0108-152 (SFD)I�.0 � �''>� � `w S ._. ..,w y-.' :i .•.n .-.iC. .'�K:^tStiF' "'j.". :�`�.-....,4�- ..yh�..._T.,• Y
LICENSED.CONTRACTOR DECLARATION '
I hereby affirm under penalty of perjury that 1 am licensed under provisions of
Chapter 9 (commencing with 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-
Date " +• P ' Signature of Contractor f y � M -
..� y/10
""-- -�- -- —OWNER=BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
(. ) I, as ownerof 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).
( ) 1, 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
e
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.
( ),,//I have and will maintain workers' compensation insurance, as required by
Sebtfon 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 Policy No.
RX 8,1,.
(This section need not be completed if the permit valuation is for $1,00.00 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 if I should become
subject to the workers' compensation proGisions of Section.3700 of the Labor
Code, I shal Sforthwith comply with those provisions. 1
Date:/ Applicant-'
Warning: Fail re^to-secure-Workers'-Comperfisation cover g 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.
IMPORTANT Application is hereby made to the Director of Building and Safety
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
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicator 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 the building
construction, and hereby authorize representatives of this City to enter upon '
the above-mentioned properWor inspection purposes. '
Signature (Owner/Agent) , ` Date-' �
BUILDING PERMIT PERMIT#.'
DATE VALUATION LOT 01 -151-0 TRACT ;
JOB SITE
APN
ADDRESS
76-715 SAGUARO DR11%
OWNER
CONTRACTOR / DESIGNER / EN INFER
1402- PEACOCK HILL
47.750 ADANO UfMq 1$22,8
I&ANT,w ARA CA 92705
A QY.t1N'T'.A CA 92253
(760)564.7824 %1%V 02063
'4
USE OF PERMIT
,:f
.91/V MAWRA, IWALIBU 0 PEWIT VOM 'NCYF INCLUDE BLOCK WALU.
POOL, OR DRIVEWAY APPROACH
y1
TRACT CONS'TfLUi1TIM4 1;768100 8F
J
TkDlI(:F PA^r 10 44.00 Ss'
'
C?1RAWCARPORT 469M SP
JiNA'g`, P COW OF C0TQW1iiMC7 7,00
7[IS
�Ai..6AA�V.7:��1'tylWfl3. 57-S9J,YJj.(.Y3,'4ti•�]d
� ,1�
0014,14 RUC'1'1O38F1EiE1C11�i1;IC�1s?w5�� $060.50
t UVN C;I•iEx'K FU $351.30
ME DEPOSIT 101-000-4' •9.316
Ar1ECK"ICAL FWF 1, 01 _000.2-r121-000 ($60.00
ELYMICAL FEE 101.000.420-000 3119176
cPd,.lfMBI'RIC➢
Vii.C+.401,,40TIOM FEE ^ RMIIS 101-000-7A14
�
--
103-000-423•
fytnC+�.n�
yO��tt+.�, �s'r�1��d��yBp�1���19:E F p,+q l���y� py
DEV .Gi1✓i"l� R !Y'�1DACT rind: i17yY��N{{Y���''
.• .
11=113F PLAN 101-400-4411 4. SEP 0 5s
CITY OF L,q QIJIWTA
FINggICE DEPfi
SIM 11'o"T.fit•C.'t7b4S'MC.rC°3'1-OR,��3•.�'''3. Px.t�Ai
.'sX33 PRR—PAW PhI�
4}�.3.07
'
yA
`1<'CDTIAL ERN. 11: f '� D'1� N'O
-
r'
r
r
+►
RECEIPT
DATEf /
BY
D E y�AL
IYJw
INSPECTOR I
/
w•,��
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION. :
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs i
Underground Ducts
Forms &Footings%//
�
Slab Grade 3�
/DDucts
Return Air
Steel I
Combustion Air
Roof Deck I
'' !
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing I
Compressor
Insulation I
Vents
Fireplace P.L. I
Grills
Fireplace T.O. I
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall I
Exterior Lath )
Drywall - Int. Lath I
/
I
Final • j ,(�G
Final I
POOLS -SPAS'.
BLOCKWALL APPROVALS
steel
Set Backs ]
Electric Bond
Footings #
Main Drain
Bond Beam #
Approval to Cover
1
Equipment Location
-
1
Underground Electric
I
Underground Plbg.,Test
Final I
Gas Piping
PLUMBING APPROVALS
Gas Test
Waste Lines I
_
9�f�� ��
Electric Final
Heater Final
Water Piping i
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans I
O.K. for Finish Plaster
Sewer Lateral]
Pool Cover
Sewer Connection)
9f�/Q� .�
Encapsulation
Gas Piping I
Gas Test
Appliances I
1
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring i
Low Voltage Wiring
Fixtures 1
Main Service I
Sub Panels J
Exterior Receptacles
G.F.I. I
Smoke Detectors
Temp. Use of Power
"
Final „I
Utility Notice (Perm)
• r+r rT • •n mvvcr T ,. .
b9_
Building
4
P.O. BOX 1504
78-495 CALLE TAMPICO
17 M G QUINTA, CALIFORNIA 92253
Owner .f l�• � h��Zi CJ
Mailing
Address 1� 6c) Pe -&C06'(? dIJ
�Coity Zip Tel
L�` f 1 (va
Contractor /7 / I
cityI
Ztp S� I el / Y -
State Lic. City
8 Classif. ) � Z�j{� Lic. #
Aron., tngr.,
Designer LP
Address U I Tel.e
Zip IState
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I herebyy.�afflimjthat I am licensed under provisionsfof.Chapter 9 (commencing with Section
7000) of;Division�3 bf the Business and Professio 6 Cbl e, and my license is In ful/l force aqa
SIGNATURE .Y' — �✓f.'%.L� DTE'
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Susiness 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 file 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
in
ealleged 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).
1: 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. 11, however, the building
orimprovement 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.)
I 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 contracror(s) licensed pursuant to the Contractor's License Law.)
1-7 1 am exempt under Sec. B..& P.C. for this reas(on�
Date O nw er .fir
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 r
rl 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 thg 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.
Date Owner
NOTICE TO APPLICANT: If, atter 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 cityvand county ordparices.and state laws relating to building
construction, and hereby' authorize representati6es-16f this city toenter the al) ove-
mentioned property for insspicti/on purposesyeX?
Signature of appl ca, t y 5._ z�' %��'"""f Date /
Mailing Address
City, State, Zip
APPLICATION ONLY
BUILDING: TYPE'C%ONNST.i�/ OCC. GRP.
A.P. Number ((C/ /(p 3j
Legal Descriptiont-
f
Project Description
0/0 8-/� �.
Sq. Ft. No. No. Dw.
Size (� Stories ` Units
Add ❑ Alter ❑ Repair ❑ Demolition ❑
k
Estimated
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
c►
AMOUNT
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
Desert.Sands-Unified School'District
47-950 `Dune.Pal
ms Road -- -
Notice: La Quints, CA'92253,
Document Cannot Be Duplicated 76077714515
CERTIFICATE OF COMPLIANCE
Date 9/4/01
No. 22439. Jurisdiction
Owner NameBill Doherty
No..78-715 Street Saguaro Road
city La Quints zip 92.253
. APN # 646-313-021
La Quinta
Permit #
Tract # Lot # Square Footage
Type of Development Single Family Residence
Comments
;Log #
Study Area
1.768;
No. of Units 1
At the present time, the . Desert Sands Unified . School District 'does not collect _fees on garages/carports, covered
patios/walkways, residential additions under 500 square feet, detached accessory structures.or replacement mobilehomes. It
has-been detennined.the above-named owner is exempt from paying school fees at this time due to'the following reason:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080'," in the amount of
2.05 X 1,768 or $ 3,624.40 the property listed above'and that.btliiding
permits and/or Certificates of Occupancy'!for this square footage in this proposed project may now be issued
Fees Paid By CC [1st Bank - Sharon Bills . ' Telephone:
`Name on'the check;
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by :Annette Barlow, Payment Received $3,624:40
Check No. 59209
Signature
NOTICE: Pursuant of Assembly Bill 3081 (CHAP. 549, STATS. 1998) this will serve to notify you that the 9Uay approval period in which you may protest tfie fees or other payment identified
above will begin to run from the date on which the building or installation permit for this project is sssuea or on which they are paid to the District(s) or another public entity authorized to
collect Nem on Ne Districl:Cs)(s') behalf, whichever is earlier.
Collector: Attach a copy of county or city check application form,to district copy for all waivers.
Embossed Original -.Building Dept./Applicant Copy :Applicant/Receipt Copy'- Accounting
FROM : RC BILLS
6eni 3y: 3AA;
. TITLE LE CO, ,
• •WHtN REsCORI)EQ NiA:� TO;
VstAck Doherty
4402 Pi aaoCk-Nul
Santa Ana: CA 91705
MAti.T4 6TATEMENTS •TA'`
SAME AS A860E-
FAX 'N0. ': 7607360-8924
7145478809;
Aug. 03.2001 03:16PM P1
Jun -20•.01 10:26AM;. Page 5'
r60R, 4VCOo' I BMi I -M197 ._
rr I LOW I MWAV MWd I E&AW i
TAX 13 $0.00
9llon or value of prepeRy oonvuyed:
leta>fort or ialue lass liens or encumbrances
OR
of the pon~ftry T►ensfar Tax oursuam to
eta sttclion 11927(6), on lransferft cortvtrunfty,
sr-metital properly assets between 6paunes,
t euelar or erWrhtbn agraeFrrent behamn spouses
iah ><ogement oi'order
�s►o�v�edc F
Thn: Isan IAtmopusal Tronehr w4 n6t6eharive in ownerehlp undo, Uaftn 63nfthe Revenue end 'teX& or Coda arne,GrVhtoi(S) ha9(have) checked
Lila 1091iCeble ftvJuslon *r M'r9eppre asr
I ❑ !1 tri j jisr to a trustee fix -#m beneficial -,-U" of ks'xusc or dw tpirvivil spouse of s damned MOnsfvor;,or,by it tnMtee of auen a trust to the
Spouse o1`10141 truster
(� `A trttnefer".to a SooW er former apouse Iii connection wdh o props*seh19M�11 og►eertient or do=e of dimoluti66 of a marriage or lased
9zperafton:
❑ ;A awbon tranafo+ or farrnlnatlon, solaly'bstweer' apouaes. of any co-owners otDBnis: • or
v:.
❑ The dlstrG;Wion d a iepalrentity'! property to a itpGir>tr'of fOrmee 8pousezin,exelieii9e for•the miere®t.Of With spouse :n trip IAQAL serity In
coniteaL>u+ uirtn 8 >bopeKy tLatgerrtent OgroeMe+n or'a decree Of.dr960WllAn of o inipmepe or legal s�aabon,
J ❑ Oilier,
X Clirtesk Wh4n seating i;oparxa;property interact in QiarLtee aprwge It is„this attpr.aa intent of & prontor, being the spouseof the grantee, to
tieetvay ee,r' t)Oo and•Ihterwi of the grantor, corhmijnity Of amerwr In and to the he rale dasmop� lbad.prto the a nice as tdarher, ade
at+d
FCR'A'UALUARL!° t Q 1610iAATIQN, receipt gf.wtiCh is Hereby taeknowledged,
holly l9oherty; wife of Gmntse
hereby ;aRAN7(6).to Pet►tek T. Doherty; ai married man as hta sola and, separs” property
the real ,propei#y, in the City of Let Quintaa County, of Rivertatde; b'te�e. of Galdomia, tlAccribed as: Lots 121 and 122 of
Deak Club Manor Tracia9:6iiDwtt=iyy map on file ift.Bdok 22 pagie 53'dVni ps, Rivarside County Rewrds, State
of Cellfomle ^ r
'I8fed June 29,. 2Cik1
STA"e OF CALIFOR�NIAnt.
COUNTY OF'.'', t�y, - •,
$holly Dohefty ^-
u `tdo2a P�IiC, naGy' peered .
paraonsh knorvn tome (or prevsd to not:on ft-b:jaia of 9811S1LOlOfy evltlencaj gNtRtT ,6iiANDARt
I0tse the'Pdroon(a) whose nert+e{e) IaItIlAiiuba&i' Od W the with rurtrum®nt incl CG91t . .i;ts76838,
ackrltl+�ledged to -rtQ that Aeieherlltay HkeA611 the, aanre h btarllerAtfa)r ••: pgt r.PUBuCifA(lftJRlltA
nuthvrfzed'oiptsr y(llWt,.t,Ptd:thetbyWSAWMhalt'elgnati:re�o):ontheinettumerrt 'gp11At�
ov persan(a) Cr tl1 `an;ty upon bChAlf Ofwnicls file petsor;s)=acso0, igxecLitad " Oetr>h. gyri i4, 4oQ2
the Insnarioent
WITH@da my he + '
3lpne!ura
L
Otdbo tvo" W- 44-3-13 "' .
DOCUMENT TRANSF
ESCRCM ilo.: 81508
_ Gomptaed :cn cnro cfir
ASWSSOR'8 PARCEL fd0r6464"13-'02V022
_ ComyuNd en Mee rs
rernalrLm+g at`Ift of<i
INTERSPCIUSAL TR6±NSFER
xx Exemq x hOm : etposY
GRANT DEEfl "
Revel" 3W Takstio
4uaW4 nr"0)v or:
(Excluded ftw rtJ40algal under California
In "contpucbrli t m a jLid n of of a
emplatioai
Comet► ian � 1,8 A 88otitjtt
signatum of doaarim
r60R, 4VCOo' I BMi I -M197 ._
rr I LOW I MWAV MWd I E&AW i
TAX 13 $0.00
9llon or value of prepeRy oonvuyed:
leta>fort or ialue lass liens or encumbrances
OR
of the pon~ftry T►ensfar Tax oursuam to
eta sttclion 11927(6), on lransferft cortvtrunfty,
sr-metital properly assets between 6paunes,
t euelar or erWrhtbn agraeFrrent behamn spouses
iah ><ogement oi'order
�s►o�v�edc F
Thn: Isan IAtmopusal Tronehr w4 n6t6eharive in ownerehlp undo, Uaftn 63nfthe Revenue end 'teX& or Coda arne,GrVhtoi(S) ha9(have) checked
Lila 1091iCeble ftvJuslon *r M'r9eppre asr
I ❑ !1 tri j jisr to a trustee fix -#m beneficial -,-U" of ks'xusc or dw tpirvivil spouse of s damned MOnsfvor;,or,by it tnMtee of auen a trust to the
Spouse o1`10141 truster
(� `A trttnefer".to a SooW er former apouse Iii connection wdh o props*seh19M�11 og►eertient or do=e of dimoluti66 of a marriage or lased
9zperafton:
❑ ;A awbon tranafo+ or farrnlnatlon, solaly'bstweer' apouaes. of any co-owners otDBnis: • or
v:.
❑ The dlstrG;Wion d a iepalrentity'! property to a itpGir>tr'of fOrmee 8pousezin,exelieii9e for•the miere®t.Of With spouse :n trip IAQAL serity In
coniteaL>u+ uirtn 8 >bopeKy tLatgerrtent OgroeMe+n or'a decree Of.dr960WllAn of o inipmepe or legal s�aabon,
J ❑ Oilier,
X Clirtesk Wh4n seating i;oparxa;property interact in QiarLtee aprwge It is„this attpr.aa intent of & prontor, being the spouseof the grantee, to
tieetvay ee,r' t)Oo and•Ihterwi of the grantor, corhmijnity Of amerwr In and to the he rale dasmop� lbad.prto the a nice as tdarher, ade
at+d
FCR'A'UALUARL!° t Q 1610iAATIQN, receipt gf.wtiCh is Hereby taeknowledged,
holly l9oherty; wife of Gmntse
hereby ;aRAN7(6).to Pet►tek T. Doherty; ai married man as hta sola and, separs” property
the real ,propei#y, in the City of Let Quintaa County, of Rivertatde; b'te�e. of Galdomia, tlAccribed as: Lots 121 and 122 of
Deak Club Manor Tracia9:6iiDwtt=iyy map on file ift.Bdok 22 pagie 53'dVni ps, Rivarside County Rewrds, State
of Cellfomle ^ r
'I8fed June 29,. 2Cik1
STA"e OF CALIFOR�NIAnt.
COUNTY OF'.'', t�y, - •,
$holly Dohefty ^-
u `tdo2a P�IiC, naGy' peered .
paraonsh knorvn tome (or prevsd to not:on ft-b:jaia of 9811S1LOlOfy evltlencaj gNtRtT ,6iiANDARt
I0tse the'Pdroon(a) whose nert+e{e) IaItIlAiiuba&i' Od W the with rurtrum®nt incl CG91t . .i;ts76838,
ackrltl+�ledged to -rtQ that Aeieherlltay HkeA611 the, aanre h btarllerAtfa)r ••: pgt r.PUBuCifA(lftJRlltA
nuthvrfzed'oiptsr y(llWt,.t,Ptd:thetbyWSAWMhalt'elgnati:re�o):ontheinettumerrt 'gp11At�
ov persan(a) Cr tl1 `an;ty upon bChAlf Ofwnicls file petsor;s)=acso0, igxecLitad " Oetr>h. gyri i4, 4oQ2
the Insnarioent
WITH@da my he + '
3lpne!ura
4.
FROM RC BILLS FAX NO. 760-360-8924 Au9..103 2001 03:17PM P2
r w Oe11L by: LbA; 7145478909; Jin -20.7 tU:23AM; pays 3!3
STATE OF CALIF
pRNIq •h
COUNTY OP'L,08 ATIGEL kS
bn Februaiy 28,.2001, before nei fl Notary Publty personally appeared Janet W. Smith.,
�pc;so o me {or droved to me on el hasis of satretactory a idericcj'to be the.peison
whoset►gm® �s;subsen'bed to the ��ithi- tnstr- ii ent and-ackriowtedged to mo•thet?she executed rdie
saine;in het: authorix�d
parity+; twd_tiinl by hets�gnaturc din tl�e instrutncnt; the;person,.br the:
entity upon bel a;f of which the' erson urted,'cxsevted'the iustrvment.
WITNESS -Pa band and,official`seal.
.;�,
ii•>-
,;
a;' £..
`'$- r
.. y'�.. .�
..<,.
,;
a;' £..
i
..
...
n� �:
..
RC-DISTRICT� PL'ANNING'REVIEW'"FORM
This form is to'be used .by. CD.D staff for -review of single,family dwellings in the RC (Cove
Residential) District per.,Sectidn 9..50.090 of. the Zoning Code.• Its purpose is to determine:
1) that the.proposed house design does not duplicate the same architectural style of any
house within 200 feet of tli-e applicant -r .and/or -2) if -there. is--a--need for -the -applicant -to file for
Master Design Guidelines. If'the applicant does need to; file a Master Design Guideline, please
transmitted this information to the Building and -Safety Department as part of your correction
list. Please attach additional explanations `as necessary.
APPLICANT Legacy Homesro <.o-,`;
SITE ADDRESS 78-715 -Saqua'ro Road
APN 646 313 - 021'• CASE NO.: 20017-537
LEGAL:
LOT 121
BLOCK . 313
UNIT
S.C.@V.L.Q.
CHECK AND APPROVED BY: Wally Nesbit. DATE:
Inform the assigned Building plan. checker upon your assignment to this case. The CDD
Executive Secretary maintains a log book -to track, applications.and assign., case numbers.
t:
REQUIRED ITEM
Y
N_.
-COMMENT/CORRECTION
Verify legal and APN.information
OX
Consistent with MDG on file (as
applicable
MDG filing required (5 filings since
9/3/98)
�
lJ �ir✓ v� �' C —
t-'�-rr 4 o' -j ;moi x
Architectural variety within 200 feet of
the surrounding area:
Colors
-2:U5E.
i 01
P A 4/'10D �`7VC—
j�.a2 t;� ,..0 ir- L -
Materials
eatures
Architectural design features-
Other Requirements:
Other
O ity: Council`
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JOG CITY OF LA QUINTA SUB -CONTRACTOR LIST
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rrges to this list must be approved by the Build' Division y �= appearing on this list or Ili it employees are authorized to work
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INSTALLATION CERTIFICATE .' ` CF-6R
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Site Address Permit Number
DUCT,gL,EAKAGE AND,-DESIGN DIAGNOSTICS
❑ .DUCT: LEAKAGE. REDUCTION'
Pressurization Test Results'(CF1VIW25 PA)
Test Leakage (CFM)
Fan Flow
If Fan Flow is Calculated as 400 cfrMon x number bf tons, or, as.2IJ -x' Heating Capacity
iriThousands of Btuft, entefcalculated value1ere
asured, enter measured value here
If fan flow is me—
Leakage Fraction Test Leakage/(Measured or Calculated Fan Flow) _
Pass if'leakage fraction 50.06 ❑
Pass Fail
❑For AEROSOL TYPE SEAUAIVTS ONLY -The following diagnostic testing was completed:
Duct FanPressurizatiori`at rough-in measured leakage (CFM)
CHECK AFTER FINISHING WALL:`
❑ Yes ❑ No ❑ Pressure span test or House pressurization test �j� ❑ ❑
❑ Yes ❑ No ❑ Visual Inspection ofDuct Connections, Pass Fail
❑. THERMOSTATIC EXPANSION VALVE,(TXV)
Yes _ ❑ No Thermostatic Expansion Valve (or Cornmissior) approved ❑
equivalent) is installed and Access is.provided for: inspection Pass Fail
Yes is`a•pass
DUCT`DESIGN
I ❑Yes ' ❑ No ACCA Manual ,D;D.esign calculations have been completed;
Duct Design i`s'on the.plans:And duct installation
.matches
plans.14
/ Y
2 ❑Yes ❑ No TXV,,is`installed or Fan flow, has been verified. If no .TXV;
verified:
flow matches'design from CF-1R:
Measured Fan Flow=
s
Yers`for both I and 2 is a Pass Pass Fail
❑ I, the undersigned, verify that t}ie above diagnostic test results and'the. work I performed associated with the test(s) is in
conformance with the requirementsy of the CF
for compliance credit [Thebuir shall pest ng and installarovide- the tion meet thep quirementsf or
signed by the>builder_employees or sub,contractors certifying that diagnostic .
compliance, credit.]
ests ignature, Date Installing Subcontractor (Co. Name) OR
General.Contractor (Co. Name)
Performed
COPY TO:' - Building Department '
HERS Provider (if applicable) .
Building Oinmer at� :occupancy
N
January 4 2001
Certificate of Occupancy
City of La'.'Quinta
Building and Safety Depar-tinent
This Certificate issued pursuant to the requirements of Section -.109 of the Uniform. Building. Code,
certifying that,, at the '&ne, of issuance, this structure was in- compliance. with the various ordinances
of the Cit ire u/adn bui/din construction or.use. For the fo/%win
Y 9 9' 9' g
BUILDING °ADDRESS: - 78=715 SAGUARO'.DRIVE
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0108-152,
Occupancy Group: R-3, U-1 Type of .Construction:- VN Land Use"Zone: RM `17/1
Owner of Building: WILLIAM DOHERTY Address: 1402 PEACOCK HILL
City- . SANTA ANA GA..927Q5- . :.... �. .
By: KIRK KIRKLAND
b Date: 1-16-2002
Building Official
POST IN A CONSPICUOUS PLACE