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0106-264 (SFD)H CV W W O =) M W r`'tr o Z to O o HC) —JUr2 U) Z CO LO N ON U °) CL Z CC LO 0 JJ mUU O rn H It Z r- d .Q J LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing 6ith 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 " .31�1f�f, Rde`Signature of Contractor �~' �" �•^�_;✓ "�'�' OWNER -BUILDER DEGLARATION I"" 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 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. (,.J -'11I 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 re:`Carrier Policy No. (This section need not be completed if the permit valuation is for $100.00 or less). ( ) 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 Pishould become subject to the workers' compensation provisions of'Sectiod 3700 of the Labor Code, I shall forthwith comply with thos pro aslons. ' J/ Date: tom� y f Applicant �,r- �•'.r` 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. r IMPORTANT Application is hereby made to the Director of Building and Safetyfr,,. 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 f 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 City, and State laws relating to ther building construction, and hereby authorize representatives of this City to enter, upon the aa6ove-mentioned property for inspection purpos`e"'. Signature (Owner/Agent) a"�+ -F+` _ Date. BUILDING PERMIT PERMIT# }` DATE VALUATION LOT 010&TRACT 1) sT 7.9`°47 •'i JOB SITE APN ADDRESS 511. -7W P1 ACX 01AW10M) 76141WOM OWNER CONTTRpACTOR / DyESPIhGNlER / EN IN»EER 3:O.d8beLnLR"!,`:�9...•A�.:1:6IY�,.�.1.'�1..�..`.�! 366 :[ : e iTL1x F'I; Il.92253L.�, +;;tii,MNVT�3, CA 922'x'3 (760)%A-48 32 rIML4 32:4? USE OF PERMIT Biel -. T :5� Yk.AN 7 4,a�'w! H RIYVISid' NS) PI<:YWIT MZ -3 NOT CUSTOM C{;.ACS TET.2: CTIO&•& 1.00 SF POR.0%It')r't9T10-- 1,053.00 Si (.%kA6.93P<GCAAP0 T krikbwu '.}t% tY RY II' �� ' � a�d ►T�� °d 6 �R u] .Y pS/4r '�vd RI CKNIISTRUCTION FU 101-000-418-000 $1d6L;a n 4711166 CH KIK i"1s19 101-000-439-3158 $t,353.89 UNI-HARIC.All f%X '101-000-421-000 9137,00 dClrt �"FIbCAI rNM 101-000.420a00D P14UMMICS D'F%c�{ 101 rt0(0.4 R 9-0iX) T233175 SA'I OHO MOTION FLIP, - RUSAD 101-000-241.000 ORADWO WK IM -000-42,34M, 7— ARTM PfiSOLi6::I: LAC3 - W: .M 701-000-255••0 $492 -SO �z vl�IIIARAL C, :C7MTC)N'A14FD 1?vM CHEZ :":K ^PATD 14W $6,099.10 $0,00 I. - — 6 2001 � a�Ta� �DUENOW (vs AUG. ��,��IQ r �..-- CITY OF•L:'l QUINTA f1w,ieCF CFP'f RECEIPT ' DATE . BY DATE NAL D 1i a2—' INSPfE O INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE TINSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Forms & Footings 3&5—:Ducts Slab Grade Q/ RCombustion A / Underground Ducts Ducts Return Air Steel Roof Deck �� _ _� f ' Air Exhaust Fans O.K. to Wrap Framing Insulation Fireplace P.L. /� / f �(fL� _ IJpn% F.A`U. Compressor Vents Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath a Final '%`J./o.� _ BLOCKWALL APPROVAL'S Final 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 8l ��Q Water Piping Gas Test Electric Final Heater Final Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Sewer Connection 7 �(,L �„ Pool Cover Encapsulation Gas Piping Gas Test Appliances 7pZ ow _ Final COMMENTS: 77b /��//��J � A / !V - 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 Final / Utility Notice (Perm) l/– {09-2002 P.02 Builder Name Plan Number ample Group Number Sample House Number - Firm: _� GSdGJG�%�S .+^ HERS Provider: _!G'�' ismGJ.v%G5 Street Address: Ul Owstate/Zip: aLdrJ 42 4txx-s 3 Copies to: Builder, HERS Provider HEN RATER r40M.PLIANCE STATEMENT The house was: 99 -Tested ❑ Approved as part of sample testing, but was not tested As the HERS rater providingdiagnostic testing and field verification, I certify that the houses identified on this form com ly with the diagnostic ested 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) Where cloth backed, rubber adhesive duct tape Is installed, mastic and drewbands 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 @ 26 Pa) 01�� values Test leakage Flow In CFM If fan Plow is calculated as 400cfmhon x number of tons enter calculated value here If fan now is measured enter measured value here Leakage Percentage (900 x Test Leakage/Fan Flow) _, �� •1O Check Box for Pass or Fail (Pass=6% or less) ❑ Pass Fail ! THERMOSTATIC EXPANSION VALVE (TXV) or Cammiseion approved equivalent A Yea ❑ No Thermostatic Expansion Valve (or Commission approved equivalent) Is Installed and Access Is provided for inspection Qr [] Yes Is a pass Pass Fal! MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT 1. ❑ Yes p No RCCA Manual D Oeslgn requirements have been met (rater has verified that actual Installation matches values in CF -I R and design on plan. 2. Q Yes 0 No TXV Is installed Fan flow has been or verified. If no TXV, verified fan flow matches design from CFAR. Measured Fan Flow = Yes for both 9 and 2 is a Pass Pass Fall JUL-9-2002 TUE 05:47AM ID: I,M09-2002 09:02 PM t OF �i�lle,.➢, �l1/lr �r1�� Builder Name Plan Number Sample Group Number Sample House Number Firm:eT Co j &, wl-47C-) HERB Provider: i3-A1.e&91-kAf1 Street Address: 7-a& 'g& '!5 ✓e;W City/State/Zlp: Zr 4PtJ n /fir �iZZ 5 Copies to; Builder, HERS Provider HERS -MTER COMPLIANCE STATEMENT The house was: Vested ❑ Approved as part of sample testing, but was not tested P-04 As the HERS rater providing diagnostic testing and field verification, 1 certify that the houses Identified on this form compty with the diagnostic tested 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 Ileu of ducts) PWhere 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 @ 25 Pa) Z values Test Leakage Flow in CFM If fan flow is calculated as 400cfmAon 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) �b Check Box for Pass or Fall (Pes"O% or less) - ❑ Pass Fall 12''THERMOSTATIC EXPANSION VALVE (TXV) or Commission approved equivalent 2"Yes ❑ No Thermostatic Expansion Valve (or Commission approved equivalent) is installed and Access is provided for inspection Yes is a pass CJ MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT 1. ❑ Yes ❑ No RCCA Manual D Design requirements have been met (rater has verified that actual installation matches values in CF -1 R and design on plan. 2. O Yes ❑ No JUL-9-2002 TUE 05:46AM ID: TXV is Installed or Fan flow has been verified. It no TXV, verified fan flow matches design from CF -1 R. Measured Fan Flow = Yes for both f and 2 is a Pass gr ❑ Pass Fail N/p ❑ ❑ Pass Fail PAGE:4 "~09-2002 09:03 PM Ij ti P.06 K Plan Number Sample Group Number Sample House Number Firm: -J L'_ tz a, 2 ,r HERS Provlder: 4 -TZ 4c tdLta, Street Address: b/ 10 14 u & city/State/Zip; ell* 49o9 Cry 47,;z -S Copies to: Builder, HERB Provider HESS RATgR COMQLIANCESTAVE ENT The house was: RrTestad ❑ Approved as part of sample testing, but was not tested As the HERS rater providingdiagnostic testing and field verification, i certify that the houses Identified on this form comply with the diagnostic ested compliance requirements as checked on this form. ZDistribution system Is fully'ducted (i.e., does not use building cavities'as plenums or platform returns In lieu educts) here 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. Jb MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT Duct Diagnostic Leakage Testing Results (Maximum 8% Duct Leakage) Measured Duct Pressurization Test Results (CFM 0 25 Pa) values ` Test Leakage Flow in CFM/ If fan flow is calculated as 400cfm1ton x number of tons enter calculated value here If fen flow is measured enter measured value here Leakage Percentage (100 x Test Leakage/Fan Flow) Check Box for Pass or Fail (Pass -6% or less) ❑ Pass Fail THERMOSTATIC EXPANSION VALVE (TXV) or Commission approved equivalent 2rYes ❑ No Thermostatic Expansion Valve (or Commission approved equivalent) is installed and Access is provided for inspection ❑ ❑ Yes is a pass - Pass Fail ❑ MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT 1. ❑ Yes ❑ No ACCA Manual D Design requirements have been met (rater has verified that actual installation matches values In CF -IR and design on plan. 2• D Yes Q No TXV is Installed or Fan flow has been verified, If no TXV, verified fan flow matches design from CF -1 R. Measured Fan Flow = ❑ ❑ Yes for both 1 and 2 is a Pass Pass Fail JUL-9-2002 TUE 05:49AM ID: PAGE:6 Coachella Valley Unified School District P.O. Box 847, Thermal, CA 92274 (760) 398-5909 — Fax (760) 398-1224 This Box For District Use Only CERTIFICATE OF COMPLIANCE (California Education Code 17620) Project Name: Date: August 6, 2001 Owner's Name: Wei skopf Partners Phone No. 771-1761 Project Address: 57-755 Black D:i±amond. PGA West. La Quinta, CA 92253 Project Description: Si ng] p Family Dwelling F\ 9►� Type of Development: Commercial Total Square Feet of Building Area: 4,731 Lot #'s: Industrial Certification of Applicant/Owners: The person signing certifies that the above information is correct and makes this statement under penalty of perjury and further represents that he/she is authorized to sign on behalfq the owner/developer. Dated: [C! Signature: ********************************** ********************************** SCHOOL DISTRICT'S REQUIREMENTS FOR THE ABOVE PROJECT HAVE BEEN OR WILL BE SATISFIED IN ACCORDANCE WITH ONE OF THE FOLLOWING: (CIRCLE ONE) Education Code Gov. Code 17620 65995 Project Agreement Existing Approval Prior to 1/1/87 Note: Number of Sq.Ft. 4,731 Amount per Sq.Ft. $ 3 34 Amount Collected $ 15-801.54 Building Permit Application Completed: Yes/No By: Foch "Tut" Pensis, Assistant Superintendent Administrative Services Administrator in Charge Certificate issued by: Marcel a Valdez Signature: Facilities Clerk Not Subject to Fee Requirement OTEST OF FEES AND' STATEMENT OF FEES Section 66020 of the Government Code asserted by Assembly Bill 3081, effective January 1, 1997, requires that this District proville'(1) a written notice to the project appellant, at the time of payment of school fees, mitigation payment or other exactions ("Fees"), of the 90 -day period to protest the imposition of these Fees and (2) the amount of the fees. Therefore, in accordance with section 66020 of the Government code and other applicable law, this Notice shall serve to advise you that the 90 -day protest period in regard to such Fees or the validity thereof, commences with the payment of the fees or performance of any other requirements as described in section 66020 of the Government code. Additionally, the amount of the fees imposed is as herein set forth, whether payable at this time or in whole or in part prior to issuance of a Certificate of Occupancy. As in the latter, the 90 days starts on the date hereof. This Certificate of Compliance is valid for thirty (30) days from the date of issuance. Extension will be granted only for good cause, as determined by the School District, and up to three (3) such extensions may be granted. At such time as this Certificate expires, if a building permit has not been issued for the project that is the subject of this Certificate, the owner will be reimbursed all fees that were paid to obtain this Certificate of Compliance. MV:c/mydocs/devfees/certificate of compliance 07/24/01 DEVELOPER FEES PAID AREA: AMOUNT: RCPT #: CK #: CASH: INITIALS: DATE: CERTIFICATE OF COMPLIANCE (California Education Code 17620) Project Name: Date: August 6, 2001 Owner's Name: Wei skopf Partners Phone No. 771-1761 Project Address: 57-755 Black D:i±amond. PGA West. La Quinta, CA 92253 Project Description: Si ng] p Family Dwelling F\ 9►� Type of Development: Commercial Total Square Feet of Building Area: 4,731 Lot #'s: Industrial Certification of Applicant/Owners: The person signing certifies that the above information is correct and makes this statement under penalty of perjury and further represents that he/she is authorized to sign on behalfq the owner/developer. Dated: [C! Signature: ********************************** ********************************** SCHOOL DISTRICT'S REQUIREMENTS FOR THE ABOVE PROJECT HAVE BEEN OR WILL BE SATISFIED IN ACCORDANCE WITH ONE OF THE FOLLOWING: (CIRCLE ONE) Education Code Gov. Code 17620 65995 Project Agreement Existing Approval Prior to 1/1/87 Note: Number of Sq.Ft. 4,731 Amount per Sq.Ft. $ 3 34 Amount Collected $ 15-801.54 Building Permit Application Completed: Yes/No By: Foch "Tut" Pensis, Assistant Superintendent Administrative Services Administrator in Charge Certificate issued by: Marcel a Valdez Signature: Facilities Clerk Not Subject to Fee Requirement OTEST OF FEES AND' STATEMENT OF FEES Section 66020 of the Government Code asserted by Assembly Bill 3081, effective January 1, 1997, requires that this District proville'(1) a written notice to the project appellant, at the time of payment of school fees, mitigation payment or other exactions ("Fees"), of the 90 -day period to protest the imposition of these Fees and (2) the amount of the fees. Therefore, in accordance with section 66020 of the Government code and other applicable law, this Notice shall serve to advise you that the 90 -day protest period in regard to such Fees or the validity thereof, commences with the payment of the fees or performance of any other requirements as described in section 66020 of the Government code. Additionally, the amount of the fees imposed is as herein set forth, whether payable at this time or in whole or in part prior to issuance of a Certificate of Occupancy. As in the latter, the 90 days starts on the date hereof. This Certificate of Compliance is valid for thirty (30) days from the date of issuance. Extension will be granted only for good cause, as determined by the School District, and up to three (3) such extensions may be granted. At such time as this Certificate expires, if a building permit has not been issued for the project that is the subject of this Certificate, the owner will be reimbursed all fees that were paid to obtain this Certificate of Compliance. MV:c/mydocs/devfees/certificate of compliance 07/24/01 6 ' uulcicv P.O. BOX 1504 Building 77 S,1� k /�f'<a L Address IUINTA78-495 CCALIFORNIA ALLE 92253 ' Owner _ maning Address�(Q� City - Zjp Cont F/a. ?n -A. :2&& City 9z ?5'3 -Zip Tel. T& aA 1 r �-' State Lic. City ' & Classif. '� Q Lic. 4a Arch., Engr., Designer Address Tel. 5"/ S 71W- Sillk- 5 City Zip State I- An-.- .1 ,-,J 47-7 i_ 9 i_ Lic. N -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 rile 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). (; 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 not intended or offered for sale. IL 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.) 1 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 Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractot(s) licensed pursuant to the Contractor's License Law.) 1'7 1 am exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company n Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) valuation or less.) I certify that in the performance of the work for which this permit is issued, 1 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 to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY Ihereby affirm that there is a construction lending agency for the performance of the work for 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 a0plicant Date Mailing Address City, State, Zip U APPLICATION ONLY BUILDING: TYPE'CONST. OCC. GRP. A.P. Number gCa-inn iU l!J Legal Description,Lo!— 2 - -72a, 7- %9fI47- Project Description .51AJ4LF_ EE5 taEldey /�Dafl�•s�, : �'1. 7S� /�/ aiir[ f).e�.t.�,I r'7 -71Z �-tprA,; e Sq. Ft. �// No. No. Dw. Size 7 7 3 l�f 5 Stories l Units New [d- Add ❑ Alter ❑ Repair ❑ Demolition ❑ itimated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. r 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 FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validation: WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION Certificate of Occupancy City of La Quinta Building and Safety Department This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code, certifying that, at the time of issuance, this structure was in compliance with the various ordinances of the City regulating building construction or use. For the following: r BUILDING ADDRESS: Use Classification: Occupancy Group: SINGLE FAMILY DWELLING 57-755 BLACK DIAMOND R-3 Type of Construction: VN Owner of Building: WEISKOPF PARTNERS, LLC Building Official Bldg. Permit No.: 0106-264 Land Use Zone: RL Address: 55-161 SOUTHERNHILLS City: LA QUINTA, CA., .92253 By: DANIEL P. CRAWFORD JR. Date: 7/11/02 POST IN A CONSPICUOUS PLACE