0307-175 (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
/," 824985 B 09/317/2(
Date Signature of Contractor ��y'✓�
J
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 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 FUND Policy No. 229-0006131
(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.
Date: 2' 1' 6 V Applicant %V._ -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.
Signature (Owner/Agent) /Z1 1�1611 Date .?'Il;dy
BUILDING PERMIT PERMIT#
® r-
DATE—, VA UATION LOT TRACT
JOB SITE
APN • .
ADDRESS 57,- 05 ,A-VgEN; A RUBIO
773-282-01.31
OWNER
CONTRACTOR / DESIGNER / ENGINEER
TVAW PALMS I)F"VFsLOPIuiINT
DESE HOME CONS`[',R.UCTION WC
2231 X AtMISA DRO 1$3419
19714 z'�If2�TINUITA LAND
RIVENS1[faF CA 92508
RiVlliSME CA 92306 .,
(909)780=5749 OBIA TBD
USE OF PERMIT
MNG IE IE J+A[aCI Y DWF13 NG
2715 S.F. S1fO PE12. 411' DOES NOT INCLUDE BLt))CK WAu, PODUSPA.
OR DRIViNVAY APPROACH. 2001 CDC,
TRACT CONSTRUCTION 2,.345,00 3F
. 4
PORCWPATIO 219.00 SF
Q4RAGUCA.RPORT 489,00 9F
C09.1 OY 6.®.EVP76 . U4X.OR
134,4 00.TiJV '
p�Db5W.,2AA1.AI'
S1�i.1�'�' S7 $Iia i��l�i�n.f.%�
• M
CONSTRUCTION FEE 101=000.418-000 $76100
;
PLAN CHECK FEE 101-000-439-318 $632.61
FERDKPOSrf 101-000.439.318 42$0100
MKC.HAN1.CAL FKE 101-000-421-000 $77.90
�
ELECTRICAL FEE 101.000°420.000 $136.86
PLUMk3f.40 FEE 101-000-419-000 $137.25
8TROINO A±I071ON FEF. - RESID 101.000.241.000 $13.44
ORAI)ING 11YE, 101-000-423-000 $15.00
DEVELOPER 1MPAwT FE, 22,405.00
s'
PRECISE PLAN' 101-000-441-345 $100.00
'
••
4
-1'(_ " . C 1a UC71'1+-' M AND PLAN C14WK
$4,279.16
IMS PRE-PAU) MES
4250.00 "
A; �R n1 ���� a P1 11KN16! I[T ,S DUE NOW
CITY OF LA OW'HITA".
,
RMANCE DEPT.
,
RECEIPT DATE.- r By<+ DATE FINALED INSPECTOR
-
0
.,1
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE-
T INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
a20 -p L
Underground Ducts !
Forms & Footings
_
z
Ducts
Slab Grade
Return Air
Steel
_
Combustion Air
Roof Deck
• 2 7 Gal
Exhaust Fans {
O.K. to Wrap
F.A.U. [
Framing
-
Compressor {
Insulation
_
G
Vents [
Fireplace P.L.
Grills {
Fireplace T.O.
Fans & Controls {
Party Wall Insulation
Condensate Lines [
Party Wall Firewall'
{
Exterior Lath
Drywall - Int. Lath
[
I
r
Final [
Final
POOLS - SPAS
BLOCKWALL
APPROVALS
Steel !
Set Backs
Electric Bond f
Footings
Main Drain {
Bond Beam
Approval to Cover f
Equipment Location
Underground Electric I
Underground Plbg. Test 1
Final -
Gas Piping {
PLUMBING APPROVALS
Gas Test t
Electric Final I
Waste Lines
_
_
Heater Final
Water Piping
Plumbing Final [
Plumbing Top Out
Equipment Enclosure [
Shower Pans
O.K. for Finish Plaster [
Sewer Lateral
Pool Cover i
Sewer Connection
Encapsulation [
Gas Piping
t
Gas Test
I
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 zz ZlEo
Final
Utility Notice (Perm) (7 7"
Date 1/20/04
No. 25381
Owner
Twin Palms Development
.Address
231 E. Alessandro -#348
City
Riverside Zip 92508
Tract #
BLK 16
CERTIFICATE.OF..COIIAPLIANCE
Desert Sands Unifed.Ul ool Dl6trict
47950 Dune i?alms-Road
La QuAnta :CA12253
(760) 7711-8515.
APN #
z o
Q. BERMUDA DUNES r
RANCHO MIRAGE
{�J INDIAN WELLS
Vr PALM DESERT ,y
LA QUINTA,.j
QINDIO
773-282-013
Jurisdiction La;Quinta
Permit # 0307-175
Study. `Area
Type Single Family Residence No. -of Units 1 .
Lot # No. Street S.F.
Unit 1 1 52505 Avenida Rubio 2245. Unit 6
Unit 2 Unit 7
Unit 3 Unit 8
Unit 4 Unit 9
Unit 5 Unit 10
Comments
Lot # • No. Street S.F.
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 Ilving;'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: 66995 Et Seq.
in the amount of $2.14 X 2,245 S.F. or $4,804.30 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/Union Bk of. California Harlin.-:Borcherding Check No: .8595798
Name on the check Telephone
Funding Residential
sy Dr. Doris Wilson
Superintendent
Fee collected /exempted by Sha 'McG' rey Payment -Recd $0.00
$4,604.30 Over/Under
Signature C
NOTICE: Pursuant to Government Code Section _.66020(d)(1), th "wilt se a 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 fromahe`date.on. hick' a 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 anotherpublic entity orized 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
�fF,
FROM :XAVIER URBINA FAX NO. :805 481 1958 Aug. 27 2004 01:10PM P1
xav;er urb[ha - ar.cnl:tect
268'alder street Arroyo U nde, calif:' 93420.' (805}'461-195a
The Lench De "G' .
P.O. 136z.450
La Quints, CA 92247
Re: Plan Manzanilla Field'✓isit,
Oear Skip, ,
The field visit to the residelioe: known as Marizanilla-yielded the -following
observations: Thejstrap;details for the lateratattachment of.the patio roofs to the
main stricture maybe.chaltged..to aHL55° angles with the' "to ' &dd`machine-
Molts (to -fit the prefiored`Fi�les in the{angle}, the trusses'at' he rear of the house'
need plywood across the ends of the trusses from top piste to top chord to
prevent reeking ofJ usses;ahe shear panels have been Incorrectly sheath_ ed: with
OSB instead of cox plywao9 The nalling of the shear panels wlllneedAoae
increased per revised lateral sincl, ysisk,calculations andgn some instances an
additional layer of 6§6rni�;t be ad the ;other side iortwo-face 8pplicetion.
The last item Is thatof strapping the entire length of'top plates allahe.way around
the octagonal kitchen vvltame. iTta follow up inspection'may be performed by the
cit s buildin Ins ' ctor.
Please feel,free.to call," if you haveany questions.
Respectfully,.
�2 0 �o
�V
kavier
Urbina. 7
- �l
Z'd LZ924.9S09G
WJ,I-S3a ; HOW3-1 eO T :O T b0 T O 400
F
L -V► ,- Certifica to of Occu anc y
0 op
_
L icv�oanisn�4�
G Buildin &
DepartnentOF_
SafetY
.
This Certificate is ;issued pursuant to the requirements of Section 109 of the California Building
x
Code'- certifying -that; at. the time of issuance, this structure *was in compliance with T the
provisions of the Building Code and the variousordinances of the City regulating building
- . construction and/or use.
+`
BUILDING ADDRESS: 527505 AVENIDA RUBIO
Use classification: SINGLE FAMILY .DWELLING Building Permit No:: 03077175 .
Occupancy Group: R3 Type.of Construction: VN Land Use Zone: RL
Owner of Building: TWIN. PALMS DEVELOPMENT Address: 231 E. ALESSANDRO #348
City, ST, ZIP: RIVERSIDE, CA 92508
By: KIRK KIRKLAND
Date: DECEMBER 14, 2005
Building Official
POST IN A CONSPICUOUS PLACE
NOV-14-2005 06t_11 PM
uaze • •
Bul der: ame
Plan Number
Sample Group Number
P.02
-4R
fying Slgnature — Qat Sample House Number
Firm:_. , /� o � HERS Provider: t YyE IQ .-
Street Address: _2�'� d.��►4�l ar.� t!/vL �e, City/ststelzip: z a 117 LC/1
C6ples to: Builder, HERS;Provider'
HERS RATER OM CE STATEM_ ~
The house was: Teatetl �] Approved as part of sample testing, but wasmot tested
As the HERS rater providing diagnostic testing and field verification, I certify that the houses Identified on this form
com with the dlapnostic tested compile ice requirements as checked on this form.
ZJ Distribution system is fully ducted;(i.e., does not use building cavities as plenums or platform returns in lieu
f ducts)
Where cloth backed, rubber adhesive duct tape.is installed, mastic and drowbands are used in combination
with cloth backed, rubber adhesive duct tape to seal leaks afduct connectlons,
MINIMUM'REGUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT
Duct Diagnostic LeskageTesting Results (Maximum t% Duct Leakage)
Duct Pressurization Test Results (CFM ® 25 Pa) Measuredvalue®
Test -Leakage Flow In CFM
If fan flow is calculated as 400cfm/ton x number of tons -enter
calculated value here.
If fan flow is measured enter measured value here
Leakage Percentage 000 x Test Leakage/Fan Flow) =
Check Box for Pass or Fail (Pass=6% or less)
pel*� 13
Pass Fall
'THERMOSTATIC EXPANSIONVALVE (TXV) or Commission approved equivalent
Yes ❑ No Thermostatic Expansion Valve (or Commission approved
equivalent) is installed and Access -is provided for inspection❑
Yes' to a pass ass Fall
❑ MINIMUM REQUIREMENTS FOR DUCT DESION 'COMPLIANCE CREDIT
1 Cl Yes Cl No ACCA Manuel D Design requirements have been met
(rater has verged that ectual Installation matches values in , 7
CF -1 R end design on plan,
2. ❑ Yes 17 No TXV Is installed or Fan flow has: been verffled. If no TXV,
verified fan.now matches'design from CF -1 R,
Measured Fan Flow a '
❑. ❑
V � Yes for both 1 and 2 is a Pass Passe Fell