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0301-276 (SFD)' LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed u.1d'er, provisions of H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and 04 W Professionals Code, and my License is in full force and effect. p =) M License # yy��ijA Lic. Class 1 Exp. bate �j t eryt oZ / Date ^;�a t' ' Signature of Contractor (O t� J U C:) OWNER -BUILDER DECLARATION W WW r- I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason: Z_ ( ) 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). a 4,Ln- () I am exempt under Section B&P.C. fob -this reason N Date Signature of Owner, O rn U QIL WORKER'S COMPENSATION DECLARATION Q �. I hereby affirm under penalty of perjury one of the following declarations: r <, OLo _ () I have and will maintain a certificate of consent to self -insure for workers' X W Yv� . = compensation, as provided for by Section 3700 of the Labor Code, for the O -J � _' performance of the work for which this permit is issued. m J < :• Q I have and will maintain workers' compensation insurance, as required by O Q 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: Z-1 - Cairier Vr1t8�'T Policy No. ob �• <1 (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 t0 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: Applicant Warning: Failure to secure Workers' Compensation coverage is unlawful and r 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. b 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. J 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.- 44 -Signature (Owner/Agent) f �� 7-' Date -;- .'LULDING PERMIT PERMIT" 0° 276 DATE VALUATION LOT TRACT 110,3.1.35) -3(_ -C :n,, JOB SITE ADDRESS $1$W AVg.1,�.i APN 774-0 OWNER CONTRACTOR/DESIGNER/EN (NEER Cf3W DE .c�. ,01114PNT X E-GAsly 140 ES 2214 A IMME BOO D 4'7450 ADMAS 07-PRIWIx 4228 SAWA ANA CA 9210 LA QUIMIt A. CA. 92253 !;76q)56A-73820 012063 USE OF PERMIT > iYJJ?,RAW.Y DWRI LN0 SFD - I8-iY SQ.14, .1.IV iNQ 469 SQ. FT. GARAOF., Peru* Vacs not include Mock wa%% fesicep,, pool or epa, iDAvoway IRMonch regturzs a separate pstArdt ixatn 1b Pumae WG& TDepariinntit, TRACT CG)1*. OTRUCTION I,15S1.00 9 PORCH/PATIO 46.00 SP 0ARAG1r!•0ARPORT fi 9,9� 3F A. OF COXYi'�#�AM11011 l.W31360 CONSTRUCTION PER 101-000-4118j-000 PLA,W CHECK FEE 101-000431-318�, � $t4.msq ]FE :CDE 081f 101-000-439-318 V 42so'.00 M :i1AXICl4Z PEF, 101-0110--421-C?t10 4nN _ $96.W RL3CCTR.IM FEF. 101-000,420-000 $1ri.67 PLUMBI1d0 FEE 101 -.000 -419 -WO `` $194.75 10 STRONG MOTION FE - FtESID 101-00'0.24.1.000 W10 0lt..+1OM iFER. 101 -000 -423 -OW $1.5.001 DEVRIAPER IMPACT RF 92,4.1615,0® PRECISE FI. XN 101-0.00-441-34.5 51110.00 `TrS 1°d'J`f AL (_"01 RENRUM1011 AM.1'UN -RECK $3,695.10 LESS 1?Et`A)I;3.. 42:0.00 JAN 3 CO 2003 CITY OF LA QUINTA FINANCE DEPT. RECEIPT DATE / -- a& BY. \ 1,!w! . DATE FINALED 3 INSPECTO —,,AV INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs _ r /3 Underground Ducts Forms & Footings v Ducts Slab Grade Return Air Steel Combustion Air Roof Deck G Exhaust Fans O.K. to Wrap Framing _ 3 /� F.A.U. Compressor Insulation -� p—� Vents Fireplace P.L. _ Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall -Int. Lath �� � —/ Final 7 �% �� BLOCKWALL APPROVALS Final steel d POOLS - SPAS Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Pibg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines �`�� 03 �� 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 % (,�i Encapsulation Gas Piping Gas Test Appliances Final Final Utility Notice (Gas) ELECTRICAL APPROVALSA 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) 7—��'� COMMENTS: C CITY OF LA QUINTA SUB -CONTRACTOR LIST ��� JOB ADDRESS l53i� �Gf !�I� PERMIT NUMBER OWNER BUILDER ' O 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 employes are authorized to wqr 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 building 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 on CompensatiInsurance:.: City Business License Company Name Classification (e.g. A, B, C-8) License Number (xxxxxx) Exp. Date (xx/xx/xx) Carrier Name (e.g. State Fund, CalComp) Policy Number (Format Varies) Exp. Date (xx/xx/xx) License Number (xxxx) Exp. Date (xx/xx/xx) EARTHWORK IC 12) � �` IV V1 -4 -7 8 2- . Cq{Adld d��to -CONCRETE-(`C--8F.----- -- --/—�, FRAMING: IC -51 yr�l— (.1A � __�. �� OoC V 04 5 �� �.'_.���/�i��T'v _ �c�U�.;� 5 `� STRUCT...STEEL (C-51) . MASONRY (C-29) t2 LA±n� M ''F "c�• ��id d ''� `�$d ►' Oqj�()0.1 60q(i -1 '4y 16,W (o I 12.Kdq PLUMBING (C-36) !% tG/tG fiA! f t. ? G` �% !. i3° tf F 02 �Ji 7`G ' VIVO � 0'6� � 3'��Q3 �• �0.. LATH, PLASTER (C.-35) , -rn L ( — �% '(� (NC200z6S31 -7-1-03 / DRYWALL (C-9) G rel`!(. c o �"�'Ca 0 �/i! L f/C.Ga.S CJZo�b3 Si^i6 HVAC (C-20)5=31otf Av19 22 -2_ m'Sy%D-2- —�t Q t'3 ELECTRICAL (C-10) �f- /b s( cr -7 g /0 0-3 .ROOFING'(C-39f; 'SHEET METAL (G-43) FLOORING (C=151 le6 P-6)7 C` S �l � �i S -31-0y GLAZING (C=17).. .INSULATION (C-2) . eH m ( G2 c G t - -�3 !�-�3U .� TCA k Ufa '-�S r 3-03 SEWAGE DISP. (C' 42).0 DO 250 6 -'L- .ti(� PAINTING (C-33) `.�- �r ©� IV ® �r3i�L�cl��� CERAMIC TILE (C-54) /1 1 I It 1 r CABINETS (C-6) I t t t 1 1 11 1 FENCING (C='13)' LANDSCAPING (C-27), 1 1 1 POOL (C-53) 0 0 ME Sladden Engineering 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 Job No. T FIELD MEMO Project Name Fc~ Client: Site Address. Job Phone Work Done I I Q 1 Test Summary / Footings Inspected , Test „ No.: Location Elev, Dry Density Moist % % Relative Compaction Ref. Max pcf Moist % u comments Field Tech. Super. or Agent 24 hour notice requested to schedule Field Technician. Thank you for the opportunity to be of service. T'd S68E ZLL 09L ijasep weed uappeTs dOT:60 60 SO ueW x 0 JUL-11-2003 06:44 AM s CERTIFICATE OF F C TESTING CF - P.02 7\7 Builder Cont cC Telephone Flan Numoer HERS ater Tele one Sample Group Number ]tying Signature D e Sample House Number Firm; STC d',I�SSOGiP� HERS Provider. e es 7��6 ,�rs��or/r1�2� City/State2lp: l �k/r� s: Street Address: Copes to: Builder, HERS Provider HERS RATERC OMPLIAN E STAT The house was: Tested [3 Approved as part of sample testing, but was not tested As the HERS rater providing diagnostic testing and field verification, I certify that the houses Identified an this form comply with the diagnostic tested compliance requirements as checked on this form. coyly system Is fully'ducted (i.e„ does not use building cavlties'as plenums or platform returns in lieu of ducts) Where cloth backed', rubber adhesive duct tape Is Installed, mastic and drawbands are us( -...d in combination with cloth backed, rubber adhesive duct tape to $eal leaks at duct connections. MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT Duct Diagnostic Leakage Testing Results (Maximum 6% Duct'Leakage) Measured Duct Pressurization Test Results (CFM @ 25 Pa) values Test Leakage Flow In CFM / v 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 (100 x Test Lbakage/Fan Flow) Check Box for Pass or Fail (Pass=6% or less) 11� ❑ �"= Fail 16c1$6 THERMOSTATIC EXPANSION VALVE (TXV) or Commission roved equivalent L,C ?"'Y'es ❑ No Thermostatic Expansion Valve (or Commission, approved equivalent) is installed and Access is provided for inspection Yes is a pass ]'ass F7 1 ❑ MINIMUM REQUIREMENTS FOR:DUCT DESIGN COMPLIANCE CREDIT 1 ❑ Yes Q No ACCA Manual D Design requirements have been met (rater has .verified that actual installation matches values in QF- 1R and design on plan. 2. ❑ Yes O No TXV is installed or,Fan flow has been verified, If no TXV, verified fan flow matches design from CF -1 R. Measured Fan Flow = O � Yes for both 1 and 2 is a Pass Pass Fail Coil Certificate of Occupancy 0 U OF Building & Safety Department V 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: 53-360 "ENIDA RUBIO is Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0301-276 ;F 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: JULY 17, 2003 Building Official POST IN A CONSPICUOUS PLACE