0401-295 (SFD)y
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 Date � Signature of Contractor.
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:
Carver. EXEMPT 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 I should become
subject to the workers' compensation ovisions of Se tion 9700 of the Labor
Code�l sh��Pfort w th comply with, tho' e provisions
Date ;-'" /pplicar�'� '- -
Warning: Failure to secure Workers' Compensation coverageis 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 fo 'nspectio`n purpdses. '!
S gnature (Owner/Agee j�1
PERMIT #
BU:ILD.1NG .P:ERMIT
DATE 4 j, VALUATION LOT TRACT
7
f $111.,749 0 - Ld771' 20 I11'x 7JOB
SITE
ADDRESS
S 32� 0%<'. 0 AS A RA.1I�.t.�d-kZ
APN
i : 7'22;^ . t
OWNER
CONTRACTOR /DESIGNER / EN INEER
1 gtJ EW T31A -S
L BOACY E1:0MES
54-865 AW.N.C_'•� A 0BR-BOON
P.0, BOX, 696
A QUINA CA , x'22.53
LA
LA QU CA 92.253
(`760)364,,7620 0_T L# 0201,,;3
-
USE OF PERMIT J
SANC1L1vFAbci#3.Y DWk:Y.:UWG
e3�I S.F. SD PERMIT w3OESNOT INC;LUti 51,.0= WALT, POOL ISP./a +, ,
OR DRIVEWAY APPROACH
TRACT CONSTRUC17Ci•w 1„031.00 Sir
Fi;: C.f€/PA.TIO 154.00 S'
0ARAC E/CARPOR.T 469100 8
°A: .
• f' r
E8"I'➢MATED C0070F C0NFM11(M, 0N'
:rLM749.90 ,'
PERWI ' FEE SU+3�'.�iRY
.
CONSTRUCTION ME 101.000.418-'040 5631.30
PLAN CHECK FEE 1.01-000-4.39-31.6 $563.19
FEE DEPOSIT 101-000.439.316 _$251199
,
WatCf1ANICAL, MAKE 101-000-4.21-040 $59.00
ELEC'TIUC~,A,L- FLEE 101.000.420.000 3122.67
P'LUMBINOF 19 $130.00
• -
STRu1N0 MOTION "E .RESID 101.000.241.000 511..1'7
`,
CODING FEE 101-000-423-000
DE'VE1. OPUZ IMPACT FEE $2,405.00
PRWISF PLAN 101-000-441-345 $100.00
,.
�n
SUIS -TOTAL C-0Wn. 11Z.L1C1T014 M14D PLAN C"TIF..C"n
LF -43 PRFI-PAY) M0_9
-$$250,00 '
•
1 0 2004.
CITOFCAUINTA PT
RECEIPT
DATE.,
BY °
DA FINALED
INSPECTOR
i l 7
Y
L
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
_
Roof Deck
Exhaust Fans
O.K. to Wrap -
F.A.U.
Framing
Compressor
Insulation
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 Pibg. Test
Final
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
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
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final _
Utility Notice (Perm)
Date 2/6/04
No. 25484
Owner
Randy Bills
Address
54-865 Avenida Obregon .
City
La Quinta Zip 92253
Tract #
BLK77 -
Type
Single Family Residence
CERTIFICATE OF COMPLIANCE
Desert Sands Unifed School, District
47950'Dune Palms Road
is Quinta..C'A;92253
(760).7714515
APN #
Jurisdiction
Permit #
Study Area
No. of Units
4�N-) "al EDsc�o
Q BERMUDA DUNES r
rn RANCHO MIRAGE
t�J INDIAN WELLS
PALM DESERT y
LA QUINTA
INDIO
QL�
Q
773-222-003
La Quinta
0401-295
1
Lot # No. Street S.F. Lot # No. Street S.F.
Unit 1 20 52080 Avenida Ramirez 1851 Unit 6
Unit'2 Unit 7
Unit 3 Unit 8
Unit 4 Unit 9
Unit 5 Unit 10
Comments
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patiostwalkways, 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 from paging 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 65995: Et Seq.
in the amount of $2.14X 1,851 S.F. or $3,961.14 have been.paid forthe 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 -Sharon Bills, Check No. 70926
Name on the check Telephone 7607880-3446
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted byYolanda Garcia Payment Recd
$3,9611.14 over/Under
Signature Pck�.,
NOTICE: Pursuant to Government Code Section 66020(d)(1), this will serve 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:buildin'g or install ation;permit for this project°is issued, or from the date on which
those amounts are�aid to the District(s) or to another public entity'authorizedlo'collect them on the District('s) behalf, whichever is earlier.
NOTICE: This DocumentlNOT VALID if Duplicated
Embossed Original - Building Department/Applicant Copy 7 Applicant/Receipt Copy - Accounting
r
JUN -28-2004]
9. P M
VERRI)FI
V. AND DIAGN. OS'
1.02
TESTING <.• CF=4R
l7
h^P�
Build =Name
Plan Number
Sample Group Number
Sample House. Number
Street Address: o -,W foi d tr1'Gu Clty/Slate/Zip; Z Al AM
Copies to: Builder, HERS Provider
H RS SAIgE COMPWAN'CtsTAtEmENi
The house was: Tested. ❑ "Approved as part of sample testing,. but was not tested
As the HERS.rater providing. diagnostic te'sting and field verification; _f certify that the' houses Identlfled on this form
coy with the diagnostic tested compliance requirements as:checkbd_on this -form.
eDistribution system is fully'dutied (i.e., does not use building cavities as plenums or platform returns in lieu
f ducts)
40"W'here cloth backed, rubber adhesive duct tape Isanstallad, mastic and drawbands are used In combination
with cloth backed, rubber adhesive:duct tape.to seal leaks at duct connections.
41—MINIMUM REQUIREMENTS. FOR DUCT LEAKA.Gt REDUCTION COMPLIANCE CREDIT r
Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage)
Measured
Duct Pressurization Test Results (CFM-@ 25 Pa) values
Test Leakage Ploiv In CFM
If fan flow is calculated as 400cfm/to6x:ntamber:of tons.enter
"calculated value•here
If fan flow is measured enter measured.value here
jj
Leakage Percentage'(100 x.Test beakage/l=an Flow)
Check Box'forPass`,or Fall.(Pass 6% or less) ❑
ass Fail
THERMOSTATIC EXPANSION VALVE (TW) or.Conrimission approved equivalent
(Yes 11No Thermostatic Expansion Valve (or Commission approved
equivalent) Is installed and Access is provided for inspection
Yes is a pass
❑ MINIMUM REQUIREMENTS: FOR DUCT DESIGN:COMPLIANCE'CREDIT
1. 0 Yes 0 No ACCA Manual D Deslgn:requirements•,have been .met
(rater.has Verl(led'.that.actual.installatlon'm etches. v,eluss In
CF•I Rand desigh on plan,`.
2. ❑ Yes O No TXV Is Installed or Fan, .flow has:been verified. If no TXV,
verified fan flow rnatches design from CF -1 R.
Measured Fan Flowt.
Yes for both'I and 2 is'a.Pass
El
ass Fail
D 0
Pass Fail
oq o
Sladden Enginering
6782 Stanton Ave.. Suite A, Buena.Rark, 6A 9062I'
39-725 Garand Ln., Suite G, kim Desert, CA 92211
00-0520
-(714),523-0952 Fax (714) 523-1369
(760);772-.P,Q93 Fax (760) 772-3895
Date
Job No. 52-2 —qOg-?—
'FIE'LOVEMO
.4Project Name. Client:
.Site Address
Job Phone
Work Done
0 -C4-
6
cz,
TP§tt rnmrnarw I Footinas Inspected
Test
No.
LocationElev.
Dry
De.n9ity
Moist
%,:Relative
Compaction
Ret. Max
pct
Moist
%
AAn
IV. b
Comments
Field Tech. Super, or Agent
24 hour notice requested to schedule Field TocMician. Thank you for the opportunity to be of service.
d 60ZULNWONAI 'Ism --8 bO.H,6l 833(AH1) 183SH WIVd N300VIS WOU
oCCU.,�
-, Certificate o�f Occupancy
��� �
,f
W
___
f
isms;V
Building,& S' ty.. epa m ent
'OF; afe -D
This Certificate-is issuedpursuant to the requirements of Section 109 of the California Building.
Code, certifying that, at the time of is'suance, 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-.- 52080 AVENIDA RAMIREZ
Use classification: SFD Building Permit No.: 04-3573
Occupancy Group: R3 Type of Construction: VN Land Use Zone: RC
Owner of Building: RANDY BILLS Address: PO BOX 699
City, ST, ZIP: LA QUINTA CA 92253
By: KIRK KIRKLAND
Date: 7-2-04
Building Official
POST IN A CONSPICUOUS PLACE
................... 4
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