04-7185 (SFD)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number . .
Property Address . . .
APN:
Application description
Property Zoning . . . .
Application valuation .
BUILDING PERMIT
BUILDING & SAFETY DEPARTMENT
(760).777-7012
4 FAX (760) 777-7011
INSPECTION REQUESTS (760) 777-7153
0�4--0=0=0=0 7--1--8 5 Date 11/17/04
542-6-0 WEST RESIDENCE CLUB DR
775-380-999-4 -31627 -
. . . DWELLING - SINGLE FAMILY DETACHED
. . . MEDIUM DENSITY RES
. . . 287914
Owner
Contractor.
------------------------ ------------------------
NADADOR, LLC JACOBS HOMES INC,
PETER
78120 CALLE ESTADO, SUITE 203 P.O. BOX 692
LA QUINTA
CA 9225_3 LA QUINTA
CA 92247
(760) 777-9921
��a
J� _ - `;' iN WCC. EXEMPT
WC: EXEMPT
04/30/05
CSLB: 799449
04/30JOS
CCC: B
------------------------
-rS'f-ru "t re -Information -------------------------
Construction Type C `-\° c'J-: " TY -PE � 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
422.00
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
Permit Fee
171.50 Plan Check Fee
10.72
Ts -sue 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 4 4 a -
INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: 0q- 1 gS Date: o;7 -
Applicant: _ArliteCtAp EnnInee :
Applicant's Mailing Address: Architect or Engineer's dress:
4 -tic. 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
de, and ss Liceis is in full force and effect. ;W "dy
License Class / ( icense No.
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 1, 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.
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
ste�teed. �►Y worl tM compensation insurance camera ,d policy number e:
�rier 6 71 Y� /��s�5,/���cy Number 9//_ �i &4
_ I certify that, in the perfo anmi ce of the work for which this pe it is is�su'ed, 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 provision
WARNING: FAILURE TO SECUREWORKERS' 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
Lenders Address N 1A
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 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 info rmati is correct. I ag to comply with all city and county ordinances and state laws relating to building
construc/tion, and hereby authorize representatives of this county to ent p th�e`aiboovvvee- tioned property for inspection purposes.
ate < �� �C� ignatura (Applicant or Agent): (/
to
Application Number . . . . . 04-00007185
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 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 . . .
. . .
7 ------------------------------------
GRADING PERMIT
Additional desc
Permit Fee .
. . .
15.00 Plan Check Fee
.00
Issue Date .
. . .
Valuation
0
Qty Unit
Charge
Pet
Extension
BASE PEE
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 CENTER'S -RES
97.00
Page 3
Application Number
. . . .
04-00007185 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
Fee summary
-----'------------
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
FA
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page 1 of 7) CF4R
Protect Tttle Date �
T41— 6
Project Address Builder Name
Builder Con ct
ERS Rater
Certifying Signature
Firm:
1 elephone Plan Number
�elep�honeSample Group Number
3
Date Sample House Number
HERS Provider:
Street Address:7 S= 9�.� rt ei��. • �^. City/State/Zip:
Copies to: Builder, HERS Provider
HERS RATER COMPLIANCE STATEMENT
The house was: ❑ Tested Approved a's 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 -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)
Duct Pressurization Test Results (CFM @ 25 Pa)
Test Leakage Flow in CFM
If fan flow is calculated as 4006fin/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) _
Measured
values
Pas§ Fail
❑ THERMOSTATIC EXPANSION VALVE (TXV)
❑ Yes ❑ No Thermostatic Expansion Valve is installed and Access is
provided for inspection
Yes is a pass
❑ 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 -1R.
Measured Fan Flow =
Yes for both 1 and 2 is a Pass
❑
Pass Fail
❑ a
Pass Fail
Compliance Forms August 2001 A-16
- Qe.-r. tifica te. of Occupancy
TAt
OF9wJ = - `. Building & 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. 54-260 WEST RESIDENCE CLUB DR.
Use. classification: SFD - Building Permit No.: 04-7185
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
POST IN A CONSPICUOUS PLACE