002846 (AR)P.O. BOX 1504 No.
Building 78-105 CALLE ESTADO
Address 80--319 palm J=VX2?A CirC1.f-LA QUINTA, CALIFORNIA 92253
Owner j U7=1 _ . w
Mailing
Address rv-,nM
City ZipTel.
M . 11_a,l[`ta_ .. 9.2253 342-1692
Contractor
. ?�Q1r
Address
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description
P.O. Box 2&23
''City� Desext
Zip . 92261
Tela 340-3525
State Lic.
City
& Classif. , 483454
Lic. # app2iad
Sq. Ft: No.
No. Dw.
�
Size . 12 -stories
--Units
. Arch., Engr., .. ..
Designer
New ❑ Add ❑X Alter ❑
Repair ❑ .' Demolition ❑
Address
Tel.
City
Zip
State
-
Lic. #
t`t LICENSED CONTRACTOR'S DECLARATION
hereby affirrti,that I am licensed under provisions of Chapter 9 -(commencing with Section
7000) of Dwvisio 3 of=the Busi ess and Professions 'Cb►dpe,--annd my license is infull force
"
and
effect. . • . i* 3
SIGNATURE? °. 11 DATE
' d(' OWNER BUILDER DECLARATION
Estimated Valuation
hereby affirm that I am exempt from the Contractor's License Law for.the followingq
•
'
reason: (Sec. 703 1..5, Business 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
-. ..
-PERMIT . -
• ' ' AMOUNT -
. the provisions of the Contractor's License Law, Chapter 9 (commencing with. Section 7000) of
Division 3 of the'86siness and Professions Code, or that. he is exempt therefrom, and .the basis..
for the Any Section 7031.5 by 'any''applicant.'for
Dep.
.
'
. alleged exemption. violation of a permit
'subjects the applicant to a civil penalty of not more than five hundred dollars ($500).'. •
,Plan.Chk:
Plan Bal.
-
36.7?
0 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
.Chk..
COrist.
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. If, however, -the building
Mech.: -
or improvement is sold within one year of completion,- the owner -builder will have the burden
Electrical_ -
of proving that he did,not build or. improve for the purpose of sale.) -
-• O I, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
e
struct the project. (Sec. 7044, Business and Professions Code.,. The Contractor's License Law •
does not to builds improves thereon, for
S.M.I. -
- in
apply an owner of property who or. and who contracts
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) .. r
..;,i
Grading
0 1 am exempt under Seca B. & P.C. for this reason
Driveway Enc.
Date owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
•I'hereby affirm that I have'a certificate of consent to self -insure; ora certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800,.Labor.Code.)
Policy No. Company !-.-.1 Vii'• ex rlei4_'" .
Qcopy is filed with the city. . 0 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 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.
Date " Owner
NOTICE TO APPLICANT: If, after 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 .
I hereby 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`s 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,city and county ordinances and state laws' relating to building
construction, and hereby'yauthorize representatives -of this city to enter the above-.
mentioned property for, inspection purposes. ► t
Signature of applicant J_ - S i.ut_ A .' l - Date 1_9V7
Mailing Address Y
City, State, Zip
HARD COPY
TOTAL 1idJ a 447
REMARKS
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 1-20-87 Permit
Validated by:
Validation:
A7141 1 2u 1;.5,2'6 CK
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT. ®
POR. SQ. FT. ®
GAR. SQ. FT. ®
CAR P. SO. FT. ®
WALL SQ. FT. ®
SQ. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
BOND BEAM
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LUMBER GR.
SQ.FT.GAR Q 3/ac
HOUSE SEWER
FRAMING Z 'l
l
FINAL INSP.
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK'
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE (
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
REINF. STEEL `
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP.
FRAMING Z 'l
l
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
2tj/eNSULATIONISOUND ' /O
FINISH GRADING
L INSPECTION f7
T. OCC.
FENCE FINAL.
INSPECTOR'S SIGNATURESIINITIALS,
GARDEN WALL FINAL
Desert Sands Unified School District t
CERTIFICATION OF PAYMENT
OF ,
SCHOOL FACILITY FEES
T0: City of La Quinta
DATE: /
Department of Community Development
78-105 Calle Estado
La Quinta, CA 92253
This is to certif that
developer of �. which is
located atJ jl�L� �'! ''Within
this District, has paid school facility fees imposed pursuant to the
auth�p°rit/y generated by Gov rnment Cod Sectio 53080. in the amount of
covering a total of square fe-e4 of ) residential or
( ) industrial/commercial development tha uilding permits for
this footage in this development -may w d by your urisdiction.
for DESER SANDS•UNIFIED SCHOOL DISTRICT
White Building Department • Yellow - Facilities Planning • Pink - Accounting • Gold - Developer
(10)-37
C®p���qp p��y�g � X67 qg�p 65 cpcp �gg'�'� � �p�p' _ pyy� _ � �..//1 . _�ypy �ypO�y� - __ _. ... ...i._... -.. ..
U1)uHE uroi -De �7 'eF {i �i+ 0�0�7Y1W �SA� L'a6��t0 ' r�
COINDIVOWALLV
A EPTE � FORis-GH �,� Tri
P /'�p�_fyP ill
AND, ALL ILI. P.CICI4jik 1@iiY�_... _ __ _ _ _ ._ i .. A-•.� � a�{'`�'67ul
i
1
•
L
-CITY _ Lia. .
commup_it ®0elop�"ent/Bidg Dip o
CONDMONALLY
ACCEPTED FOR C3U�J®T R CT0®� ;
.BDECT T® INSTALLATION
-AND ALL APPLICABLE. C®®
i
1r
�• i \ �..
N Z
1-4
A
a
o
sa s
s
A
I.RiCXERTS
OF FIELD VERIFICATION & DIAGNOSTIC TESTING (Page 1 of
Palm Desert A/C - Heating / 374937
Contractor Name / License No.
rage i oz 1.3
Project Address OS -1092
Contractor Contact Telephone Permit Number
Paul Van VI men 760-777-1724 101360
H Rater ` Telephone Sample Group Number
3uly 22, 2008 CC14-1798441939
Date Certificate Number
C&Vrying Signature
Air Experts Air Conditioning HERS Provider.Ca10ERTS Inc.
Firm: City/State/Zip:L.a Quinta / CA / 92247
Street Address: PO Box 94
Copies to: Homeowner HERS Provider and Building Department
This CF -4R has been registered with the CaICERTS® registry in accordance with the Title 24 &Title 20 of the CCR.
CaICERTSO is an aDDroved HERS provider by the California Energy Commission.
HERS RATER COMPLIANCE STATEMENT
The house was ❑Tested 9 Approved as part of sample testing, but was not tested.
As the HERS rater providing diagnostic testing and field verification, I certify that the house Identified on this form complies with the
diagnostic tested compliance requirements as checked on this form. The HERS rater must check testedbuilding.nvri y that the new The HERS rater issusb ntion
system Is fully ducted and correct tape Is used before a CF -4R may be released on every_
release the CF -411 until a properly completed and signed CF -6R has been received for the sample and tested buildings.
The installer has provided a copy of the CF -611 (Installadon Certificate).
New Distribution system is fully ducted (i.e., does not use building cavities as plenums or platform returns in lieu of ducts).
New systems where cloth backed, rubber adhesive duct tape Is Installed, mastic and drawbands are used In combination with cloth
.�..'..e w...+ tnw M cPal leaks at duct connections
NEW CONSTRUCTION
Measured
Duct Pressurization Test Results (CFM @ 25 Pa)
Values
N/A
1 6FM'
Fan Flow: Calculated (Nominal _� Cooling '' _l' Heating) or-:::-' Measured
Not Tested
2
Enter Total Fan Flow in CFM:
N/A
N/A
3 Pass It be8le8ge P
ALTERATIONS: Duct System and/or HVAC Equipment Change -Out
Enter Tested Leakage Flow in CFM from CF -6R: Pre -Test of Existing Duct System Prior to
Not Tested
4 Dud System Alteration and/or Equipment Change -Out.
Enter Tested Leakage Flow In CFM: Final Test of New Dud System or Altered Dud System
Not Tested
5 for Dud System Alteration and/or Equipment Change -Out.
Enter Reduction In Leakage for Altered Dud System
Not Tested
6
[Une 4 - Line 5] - (Only if Applicable)
7 Enter Tested Leakage Flow In CFM to Outside (Only if Applicable)
Not Tested
8 Entire New Duct System - Pass If Leakage Percentage < 6% [ 100 x ( Line 5 / Line 2 )]:
Not Tested
❑Pass El Fall
STANDARDS: For Altered Duct System and/or HVAC
TEST OR VERIFICATION
Equipment Change -Out, use one of the following four Test or Verification
Standards for compliance:
El ❑ Fail
Not Tested
if Leakage Percentage <= 15% [ 100 x (Line 5 /Une 2 )]:
Pass
Pass If Leakage to outside Percentage <= 10% [ 100 x ( Line 7 / Line 2 )]: Not Tested
❑Pass El Fall
L102Pass
Pass If Leakage Reduction Percentage >= 60% [ 100 x ( Line 6 / Line 4 )]
Not Tested
El Pass El Fail
and Verification by Smoke Test and Visual Inspection
El 1:1 Fail
Pass if Sealing of all Accessible Leaks and Verification by Smoke Test and Visual Inspection
Pass
Pass if One of Lines #9 through *12 pass
❑ Pass 0 Fall
�� CaT( ERTS Page 2 of 13
•r
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING (Page 3-4 of 81
CF-4R
Palm Desert A/C - Heating / 374937
80-241 Palm Circle Dr. - La Ouinta, CA 92253 Contractor Name / License No.
Project Address
08-1092
Contractor Contact Telephone Permit Number
Paul Van VI men 760-777-1724 101360 r
�1ERS Rater 1 Telephone Sample Group Number
July 22, 2008 CC14-1798441939
n `
CertlfyJng Signature e L Date Certificate Number
Firm: Air Experts Air Conditioning--i-HERS Provider:/ipCaI uinta Inc.
Street Address: PO Box 94 City/State/Zip:La Quints / CA / 92247
r,
Copies to: Homeowner HERS Provider and'Building Department
This CF-4R has been registered with the CaICERTSO registry in accordance with the Title 24. & Title 20 of the CCR.
CaICERTSO Is an approved HERS provider by the California Energy Commission.
HERS RATER COMPLIANCE STATEMENT
The house was ❑Tested R Approved as part of sample testing, but was not tested.
As the HERS rater providing diagnostic testing and field verification, I certify that the house Identified on this form compiles with the
diagnostic tested compliance requirements as checked on this form.
The Installer has provided a copy of the CF-611 Installation Certificate).
HERMOSTATIC EXPANSION VALVE TXV :
Access is provided for inspection. The procedure shall consist of visual verification that the TXV.is
installed on the system and installation of the specific equipment shall be verified.
HVAC System TXv ❑ Pass ❑ Fail