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04-8364 (SFD).11 r. C&lf BUILDING & SAFETY DEPARTMENT i BOX 1504 (760).777-7012 D �oO95 CALLE TAMPICO C ' J FAX (760) 777-7011 A QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 CITY OF LA QUINTA FINANCE DEPT. BUILDING PERMIT Application° Number 04-00008364 Date 4/05/05 Property Address . . . . 54140 WEST RESIDENCE CLUB DR APN: 175-380-999-6 -31627 - Application description DWELLING - SINGLE FAMILY DETACHED Property Zoning . . . . . . . MEDIUM DENSITY RES Application valuation 287914 Owner Contractor ------------------------ NADADOR, LLC ------------------------ JACOBS HOMES INC, PETER 78120 CALLE ESTADO, SUITE 203 P.O. BOX 692 LA QUINTA CA 92253 LA QUINTA CA 92247 (760) 777 -9921 - WCC: HRH INSUR WC: 176983304 06/01/05 CSLB: 799449 04/30/05 CCC: B -------------------------- Structure Information -------------------------- 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 3.00 FIRE SPRINKLERS NO GARAGE SQ FTG 531.00 PATIO SQ FTG 422."0'0 NUMBER OF UNITS 1.00 1ST FLOOR SQUARE FOOTAGE 3365.00 ---------------------------7--------------------7--------------------------- Permit . . . . . . BUILDING PERMIT Additional desc Permit Fee . . . . 1297.50 Plan Check Fee. 843.38 Issue Date Valuation . . . 287914 Qty Unit Charge .Per Extension BASE FEE 639.50 188.00 3.5000 THOU BLDG 100,001-500,000, .. 658.00 - --------------------------------------------- Permit . . . . . . ------------------------------- MECHANICAL Additional desc Permit Fee . . . . 171.50 Plan Check. Fee 42.88 Issue Date Valuation 0 Qty Unit Charge Per Extension BASE FEE 15.00 4.00 9.0000 EA MECH FURNACE <=100K 36.00 4.00 9.0000 EA MECH B/C <=3HP/100K BTU 36.00 12.00 6.5000 EA MECH VENT FAN 78.00 P.O. BOX 1504 VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: O - 00 Date: 41 Z( OS Applicant: Architect or Engineer: Applicant's Mailing Address: Architect or Engineer's Address: A ic. 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 Cod , and my License is u11 force and effect. G 1 ense Class -e5'nse No. OAC -063 OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Conlractors' State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit 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 for a 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 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. 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 is� e`��r My workers' compensation insur ce carrier and otic number are: arrier 4T I; 055. A, --c � Number I�(� 9- 5 z ` _ I certify that, in the performance of the work for which this permit is issued, I shaft not employany 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 ZIf cant f7 �� ai,.9g� 1 V -./C 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 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 AP'PLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety fora 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 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 ree to comply with all city and county ordinances and state laws relating to building construction and hereby authorize representatives of this county to enter y0on the o entioned property for inspection purposes. ate �� �/ Si (Applicant or Agent): Application Number . . 04-00008364 Page 2 Date 4/05/05 Qty Unit Charge Per Extension 1.00 6.5000 EA MECH EXHAUST HOOD 6.50 ---------------------------------------------------------------------------- Permit . . . . . . ELEC-NEW RESIDENTIAL Additional desc Permit Fee . . . . 145.60 Plan Check Fee 36.40 Issue Date . . . . Valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 3365.00 .0350 ELEC NEW RES - 1' OR 2 FAMILY 117.78 641.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL 12.82 -=--------------------------------------------------------------------------- Permit PLUMBING Additional desc Permit Fee 185.25 Plan Check Fee 46.31 Issue Date Valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE -115..0.0 18.00 6.0000 EA PLB FIXTURE 108.00 1.00 15.0000 EA PLB BUILDING SEWER 15.00 2.00 7.5000 EA PLB WATER-HEATER/VENT 15.00 1.00 3.0000 EA PLB WATER INST/ALT/REP 3.00 1.00 9.0000 EA PLB LAWN SPRINKLER SYSTEM 9.00 7.00 .7500 EA PLB GAS PIPE >=5 5.25 1.00 15.0000 EA PLB GAS METER 15.00 ---------------------------------------------------------------------------- Permit. . . . . . . GRADING PERMIT Additional desc Permit Fee . . . . 15'.00 Plan Check Fee .00 Issue Date Valuation 0 Qty Unit Charge Per Extension BASE FEE 15.00 ----------------------------------------------------------------------------- Special Notes and Comments SFD - LOT 2, PLAN AR. PERMIT DOES NOT INCLUDE .POOL, SPA, BLOCK WALLS, OR DRIVEWAY APPROACH. ---------------------------------- ---------- Other Fees . . ... . -------------------------------- . . . . ART IN PUBLIC PLACES -RES 222.74 DIF COMMUNITY CENTERS -RES 97.00 DIF CIVIC CENTER - RES 366.00 ENERGY REVIEW FEE" 84.34 M 0 U n Page 3 Application Number . . . . . 04-00008364 Date 4/05/05 ------------------------ Other Fees. . . . . ----------- . . . . . -------------------- DIF FIRE PROTECTION ------- -RES -------------- 97.00 GRADING PLAN CHECK FEE .00 DIF LIBRARIES - RES 225.00 DIF PARK MAINT FAC - RES 5.00 DIF PARKS/REC - RES 502.00 STRONG MOTION (SMI) - RES 28.90 DIF STREEt MAINT FAC -RES 15.00 DIF TRANSPORTATION - RES" 1098.00 Feb summary ----------------- Charged Paid Credited Due Permit Fee Total. --------'-- 1814.85 -------------------- .00 ---------- .00 1814.85 Plan'Check Total 968.97 .00 .00 968.97 Other Fee Total 2740.98 .00 .00 2740.98 Grand.•Total 5524.80 .00 00 5524.80 0 U n T ' Certificate of Occupancy 0 G OF Building Y p & Safety Department This Certificate is issued pursuant to the requirements of Section 109 of the California Building Code, certifying that, at the time of issuance, this structure was in compliance with the provisions of the Building Code and the various ordinances of the City regulating building construction and/or use. BUILDING ADDRESS: 54-140 WEST RESIDENCE CLUB DRIVE Use classification: SINGLE FAMILY DWELLING Building Permit No.: 04-8364 Occupancy Group: R3 Type of Construction: V -N Land Use Zone: RM Owner of Building: NADADOR, LLC Address: 78-120 CALLE ESTADO, STE. 203 City, ST, ZIP: LA QUINTA, CA 92253 By: GARY HARTMAN Date: MARCH 29, 2006 Building Official . POST IN A CONSPICUOUS PLACE r CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING/(Page 1 of 7) CF41R Project Title b / p / Date / r�� f�/D %it/. /�,P fi �P L v G �1J b �� / � zge-" z Gt1 f Project Address Builder Name Builder Contact/ ++ Telephone ,/V11 e /ie� 4hll,016�J HERS Rater Telephone 3�z2/ate Certifying Signature 6ate Firm: Street Address: Copies to: Builder, HERS Provider Plan Number s Sample Group Number 7 Sample House Numbers HERS Provider: City/State/Zip: HERS RATER COMPLIANCE STATEMENT The house was: ❑ Tesed Approved as part of sample testing, but was not tested As the HERS rater providing gnostic testing and field verification. I certify that the houses identified on this form comply with the diagnostic tested compliance requirements as checked on this form. The installer has provided a copy of CF -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 @ 25 Pa) values Test Leakage Flow in CFM If fan flow is calculated as 400cfin/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) _ ' f'1, Y n F n' c •f rn ini Pa§s Fail THERMOSTATIC EXPANSION VALVE (TXV) 0 Yes ❑ No Thermostatic Expansion Valve 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 -1R and design on plan. 2•❑Yes ❑ No TXV is installed or. Fan flow has been verified. If no TXV, verified fan flow matches design from CF -IR yMeasured Fan Flow ' ❑ ❑ Yes for both -1 and 2 is a Pass Pass Fail Compliance Forms - August 2001 A-16