0401-316 (SFD)#k.1 f1` I
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�, 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
6V 90.1 B 124 117,
06ate'Signature of Contractor ' + l �
i ✓ — cr• i i
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).
( ) 1, aslowner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
O I am exempt under,Section B&P.C, for this reason f f
Date �' r / % S gnature, of Ovine ' f I �"
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 SLATE FUND Policy No. 224- 00197$' /-^003
(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: • 1 1 ' 1 tApplicant / r
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. % 1
Si nature (Owner/Agent) t Date
BUILDING PERMIT PERMIT#
E3401-316 •
DATE ..,- y VALUATION LOT TRACT
e
'JOB SITE'. •� _ ,,.
ADDRESS
APN� $••ti.t'
OWNER
CONTRACTOR / DESIGNER / EN (NEER
RID. BOX 131
.43.7SS0 �fi.�WTYAGE j�,R
L. A,�,,?1`.�:t'l.A CA, 92253
Ti:E ,PATJi:)A1`+1111aO C.A.. 92201
(15000.1525 C''Blit 372 •
USE OF PERMIT
149.9 SY. SYL) PERMIT DOES NOT INCL. IDE,, F@d.( 11" WAL..LK PODUSPIk
Oft DRIV1+.a'�AY APP)LCiACH
TRACT C 014STRUCTION 1,49Q.OU 9F
!P•ORCI IPATIO `. 50.00 SF
CAfdACEYCARP6111T 'ti. 40,00 SF
C00, OF COHNUMUenov
CC%5+3::3TRUC1,11 N FEB 101.000-418.000 %0 3. s0
PLAN CHECK F11iE 101-000-439-318 $P I.70
I1E1s DEPOSIT 101-000-439-318 4250100
PlEr,H,faNIC.€AL:. PEE 101-000-421 x000 *32,:30
ELECTRICAL FEE 101-000-42" 00 v!+im
IGLUMBLNO IFFE 101-000-419-000 41.9-1000 $11&00
STRONG MOTION FEE - PX, BID 101.000-'241. -000 $9.12
-ORADINO PEI?, 101-601 x-000
DEVE1,0FOR IMPACT YtE $2,403,00
PIZEC ISE PLAN '101•000-441-34a
y•1°y
I1t.ik�- i .�a.CC�h L 't3�F1 A141)PTL.A C:1TECIl',
$3,015.t9O,
LESS PRE -P. Fa --Z 7
;
-$750.00
t,
TOTAL .yTAL PEM- WI.- FEES 3i k%f', NOW
D
$3,05,09
d
Ch."
R P 4�`' °ji�
[DATEv
BY. t
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
— Q
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
—tel
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 Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Q
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
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) �_
Date 2/2/04
No. 25448
Owner
Address
City
Tract #
Type
Power Finance
P.O. Box 134
La Quinta Zip 92253
Single Family Residence
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
47950 Dune Palms Road
La Quinta, CA 92253
(760) 771-8515
Q BERMUDA DUNES r
rn RANCHO MIRAGE
,,� INDIAN WELLS
C4,PALM DESERT ,y
i� LAQUINTA
QINDIO y7ti
Q
APN # 773-322-019
Jurisdiction La Qu nta
Permit # 0401-316
Study Area
No. of Units
Lot # No .1 Street S.F. :; Lot # No. Street S.F.
Unit 1 52885 Avenida Ramirez 1498 UniV
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 patiosfwalkways, 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 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 65995 Et Seq.
in the amount of $2.14 X 1,498 'S.F. or $3,205.72 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 CCNIB-Alissa Aiton Check No. 305304
Name on the check Telephone 760-480-3039
Funding Residentiad
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Yolanda Garcia Payment Recd 1$0.00
$3,205.72 Over/Under
Signature
NOTICE: Pursuant to Government Code Section 66020(d)(1), this Will serve to notify you that the 90 -day approval period iruwhich 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 amounts are paid to the District(s) or to another public entity authorized 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;,
JUL-22-2004 06:30 PM '
P. 02
AND DIAGNOSTIC TESTING CF
-2
Project Title
<2 --M� Le
Proj t Ad ass Builder Name
' J
Bu Ider Cont t Telephone Plan Number
HERS Rater I Telephone Saiiip4e roup u--rber
r1rfying Signature Da Sample. House Number
:.7~C. ��,�sag"d HERS Provider.
Street Address: 7ga0 .8r��od GYGLa, CitylState2lp:
l w 49ylyr c& UM:3
Copies to: Builder, HERS Provider
H9R§ RATER ,9 AXAT,EMENT
The Mouse was: Tested ❑ 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 on this form
Coy with the diagnostic tested compliance requirements as checked on this form.
Distribution system Is fully'ducted (i.e., does not use building cavities as plenums or platform returns in lieu .
ducts)
l�[J Where cloth backed, rubber adhesive duct tape is installed, mastic and drawbands ere used in combination
with cloth backed, rubber adhesive duct tape to seal ?asks at duct connections.
MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT ' y
Duct Diagnostic Leakage Testing Results (Maximum SSS Duct Leakage)
Measu •ed
Duct.Pressurization. .Test Results (CFM @ 25 Pa) values
Test Leakage Flow In CFM 70/
If fan flow is calculated as 400cfmiton x number of tons enter
calculated value here i
If fan flow is measured enter measurSd value here
Leakage Percentage (100 x Test Leakage/Fan Flow)
Check Box for Pass or Fall (Pass=6% or less) ❑.
ass Fail.
�.! THERMOSTATIC EXPANSION VALVE (TXVj or Commission approved equivalent
:KYes ❑ No Thermostatic Expansion Valve (or Commission approved°
equivalent) is installed and Access Is provided for inapectivn
Yes is a pass
C� MUMUM REQUIREMENTS F04 DUCT DESIGN COMPLIANC12 CRZOIT
t 0 Yes I3 No ACCA Manuel 0 Design requirements have been met
(rater has verified.that actual installation matches values In
CF -1 R and design on plan.
2. ❑ Yes ❑ No TXV is installed or Fan flow hes been verified. If no TXV,
verified fan flow matches design from CF -1R.
Measured Fan Flow =
Yes for both 1 and 2 is a Pass
or❑.
as Fail
a o
Pass Fail
L..
Certificate.,of Occupancy0
Tat
Luw�oSA7m
OF Building & Safety Department
r
r
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.
a
BUILDING ADDRESS: 52885 AVENIDARAMIREZ
V
Use classification: SFD _- - o.: 0401-316 Building Permit N
,
Occupancy Group:•R3U1 Type of Construction: VN Land Use Zone: RC
°
Owner of Building: POWER FINANCE Address: P.O. BOX 134
5
City, ST, ZIP: LA QUINTA CA 92253 ,
By: KIRK KIRKLAND
j Date:' 7-23-2004
Building Officia
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s
POST IN A CONSPICUOUS PLACE `
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