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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�