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04-6325 (RER)T4hf 4 4 a" BUILDING & SAFETY DEPARTMENT P.O. BOX 1504 (760).777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT /Application Number . . . . . 04-00'006325 Date 9/16/04 Property Address . . . . . . 57690 BLACK DIAMOND APN: 762-380-024- - - Application description . . . REMODEL - RESIDENTIAL Property Zoning . . . . . . . LOW DENSITY RESIDENTIAL Application valuation . . . . 500 Owner Contractor ---------------------`_4 f` `_-----.---1-----------^--- BILL TESSER \� AMERICAN QUALITY PLUMBING; INC GA -03-0-65 SANTA BARBARA CA 93103 (310) 456-7220 WCC: STATE FUND SEP 1/05 CSLB: 81870038438 04/300/05 CITY OF LAQuiNTA CCC: B-C36 "=.G'_T=--_------------------------------------- ----------------------------�=➢ G -J Permit .. . . . . . ELECT -'ADD/ALT/REM Additional desc . . Permit Fee 15.00 Plan Check Fee 3.75 Issue Date Valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 ---------------------------------------------------------------------------- Permit . . . . PLUMBING Additional desc . . Permit Fee . . . . 18.00 Plan Check Fee 4.50 Issue Date . . . . Valuation . . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 3.0000 EA PLB.GAS PIPE 1-4 OUTLETS 3.00 -------------------------------------------------------------------------- Special Notes and Comments GAS LINE AND ELECTRICAL LINE FOR FUTURE APPROVED BBQ Fee summary Charged Paid Credited ---------- Due ----------------------------------------------- Permit Fee Total 33.00 .00 .00 33.00 Plan Check Total 8.25 .00 .00 8.25 Grand Total .41.25 .00 .00 41.25 P.O. Box 1504�� VOICE (760) 777-7012 T-Vf 78-495 CALLS TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: ZS_ Date: �6 Applicant: 601,- Architect or Engineer: Applicant's Mailing Address: Architect or Engineer's Address: Lic. No.: BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S 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. �� O License Class C License No. r Date O Contractor t u!(p�t[if1 OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a pennit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file 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 the alleged exemption. Any violation of Section 7031.5 by any applicant fora permit subjects the applicant to a civil 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 structure is not intended or offered for sale (Sec. 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 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 improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not 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 (Sec. 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 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. 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 s d. orke compensation insurance carrier andpolio-y nu ayq,. Carrier � ,� Policy Number 2i2. 0172 !S _ 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 the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date Applicant 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 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name Lender's Address APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit 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 the 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 pen -nit, or cessation of work for 180 days will subject permit to cancellation. 1 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 county to enter upon the above-mentioned property for inspection purposes. Date Signature (Applicant or Agent): �llL� a Application Number . . . . . 04-00006325 Page 2 Date 9/16/04 TJ& kite, F� - T�=7--owm©Y) (i L4,l -- DC7 ,. V's � a TJ& kite, 5�-G 90 KJ IA(MI00 D Desen- - ENERGY -- Za°Et~ seances P0. Box 629 Rancho Mirage. CA 92270 Email: At(rown62370aat.corn Ph/Fax [760) 564-2000 Cell: (760) OWPOOM 250 -165% • CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7) CF -411 Pas-nh Rig Ph ---3- m:R� =--,�I � 5 03 ��hh�aolo�ti�1{�. Builder Na a lan�r qA "Lie* Sample Group Number "-t-* 7 q Firm:F161EIT Y 6efm exs Street Address: Po • F6V. 62-1 Copies to: Builder, HERS Provider ample "Ouse Number HERS Provider:-t�°��-�.5. City/State/Zip: g49Q'ttj1t.A4E A5227o HERS RATER COMPLIANCE STATEMENT The house was: E-1tET Tested Approved as part of sample testing, but was not tested As the HERS rater providing dialgnostic testing and field verification, I certify that the houses identified on this form complN with the diagnostic tested compliance requirements as checked on this form. ❑ The installer has provided a copy ofCF-6R (Installation Certificate. ❑ Distribution system is fully ducted (i.e., does not use building cavities as plenums or platform returns in lieu of ducts) ❑ Where cloth backed, rubber adhesive duct tape is installed, mastic and drawbands are used in combination with cloth backed. rubber adhesive duct tape to seal leaks at duct connections. ❑ MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage) Measured Duct Pressurization Test Results (CFM Q 25 Pa) values Test Leakage Flow in CFM If fan flow is calculated as 400cfm/ton 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) = Check Box for Pass or Fail (Pass=60/o or less) ❑ ❑ Pass t=ail ❑ THERMOSTATIC EXPANSION VALVE (TXV) • ❑ Yes ❑ No Thermostatic Expansion Valve is installed and Access is ❑ ❑ 10 provided for inspection Yes is a pass Pass Fail