0403-212 (SFD)LICENSED CONTRACTOR DECLARATION j
I hereby affirm under penalty of perjury that'l am licensed underprovisions 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
132324 B .MR:IS/31 J 2(
D Signature of Contractor 41 NJ'
-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 Sianature 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 81 -ATL+ FUND Policy No. ISW.457-02
(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 4he workers' compensation y provisions of 'cti n 3700 of the Labor
Code, I_s� II foorthwith comply with Ihblse pro isions
Date: '� , 0 7 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 aV
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
lfor in_sjpeection purposes.
Signature (Owner/Agent) r ` / r �- _ Date. -;/]--7
• � h
A Jv1a
BUILDING PERMIT PERMIT#
_
DATEVALUATION LOT , - - d-�''� TRACT
} i!` 9
JOB SITE
A
ADDRESS 1�tYL'yI�117JA. }3.A.I�£II�:
'ii�6-24.*'i7e C}
OWNER
CONTRACTOR / DESIGNER / EN (NEER .
P.AM-1014OMES
PAWIC HOMES
77564 A 00'QVMY CLUB DRIVE, UU .rE 133
77564.A COMTRY CLUB DRrVF,, sUTE 11:3
PALM IYFZ AZT CA 92211
PALM DESERT CA 92211
(760)408-3495 C`.BL # 2953
USE OF PERMIT
MN01Y, FAMILY D• ,LUNG
-
1498 SAI SPD P1GRMIT DOES NOT rMCLAIDE RLOC'K_' %t4ALI.,, NOOL&PA.
OR U11;1VL". AY .APPROACH �
tP.
TRACT CONSTRUCTION 1,495.00 SF
PC3I€CHIPATIO 50.00 Sp
_
OAIt.t` OEICARPORT 467.04 3P
MMAIED COFF OF (X)MMMUMON
9111,V.69
P�.T FEE 9MTKAIZY
COWSTRUCTION FRE 101 -OW-4.1 B-000 $603.5D
PLAN CHECK FEE 101'•000.439-318 $309.57
FEE DEPOSIT 101.000-439-418 4250.00
MECkiLANIC AL FEE 101-000-421-000 $60.00
9Lj?1CTR1C.i'1L FEE 101 -000-420-000 $1I0:2r
PLUM 131140 FEE 101-000-A 19-000 $118.00
STRONG MOTI(M FEE RUID 101.000-241-000 $9.12
GRADING FEE 101-000-423-000 $.15.00
wf"FLCIpm IMP. ar fu SZ,403S 00
PRECIZZ PLAN 101-000-441-345 $100.00
817R = fC`9AL CC7MT•R't 78.014 AND :P.LM r-bFC K
$3,1124.46 -
LESS PRR-PIM) FM
D 1Y?TA.T:,NOW
-$2:50100
&4,674.46
MAR 17 2004
CITY OF LA QUINTA
FINANCE DEPT.
RECEIPT
DATE,
BY,
DATE FINALED
INSPECTOR '
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
— -Underground
�- ti
Ducts
Ducts
Slab Grade
4) l/.rte
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
.l
F.A.U.
Framing
2
Compressor
Insulation
o
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 . L .G�
BLOCKWALL APPROVALS
POOLS - SPAS
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
Waste Lines
Gas Test
Electric Final
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Server Connection
� �—
Encapsulation
Gas Piping
Gas Test
av
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole QG
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power WEv
Final
Utility Notice (Perm)
COMMENTS:
,CERTIFICATE OF COMPLIANCE v��'�s�
DesertSands. Unafied School Destrict
. y Cry- �, � x
, . 4 : 6. ,6""b6 ne PiIIQYlS R01d Q' BERMUDA DUNES r'
Date 3/16/04 La• Q191►I8t� CA 92253'' rn RANCHo'MIRAGE t7
. 7. INDIAN WELLS
No. 25703
PALM A UINTS �
- - J'3QINDIO y�l
0
Owner Pacific Homes APNV 774-243-020
Address 77564 A Country Club Drive, Suite 113 Ju isiJiction La Quinta
City Palm Desert' Z10:92211 Permit # 0403-212
Tract # Study Area .
Type Single Family.. Residence i No: of Units. 1
Lot # No. :'Street SF. Lot # No: Street S.F.
Unit 1 9 54405 AveriidaRamirez '1498.. 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'Di§thct does.not colle6t4ees on. garages%grports covered patiostwalkways; residential additions under
500 square feet, 'detached,accessory stiuctures{spaces that do not contaihJacll(t(es,.fo'r hvmg;xsleepmg;:,cooking, eating or sanitation) or replacement mobile
homes. It has been detemtinedahat 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 -1.7620 ari&Governmeht Code 65995 Et Seq.
in the amount of, : $2.14X 149,8 - S P;;or{$3,20572: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 Pai&By Cc/1st Bank tidk Scott Check No. 71006
Name ri tN6 checkTelephone 760/408-3495
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected' /exempts by harm MC IVrey , Payment Recd " $0.00
$3,205.72 Over/Under
Signature C`
NOTICE: Pursu t to Government Code Section 66020(d)(I t is wll serve to.not(fy you`t6it.the 90 -day, approval period in which you may: protest the fees or
other payment i entfied'above 'will begm to`'ruun from'the date on chahe building ;or iristallaition•perm*d for,this project is issued, or from the date on which
._
those amounts are paid 1: the D'istria(s) or id�another,public:enti— auttioriied io collect them on the District('s) behalf, whichever is earlier.
NOTICE: This~ Doeument NOT. VALID if Duplicated
Embossed Original -1 Building D'epartment/Applicant . Copy - ApplicantlReceipt Copy - Accounting
SEP -16-2004 07:16 AM
CER,TtFI.CATE .OF.•FI)ELD-V1!
N. P.02
/SIL/f7G �DrtifP S.
Build®r,,Name'
ne` Plan Number
e :'Sample Group Number
dY
Sample House Number
HERS Provider:-Gi�f-�ssoc:i4lrs
City/State/21p: Lu
HERS RATIR gOMPLIAN�STJ:6Tg"IMENT: e
The pause ayes:: Tested Approued as part of-sam" testing,. but was not tested
As the HERS rater providing -diagnostic testing'and field Verification, I;Certify that.the houses -identified on th,s form
Com iy with the diBgn�S.tic to.StWcompliance,,requirementt.,6t checkecfon this form.
'Districution systemis fully ducted (i.e.,'does-non use buidding,cavities"as plenums or platform retLms In lieu
ol.ducts; • - .
Where cloth backed, rubber adhesive dud116pe Is Installed, mastic: and -drawbands are used in co•mboation
Will, cloth backed, rubber•adhie sive.duct tapeto seal leaks at•duct`connectlbns.
0`MiNIMUM,REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT
Duct Diagnostic;Leakage Testing Results (Max li u%UM8!/a•Duct Leakage)
Measured
Duc: Fressurizati.bm Test Rssults (CFM4:25;Ra)` values
Test Leakage Flow ln`CFM_.____�_e_/
if -far floes Calculated=as 4000fnn .'.x=number.,o.f tons enter:--�---- --
calculated value hereG~
If fan flow, Is- measured enter':measured valuWhere
Leakage;:Percentage (11 Op x Tes( Leakage/Fan' Fld,rv) = 5,
Check B.ox for Pass or Fail (Pass=t3% or less)
Pass ::all
THERMOSTATIC EXPANSION>VALVE.:(TXV),or.Commission epproved'equivalent
Yes ❑ No Thermostatic Expansion`Velve.(or Commission approved
equivalent) -Is Installed anq Acoess
18-provldedfor inspection ❑
Yes is.-Ppa"ss - Pass Fail
❑ MINIMUM REQUIREMENTS FOWDUCT DESIGN COMPLIANCE CREDIT
10 Yes ❑ No ACCA Man`uV Y.6eslgn requlr®menta halve;been met
: (rater has veil"ietl:tjtat'actuef installation°matches values in
CF•1R-and design°on,pl8n:`•.
2 O Yes t7'No TXV is installed or, Fan. flow,,has been verified. If no TXV, -
-verified fan elow,matchestdesign •frorn CF -.1 R,
Measured Fen Flo,,4
Yes for both I and 2. is a Pass Pass Falx
Prpie. t Titi9
y►
?rot t dress
-
801der.Coni -t
Telgpho
/
.HEr:k- Rater T—
,Telgpho
rtitytny, Signature
ate
Street Address: `�(� �I'tfL�OY� tr�l•G��
Cobles to: Builder. HERS Provider
N. P.02
/SIL/f7G �DrtifP S.
Build®r,,Name'
ne` Plan Number
e :'Sample Group Number
dY
Sample House Number
HERS Provider:-Gi�f-�ssoc:i4lrs
City/State/21p: Lu
HERS RATIR gOMPLIAN�STJ:6Tg"IMENT: e
The pause ayes:: Tested Approued as part of-sam" testing,. but was not tested
As the HERS rater providing -diagnostic testing'and field Verification, I;Certify that.the houses -identified on th,s form
Com iy with the diBgn�S.tic to.StWcompliance,,requirementt.,6t checkecfon this form.
'Districution systemis fully ducted (i.e.,'does-non use buidding,cavities"as plenums or platform retLms In lieu
ol.ducts; • - .
Where cloth backed, rubber adhesive dud116pe Is Installed, mastic: and -drawbands are used in co•mboation
Will, cloth backed, rubber•adhie sive.duct tapeto seal leaks at•duct`connectlbns.
0`MiNIMUM,REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT
Duct Diagnostic;Leakage Testing Results (Max li u%UM8!/a•Duct Leakage)
Measured
Duc: Fressurizati.bm Test Rssults (CFM4:25;Ra)` values
Test Leakage Flow ln`CFM_.____�_e_/
if -far floes Calculated=as 4000fnn .'.x=number.,o.f tons enter:--�---- --
calculated value hereG~
If fan flow, Is- measured enter':measured valuWhere
Leakage;:Percentage (11 Op x Tes( Leakage/Fan' Fld,rv) = 5,
Check B.ox for Pass or Fail (Pass=t3% or less)
Pass ::all
THERMOSTATIC EXPANSION>VALVE.:(TXV),or.Commission epproved'equivalent
Yes ❑ No Thermostatic Expansion`Velve.(or Commission approved
equivalent) -Is Installed anq Acoess
18-provldedfor inspection ❑
Yes is.-Ppa"ss - Pass Fail
❑ MINIMUM REQUIREMENTS FOWDUCT DESIGN COMPLIANCE CREDIT
10 Yes ❑ No ACCA Man`uV Y.6eslgn requlr®menta halve;been met
: (rater has veil"ietl:tjtat'actuef installation°matches values in
CF•1R-and design°on,pl8n:`•.
2 O Yes t7'No TXV is installed or, Fan. flow,,has been verified. If no TXV, -
-verified fan elow,matchestdesign •frorn CF -.1 R,
Measured Fen Flo,,4
Yes for both I and 2. is a Pass Pass Falx
111 -44
oti Certificate of Occu=ant% ll
f4z,
M
Building.-,&, SaMty,Department
This Certificate ,is issued pursuant. to the requirements of Section 109 of the 'C-alifomia.Building
C0de,,,'coHifyjng_.that, at" the, time of issuance, this structure was in, compliance with e,
provisions -of the Building Code and the. various ordinances of the City. 'regulating- building
construction and/or use.
711
BUILDING ADDRESS: 54405-AVEN'IDA'.RAMIREZ.
Use classification: SFD Building Permit-No.:::0403=212•
Occupancy Group: R-3 Type of Construction: VmN Land Use Zone: R -L
Owner of Building: PACIFIC HOMES Address: 77564 -COUNTRY CLUB
City,,.ST, ZIP: PALM DESERT CA 92260
4
By: KIRK KIRKLAND
Date: 9/22/04
POST IN A CONSPICUOUS PLACE