9602-031 (AR)" LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with
r W Section 7000) of Division 3 of the @,usi9iess and Professionals Code;,tang my
rR C:3 ,C' License is in full force. and effect.
n W License r n _ 1Exp. Date
dL "7 Lic. Class f
rnZ ^ Date ✓ i�� I ± / SlgnatureofContractor
(+F o> OWNER -BUILDER DECLARATION
J U I hereby affirm that I am exempt from the Contractor's License Law for the
I
0_ following reason:
U) () I, as owner of the property, or my employees with wages as their sole
Z 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 pr9perty, em 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_
co Date Signature of OwnerLO -
N
rn WORKER'S COMPENSATION DECLARATION
FL Q 1 hereby affirm under penalty of perjury one of the following declarations:
Z ( ) I have and will maintain a certificate of consent to self -insure for workers'
LO l< Cc compensation, as provided for by Section 3700 of the. Labor Code, for the
X W LI_ performance of the work for which this permit is issued.
O J J () I have and will maintain workers' compensation insurance, as required by
m Q U Section 37009f the Labor Code, for the performance of the work for which this
O U permit is'issu*ed:•• lyw�grkers''compensation insurance ca{rieer olicy no. are:
CL �. Carrier Policy No.
Z (This section need not be completed if the permit valuation is for $100.00 or less).
r O O. 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 totheworkers' compensation provisions.of•Section 3700 of the Labor
@? Code, I shall, forthwith comply withQth9 ;e' pr kii lic
\Date: ' f 1 of f Applicant 1Z e R R1. t
t-=T✓a w
Warning: Failure to secure Workers' Compensation coverage is unlawful and shall
subject an employer.to criminal perialties 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 persomat
44
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 1130 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 inspettio urposes.
r J 1f
ignehlre (Owner/Agent) j i ii 44c,Date
ALCM .4/ 7196
-g.UJILDING PERMIT
PERMIT'i` "°'-66
DATE
a
VALUATION
s�_ T �s• �.w a is vr�asvr
LOT
TRACT
•n. ,.•n a�.wr.
JOB SITE ADDRESS
APN
OWNER
CONT IRI*TOR DW.� US C'.tii>iS I.RUC-floN
fOi E k1CJSI�IPIS'19-020
1112 -STA 1 R1Vr,
ROM/ % PALM 1;HWLE DR
t k\ Q it`TY, tJll MKI
LA { INTA CA. 92253 ,
(019)775-7933 C ULA# 3212
DESIGNERIENGINEER
A 1 RO
USE OF PERMIT
,:A awe �,�.•
s. i iv �. rvlt�a.t .r. -
FEE DESCRIPTION
FEES
�4�'4`!r'.f' • •p' `�fw I� r4,ll, S", I'. ir,• RW7_ t n'•1fIs' ♦
IS..>Ai1.Y1.'.*.S�N/V.l.l."Aa V.P 8,.t.01V.y�3e,6Ji...�8iJ1�1
? - •f Fl<
:9p�iJ9)•.iri) :_
i'r✓'•RIt7I'1 FEF,CININIARY
PLAN CHECK F"Fir✓ '101-000-439-319
CONSTRUCTION.FE 1G'i•40041.8.000 MI,Ut)
iW1GC1i.l�Idl�:Af:.1' [`s 101-060-421-000 $i5.C1
iii 1rt .I'fti:CAI:,.C'Fil i01 ,000-420-000
�p
CT)
SUB -1 C`TAL CQNSI'RUC; IJON AND PLAN CHECK
$148.65
LESS PRE -PAID PEPS
$0.00
TOTAL PERMIT FEMMENOW
t
RECEIPT
DATE
BY
DATE FlNALEO
INSPECTOR
INSPECTION RECORD
w OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing !
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wail Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath f
Drywall - Int. Lath
!
Final
Final
BLOCKWALL A PR VALS
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.IC for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Ei 17—
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPRO ALS
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 Unified School District
%
82-879 Highway 111
Notice:
Indio, CA 92201
Document Cannot Be Duplicated 619-775-3500:y=
CERTIFICATE OF COMPLIANCE
Date 3/19/96 APN # 649-090-029
No. 14273 Jurisdiction La Quinrta
i
Joe E. Huskins
• Owner Name Permit #
No. 80137 Street Palm Circle Log #
City La Quinta zip 92253 Stud- Area 229
Tract # 9603-031 Lot .# "' Square Footage 100
Type of Development Residential Addition No. of Units 1
Comments
encrease den.
t
At the present time, the Desert Sands Unified School District does not collect fess on garages/carports,
covered patios/walkways, residential additions under 500 square feet, detached accessory structures or
replacement mobilehomes. It has been determined, the above-named owner is exempt from paying
school fees at this time due to the following reason:
Residential Addition 500 Sq Feet or Less
EXEMPT
This certifies that school facility fees imposed pursuant to Government Code 53080 ,
in the amount of 0.00 X 100 or $ 0.00
the property listed above and that- building. ermits and/or Certificates of Occupancy for
this square footage in this proposed project may now be issued.
Fees Paid By N/A Telephone . 775-7933
Name on the check
By Dolores A. Ballesteros
Superintendent j
Fee collected /exempted by Pauline Pearson Exempt $+0.00
. Check No. N/A
Signaturen
`k0� �uJlp,v10 �. Q SX9 A A4 --
Collector: Attach a copy of county or city plan check application form to district copy for all wiivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
a
WO
,
II
�O
.5: (7N R) J51 i
3 j
'Nino
���� .�+c 1, � •
•1X3. 4' � � � �� � • � - n ?� i . � �,C"��l'7�3 � -
9
''i7!l�,.S ���►�X,?� �►1ty 3191 2%x/1 bal �%X�- .. _..._`
— S AF1� 1,x3vot
77eP hap
17
iN.7)
ry. .
„o, 4,
iIj
i
�� Mar
zl-
N�o
�►''w►
�.M
b
L
No Increase BSc
No Change Na Na Na Na
Replacement:
No Increase Standards"
Standard
Standard
Standard
Increase Allowed :allowed Allowcd .allowed
w/Calculations w/Calculation w/Calculation w/Calculation
I Meet the component.prescnpttve mqutrcment for Package D for slab -on -grade construction or
Package E for raised floor construction (see Chapter 3)
'_. " Heavy ' and "Light Mass" mass walls may meet the Package D or 'E requirements for mass wall
instilation instead of R- I3 (.see Chapter 3).
3. Tor compliance of additions and alterations oniv, dual glazed " greenhousc'' windows anj skvliehLs
may be assumed to meet this requirement. -
�. The Package. D or E fenestration area plus the area of any glazing removed because of the addition.
5.. All mandatory measures for. HVAC systems must be met (see Chapter 2).
6. No eiectnc resistance space heating may be installed.
7. A standard water heating system is explained in Section 6.6.
3. If the total number of water hearers increases in the residence, then the entire existing pl is addition,
system must meet the water heating energy budget (see Chapter 6). Table 3-1 lists watc: heaung_
wstem combinations which have.been pre -calculated to comply with the water hearing cudgel.
7-4 Revised January 1992 Apciriantiai Mani in
%' (,O.NiPLI,�N(:E
:1NALI'SI5 OF
Ute existinu structure, except when c uc iaune the
AN ADDITION
ALONE.
watcr-hcaune cncrgy use foran.v addition in which -
:any addidon —,hat is. the stun of all newincr>rascs.
the total number of water heaters in Lhc huilding
fie analysts may he pertormcd using
�onditioncu soaccs and associated new cxtcnor
.
either a special prescnptivc packaoc accordine to
walls. ccilinvs. and floors within the buildine —
the size of the addition or with.thc point system or
:nay tic snown :o meet the
cncruv hud_cras a
any approved Computer pertormancc me noa.
,cparatc cnun'. This proccaurz docs not involve.
Table.7-1: Prescriptive Compliance of Additions -
. Summary of Section '152(a)l Requirements of the- Standards
COMPONENT
00 ft';�
100--199 ft` 5.00-999 ft" >_ 1000 ft`
Insulation
Ceiling
j R -1;9,N
Packacct Packaec Psckacc
Wall
Floor
R:31_�
R-13 R-13 Packaec
R-13
Packaec, Package PackaL_c
Fenestratign
i U -Value'
i % of CFA
0.75 4
5 ft .1
0.75 Package Packaec
Pkg Removed ;
+ , Pkg + Removed Package
Shading
Na
Package Package Package
� . Thermal Mass
Na
Package Package Packaec
i Space Heating
Mandatory-
Package Package Package
& Cooling
(No electric')6
(No electric) (No electnc) (No ciectnc)
Water Heating -
No Increase BSc
No Change Na Na Na Na
Replacement:
No Increase Standards"
Standard
Standard
Standard
Increase Allowed :allowed Allowcd .allowed
w/Calculations w/Calculation w/Calculation w/Calculation
I Meet the component.prescnpttve mqutrcment for Package D for slab -on -grade construction or
Package E for raised floor construction (see Chapter 3)
'_. " Heavy ' and "Light Mass" mass walls may meet the Package D or 'E requirements for mass wall
instilation instead of R- I3 (.see Chapter 3).
3. Tor compliance of additions and alterations oniv, dual glazed " greenhousc'' windows anj skvliehLs
may be assumed to meet this requirement. -
�. The Package. D or E fenestration area plus the area of any glazing removed because of the addition.
5.. All mandatory measures for. HVAC systems must be met (see Chapter 2).
6. No eiectnc resistance space heating may be installed.
7. A standard water heating system is explained in Section 6.6.
3. If the total number of water hearers increases in the residence, then the entire existing pl is addition,
system must meet the water heating energy budget (see Chapter 6). Table 3-1 lists watc: heaung_
wstem combinations which have.been pre -calculated to comply with the water hearing cudgel.
7-4 Revised January 1992 Apciriantiai Mani in
-
�
-
�
a,
vicate az Comciiiance: Residential
(Daae t OT '_') CF -1 R
Date
oject Title
'
�o L37
Building Permit o
oject Address - '
(attic. to garage, typical, etc.)
�1
Plan Check i Date.
xumentation hor
Telephone
Field Check/ Date
Climate Zone Enforcement Agency use Only
�mpliance. Meltho—d—W—ack—aye. Point System or Computer) ---------------
Roof ..:..........
3ENERAL INFORMATION
1�0
otal Conditioned Floor'Area:
1t2
'Wilding Type:
Single Family Addition
Mufti -Family Existing -Plus -Addition
:heck one or more)
=ront Orientation:
North / East / South / West / All Orientations
'
(input orientation in degrees and circ) one.)
Vumberof Dwelling Units:
=door Construction Type:
S / Raised Floor (circle one or both)
BUILDING SHELL INSULATION
Construction
3omponent Insulation
Assembly
LocatiorVComments
Type R Value
U -Value
(attic. to garage, typical, etc.)
Wall ..:...........
Wall ..............
Roof ..:..........
Roof :............
Floor .............
Floor ....:........
Slab Edge ....
FENESTRATION
Shading Devices
Fenestration Area
Fenestration
Interior Exterior Overhang. Framing Type
(sh'escreen, etc.) lues/riot (metalMroodNinyl)
ad
Orientation (Sf)
LI -Value
(roller blind. etc.)
Front.....
Front..... ( )
Left ....... ( )
Left ....... ( )
Rear..... (. )
Rear
Right..... ( )
Right...:. ( )
Skylight ......:
Skylight ........
THERMAL MASS
Type/Covering
Area'
Thickness -
Location/Description (kitchen, bath. etc.)
(slab/exposed. tile, etc.)
(sf)
(inches)
yi
Certificate of Compliance: Residential
denttal
/P-Mnc 0 M 13\ C`C_1 O
: HVAC SYSTEMS
:
Note: Input hydrornc or combined hydromc data under
Water Heating Systems, except oesgn Heating Load.
Heating Equipment
Minimum
Distribution
Type and
Duct or
Type (furnace, heat
Efficiency
Location
Piping'
Thermostat
pump. etc.)
(AFUE /HSPF)
(ducts/attic. etc.)
R -Value
Type
t (
Cooling Equipment
Minimum '
Duct
Type (air conditioner, ...
heat umo
Efficiency
Location
Duct
Thermostat Configuration
ev io. coolina)
(SEER)
attic, etc.)
R -Value
Tv e soli( or oacka e
----------------
WATER HEATING SYSTEMS
"
Energy • External
Rated' Tank Factor or. Tank
Water Heater Distribution Number Input (kW . Capacity Recovery StandbyInsulation
Type TvDe in S stem or Btu/hr) (gallons). Efficiency Loss %) R -Value
1. For small gas storage (rated input S 75.000 Btu/hr), electric resistance and haat pump water heaters. list =nergy Factor.
For 18,90 91.0 storage ulster heaters grated input 2 75.000 Btu/hr), list Rated Input, Recovery Efficiency and Standby Loss.
For Inetantuneoua 988 water halters, list Rated Input and Recovery Efficiency.
SPECIAL FEATURESIREMARKS (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 t and 6, of
the California Code of Regulations, and the admin(strative regulations to.lmplement them. This certificate has-been signed by the
individual with overall design resoonsibility. 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 6 Piatesaions Code) h DOciumentatlon Author
Name:
Tide/Finn: Name:
Address:
Tide/Firm:
Address:
Telephone:
Telephone:
Llc. is
(signature)
(date) (signature)
(d")
Enforce mentAgency -
Narne:
Tide:
Agency:
Telephone:
---------------
(sipnatureistamp)
• (datel •. . -