0308-328 (SFD)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 .
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).
(; f I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code). r I ,
( ) I am exempt under Section B&P.C. fo.r t"is 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:
Carrier Policy No.
(This section need not be completed if the permit valuation is for $100.00 or less).
1�r I certify that in the performance of the work for which this permit is issued,
I stiall 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' compensationprovisions of Section 3700 of the Labor
Code, I shall forthwith comply with those'rovisionsr
.,,Date: 17 Applicant—
Warning:
pplicant Warning: Failure to secure Works' Compensation co_ue age 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
fur 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 isnot 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 authori7,e -representatives of this City to enter upon
the above mentioned<P[operty fo�inspectio ',inoses.
Signature (Owner/Agent) A Z,
BUILDING PERMIT PERMIT#
DATE ` VALUATION$114J
x x,v , +.. LOT r TRACT. BLX 2 1
.38
JOB SITE
ADDRESS WA—;MA.VXV+flr)A el ...
APN
.7744301-009
OWNER.
CONTRACTOR/DESIGNER/EN INEER
3 Z .O'ROx 3O1r
k 1MTRIMR, .
PALM Dtf.11UZT CA 92211.1
CRU11 .
USE OF PERMIT
1936 S.F. SPO PERMIT DOES -NOT YNCX.C3Z?.A; BLOCK WALL10 POOL APA
z• ,
O.'t DRIVF,WAY APPP,OACl4,. 7,1% RF.DUCET3 PLAN CRE? %'
-
1 lr UL`PiPLE 1�1. IVNS OF SAME TYPE � ��� •'
L]no
OCT 08 2003. '
TRhCT CONSTRUCTION Sin
110iLCIOP,AT.10 19;00 511
0ARNOEICAi1.PM 447.00 SF CITY OF I
A QUINTA
FINANC
E DEPT.
�•qp':T•�'.1�fA,'.�7
�7p f�y+�p �gry+ •�t�p�
.S'k_RSJ.YYdS i7 EE KODMAR ,II
CONSTRUCTION F&F, 101p000=41.8.00tY 4�„ �692r00
PIAN CHECK M,
1'EL DEPOSIT 101 �1000439A318 4230100
tti+i tiF dtt�t4l. ;tiL 101-000-421-000 $99.00
ELECTRICAL FZF. 101-000-420-000 1123a20
A'1dTJikQi IWO FEE: 101-000-4 19.000 $1310.00
STUNG G MOT10N f?,R 09,31.D. 10.1-000441-000 M41
QF3IDINO1E1a 1�'1=U4)0-42s�000 1 t7g
D si'VF10PEft iMv1PACTPE9 11 ,:1p3. Y0
PRECISE PLAN '101-000-44.1-345' l$100.06
nm"wnm, commucTiog m1yy.!((,�d��deegr�C9pl�Byry4d1CJ,�t�yyl/.�-.;
$3,68Nrr...151�1 ,.
yy•+.�p�}}� ��q
. IMIIS PRE-PACD 1ST.eC.tr3 .:
4260.00
N'ONY
3,�l.5D4
RECEIPT
DATE
BYD/
N Lia
INSPECT
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel , O
Combustion Air
Roof Deck Pl L
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
BLOCKWALL APPROVALS
POOLS - SPAS
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
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
Sewer Connection o. 3
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
R6ugh Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power —
Final
Utility Notice (Perm)
COMMENTS:
t
Comments Certs #25058 through 25060 used for CC#116332 in the amount of $11,594.52.
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patics/walkways, residential additions under
500 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eatiig 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 b1lowing reason:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to r
Education Code Section 17620 and Government Code 65995 Et Seq.
in the amount of $2.14X 1,936 S.F. or $4,143.04 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 CC/South Bay Bank - Roper Morris Check No. 116332
Name on the check, Telephone 760/272.9292
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempte by S on MCGIIVrey Payment Recd $0:00
$4,143.04 OverlUnder
Signature
NOTICE: Pursuant to Government Code Se 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 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, wh chever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy- Accounting
+
CERTIFICATE OF COMPLIANCE
�r
Desert Sands Unified School District
'
47950 Dune Palms Road
0
Q BERMUDA DUNES h -
Date
10/8/03
La Quinta, CA 92253
En RANCHO MIRAGE
No.
25058
760 771-8515
� INDIAN WELLS 1
(� PALM DESERT �
La D SE
. �y
Owner
Rico Properties
•APN #
774-301-009'
Address
.77-570 Springtime Ln
Jurisdiction
La Quinta
City
Palm Desert. Zip 92260
Permit #
Tract #
BLK 311
Study Area
Type
Single Family Residence
No. of Units
1
Lot # No. Street
S.F. Lot # No.
Street • S.F.
Unit 1 16
54880 Avenida Ramirez
1936 Unit 6
Unit 2
Unit 7
Unit 3
Unit 8
Unit 4
Unit 9
Unit 5
Unit 10
Comments Certs #25058 through 25060 used for CC#116332 in the amount of $11,594.52.
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patics/walkways, residential additions under
500 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eatiig 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 b1lowing reason:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to r
Education Code Section 17620 and Government Code 65995 Et Seq.
in the amount of $2.14X 1,936 S.F. or $4,143.04 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 CC/South Bay Bank - Roper Morris Check No. 116332
Name on the check, Telephone 760/272.9292
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempte by S on MCGIIVrey Payment Recd $0:00
$4,143.04 OverlUnder
Signature
NOTICE: Pursuant to Government Code Se 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 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, wh chever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy- Accounting
�r
OCT 07 2003 14:57 FR F1R51- HMtKlC-AR TITLE 0 566 5954 TO 92004486
i
DOG i! 2003L-0911614
P.02 -
09AI iaa 14:06 F«:u.a
RECORDING REQUESTED 6Y ecoo t of ffa D6c';T Taft carPild
• Recorded lw Off1'Olai Ricardo
Fust Amefitan lode CDMPanY Corny of Rlvirolds
Gary L. Oki
rhamoer, Calmy Clerlt t Reearder
RoP w moffft "COWED MmTo: 11111 BOOM 11111111111111-
77b7o. Springfield Lane, #M
SpringReld, CA 92211
Y. a it ••ct ;nee OR .00e M000a ow rrrc.
a ► ears we ■an" win nm
fli GRANT DEED
Q A.P.N.: 774-3101-009 T.R.A. No. a" File No.: RPD -1065258 (A)
rhe UMnslgnW Qanlm(sj DWwKsk DOCUMWrARY TRMISM TAX $SSS O; QTY Y1 MgU TAX S&OD,
cmWLftd an the cmWma6m or U vias d inwa tr =WA4 OR t
-9 a qmw an tt* amdderom Or (W vow ho VWA of k"S and/or mamhrano" remaining at ON a WK
wdnwrpwowd aerr 04 w of La Quraq, ano VG
FOR A VALUABLE CONSIDERA170N, react pt of whkh is hereby ackraMedged, Mary 7eaa Snyder and Eric R.
Snyder
hereby► GRANT'S to 14 Properties, LLC
the foilovAng described property in the of La Quints, County of Rlverdd% Stbte of CaWarntR;
Dated: 27/09/2003
Maryear ny r 41 Eric R. Snyder
HaN Tax Stnents To; iAM! AS AsOW
Description: Rivwslde,CA Document-Year.DoclD 2003.696514 Page: 1 of 4
Order: roper Comment:
Y
OCT -07 2003 14:58 FR F1R5T RMER1Ci*•HN TITLE 17 �66 5y54 10 yGbe44ub F',e5
1
Order Number: RW -106525!
Pepe Number. 4 .
LEGAL DFSCRIMON
Rear � h ft City of 1.8 Quift, County of Riverside, State of Callfomla, described as
folloa LOT 16 IN BLOO( 311 UNIT NO. 28 OF SANTA CAWeUTA AT VALE LA QUINTA, AS SHOWN BY
MAP ON FILE IN BOOK 19 PAGES 59 AND. 60 OF MAPS,.REOORDS OF RIVERSIDE COUMIr,
CAUFORNIA.
APN: 774-301-009-5
1
N�ieee�94se^ �
Rist AMe*jn pile
Descrfption: Riverside, CA Document -Year DoclD 2003.696514 Page: 4 of 4
Order; roper Comment:
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11IM T - l Y-Lt7 YJY V 1 . 1 ♦ M1'1
- • `-'
.. CE RTI FICATE:OFTIELD VEgIFICATION AND DI'AGNOS'TIC TESTING -
CF4R .
Project Titin �+ L6� Oat C.G �,.fi
Wd a /i kis? li-t'r�
Z.
_64; �6 •
t1roject Ao ress Builder Name-...,
suiioer on1 t . Telephone Plan Number
ci/
U?1;;n
h=R Raier To ephone Sample Group Number
rt.tying Signawra at Sample House Number '
` Firr' S.C. d fOCi HERS Provider: �G_�f�S�oGi4�CS
S:reet Andress GltylState2lp: 1 a C�k ih c:
r'9 9 3'
Ccp es :o'. 6jilder, HERS Provider
HERS RATER GOM/..P�L-IANgg STATtMENT
The house was: Tested' Cl. `Approved as;pert.of sample testtn:p:,but:was.not tested
Y
As the KERS rater providing Olegnostic testing and field veriflctallon, I certify that -the houses, identified on this.fcrm
this form. '
comply with -the diagnostic tested compliance requirements as checked on
Distribution system is fully ducted (i.e., does not use.bullding cavities as plenums or platform
returns in lieu `
I ductsi.
'v. 14'ive cloth backed, rubber adhesive duct tape is installed, mastic. and drewbands ere used
in combination
with clots- backed, rubber adhesive duct tape to seal leaks at duct connections.
(INIMUM'REQUIREMENTS FOR DUCT LEAKAGE REDUCTIOWCOMPLIANCE CREDIT-
Ducf Diagnostic Leakage Testing Results (Maximum 0% Duct Leakage)
Measured -
D;c: Pressur zation'TestResults (CFM (x`25 Pe) values'
Test Leakage Flow in CFM1 a .
If fan flow -is calculated. as 400cfm1tonx nurtiber.oUtons enter.
-_calculated value .hero
If fan flow Is measured enter measured value here
�r
Leakage Percentage (100 x Test LeakagelFan Flow) x. ✓�/� .
•
Check Box for Pass or Fall (Pass=8% or less)
.
PC Fait
;(.THERMOSTATIC EXPANSION VALVE (TXV) or Commission approved equivalent,
9rLG Yes C) No Thermostatic E=xpansion Valve.(or Commission-approve.d,..
®
equivalent) Is Ihstalled and Access is provided for'lnspection,
..❑
Yes is s'pass
Pass Fail
❑ MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT
t . 0 Yes. C No ACCAManual D Design'requiremerits.have been me!
(rater°_s verified that actual Inslallation matches values In
CF -I I and design on pian,
2. 0 -Yes- . ❑ No . TO is installed.or.Fan flow. has been verified. If no TXV,
verified fan.fiow.matches design from CF -1R.
Measured Fan Flow
C O
Yes for both t and 2 is a Pass
Pass Fail
0
di, fica.te •. of:-OdcupancX,
�-. • '. .
G�� 94,5 ,� � ,• ti, �, � .LLQ ,� y ,�
. oF� ...... _ . •�Bu�ld�ng.&_ Saf_ a#y Department_ f
_ This Certificate is issued pursuant. to, the requirementsr of `Section '109'0f'.. 'the ,California •Building _
J .Code, _certifying 'that, 'at the .time 'off issuance;' this) structure was in •_compliance with? the _'
provisions , of.. he; Building -Code and:.the various , ordinances ' of the ..City regulating --,building
construction -and/or use. � r ��, - , � "� . i .. - • - - ,^� s _
• i " �•- � ``• s ��� : BUILDING ADDRESS:``54=880 AVENIDA RAMIREZ � T � •,' = � " �'�
Use classification: SFD z_ _ �: -' � ,,, ' �'� • Building
No.: 0308-328
- .Qccuparicy Group: R3 Type of Construction:AVN Land Use Zone: RC
Owner of Building: RICO_. PROPERTIES..Address: 77=570 SPRINGTIMELANE`,-"
r(City, ST, ZIP: -PALM DESERT CA`92261
By: �KIRK •KIRKLAND:.-
-� Date: 5=25=2004 � �• . - �� .. _
. ,Building Off
i .I..
t � ` POST IN A CONSPICUOUS PLACE.. `
0
di, fica.te •. of:-OdcupancX,
�-. • '. .
G�� 94,5 ,� � ,• ti, �, � .LLQ ,� y ,�
. oF� ...... _ . •�Bu�ld�ng.&_ Saf_ a#y Department_ f
_ This Certificate is issued pursuant. to, the requirementsr of `Section '109'0f'.. 'the ,California •Building _
J .Code, _certifying 'that, 'at the .time 'off issuance;' this) structure was in •_compliance with? the _'
provisions , of.. he; Building -Code and:.the various , ordinances ' of the ..City regulating --,building
construction -and/or use. � r ��, - , � "� . i .. - • - - ,^� s _
• i " �•- � ``• s ��� : BUILDING ADDRESS:``54=880 AVENIDA RAMIREZ � T � •,' = � " �'�
Use classification: SFD z_ _ �: -' � ,,, ' �'� • Building
No.: 0308-328
- .Qccuparicy Group: R3 Type of Construction:AVN Land Use Zone: RC
Owner of Building: RICO_. PROPERTIES..Address: 77=570 SPRINGTIMELANE`,-"
r(City, ST, ZIP: -PALM DESERT CA`92261
By: �KIRK •KIRKLAND:.-
-� Date: 5=25=2004 � �• . - �� .. _
. ,Building Off