04-7186 (SFD)Tdf
P.O. Box 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING PERMIT
BUILDING & SAFETY DEPARTMENT
(160).777-1012
FAX (760) 777-7011
INSPECTION REQUESTS (760) 777-7153
Application Number . . . . 40-0007 81 6 Date 11/17/04
Property Address . . . . . . -54200 WEST RESIDENCE CLUB DR
APN: 775-380-999-5 -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 "2P.O. BOX 692.
LA QUINTA CA '92253�..�'� LA QUINTA CA. 92247
�'- (760) 777-9921
WCC: EXEMPT
WC: EXEMPT 04/30/05
CSLB: 799449 04/30/05
CCC: B
-------------------------�S-tructure Information -----------=-------------
Construction Type . . . . TYPE V - NON RATED
Occupancy Type . . . . . . DWELLG/LODGING/CONG <=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 422.00
NUMBER OF UNITS 1.00
FIRST FLOOR SQ FTG 3365.00
---------------------------------------7------------------------------------
Permit . . . . . . BUILDING PERMIT
Additional desc
Permit Fee . . 1297.50 Plan Check Fee 210.85
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
PermitFee . . . 171.50 Plan Check Fee 10.72
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 CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: _ o q — 7 i ho Date:
Applicant:
Applicant's Mailing Address:
Archlt�ct oy Engineer- A��/i
.—Architect or Engineer's dr
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
C and my License is in full force and effect.
icense Class ti -cense No -22
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 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 wish 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.
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
ssu d. workers' compensatio2jvurance car ier and clicy number are:
arrier (�¢' /policy Number / �y, !� % 7 ZA4
I certify that, in th performance of the work for which t itis permit is istued, 1 `9hhall rfot 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.
ate
/
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.).
Lenders 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, end the applicant, each agrees to, and shall, defend, indemnify and hold harmless the City of La Ouinta, its
officers, agents and employees for any act or om,ssion 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 ' 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 n e above- entioned property for inspection purposes.
Date IMfig`onature (Applicant or Agent): �--'
Application Number . . . . . 04-00007186.
Page 2
Date 11/17/04
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
9.10
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
11.58
Issue Date .
. . .
Valuation . . . .
0
Qty Unit
Charge
Per
Extension
BASE FEE.
15.00
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 4, PLAN
BR.
PERMIT DOES NOT
INCLUDE POOL,
SPA, BLOCK
WALLS, OR
DRIVEWAY -APPROACH. 75%
REDUCTION TO
PLAN CHECK -FEE
DUE TO
MULTIPLE ISSUANCE
OF SAME PLAN TYPE
Other Fees .
. .
. . . . ART IN PUBLIC PLACES -RES
222.74
DIF COMMUNITY CENTERS -RES
97.00
Page 3
Application Number
. .
04-00007186 Date
11/17/04
----------------------------------------------------------------------------'
Other Fees . . . .
. . . . .
DIF CIVIC CENTER - RES
366.00
ENERGY REVIEW FEE
21.09
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-
098.00Fee
Feesummary
-----------------
Charged
Paid Credited
Due
Permit Fee Total
----------
1814:85
--------------------,----------
.00 .00
1814.85
Plan Check Total
242.25
.00 .00
242.25
Other Fee Total,
2677.73
.00 .00
2677.73
Grand Total
4734.83
.00 .00
4734.83
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page 1 of 7) CF4R
Project Title Date7—
Project Address Builder Name
Builder Contact Telephone
Plan Number /
Firm:
Street Address:.= 9P3
Copies to: Builder, HERS Provider ..
Sample Group Number
Sample House Number
HERS Provider:
City/State/Zip:
HERS RATER COMPLIANCE STATEMENT
The house was: ❑ Tested Approved as part of sample testing, but was not tested
As the HERS rater providing diagnostic 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 -611 (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)
Duct Pressurization Test Results (CFM @ 25 Pa) Measured
values
l 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) _
Gk -RAX . for PA AS or. Fail (Pass -656 or less)
❑ THERMOSTATIC EXPANSION VALVE (TXV).
09 0�
Pas Fail
❑ Yes ❑ No Thermostatic Expansion Valve is installed and Access is
provided for inspection
0
Yes is a pass
❑ MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT
Passim Fail
1' ❑ Yes 0 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 ❑ Yes ❑ No TXV is installed or.Fan flow has been verified. If no TXV,
verified fan flow matches design from CF -IR.
t`. Measured Fan Flow =
❑ ❑
Yes. for both -.1 and 2 is a Pass
Pass Fail
Compliance Forms August 2001
A-16
J"ql
Certificate,,of Occupanc y
s 4QUM&
�i j L a•�,e,ro 4
OF IBuilding & 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: 54-200 WEST RESIDENCE CLUB DR.
Use classification: SFD Building Permit No.: 04-7186
Occupancy Group: R3 Type of Construction: VN Land Use Zone: RM
Owner of Building: NADADOR LLC Address: 78-120 CALLE ESTADO #203
City, ST, ZIP: LA QUINTA, CA 92253
By: GARY HARTMAN
_
Date: January 25, 2006
Building Official
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