPT
ROOFING
iz0
C-39
_
s+ �7 e u
SHEET METAL
C-43
FLOORING
}��
dirt S �r
C-15
11590, -• . � i . ; ..
STATE Ft44P
06 q1 -1 -
�}1S
- � "' •
GLASS/
GLAZING'
LA�Ci LG►ti' ✓L!G �vr
C-17
-
INSULATION
IZo�I�✓ IrtSK C�1 ►OK
C-2
3�1
RSP l OFa+I.
/pay
SEWAGE DISP..
C-42
PAINTING/%�►`'
DECORATING:
t�rtvS��
C-335
�10�6 b
-9
rx"'p-1
31`19
I t
TILE
MPG S't��cc}i�,c
C-54
50ii�ol
S'�ftTl; :3x15
y
CABINETS/
INSTALLATION
l>P.? CA*t�frki-4ivet
C-6
�LU%
FENCING
(a}G5 CCK, u, f;e,K
C-13
LANDSCAPING
C-27
POOLS
C-53
OTHER
02/13/1994 15:55 760-321-605
i
7 CNC ENGINEERING CO.
TITLE 24 REPORT FOR:
JACK CLARK
51805 AVE. RUBIO
LA QUINTA, CALIFORNIA
PROJECT DESIGNER:
REPORT PREPARED BY:
JOAN D. HACKER
INSU-FORM, INC.
2721 THORNHILL RD. S.E..
PUYALLUP, WA 98374
(253),840-3982
r
Job Number:
Date: 1.1/17/1998
7
PAGE 02
The COMPLY 24 computer program has been used to perform the calculations
summarized in'this compliance report. This program has approval and is
authorized by.the California Energy Commission for use with both the
Residential and Nonresidential Building Energy Efficiency Standards.
02/13/1994 15:55 760-321-6057 CNC ENGINEERING CO.
PAGE 03
CERTIFICATE OF COMPLIANCE Residential (part-l-o£-2)--CF-1R---Page3of 12
------------
---------------------
-_ - ------ Date: 11/17/1998
Project Name: JACK CLARK
Address: $1805 AVE. RUBIO Buil ing Permit No
LA QUINTA,CALIFORNIA
Checked by 7 Date
Designer:
COMPLY 24 User 2655
Documentation: 1NSU- -
FORM,INC---------------------------------- ----
GENERAL, INFORMATION
Compliance Method:
Climate Zone:
Conditioned Floor Area:
Building Type:
occupancy Type:
Building Front Orientation:
Number of Dwelling Units:
Floor Constructign Type:
BUILDING SHELL INSULATION
Component
-----------------------
R-13 Wall w/1" EPS
Solid wood Door
R-38 Roof(R.38.2x14.16)
Slab Perimeter w/R-0.0
Slab Perimeter w/R-0.0.
FENESTRATION
Orient. Area U-va1..Type
COMPLY 24 version 5.10
15
1505 sgft
New
Single Fam Diet
90 deg (9'-
Slab
E}Slab on Grade .
U -Value
Location/Comments
--0.059
WHOLE
HOUSE
0.387
WHOLE
HOi;'SE
0.028.
WHOLE
HOUSE'
0.900
WHOLE
HOtTSE
0.720
WHOLE
HOUSE
Right
(N)
40.0
0.77
Double
Right
(N)
21.5--0.07
Double
Front*
(E)
6.0
0.72.Double
Type
-----
Front
(E)
20.0
0.87
Double
Left
(S)
56.0
0.87
Double
Back
(W)
40.0
0.77
Double
Back
(W)
3'0.0
0.87
Double
THERMAL MASS_
Type
Concrete, Heavyweight
Concrete, Heavyweight
Area Thick
Covering (sf-) (in)
Exposed 170 3.50
Covered .1335 3.50
Lccation/Description
------------------------------
Slab on Grade
Sl.ab , on Grade
Shading
Devices
Frame
Interior
Exterior
OH
--
SF
-
Type
-----
-------------
Std
Drape
- - --------------
Standard
Bug:Scr
Y
N
Metal
Std
Drape
Standard
Bug
Scr
Y
N
Metal
Std
Drape
none
Y
N
Metal
Std
Drape
Standard
Bug
Scr
Y
N
Metal
Std
Drape
Standard
Bug
Scr
Y
N
Metal
Std
Drape
Standard
Bug.Scr
N
N
Metal
Std.Drape
Standard
Bug
Scr
Y
N
Metal
Area Thick
Covering (sf-) (in)
Exposed 170 3.50
Covered .1335 3.50
Lccation/Description
------------------------------
Slab on Grade
Sl.ab , on Grade
02/13/1994 15:55 760-321-6057 CNC ENGINEERING CO.' PAGE 04
COMPUTER METHOD SUMMARY (part 1 of 3)
--------------------------------- C -2R page 7 of 12
Project Name: JACK CLARK -----------------------------------------
Date: 11/17/1998
Documentation: INSU-FORM, INC.
------------------------------------------COMPLY 24 User 2655
Source Energy Use (KBtu/sf-yr) Standard
-------------- tan
--- g
Space Heating 3.61
Space Cooling 30.68
Domestic Hot Water, 14.15
TOTALS 48.44-
*** BUILDING COMPLIES ***
GENERAL INFORMATION
Compliance Method:
Climate Zone:
Conditioned Floor Area:
Building Type:
Occupancy Type:
Building Front Orientation:
Number of Dwelling Units..
Number of Stories:
Floor Construction Type:
Total Conditioned Volume:
Conditioned Footprint Area:
Ground Floor Area:
BUILDING,ZONE INFORMATION
Zone -Name Floor--- Area
WHOLE HOUSE - - 1505
Proposed
Compliance
Design
Margin
3.59
----0.01
32.53
-1.85
12.20
1..95
48.32
---0.12
COMPLY 24 version 5.10
15
1505 sgft
New
Single Pam DE.t
90 deg (E)
1'
1
Slab on Grade:
12040. cuft
1505' sgft
1505 sqft
# of Vent
Volume Units Zone Type TStat Type Hgt Area
_-_ -
12040 1.00 Conditioned Setback - 2 n/a
OPAQUE SURFACES
Act.
WHOLE
Solar
WHOLE
HOUSE
Type
Area
U -Val
-----
Azm
Tilt
Gains
Form
3 Reference
ZONE
NAME
_
=. WHOLE HOUSE
_ ----
-----------------------
Wall
Door
86
40
0.059
0.387
90
90
90
yes
R-13
Wall w/1" EPS
Wall
400
0.059
18D
90
90
Yes
Yes
Solid Wood Door
R-13
Wall-
Wall
2SO
331
0.059
270
90
Yes
R-13
Wall w/1" EpS
Wall w/1" EPS
Roof
1505
0.059
0.028
0
90
90
22
Yes`
R-13
Wall w/11' EPS
Yes
R-38
Roof(R.38.2xl4.16)
Location/Comments--------------------
WHOLE-
WHOLE
HOUSE
WHOLE
HOUSE
WHOLE
HOUSE
WHOLE
HOUSE
WHOLE
HOUSE
WHOLE
HOUSE
02/13/1994 15:55 760-321-6057 CNC ENGINEERING CO PAGE 05
CERTIFICATE -OF -COMPLIANCE Residential -(part -2 of--------------------------- --
2)CF_1Rpage 4 of 12'
Project Name: JACK CLARK ------------
Date: 11/17/1998
Documentation: INSU-FORM, INC.
--------------------------------------------------------COMPLY-24-User-2655
HVAC,SYSTEMS Minimum Distrib Type Duct TStat
System Type Efficiency and Location Rval e
______________ -- 1'YP Location/Comments
Furnace 0..800 AFUE Ducts in Attic -----------
4.2 SetBck WHOLE HOUSE
SpltAirCondlO.000 SEER Ducts in Attic 4.2 SetBck
WATER HEATING SYSTEMS Water No.. Tank Ext.
System Name Heater in Energy Size Ihsul
------------------------
--- Distribution Type Type Sys Factor (gal)' R -Val
A -O -SMITH FSG -50-224 Standard --- ---
StorG.3s 1 0.60 50.0 12.0
AFUE
WATER HEATER EQUIPMENT DETAIL Rec
System Name /Rec Rated Stdby Tank Pilot
- --- ------ System Type Eff Input. Loss R -Val Light
A.O.SMITH FSG -50-224 DomesticHW 0.760 4000() 0;000 0.0 0
SPECIAL FEATURES/REMARKS
COMPLIANCE STATEMENT r
This Certificate of Compliance lists the Building -features and performance
specifications needed to comply with Title 24, Parts 1 & 6
nia Code of Regulations, and the admof the Califor-
inistrative regulations to implement
them. This certificate has been signed by the individual with overall
design responsibility. When this certificate of compliance is submitted for
a single Building plan to be built in multiple orientationsny,
feature that is varied is indicated in the Special Features/Rematksadinsection
DESIGNER or OWNER
(Per Business & Professions Code)
Lic #:
(signature) - (date)
ENFORCEMENT.AGENCY
Name:
Title
Agency:
Telephone:
DOCUMENTNTION AUTHOR
JOAN D- :SACKER
INSU-FORM, INC.
2721 THORNHILL R.D.
.PUYALLUP. WA 98374
(253) 840-3982
0§ 0*a ture)
date)
(sib a stamp) (date)
11/18/98
TO: JOAN HACKER
FROM: DANNY (CITY OF LA QUINTA)
RE: JACK CLARK 51-805 AVE RUBIO
1. THANK YOU FOR THE FAXED REVISED TITLE 24. PLEASE
BE ADVISED A PROPER SUBMISSION FOR A CHANGE MUST
INCLUDE THE OLD TITLE 24. PLEASE ADVISE MR. CLARK TO
SUBMIT OLD AND REVISED TITLE 24 FOR FORMAL PLAN
CHECK.
THANK YOU
DANNY