04-7184 (SFD)0
P.O. Box 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING PERMIT
BUILDING & SAFETY DEPARTMENT
(760).777-7012
FAX (760) 777-7011
INSPECTION REQUESTS (760) 777-7153
Application Number . . . . . X0-4,-7,007,1=84 Date, 11/17/04
Property Address . . . . . 54320 WEST RRESIDENCE CLUB DR
APN: 775-380=999-3 -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: EXEMPT
WC: EXEMPT 04/30/05
CSLB: 799449 04/30/05
.CCC.: B
-----------------
Structure Information --------------------------
Construction Type_ . �'.� TYPE V - NON RATED
Occupancy Type DWELLG/LODGING/LONG <=10
Flood Zone—"7"'. NON -AO FLOOD ZONE
Other,(struct�� nfo CODE EDITION 2001 CBC
# BEDROOMS 3.00
FIRE 'SPRINKLERS NO
GARAGE SQ FTG 531..00
PATIO SQ FTG 422.100
NUMBER OF UNITS 1.00
FIRST FLOOR SQ FTG 3365.00
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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
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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
0- 31
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: - Date: (. I Q ' d
Applicant: Architect or}Engineer: L �
. ��iit_ / / z, 7, _ 7 A L /[ Xe'
Applicant's Mailing Address:
Architect or Engineer's dress
I Co,9 All.Z ���,
A
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
1 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 my Licens�js in full force and effect.
License Class ( —License No. Z�Z yL%p
mate % ��actor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that 1 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 with licensed ccntractors 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
Csu workers' compensationJpsnrance carrier r�Q policynumber re:
arrier �cJJ /Policy Number /� 10 4,4
_ I certify that, in t e performance of the work for which this peri is issue ,, 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 provisigos.
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 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 inforati 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 7/en�ponthe above- entioned property for inspection purposes:
ate/� / Signature (Applicant or Agent):
.j
Application Number
. 04-00007184
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
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
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Permit . . .
PLUMBING
Additional desc . .1
Permit Fee . . . .
185.25 Plan Check Fee
46.31
Issue Date . . . .
Valuation . . .
0
Qty Unit Charge
Per
Extension
BASE FEE
15.00
18.00 6.0000
EA PLS 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
15.0.0
Special Notes and Comments
SFD - LOT•3, PLAN. AR.
PERMIT DOES NOT
INCLUDE POOL, SPA, BLOCK
WALLS, OR
DRIVEWAY APPROACH.
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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
tiW
`
'
1
z
Page
.3
Application Number
-04-00007184 Date
11/17/04
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
Fee summary
Charged
Paid Credited
Due
a 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
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page 1 of 7) CF4R
Project Dat
<Z/11220 /,J_ ��,�rlr (4W -11r.
Project Address Builder Name
Builder Contact
G
HERS Rater
Certifying Signature
Firm:
Telephone Plan Number
Telephone Sample Group Number .
Date Sample House Number
HERS Provider:
Street Address: j&dCity/State/Zip: J,y_
Copies to: Builder, HERS Provider
HERS RATER COMPLIANCE STATEMENT
The house was: ' ❑ Tested X 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 -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
1 Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage)
/
Duct Pressurization Test Results (CFM @ 25 Pa) Measured
t
Cin S
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) _
Check -Box r �ail -6%
-fo -Pass eF (Pass gr less)
13
Pas Fail
❑ THERMOSTATIC EXPANSION VALVE (TXV)
❑ Yes ❑ No Thermostatic Expansion Valve is installed and Access is
provided for inspection .
❑
Yes is a passPass
❑
Fail
MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT
1 ❑ Yes ❑ No ACCA Manual D Design requirements have been met (rater has
verified that actual installationmatches 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
Compliance Forms August 2001A-16
Certifica to of OccupancY
wit 4 gum&
-
OF��,�. Building & Safety Department
. L
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: 54-320 WEST RESIDENCE CLUB DR.
Use classification: SFD Building Permit. No.: 04-7184
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
CO