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15159 (AR)44Q P.O. BOX 1504 Building 78-495 CALLE TAMPICO Address 52-125 Avenida Rubio LA QUINTA, CALIFORNIA 92253 Owner Thomas/Debra Affee Mailing Address 52-125 Avenida Rubio . City Zip Tel. La Qui to 1 •92253 1 Contractor Owner/Builder Same s above City & Classif.. I Lic. # iarcn., Lngr., Designer Address Tel. City(Zip I State Lic. # LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm that I am licensed undeyprovisions of'Chapter 9 (commencing with Section 7000) of Division 3 f•th'Business and'Profess'on Code, and my license is in full force and effect. SIGNATt1RG" - .••d"•• f DATE OWNER-11911DER 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 or not more than five hundred dollars ($500). ' 1, 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 or 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 or proving that he did not build or improve for the purpose of sale.) O I, as owner of the property, am exclusively contracting with licensed contractors to con- struct 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 contractors) (lcensed pursuant to the Contractor's License Law.) O 1 am exempt under Sec B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that 1 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 O Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATIONINSURANCE (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 the work for which this permit is issued, I shall not employ any persbn in any manner so as to become subject to the Workers' Compensation Laws of California. Date Owner NOTICE TO APPLICANT: M, after making this Certificate of Exemptionyou 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. WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION; DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. 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 No. 15159 11LDING: TYPE CONST. - OCC. GRP. P. Number 773 212 017 Legal Description Project Description Room Addition Sq. Ft. •323 No. 1 Size Stories - No. Dw. Units New ❑ Add Alter ❑ Repair ❑ 'Demolition ❑ Estimated Valuation ;17,539.00 PERMIT AMOUNT Plan Chk: Dep. =22M Plan Chk. Bal. $122145, Const. $189.00' Mech. $ 15.00 Electrical ', $ 26.31 Plumbing 0 S.M.I. 1.75 Grading Driveway Enc. Infrastructure TOTAL $354.91 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 ?prtrait Validated by: l Validation: I „ II VIH Y 1 0 5551 IJ , CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBINL ES 1ST FL. SO. FT. @ $ 2ND FL. SO. FT. @ POR. SO. FT. @ GAR. SO. FT. @ CAR P. SO. FT. @ WALL SO. FT. @ SO FT @ ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET ' YARD SPKLR SYSTEM BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN URINAL WATER PIPING NOTE: Not to be used as property tax valuation BONDING FLOOR DRAIN MECHANICAL FEES FORMS Il WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH) GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APPJEOUIP. LAUNDRYTRAY AIR HANDLING UNIT CFM TEMP. POLE KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET' COMPRESSOR HP POLE,TEMIPERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO. FT. @ c BATH TUB SO. FT. @ c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID @ 11A c SEWAGE DISPOSAL �/,W/v SO.FT.GAR @ 3/ac HOUSE SEWER VENTILATION GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK �O GROUND PLUMBING UNDERGROUND A.C. UNIT17 COLL. AREA SLAB GRADE G �/� S ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS Il SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCKSTORAGE FOUND. REINF. G 311 =�' GAS (ROUGH) METER LOOP .HEATING (FINAL) OTHER APPJEOUIP. REINF. STEEL �j �� A� GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ =$ LUMBER GR. FINAL INSP. FRAMING / / V/ FINAL INSP. ROOFING �� �lj J �/,W/v REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND ' 94 FINISH GRADING FINAL INSPECTION /O i2%I6 CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL Certificate of Compliance: Residential (Pagel of 2) CF -1 R 7;,14oA1,,qs 14: F ocy!%104 � '56 Y- t� ^ -Project Title Date , 52/2s' Project Address Building Permit 8 Documentation Author Telephone Plan Chock/ Dater / 9-4C 4 6 e /S' Feld Check / Date Compliance Method (Package, Point System or Computer) climate Zone Enforoement Agency Use Only GENERAL INFORMATION Total Conditioned Floor Area:. Building Type: (check one or more) Front Orientation: 4j'o Number of Dwelling Units: Floor Construction Type: 3.'Z 3 n2 Single Family , Addition Multi-FExisting-Plus-Addition North15@1"Soouth / West / All Orientations (Input o anon in degrees and circle one.) la Raised Floor (circle one or both) BUILDING SHELL INSULATION Construction Component Insulation Assembly Location/Comments Type R -Value U -Value (attic, to garage, typical, etc.) Wall .............. R (3 ?YPICs�i� LIJM�� Wall .............. Roof ............. PICAI- Roof ............. Floor ............. Floor ............. Slab Edge..... FENESTRATION Shading Devices Fenestration Area Orientation (sf) Fenestration U -Value Interior Exterior Overhang (roller blind, etc.) (shadescreen, etc.) (yes/no) Framing Type - (nietalMrood/vinyl) Front..... ( ) n Front..... ( ) Left....... (1O , Left...... ( ) Rear ..... (X) Rear...... ( ) w: Right..... (X) . 75: ✓ P.s—)?i ►— fw Right..... ( ) Skylight ....... Skylight ....... THERMAL MASS Type/Covering Area Thickness (slab/exposed, tile, etc.) (sf) (inches) Location/Description (kitchen, bath, etc.) IEONVTAX1111 Cooling Equipment Minimum Type (air conditioner, Efficiency heat pump, evap. cooling) (SEER) , WATER. HEATING SYSTEMS Duct Location attic, etc. Duct Thermostat R -Value Type Configuration (split or DackE Energyl External Rated' Tank Factor or Tank Water Heater Distribution Number Input (kW Capacity Recovery " Standbys Insulation Type Type in System or Btu/hr) (gallons) Efficiency Loss (%) R -Value 1. For small gas storage (rated inputs 75,000 Btu/hr), electric resistance and heatpump water heaters, list Energy Factor. ( For large gas storage water heaters (rated input 2 75,000 Btu/hr), list Rated Input, Recovery Efficiency and Standby Loss. For Instantaneous gas.water heaters, list Rated Input and Recovery Efficiency: SPECIAL FEATURES/REMARKS (Add extra sheets if necessary) COMPLIANCE STATEMENT This certificate of compliance lists the building features and performance specifications needed to comply with Title 24, Parts 1 and 6, of the California Code of Regulations, and the administrative 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 orientations, any shading feature that is varied is indicated in theSpecial Features/Remarks section. Designer or Owner (per Business a Professions code) Documentation -Author Name: Name: Title/Firm: Tide/Firm: Address: Address: Telephone: ' Lic. Jt: (signature) (date) Enforcement Agency. :Name: Title: Agency: Telephone: (signaturostamp) (date) Telephone: (signature) (date) Certificate of Compliance: Residential (Page 2 of 2) CF -1 R Project Title Date HVAC SYSTEMS • Note: Input hydronic or combined hydronic data under Water Heating Systems, except Design Heating Load. Distribution Heating Equipment Minimum Type and Duct or Heat Pump Type (furnace, heat Efficiency Location Piping Thermostat Configuration pump, etc.) (AFUE/HSPF) (ducts/attic etc.) R -Value Type (split or package) Cooling Equipment Minimum Type (air conditioner, Efficiency heat pump, evap. cooling) (SEER) , WATER. HEATING SYSTEMS Duct Location attic, etc. Duct Thermostat R -Value Type Configuration (split or DackE Energyl External Rated' Tank Factor or Tank Water Heater Distribution Number Input (kW Capacity Recovery " Standbys Insulation Type Type in System or Btu/hr) (gallons) Efficiency Loss (%) R -Value 1. For small gas storage (rated inputs 75,000 Btu/hr), electric resistance and heatpump water heaters, list Energy Factor. ( For large gas storage water heaters (rated input 2 75,000 Btu/hr), list Rated Input, Recovery Efficiency and Standby Loss. For Instantaneous gas.water heaters, list Rated Input and Recovery Efficiency: SPECIAL FEATURES/REMARKS (Add extra sheets if necessary) COMPLIANCE STATEMENT This certificate of compliance lists the building features and performance specifications needed to comply with Title 24, Parts 1 and 6, of the California Code of Regulations, and the administrative 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 orientations, any shading feature that is varied is indicated in theSpecial Features/Remarks section. Designer or Owner (per Business a Professions code) Documentation -Author Name: Name: Title/Firm: Tide/Firm: Address: Address: Telephone: ' Lic. Jt: (signature) (date) Enforcement Agency. :Name: Title: Agency: Telephone: (signaturostamp) (date) Telephone: (signature) (date) i 78-105 CALLE ESTADO - LA QUINTA, CALIFORNIA 92253 - (619) 564-2246 May 20, 1991 To Whom It May Concern: The structure located at 52-125.Avenida Rubio will be located in a "B" flood zone per the revised F.I.R.M. (panels 0607,09 005 A and 0010 A) for La Quinta This change will be effective August 13, 1991. -The property is currently designated as zone AO (depth two (2). feet). If you .have any questions, feel free to contact me.. Sincerely,. BUILDING AND SAFETY a Tom Hartung .Director of Building and Safety TH/lc MAILING ADDRESS - P.O. -BOX -1504 = LA QUINTA, CALIFORNIA 92253 STATE FARM - .n ©� JEFFREY L. LILLEY INSURANCE m Auto-Life_H_eal th= Home and Busiliess 45300 CLUB DRIVE - INDIAN WELLS. CA 92210 PHONE (61.9) 345-2424; FAX 619-345-1741 City of L.a Qui.nta i i P.O. Box 1504 La Quinta, CA' 92253 1 Attention: Building & Safety Department RE: Flood Zonation Buildinq and Safety: Kindly forward to u=_ a letter from your office verifying that the following La Quinta property is located in the "B" flood zone: Property Owner: Property Location: 6 7RO11449 � ' ------------- -'A -`--------------- ------------------ , Thank you for your help in this matter. Sincerely, Je f L I y. A e t