0109-196 (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� f� Exp. Date
743118 13 W e A TETI(i
1 -246 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 ISignature 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 STATE Policy No. 1508706-"
(This section need not be completed if the permit valuation is for $100.00 or less).
a ( ) 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 s bject to the
workers' compensation laws of California, andl/agree that if I sh 61d become
subject to the workers' compensatignlprovisiotns of Sectiln.3700,of the Labor
/Code, I shall forthwith comply with those provi Ions.
Date: I.v°+ g)�. 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 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 C!Iy, and Stite laws relating to the building
construction, and hereby authtorize ieprefseptalives of this City to enter upon
the above-mentioned property for inspec7on purposes/.Sthignature (Owner/Agent) � Date 4t,I'=��y
y.
!-BUILDING PERMIT PERMIT l/
�13�.£!9-•lam
DATEf/ / r VALUATION $1051377.70 LOT TRACT T4T-44; 204
JOB SITE
ADDRESS � Ortkj$ A .n)i9L 1i) . ���v
APN
OWNER
CONTRACTOR/DESIGNER/EN (NEER
M0 (hriAW COVE, DIEW �03M i°r
:14P LNT'.�:%�'RIS&N
,1%'AL°M D:irMM CA 92261
DIT010 CA 92201
'
(16,0)347-8913 CTIA 49988
USE OF PERMIT
I IGLE 1T'.AMILY
SM 1111 &*F ?t?RIMI'T 00rS NOT 1'uf:1.UDE? BLOCK W)LI1 S,
Pt OW...PA 0k DRIV FWAY APPROACH.
TRACT CCa1~!S'i` IUC:'i'ION 1,71.1.00 O
PORCHfA.PTIO 152 go SIF
t71!�a�.C9�C'AI~dr�'L�3�T ,�33.bt) ;3iY
M1;z DEPOSIT i 01.000.439..318 -$2:M OD
MW1.3A'14CCAL ME 4.01-000-423-000 $£6.50
ikLEC,PP'RIC,i'-il.I IP. 101 �U00.4. 0.090 $12`x,7.3
:i I llC?Ait i %►11uI°Iua lrlfrt:' a 17mw 101-000-241-000
ORADINO FEE 101-C 00.423 -Ml $M00
DLrVf?I. R IF9R. IMPACT IMi? $2,405.00
,PRECISE PLAN' 101-000-441-345 V00.00
CONS"t"R JCTION ME 101-000"118-00 0 $60.50
PLAN CHECK 1,i2, 101.000.439.318 031M
PL1 NIHING ME 101-000-«11,9.00{1 $124.00
'c11TV170TE11. CEM, M,
$4,3D.68
M3 PTT«:I',FiMP;V,q
4'250ioo
e `t
I I 'A'id S':GYX.I,�t!.d, 7��Cn .tsyaJla ,L� V 5'Yh
4 sY1
JAN 3 0 1003
CITY OF LA QUINTA
'
FINANCE DEPT.
RECEIPT_
DATE�f
BY .y
DA FINALED
INSPEC OR
U
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
// 0
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
— - Q
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
_
Compressor
Insulation
G
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
/O3
Final
Final _02 5�x7� ��/
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
Gas Test
Electric Final
Waste Lines
_
•� �3 �/
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
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 6oi_
Final
Utility Notice (Perm)
COMMENTS:
Building _
Address
.4 4 Quim
$S P.O. BOX 1504 APPLICATION ONLY
_n 78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BV OT L`n1 (_419E7— D Zai . Lk. -)C --
Mailing UC -Mailing
Address
tyn , Zip Tel.
A.Q✓lt [ �rc'�t'Q P ZZ G ( -7-71 —1 (r ? O
Contractor
P
State Lie. I City
& Classif. Lie. #
Arch., Engr.,
Designer
Address Tel.
CityI Zip I State
l Lie. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I 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 .
SIGNATURE DATE
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).
1! 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, Buisness 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 nor intended or offered for sale. If, however, the building
or improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
I 1 I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License 'Vaw
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a conUaClor(s) licensed pursuant to the Contractor's License Law.)
11 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
1 hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereat. (Sec. 3800, Labor Code.)
Policy No. -Company
- Company
f) Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not De completed if the permit is for one hundred dollars ($100) valualion
or less.)
I certify that in the performance of thg 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.
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
subject (o file Workers' Compensation provisions or the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1hereby affirm that there is a construction lending agency for the performance of the
work lot which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives :of this city to enter the above-
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
BUILDING: TYPE'CONST. OCC. GRP
P. Number
Bgal Description
roject Description SF.D
Sq. Ft. No.
Size �%1 Stories
NewNp Add ❑ Alter ❑
-7 7 (—�/ 70
stimated Valuation
No. Dw.
Units
Repair ❑ Demolition ❑
Sgz-ac.
PERMIT AMOUNT
Plan Chk. Dep. a
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line '
Side Setback from Property Line a
FINAL DATE
INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
Comments
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, 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 $2.14X 1,711 S.F. or $3,661.54 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/Canyon Natl Bank - Larry Shields Check No. 13119
Name on the check Telephone
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Monica Guillen $3,661.54 0.00
7 J
Payment Recd Over/Under
Signature 1
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 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 - ApplicanUReceipt Copy - Accounting
RC DISTRICT - PLANNING REVIEW FORM
This form is to be used by CDD staff for review of single family dwellings in the RC (Cove
Residential) District per Section 9.50.090 of the Zoning Code. Its purpose is to determine:
1) that the proposed house design does not duplicate !he same architectural style of any
house within 200 feet of the applicant, and/or 2) if there is a need for the applicant to file for
Master Design Guidelines. If the applicant does need to file a Master Design Guideline, please
transmitted this information to the Building and Safety Department as part of your correction
list. Please attach additional explanations as necessary.
APPLICANT Mountain Cove DEv. Inc.
i
SITE ADDRESS
85—Bermudas
APN7�y s_p1�}CASE NO.: 2002-681
LEGAL: LOT ?2 BLOCK 70 UNIT
CHECK AND APPROVED BY: Martin Magana DATE:
S.C.@V.L.Q.
Inform the assigned Building plan checker upon your assignment to this case. The CDD
Executive Secretary maintains a log book to track applications and assign case numbers.
REQUIRED ITEM
Y
N
COMMENT/CORRECTION
Verify legal and APN information
Consistent with MDG on file las
applicable
MDG filing required (5 filings since
9/3/98)
Architectural variety within 200 feet of
the surrounding area:
Colors
Materials
Architectural design features
oved by: Q�Q e o #
ty Council
Dev. Dept.
Upmrinunity
Initial
Case
No. 1A 1
Other Requirements:
❑ With
Conditions
❑ EN Chit &od:) The a
t. FINANCHM: THE
u
L1
Ma mftct.i^ - Kmm' g Adde dura is Incorporated irdo ttrR Agreement.
IING OF yug :.GTAM B&OW IS A CONT94OL41CY OF n0I A Iffig8ff. Buyer sf . ad t .-y and- in good faM
LCL CORMOM"U :.14-11 o.. i 41 41169t r fd, ((.�IVK* CMY .ONE Of tiro b bMnp:)
(1) The desipmied 1tTM We 11widW andl'Or me aSustpdon of adoft Arrandrq is amomed by leader and cwrrpWAd.
Ea? days ham 8xeptarta. by whfdt tAtre Bayer af>ap give to Sellar wrblen sotiae of efectfon to Carl this Agreement because
M ti's inter to ordain: (t) -ire des;gnded bans, or (g) The approve) of aetay"m of ` `ft ti►. a Buyer does not ghee SOW
such -10#0e, f O *mfirtgerICY Of Obtlinsrg the doWIF101ed bass Mall beren by tt+e "Orad spv~h paragraph IS. A
tUVM*Ss DEfDrM'T in tare Corm of p persond dmdi C] 081h*b &Wk, p anter
FAYABLE TO
shad be deposited p with Esaow holder, p rata tie ft Aust m+,mt, or p
Fri BE MEtID UNCASHED UMIL the next ImAk ess day mer aoce of iha abler or
C. NUCREASED DEPOW w&gn _ _y dam shd bee miter &ftI t3
D. R4LAUM OF D 1YIlaf i4AYYENr to be d E=m H vii�iidtt eufiicient thne to Noss escrow ........... .
E. FNR81LOAN iN tHE AVOUNT OF., . .....................................................................i
❑ NEW Phar Des�dof Thief In &Vnr of p L EM*K Ci SELLER; OR u ASSUMPTION of Exwhg First Deed of 7kust;
encumbering the'Progerty, sett ". V s not WoMe at appm; nnateiy $ per month, at maximum interest o1
% fixed rats. or % infirm adjcrataWe rate with a maMmum tifettms Interest rete cV of 96,
belanm dme itt Vemms. styes 09 pay roar► fampofnta not to exceed
F. SEC0109 LOAN I!d THE A9OW Or...................................................................... 6
p NEW Ses Jiaad of Trat in Ivor of p LI htI7EFi, p 6FJ.LM- CR p ASSi.iMFTiON of Existing SOMW Deed of
Th.4 as ma Bering td& Fioparty, securing a nota peryafola at apprm&nm* s per starter, at nmk"n (0 --mg nt
% tt d mav, ur % irmliiat ad)tretebie rats wish a rttaprrurrrt litettme interest rate cap of %.
bwa(tca dila "A Bears. Suter &'Leri Pat batt tee6/ mf� rot to ermceed -
G. 0 Of Grmo*M*) i iiF WnIAED HOME L UM In the amount of .......... I ...... . ............................E
Oar fire terms sad descrtttod in Lha atteudred Ma m► &Avd fiars6rg Addertdatm f*W14).
iii. ADDVn0NAL T9UIIS: :
1. 'TOTAL V11MCNA30- PRICE, A& driefudt cam of obMining bM and ottw dosft costs .... ......................S
J. 96T'A i3£O3r'f: Wft MOT, and 4Yster`t Ci OSM CWM by &W Is NOT a carting ft unfesa owe Seed m
X IF T HISIg AN ALL; C"k CIF . Suvw shaft, W Wn 3 W i7 _� dos from acus Wance, Wovide to Sofia writian varfl4rMM Of outfidaM
fundis 0 cross itis tarmac-som SOW may cancet this Agraetnent in wr&q wIMM 5 Off 0 j days: 41) ear "Umpt of me bads =.-=0o,1,
tt sc uer vvn,"i Ii: or (a) aeter Ve Wm to provift the funds mititatiOn mqftz. it Buyer fats to provide IL
L ::its APPCiCAT,IOU&;;PR&Q0A1JW-ATI;
(i) FW ft&K and 4"Umm amdat 4-g: t t0 totL�_...1 �!►. from atx rice, i3trYar atratl id•to Setter mt t tomer
smng roar, on a review of Suyerls vmrttlort apOICOM and are* report. Buyer is prequehlW for the NEW wWar ASSUMED foams
Indicated abovek it auym lefts to WmWe such tatter wlNmin that time. SMor may cermet Orb Agroement In wrftdM.
(2) For SELLER : WftM n s (or i7 __j ifte Poom aocepmnce: Ni Buyer rdetll sulatrdt tO Seam it mnpWAd Wan Whastim on
FNi►AAi M MC Unibrm Residentim) loan AppOcadOn. (b) Buyer arrNrOMM Getter WWW 9Mksts to oft. at BuYSeS erperrse. a Copy of
6ruy b orso report: and (a) Buyer shelf provide any mvportb+g dorxrtnantapen reaeom* mquadW by Soler Guar msy atncd Vis
Agrrremartt do v rgitrg M wyer biis to provide Larch ow"Oft to wiNrhr the► Orta!, o< If ft"m ftwms.- ire amort. as& repom or
suppormrg doajmeettedorm rrW tt a W C) --j j 'from soarer of thtrrse dommW te.
IL EX}SMG it.O MS.- 1FOr eadstfnp bens to be Mm over by Buyer, Gdm sW, wWn the *m mpectded M prrs&Wmh 15, OWO.d a to Ehiyw acows
of aii appkabis rwto and deeds of trust. tom+ baianoea, and ament irderest rates. Bumsink vert h ilm ttffl. W -1,011.r 2-
JUL-24-2003 09:45 PM
CERTIFICATE OF FIELI
Project tie
U��
Proje t Adare
guilo r Cont
14
HERS,Fater ern ./'
we
-ATI,ON AND DIAGNOSTIC
X043
r1rhying Signature Data
m: SC.SrOGi��S
Street AaoresS:
Copes to: Builder, HERS Provider
HERS RATER COMPLIANCES ATEM
Builder Name
Plan Number
P. 02
Ci; -4K
Pe ,� Sample Group Number
�
Sample House Number
HERS Provider: �G ��101.14%Cs
City/State/Zip: Z-0 19-4je ra cd
The House was: Tested ❑ Approved as part of sample testing, but was not tested
As the KERS rater.providing diagnostic testing and field verification, I certify that the houses identified on this form
coy with the diagnostic t -est , 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
�(of ducts)
A! where cloth backed, rubber adhesive duct tape is installed, mastic and drawbands are used In combination
Mtn cloth backed, rubber adhesive duct tape to seat leaks at duct connections.
A"*M'INIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT
Duct Diagnostic Leakage Testing Results (Makimum 6% Duct Leakage)
Measured
Duct Pressurization Test Results (CFM C 25 Pe) values
Test Leakage Flow In CFM
It fan flow is calculated as 400etmlton x number of tons enter
calculated value here
If fan flow is measured enter measured value here
Leakage Percentage (100 x Test Leakage/Fan Flow) = v
Check Box for Pass or Fail (Pass=6% or less) ❑
ass Fad
THERMOSTATIC EXPANSION VALVE (TXV) or Commission approved equivalent:
YJ Yes ❑ No Thermostatic Expansion Valve (or Commission approved
equivalent) is installed and Access is provided for Inspection ❑
Yes is a pass ass Fail
❑ MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT
. O Yes O No ACCA Manual D Design requirements have been met
(rater has verified that actual installation matches values in
CF• 1 R and design on plan.
0 Yes O No TXV is Installed or Fan flow has been verified. If no TXV, ell1)f
verified fan flow matches design from CF -1 R.
Measured Fan Flow
C C
Yes for both 1 and 2 Is a Pass Pass Fail