04-6216 (AR)BUILDING & SAFETY DEPARTMENT
P.O. Box 1504.
9 78-495 CA (760) 777-.7012
OF LLE TAMPIC.O FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS. (760).777-7153
BUILDING PERMIT
.Application Number . . 04-00006216 Date: 10/13/04
Property Address 57620 BLACK DIAMOND
APN': 762-380-028-
�u
Application desctipt.ion ADDITION . - RESIDENTiIAL j�pj'11'li'
Property Zoning LOW DENSITY RESIDE IAL
Applic
�uation .valuation 20000
a
-Owner Cont ractor
CHUCK &:SALLY SILVA PAGE CONSTRUCTION
57=620. BLACK DIAMOND ,7782.0 MOUNTAIN VIEW AVENUE
LA QUINTA;-C.A. 92253.: PALM DESERT, CA .92211 ,
(760) 345-1936.. .
WCC: VIRGINIA
WC: 00500.018077 '0]�O1/05.
CSLB: 716.999 :06/30:./:06
CCC: B
P.O. Box 1504 VOICE -(7-60)777=701"2
79-495 CALLS TAMPICo FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 4 INSPECTIONS (76.0)'777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: 6% 1p 2 % Date: /0- Y
Applicant: Architect or Engineer:'
Applicant's Mailing Address: Architect or Engineer's Address:
.0 4Kff
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
1 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
ode and my License is in full force and effect
/License Class
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors`, State License Law for the following reason (Sea 7031.5, Business and Professions Code; Any
city or county that requires a permit to constrict, alter, improve, demolish, or repair any stnxture,'prlor to its issuance, also requires the applicant for the permit to fife a signed
statement that he or she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business
and Professions Code) or -that he or she Is exempt therefrom and the basis for.#* alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects
the applicant. to a civ? penalty of not more than five hundred dollars ($500).):
U i. as owner of the property, or my employees with wages as their sole compensation. will do the work, and the Wucluure is not intended or offered for sale (Sea 7044,
Business and Professions Code: The Contractors' State License law does not apply to an owner of property who builds or Improves thereom and who does the work
himself or herself or through his or her own employees, provided that the improvements are not intended or offered for sale. If, however. the building or irmprovement Is
sold within one year of completion, the owner -builder wig, have the burden of proving that he or she did riot build or Improve for the purpose of sale.).
U I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sea 7044, Business and Professions Code: The Contractors'
State. License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to
the Contractors' State License Law.).
U I am exempt under Sec. BA P.C. for this reason
Date Owner
WORKERS' 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. .
,1 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
. �vw�kers' compensati�y urance carrier and potty r are:
trier _s 7W te1 � /Policy Number O(� kD% `% .
_ I certify:fhat, 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 Cafrfomia; and agree that, If I should become subject to the workers': compensation provisions of Section 3700 of the Labor Code. l shad
• forts Mth comply with those provisions.
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the,perfommance of the work for which this permit is issued (Sec. 3097, Civ. C.). .
Lenders Name
Lenders Address
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a pernit subject to the conditions and restrictions set forth on this 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 application, the owner, and the applicant, each agrees to, and shall, defend, indemnify and hold harmless ft City of La Quinta, its
officers, agents and employees for any act or omission related to the work being performed under or following Issuance of this permit
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 1 have read this application and state that the above information is conecr`iea_r'd'9 to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorizere ntatives of this county to enter above -m' tioned property for inspection purposes.
Date 10/1 zfci Signature (Applicant or Agent):
----------------------------------------------------------------------------
Y Application Number .
----------------------------------------------------------------------------
. . . . 04-00006216
------ Structure Information
150 SQ. FT. REM / ADD
-----
Construction Type . .
. . . TYPE V - NON RATED
Occupancy Type . . .
. . . DWELLG/LODGING/LONG <=10
Flood Zone . . ... .
. . . NON -AO FLOOD ZONE
Other struct info . .
. . . CODE EDITION 2001
CBC
# BEDROOMS
1.00
FLOOD ZONE NO
-------------------=---------
FIRST FLOOR SQ FTG
=----------------------------------------------
150.00
Permit . . . . . .
BUILDING PERMIT
Additional desc
Permit Fee . . . .
207.00 Plan Check Fee
134.55
Issue Date . . . .
Valuation . . . .
20000
Expiration Date . .
4/13/05
Qty Unit Charge
Per
Extension
BASE FEE
45.00
18.00 9.0000
----------------------------------------------------------------------------
THOU BLDG 2,001-25,000
162.00
Permit . . . . . .
ELECT - ADD/ALT/REM
Additional desc . .
Permit Fee . . . .
20.25 .Plan Check Fee
5.06
Issue Date . . . .
Valuation . . . .
0
Expiration Date
4/13/05
Qty Unit Charge
Per
Extension
BASE FEE
15.00
150.00 .0350
----------------------------------------------------------------------------
ELEC NEW RES - 1 OR 2 FAMILY
5.25
Permit
MECHANICAL
Additional desc . .
Permit Fee . . . .
24.00 Plan Check Fee
6.00
Issue Date . . . .
Valuation . . . .
0
Expiration Date . .
4/13/05
Qty . Unit Charge
Per.
Extension
BASE FEE
15.00
1.00 9.0000
EA MECH APPL REP/ALT/ADD
9.00
----------------------------------------------------------------------------
Special Notes and Comments
150 SQ. FT. ADDITION
OFFICE. THIS PERMIT
DOES NOT INCLUDE POOL
& SPA , BLOCK
WALKS OR DRIVEWAY APPROACH.
10/13/04 8:
50:38 AM JJOHNSON
----------------------------------------------------------------------------
Other Fees . . . . .
. . . . ENERGY REVIEW FEE
13.46
STRONG MOTION (SMI) - RES
2.00
Fee summary Charged Paid Credited Due
---------------------------------------------------------
Permit Fee Total 251.25 .00 .00 251.25
Plan Check Total 145.61 .00 .00 145.61
------------------------------------------------7---------------------------
Application Number . . . . 04-00006216
----------------------------------------------------------------------------
Other Fee Total 15.46 .00 .00 15.46
Grand Total 412.32 .00 .00 412.32
P.O. Box 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING PERMIT
Application.Number. . . .
Property Address . . . .
APN:
Application description
Property Zoning . . . . .
Application valuation
Owner
------------------------
CHUCK & SALLY SILVA
57-620 BLACK DIAMOND
LA QUINTA CA 92253
BUILDING & SAFETY DEPARTMENT
(760).777-7012
FAX (760) 777-7011
INSPECTION REQUESTS (760) 777-7153
04-00006216 Date 10/19/04
57620 BLACK DIAMOND.
762-380-028- - -
ADDITION - RESIDENTIAL
LOW DENSITY RESIDENTIAL
20000
Contractor
PAGE GEN CONTR INC., DAVID L.
2210 N. MILBEN CIR
PALM SPRINGS CA 92262
(760) 323-1597
WCC: STATE FUND
WC: 0460011619 04/01/05
CSLB: 767129 08/31/05
CCC: B
------ Structure Information 150 SQ. FT. REM / ADD -----
Construction Type . . . . TYPE V - NON RATED
Occupancy.Type . . . DWELLG/LODGING/CONE <=10
Flood Zone . . . . . . NON -AO FLOOD ZONE
Other st.ruct info . . . . . CODE EDITION 2001 CBC
# BEDROOMS 1.00
FLOOD. ZONE NO
FIRST FLOOR SQ FTG 150.00
---------------------------- --------------------------------------------
Permit . . BUILDING: PERMIT
Additional desc
Permit Fee 207.00 Plan Check Fee 134.55
Issue Date 10/14/04 Valuation . . . . 23540
Expiration.Date 4/13/05
Qty Unit Charge Per Extension
BASE FEE 45.00
18.00 9.0000 THOU BLDG 2,001-25,000 162.00
---------------=------------------------------------------------------------
Permit . . . . ELECT - ADD/ALT/REM
Additional desc
Permit Fee. 20.25 Plan Check Fee 5.06
Issue Date . . . . 10/14/04 Valuation . . . . 0
Expiration Date.. . 4/13/05
Qty mUnit Charge Per Extension
BASE FEE 15.00
150.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY 5.25
------------------------------------------------=---------------------------
Permit . . . . . . MECHANICAL
Page
2
Application Number .
. . . . 04-00006216
Date
'10/19/04
Additional desc
Permit Fee . . . .
24.00 Plan Check
Fee
6.00
Issue Date . . . .
10/14/04 Valuation
. . . .
0
Expiration Date
4/13/05
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 9.0000
EA MECH APPL REP/ALT/ADD
9.00
----------------------------------------------------------------_------------
Special Notes and Comments
150 SQ. FT. ADDITION
OFFICE. THIS PERMIT ,
DOES NOT INCLUDE POOL
& SPA , BLOCK
WALKS OR DRIVEWAY APPROACH. 10/13/04)8:.
50:38 AM JJOHNSON
-------------------=--------------------------------------------------------
Other Fees .. ... . .
. . . . ENERGY REVIEW FEE
13.46
STRONG MOTION (SMI)
- RES.
2.00
Fee summary Charged
Paid Credited
Due
---------------------------
Permit Fee Total
--------------------
251.25 251.25
----------
.00
.00
Plan Check Total
145.61 145.61
.00
.00
Other Fee Total
15.46 15.46
.00
.00
Grand Total
412.32 412.32
.00
.00
r CERTIFICATE OF COMPLL4NCE: RESIDENTIAL (Page 1 of 3) CF -IR
FroJect Title
Pro ect Address
. i +Qpr
Documentation Author Telephone
Compliance Method (Package or Computer) Climate Zone
_CITY OF LA QUIRTA
T
C
B
(t
ft2
Date a
Building Permit #
Plan Check! Date
Feld Check / Date
tnlorccmcnt Agcncy Use Unly
Average Ceiling Height: I{Z ft
_ Addition
Existing -Plus -Addition
East / West / All Orientations
tation in degrees from True Narth and circle one)
Number of Stones ,
Number of Dwelling Units:
Floor Construction Type:Slab ' 'sed Floor (circle one or both)
RADIANT BARRIER freguired in climate zones 2.4.8-15)
BUILDING ENVELOPE INSULATION
Requited for this submittal X yes _no
Component Frame Type Cavity Sheathing Total R- Assembly Location/Comments
Type wd = wood Insulation Insulation Value' U -Factor' (attic, garage, typical, etc.)
st1= steel R -Value R -Value
Wall
Wall
Roof Lill.
-
'Roof
Floor
Floor
Slab Edge
' For prescriptive compliance Total R -Value and Assembly U -Factor are not regutred for a wood-tramed wall mat meets cavity x -value
insulation requirements for the Prescriptive Packatte. r
FENESTRATION
Shading Devices
Compliance Forms
August 2001
A-2
CERTIFICATE OF COMPLIANCE: RESIDENTIAL (.Page 2 of 3) CF -IR
Date
Project Title
HVAC SYSTEMS
Note: Input hydronic or combined hydronic
data under Water Heating Systems, except Design Heating Load.
Distribution
Heating Equipment
Minimum
Type and
Duct or
Heat Pump
Type Uumacc, heat
Efficiency
Location
Piping Thermostat
Configuration
Dump etc.)'
fAFUH or HSPF) (ducts attic. etc)
R -Value Tvpe
(split or packaec)
X lsTl
NG, �rC�1V1PMy—,kAl
11"at� ®
Cooling Equipment
Duct Thermostat
Heat Pump
Configuration
Minimum
Efficiency
Duct
Location
Type (air conditions,
(SEER)
(attic. cta)
R -Value Type.
(split orpackaec)
heat pump evap cooling)
SEALED DUCTS and TXVs (or Alternative Measures)
❑ 'Sealed Ducts (all climate zoom)
(Installer testing and ccriification and HERS rater field vedtcation required)
TXVs, readily accessible (climate zoncs 2 and 9-15 only)
(Installer testing and certification and HERS Rata or field verification rsgaacd)
❑ Refrigerant Charge/Air Flow (climate zones 2 and 9-15 only)
(Instatlra testing and certification and HERS Rata or field verification requircA
OR
❑ Alternative to Sealed Ducts and TXVs (see Package C' or D Alternative Package Features for Project Climate Zone)
Climate Zone Window SHGC Window U -Factor SEER Heating
Water Heater Distribution
WATER HEATING SYSTEMS
Energy'
Rated' Tank Factor or
Number Input (kw Capacity Recovery Standby'
in Svstem orBaultr) (Rations) Efftcieney Loss (%)
Exiernal
Tank
Insulation
R- Value
1. For small gas storage water heaters (rated inputs of less than or equal to 75,000 Ba/hr), electric—istance, and heat pump water heaters, list Encrgy
Factor. For large gas storage water heatem (rated input of greater than 75AW BW/hr), list Rated Irtgnt, Recovery Efficiency and StandbyLoss.
For instantaneous ga.+ water heaters, list rated input and recovery efficiencies•
SPECIAL FEATURES (add extra sheets if necessary). Package C and D: TXVs, Sealed Ducts, Radiant
Barriers (see installation requirements for radiant [tamers in. Section S.13 of the 2001Residential Manual).
Package C: thermal mass (thermal mass type, covering, thickness, and description).
Compliance Forms August 2001 A-3
_t
CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 3 of 3) CF -IR
'G I LV 1"NC7� tom- , . /�1+ . • - 1 cow— z 4
IZ" - Date
Project Title
COMPLIANCE STATEMENT
This certificate of compliance lists the building features and performance specifications needed toi comply with
Title 24, Parts 1 and 6 of the California Code of Regulations, and the administrative regulations to implement
them_ This certificate has been signed by the individual with overall, design responsibility. When this certificate
of compliance is submitted for a single building plan to be built in multiple orientations, any shading feature drat
is varied is indicated in the Special Features/Remarks section. The undersigned reeczgniz� that compliance using
duct sealing and TXVs requires installer testing and certification and field verification by an approved HERS
rater.
Designer or Owner (per Business and Professions Code) Documentation Author
Name:
TitlelFirm:
Address
Telephone:
Lic. #:
(signau=)
Enforcement Agency
Name:
Tide:
Agency:
Telephone:
(signamno / stamp) (datc)
Compliance Forms
August 2001
k
A-1
/-,A/AJ A CIC, 06 6 - z i)o -
S4 (7�