0655 (SFD)PERMIT APPLICATION
City of La Dg a
Department of Building and Safety fff
This permit becomes void if work not commenced within .180 days from date of issuance, OR, if work has been suspended or abandoned for a period of 180 days.
LICENSED CONTRACTORS DECLARATION: I hereby affirm -that' -1 am licensed under provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in -full force
and effect.
License Class
Contractor
Lic. Number
OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's License'Law for the
following reason (Sec. 7031.5: Business and Professions Code: Any city or county which requires a permit to
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for
such permit to file a signed,statement that he is licensed pursuant to the provisions of the Contractor's License Law
(Chapter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code) or that he is exempt,
therefrom and the basis for the alleged exemption. Any violation of. Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500.):
0, 1. as owner of the properly, or my employees with wages as their sole compensation, will do lhawork, and the
structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License
Law does not apply to an owner of property who builds, or improves thereon, and who does such work himself or
through his own employees; provided that such improvements are not intended or offered for saleAf, however, the .
building or improvemnt is sold within one year of completioo. the owner -builder will have the burden of proving that
he did not build or improve for the purpose of sale.). '
O I, as owner of the property, am exculsively contracting with licensed contractors to construct the project (Sec.
7044. Business and Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon, and who contracts for such projects with a contractors) licensed pursuant to the
Contractor's License Law.).
O 1 am'exempt under Sec. B. 8 P.C. (Attached Certificate). .
Date Owner
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, or a
certificate of Workers' Compensation Insurance , or a certified copythereof (Sec. 3800. Lab. C:). 4e
Policy No. Company
O Certified copy is hereby furnished.
O Certified copy is liled with the City Building Inspection Department or City Department.
Date Applicant `
APPL // Gam' (L•L/Ma
ADDRESS '
CITY/COMMUNITY/STATE/ZIP
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TRACT NAME
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CONTRACTOR -FIRM MEQ
ADDRESS '
CITY/COMMU4NITY/STTAA�TE/ZIP
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TOTAL
FEE
ARC/ENG FIRM NAME
ADDRESS
CITY/COMM UN ITY/STATE/ZI P
PHONE n
LICNCII
USE OF PERMIT
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END
SIDE
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENS 4TION INSURANCE: This section need not be completed if
the permit is for one hundred ($100) o, less. I certify tha, in the performance of the work for which this permit is
r issued, I shall not employ any person in any manner so alto become subject to the Workers' Compensation Laws of
California.
Date Applicant
NOTICE TO APPLICANT: If, after making this Certificate cf Exemption. you should become subject to the Workers'
Compensation provisions of the Labor Code, you must 4.rthwith comply with such provisions or this permit shall
be deemed revoked.
DIVISION OF INDUSTRIAL SAFETY PERMIT.CERTIFICATION:
O 1hereby certify that noexcavation five (5)ormore feet It depth into which a person is required to descend, will be
made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or
demolition ordismantling thereof, will be more than thirt-'-six (36)'teet high. (Chap 3.2, Grp 2, Art 2, Sec341, Title B,
C.A.C.) .. i
O As owner -builder, I will not employ anyone to do v.Drk which would require a permit from the'Division of
Industrial Safety, as noted above, unless such person tas a permit to do such work from that division.
O Division of Industrial Safety Permit No.
Date Applicant
CONSTRUCTION LENDING AGENCY: I hereby affirm that here is a construction lending agency for the performance
of the work for which this permit is issued (Sec. 3097, Div. C.).
Lender's Name
Lender's Address
certify that I have read this application and state that ttne above information is correct. I agree to comply with all
city and county ordinances and state laws relating to buiding construction, and hereby authorize representatives'
of this county to enter'upbn the above=mentioned property for inspection purposes.
Signature of Applicant or Agent Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that
the information given is correct. I agree to comply with Of state laws and county ordinances relating to buidling
construction, and authorize a'representative of the Cityof La Ouinta Department of Building and Safety to enter
upon the property for which I have applied for,this permit for the purpose of making inspections. .
i�
Signature of Applicant or Agent Date
Print Applicant/Agent Name
' APPPUPP•)RMT n r S C 4�271ffsv
1-46 6-,owSl�'!vc?"">320 SFT
old.--�//c/.0 �`yBD..s¢/r or��� ���✓',�'�/
c.Z:rJ"wf6 veel /z/A;
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yo •1
S/91/�
14: 4W6�/.�/y�®r-e-e
53•��
S44
.fess Aeelep A5v3
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RECEIVED
lt:a EliiiLt�
TOTAL
FEE
✓ALUATION
BLDG.DEPT.
NO.
OPERATION DATE
INSPECTOR
NO. OPERATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33 Vdntilation System
2
Ftgs & Frms
34 Plenums & Ducts Gr
2A
Slab Grade
35 Furnace Compart.
3
Steel
36 Inlets & Outlets
4
Grout Blocks
37 Combustion Air
5
Bond Beams
38 Compressor
6
Roof Deck
39 Appl. Clearance
7
Framing40
Fire Damper
8
Vents
41 Smoke Detection Device
9
Garage Fire Wall
42 Commercial.Hood
10
Fireplace P.L.
❑
43 Final
10A
fireplace T.O.
❑
NON ADDITIONAL INFORMATION
-SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lathci�/6�(/`�
12A Drywall
13 Finish Grade
INSULATION Thick
Value
7A Walls (Batts)
128 Ceiling (Batts)
12C Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb
16 Water Piping
17 Rough Plumb /D
18 Vents
19 Sewage Disposal
20 Sewer 3
►
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test
25 Final
Tank Pit L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
P/L P/I
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final
v�3 3 Li
E p
O
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Desert Sands 'Unihed School District
y BERMUDA DUNES r
RANCHO MIRAGE
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82-879 HIGHWAY 111,0 INDIO CALIFORNIA 92201-5678 • (619) 347-8631
' INDIAN WELLS H
PALM DESERT
%P' LA OUINTA .
December 19, 1984
d0 INDIO V�
C.i.ty of La Quinta
Department of Community-
Development
'78-105 Calle Estado
La Quinta, CA 92253
Re:. Lot ,6�, Block 223, Santa Carmel ita Va11e, La. Quinta,- lJni.t No. 21
Gentlemen:
The developer of the
above.'referenced home
has mitigated its impacts
on our overcrowded schools by payment
of the amount of $628
per unit -to be applied to 'the cost of.
district educational
facil 'ties made 'necessary by such, new
development.
Sincerely,
John D. Brooks .
'
Assistant Super!' tende.nt
Business Services
JDB/crm'.
058:10 R2 -,28/84 VH/dr
Attachment 0
Form 2
(Revised 3/84)
Climate Zones 2. 4. 6, and 8-15
COMPLIANCE CHECKLIST
For Low -Rise Residential.Buildings
(except hotels and motels)
Step -1: Enter on the form the values for each measure from your build'ng plan
and specifications sheet.
Step 2: Enter points on this -page while working through the point system
Building Shell 1MeaPoints
*Total Floor Area •• . . 1.E16z
as�sure f t2
1. Slab -on -Ground; Perimeter ft. ,Depthin.
2. Raised Floor R -Value. . . . . • . . . . . . . . . 1-
3. Ceiling Insulation or ConstructionAssembly . . g--
Attic. Percent of Roof Over Conditioned Spaces.. ft2
n or Construction Assembly. @�
4. Wall Insulation -
Glazing; Total x Floor Area Single Double Triple
5. North -Facing.. S ft
5. ft2
6. East -Facing ft2 ft2 ft2
7. South -Facing.•. Y ft2 ft2 ft2
8. West -Facing i ft2 ft2 ft2
9. Skylight. . . . . ft ft ft .
10. Shading Coefficient.
(excluding overhang)
I East U. SC . . . . . . ... .
I South. ..
c. West . . . . . . . . . . SC . . . . - . . . .
d: North. SC . . . . . . . . . . . . .
e. Skylight SC .
11. Horizontal South•Overhang Length. ft . . . . . . . . . . . . .
12. Movable Insulation, 1 Floor Area.:
13. Infiltration (indicate Standard.
14. Thermal Mass
Exterior Wall Thermal Mass
Area. Heat Capacity, R -Value . . . . . . . ft, HC; R -
Interior Thermal Mass
Area, Heat Capacity, R -Value . . . . . . .! ft2, rL.7i H-,
HVAC System*'
15. Gas Furnace without Refrigeration; Cool ing
(Seasonal"Efficiency).. . • • . . • • . • • SE
16. Heat Pump (Energy Efficiency Ratio) . . . . . . . . .;EER
17. Gas Furnace with Refrigeration Cooling
Seasonal Efficiency and Seasonal
Energy Efficiency Ratio . SE SEER
18. Active Solar (Net Solar Fraction, x)• . . . . . . . SNSF
19. Zonally Controlled Electric
Resistance Space Heating (Yes/No)
Domestic Water Heating**
20. Solar With -Gas Backup (Net Solar Fraction. S) . . . . . . . . SNSf
21. Other Water Heating (Describe type)
Point System Compliance Total. . . . . . . . . ... . . . 'r
'Checklist items; not a point system measure.
"Attach documentation for efficiencies and NSF.
',,HEAT TRANSFER COEFFICIENT Form
PROPOSED CONSTRUCTION ASSEMBLY..(eiel)
EAfoa:anwnt Agency Use Only
owner proNct title Ou Iding permit numow
L ITS
. prolKb location Checked by
aoeumentauon author oat* I III
Sketch of Conrtruction Assembly List of Construction Components = R
(for sectlon between framing memWn) (horn Table 3.11
2.
3' 1
4
Framing Size 2• x 6
L-
Framin Soacin �•' O.C.
7.
Check one:
X8. Inside Surface Air Film (from Table ]-181........ .
Ceiling/Roof
Floor9. Outside Surface Air Film.lfrom Table 7.181.. O, COI
Wall
.Total Thermal Resistance (RTI. -
Al Wall. ChlCk the - - sum of the 600.0
" .. '- '�aOD►OOnate weight:. _ _ _ •
less than 25 Ib/h2
25 to a0 ID/tc2 i�VERAGE U VALUE OF ASSEMBLY
�rlaar :"ran dO :bih2
I• 9(h, 1. Btu/(hr . h2 .'F1
Framing AT Nom 600w l
/a-t0r from _ -
Table ]-e
Usa this U value for*haat load
- calculation or Code comparison
..., .. -._ .'.��� ., �.. !c.:�a-.,o-,..,_�'4k-.._.•'0t'S°:?::Mw":`P•s�"'�,,..,,.�..:T-��'cC:.!.:.A�C�^nLS�RP,C:`•T:5^�.•».:t..�4;a'n:r"'�+'i4'rnu^':.e••�..+.w<.•,.;,--n^:.;.yam..-r ..s:-a.....�,..n-meq,
HEAT TRANSFER COEFFICIENT
PROPOSED CONSTRUCTION ASSEMBLY •
Owner ' , Project title .
project location .
OOcumentallon sulnor oats
r.
Sketch of Construction Assembly List of Construction Components R
(for section between framing members) (from Table 3.11 -
4.
Framing Size x —cig—�— 6'
Framin§ Soacing O.C.
7: _.
Check one:
S. Inside -Surface Air Film (from Table 3-18).
Ceiling/Roof
Floor 9. Outside Surface Air Film (from Table 3-18)...
Wall A
Total Thermal Resistance (RT)
If Well, check the sum of the above
appropriate weight:
I less than 25 Ib/0.
25 to 40 Ib/ft2 AVERAGE U VALUE OF ASSEMBLY_
• '
• greater than 40 Ib/h2
l/ D� Btu/(hr .ft2 •-Fl
Framing AT from above
factor from
Table 3.6
e Use this U value for heat load
calculation or Code comparison
w.
Form 3R
(8/81)
1
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Volume: Ft3
" Time:
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