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0212-164 (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 7.73?.8Cf r 1 05/31/2( Date %!1 �'��' Signature of Contractot- /fT 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 1$�97.Al PT 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 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. 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 " >{ '✓.i ��� " � Date `5, "�• � v. k;BUILDING PERMIT PERMI0212-F64 y * (� �(9 y� eta LOT TRACT DATE VALUATION =01313-50 W.L,6.0131� -50 i A, _ � �7 � JOB SITE ADDRESS 50,340 AM-43 9MA RYRTf. OWNER CONTRACTOR / DESIGNER / EN INEER CO's E T rpt .OPIO ' -LEZ, ACY TION I/ •Z. 4214 k3, 7k�0�F1°��0PD 5 l 1 Y� f 47-750 ADAC 8!J_'P.lZ X28 a CA 92107 TLA QUWA CA 9225; (760)564.78209 CR1O 0201153 USE OF PERMIT 310. 18.$1qS�Q.FTf'. � iVI�3t3, 469 3Q.t�', O,�f;.�4 E7 Ponrit doc not dnd ide blook walk, f#iIDCm pool os byqq. Driveway gpsoat h se quimt a sepai� u pet�the: Pula& iR wks Department TRACT CONSTRUCTION 1,851.00 SP �ORCFiiMTIO d6.00 !,'lp 01MAGEICARPORT 409.00 8F EST W TFD COW OF 0i'OMM1.Tt","IT{' N 1.3.017*? 3w CONSTRt3G'd`IOk?..W? 101-000-418-000 0 M4169 PI.KN CHI UNK FE8, 1011-0,004.39-318 $3'x11.£3 FEE DEPOSIT '101-000-439-318 4250.00 -MECHk XICAL YZE 101-000-421-000 0-421.000 $86.00 XL;,ECTIMAL M. $122.67 I=B•1JTV1erme Irl 101-000.419-000. V34.15 STUNG MOTION FIE - RESTI.p 101»000 -?AI -000 $11.03 ORADYNO Kt&l 101 -0b00 -42:3-i3 ) $515.00 1)EVRW1'FR IMPACT FUR 54405.00 PXECISE PLAII 101-000-441--345 I Oti.00 OC 3-'P° 1riAs1 G`C3t iid t�'i Il°J1�11�;r1>~i :I?I AAId' C Cr swK 14:12°x.09 t, .TALF1?`'.0�'NIY1'7=":S F`D'07C; 3ROW �9,I4`r'3.01f3 N 3 0 0003 [FINANCE OF LA QUINTA M�1, nF RECEIPT_177 BY af, a .�� DATE FINALED INSPECTOR y�II lPryyffta7f�1'��; t;fYT'�.Anyr. INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs U3 Underground Ducts Forms & Footings Ducts Slab GradeReturnAir Steel Combustion Air Roof Deck _ r Exhaust Fans O.K. to Wrap L _Q— 6 _ F.A.U. Framing Q, Q Compressor Insulation �t��j� _ 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 BLOCKWALL APPROVALS POOLS - SPAS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final I I Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines _ �— �� (>3 Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection _ 3 j p� ,� Encapsulation Gas Piping Gas Test Appliances Final 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) COMMENTS: 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 (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 trom paying School fees at this time Alfie 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 t he al;fount of $2.114AX 1.0-51 S.F. or $3.961.14 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/1 st Bank - Randy Bills Check No 65394 VV b!Y y ' VA e�V. Name on the check Telephone Fandinu Residential By Dr. Doris Wilson Superintendent Fee collected /exempted by Monica Guillen $3,961..14 _ 0.00 l Pavrni_nt. Rard .fivcrrl Ini4ov a Signature / NOTICE: Pursuant to Government Code Section 66020(d)(1), this will seive to notify you that the 90 -day approval period in which you may protest the fees or other payment identified above will begin to run from the date on which the building or installation permit for this project is issued, or from the date on which those ar-nountg aro pair! to the anti—its) or to nnnthw ni ihlir Qnftt%J aL!thnr SQA to r Hpir-.t th9m on the i)istrirt('S) behalf, which@Ver is sarliar. NOTICE: This Document NOT VALID if Duplicated Frnhnsspri � lrinir.?i - Kliildinn i �ergrtrnPnVAnniirgnt Copy - ApniirantlReceint finny - Accounting CITY OF LA QUINTA SUB -CONTRACTOR LIST JOB ADDRESS 53� / l D (ta PERMIT NUMBER OWNER BUILDER This form shall be posted on the job with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their employe s are authorized to wor on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance of buildin9 permit For each applicable trade all information requested below must be completed by applicant. "On File"'is not an acceptable response. Trade / Classification Contractor State Contractor's License Workers Compensation Insurance City Business License Company Name Classification (e.g. A�3, B, C-8) License Number (xxxxxx) Exp. Date (xx/xx/txx) Carrier Name (e.g. State Fund, CalComp) Policy Number (Format Varies) Exp. Date (xx/txx/xx) License Number (xxxx) Exp. Date (xx/xx/xx) EARTHWORK (C -12)u t CONCRETE (C=8)-. FRAMING (C-5) ... tL:� �y,f.» r� G /, �� 0� V 591-()41 5 1613 STRUCT. STEEL (C-51) MASONRY (C-29) !�- rna'�_-a _� aj G d Zo(a�� Fes.• �i��r (JE7.� f7CaiC�i (� I �6U b(o-2$i PLUMBING (C-36) ,+a J.5 ig° �f 'J��: No ,' ,d ' LATH, PLASTER (C-35) -rn i�t'_3 �%' "�� WC -4002_653 1 -0 DRYWALL (C-9) c`#t G F '► 'y . �� r U S" �: Q G HVAC �}- iiJTi �{Lli�f ,' C-�Q ��Q3 y5 Al 1-) 22Q2.0,577D'Z -�C Q �'3 ELECTRICAL (C-10): - ,�. _ �, (_ � �-icy Sr -7A 2 0 -03 .ROOFING (C739) , SHEET METAL (C-43)-. ". FLOORING (C-15).'. 2(:6 � ; ..� = �%� �i S'. /UD 2_0 GLAZING (C=17) . INSULATION (C-2) . r ' y�� r r G2 G /� j _o ` R CAK (t 'i'o SEWAGE DISP. IC -421 PAINTING (C-33) CERAMIC TILE (C-54) CABINETS (C-6) (t \ 1 t► 1 I t I r FENCING (C-131' LANDSCAPING (C-27) POOL (C-53) uN. of ep a 0 - ole JUN -25-2003 06:50 AM RTIFICATE OF P. 0:2 .4 PW Rvmber Sampla ro-jp Number Sample Houae Number 7--- _—a Firm; Street Address:. i���la �_ LT�YLw city/swelzip.- .it. HERS Provider _ .m.A...... ....��.. H RTS SCAT E PLIAN SAT MNT a T;�C houSC was: as not tasted Tested ® Approved as part of sampt4 testing, but %v As the HERB rata providing diegnostic testing and field verification, t oertify that the houses Identified c thi3 form com ly with the diagnostic i"ested compliance requirements os.checked. on this form. Distribution system is futly'dueled (i.e., does not use building cavities'as plenums or platform roiurns in lieu of ducts) Where cloth backed, rubber adhesive duct tape is installed, mastic and drawbands are used.in cnnibination with cloth backed, rubber adhesive duot tape to seal leaks at duel connections. MINIMUM REQUIREM9NTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CRED17 Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage) MeasursO f)uct Pressurization Test Results (CFM Q 25 Pa) values, Fest Leakage Flow in CFM If fan flow is calculated as 4000fmlton x number of tons enter calculated valva here �• If fan now Is measured enter measured vahA here 10 i t-eakage Percentage (100 x Test Leakage/Fan Flow) Check Box for Pass or Fail (PA5840/1 orless) ; ,g Fall l eTHERUnCTATIC EXPANSION VALVE (T)(V or Commisslot' 833 rhe: P?rYes No Thermostatic Expansion Valve (Or Commission approved equivalent) Is Installed and Access Is providedfor inspection .;s Fail. P. Yes is pass (� M1NIt4Ul'A REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT t Q Yes ONO ACCA Manual D Design requirements have been met (rater has verified that actual inst811Pttlo11 matches values In CF -IR and design on plan. r Y° 2. © Yes 0 No . TXV is installed or Fran flow has been verified. If no TXV, verified fan flow matches design from +:F•1R. Measured Fan Flow = ---- ___ — Yes for both 1 and,! is a Pass Pass Faii Sladden Engineering U_' 6782 Stanton Ave., Suite A, Buena Park, CA 90621 (714) 523-0952 Fax (714) 523-1369 \\� 39-725 Garand Ln., Suite G, Palm Desert, CA 92211 (760) 772-3893 Fax (760) 772-3895 Date L L p 7 Job No.z�'3� . FIELD MEMO Project Name .EktL5'e fcc �� Client: Site Address 5 3 2", 1 �� Job Phone Work Done Test Summary, / Footings Inspected Test No. Location i Elev. Dry Density Moist % % Relative Compaction Ref. Max pcf Moist % -2- Comments Comments Field Tech. Super. or Agent 24 hour notice requested to schedule Field Technician. Thank you for the opportunity to be of service. I of S686 ZLL 09L quasap wjed .uappets e6b=80 60 LZ..ga- Certificate ofOccupancy . Ihn r 9w5 in t . De of Budd g &Saf artment e y p 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: 53-340 AVENIDA RUBIO Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0212-164 Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RC Owner of Building: COVE DEVELOPMENT Address: 2214 N. RIDGEWOOD City, ST, ZIP-: SANTA ANA, CA 92107 , . By: KIRK KIRKLAND Date: 06-25-2003 Building Official POST IN A CONSPICUOUS PLACE 0 49 d v (Xc I h Gg�j�p�__9 7 CJ