9511-088 (AR)LICENSED CONTRACTOR DECLARATION
I hereby affirm that I 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 Signatureof Contractor
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
following reason:
( ) 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 & Professionals Code).
() I, 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
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
Section 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.
(This section need not be completed if the permit valuation is for $100.00 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 provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
Date: Applicant
Warning: Failure.to secure Workers' Compensation coverage 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 application agrees to, & shall, indemnify
& hold harmless the City of Indian Wells, 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 property for inspection purposes.
Signature (Owner/Ager Date
ALC'
BUILDING PERMIT
DATE 21/L r95
VALUATION . rp;7t .V% LO TRACT
JOB SITE ADDRESS 7"2(1 SafdU I)r
APN 604463-007
OWNER
CONTRACTOR
Owner Builder
MARK $:, KAR.EN SARTO
Some as above
78820 SANffA DR
LA. QUINTA. CA 92253
CRU
DESIGNERIENGINEER
USE OF PEcRwTILU t UPJ
BONUS RO()Mi PLAN 3
FEE DESCRIPTION
FEES
BONUS .ROOM 29f3.tfJ SF
T1:.AC%W,.D COST CDS+ CONS171R JC 17ION
7,S".60
11-1-CRIVI.I 1 1, EW S 11i M "'Y
ULAN CKCK VETS 101-000.434-118 $64.33
CONSTRUC'!'ION FEE t0? -000-18-!-0 $".00
ST0N MO'rtON .I 111E - IkESID 100 -OW -211-000 $.?6
s-,
rt3-T(.,T.0 cl`iM5" ZUC'r'iON AND PL: d C14ECK
$164.11
USS PRE -PAID FE..:S
$0.0o
TOTAL PERMIT r;! ,If.S DUENOW
$164.111.
TOTAL B'RCW L1' PERRIT FEES
lti�8.:lii.
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
.Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade z
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing 'jj
Compressor
Insulation t
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final Vv
BLOCKWA4APALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping -
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
Desert Sands Unifie&&'.hool' District
Notice: 82479 Highway 111;;
Indio; CA 9220,1
Document Cannot Be Duplicated 619;-;715=3500
CERTIFICATE' OF COMPLIANCE
Date 11/28/95 .APN # 604-163-007
1391.8
No. Jurisdichon . La Qumta
Mark &Karen Sarto '
Owner Name Permit #
No. 78820 StreetSanita:Dr9 Log #
City La Quints Zip 92253 Study; Area 123
Tract # Lot # Squa-re"Footage 218
Type of Development Residential Addition No: of Units 1 .
Comments Enclosing part of garage. .
At the present time, the Desert -Sands Unified SchoolyDistrict does not'collect fees on.garages/carports,
covered patios/walkways, 'residential additions under 500 square,fe -f,A&ached accessory structures or
replacement mobilehomes. It hasabeen determined the above named' owner is exempt from paying
school fees at this time diiOo the following reason:
Residential Addition 500_ Scf"Feet or Less
EXEMPT.
This certifies that school facility fees imposed pursuant to Government Code 53080
in the amount of 0:00- X 218 or $ 0 A0.
the property. listed above and that `$wilding permits and/or Certificates of Occupancy for
this square footage in this proposed project may,now be issued.
Fees Paid By N/A Telejione-
Naine.on. the check
By Dolores A. Ballesteros '
Superidtendent R' -
Fee collected /exempted by ;Pauline Pearson $0.00
. y
a Check No. N/A
Signature �, \\� :O. Q� a 0✓✓L.
Collector: Attach ,a•copy of co'untysor city plawcheck application form to district copy for All, wailers.
Embossed Original- Building Dept./Applicant p Copy = Applicant/keceipt Copy Accounting
'Pae 1 of 2) CF -1 R
,artificate of Compliance: Residential (Page
roiect Title
is
bcume
L'-�
'omptlF
3ENERAL INFORMATION
i otal Conditioned Floor Area:/ 21 S ft2
3uilding Type: V Single Family V//Addition
Existing-Plus-Addition
,check one or more) Mufti -Family 9
Front Orientation: (¢ ° North / East / outh West / All Orientations
(Input onentation i groes and circle one.)
Number of Dwelling Units: I
Floor Construction Type: SlabRaised Floor (circle one or both)
BUILDING SHELL INSULATION
Construction
Component Insulation Assembly Location/Comments
Type R Value U -Value (attic to garage typical, etc.)
Wall .............. I Yrs LyA-u�
l
Wall ..............
Roof .............�,—
Root ............. T
Floor .............
Floor .............
Slab Edge....
FENESTRATION
Fenestration
Orientation
Front..... (�)
Front..... ( )
Left ....... ( )
Left ....... ( )
Rear ..... ( )
Rear ..... ( )
Right..... ( )
Right..... ( )
Skylight .......
Skylight .......
Area Fenestration
(st) LI -Value
tto . 7C3
Shading Devices
Interior
(roller blind, etc.)
Exterior
etc.
Building Permit #
Plan Check / Date
Field Check/ Date
Enforcement Agency Use Only
Overhang Framing Type
es/no) metal/woodNin I)
Ex�sri�/G-
THERMAL MASS
Type/Covering Area Thickness
(slab/exposed the etc) (st) (inches) Location/ Description (kitchen, bath, etc.)
TtLleLLtAL O 44 -
Revised January 1992
Certificate of Compliance: Residential (Page 2 of 2) CF -1 R
Project Title Date
HVAC SYSTEMS
Note: Input hydronic or combined hydronic data under Water Heating Systems, except Design Healing Load.
Distribution
Heating Equipment Minimum Type and Duct or
Type (furnace, heat Efficiency Location Piping Thermostat
pump, etc.) -4 (AFUE/HSPF) (ducts/attic, etc.) R -Value Tvoe
Cooling Equipment Minimum Duct
Type (air conditioner, Efficiency Location Duct Thermostat Configuration
heat pump, evap. cooling) (SEER) (attic etc) R -Value Type (split or package)
nlA= — —
WATER HEATING SYSTEMS
Rated' Tank
Water Heater Distribution Number Input (kW Capacity
Type Type in System or Btu/hr) (gallons)
Energy'
External
Factor or
Tank
Recovery Standby'
Insulation
Efficiency Loss (%)
R -Value
1. For small gas storage (rated input S 75,000 Btu/hr), electric resistance and hest pump water heaters, list Energy Factor.
For large gas storage water heaters (rated input 2 75,000 Btu/hr), list Rated Input, Recovery Efficiency and Standby Loss.
For Instantaneous gas water heaters, list Rated Input and Recovery Efficiency.
SPECIAL FEATURES/REMARKS (Add extra sheets if necessary)
COMPLIANCE STATEMENT
This certificate of compliance lists the building features and performance specifications needed to comply with Title 24, Parts 1 and 6, of
the California Code of Regulations, and the administrative regulations to implement them. This certificate has been signed by the
individual with overall design responsibility. When this certificate of compliance is submitted for a single building plan to be built in multiple
orientations, any shading feature that is varied is indicated in the Special Features/Remarks section.
Designer or Owner (per Business & Professions Code)
Name: �-\AHL
Title/Firm:
Address: '� Q �Q C. �Xj ; R -
LA v L C
Telephone: i a t-t,S
Lic. #:
(sign e) (date)
Enforcement Agency
Name:
Tide:
AgenR:
Telephone
(signature/stamp) (date)
Revised January 1992
Documentation Author
Name:
Title/Firm:
Address:
Telephone:
(signature) (date)
IPP
11.0
r �
IPP
11.0