9612-104 (BLCK)U)
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LICENSED CONTRACTOR DECLARATION
I 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 Code, and my License is in full force and effect.
-License # Lic. Class Exp. Date
d9 7HU4 C29 �; 01300%
Dat,/� Signature of Contractor r
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 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 provisionsl of. Section 3700 of the Labor
Code, I shall forthwith comply with those o"
visions.
Date: / 2 ? Applicant,
,dv' "�1 �
Warning: Failure to secure Workers' omperisation 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 applicaton 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 property for inspection purpose
/s�
Signature (Owner/Agent)- =��! ��t Date/
BUILDING PERMIT
DATE i2n7ti.. 6 VALUATION T,67j()0 LOT
PERMIT # CONTROL #
y61Z-104 4508
TRACT
JOB SITE
ADDRESS � 404) "FN DA EL N100 APN
OWNER ' CONTRACTOR/DESIGNER/ENGINEER
AFNITf :0r -.VE FLIANG31—ON MAS(WRY
49-2070 AVENIDA El NIDO 6967; PANORAMA. ROjk
LAQ(JWA CA, 9,2253 CA'1't-EDRA].CITY' (-'A 92234
it+1 J3"Q-9.iR1 C13L9 :3569
USE OF PERMIT
i RNPRA.I, F31,111i,lJ.INO
a:rl.i�` CFAi�N >�r1iL1.6e� 1' fiLfi Gyit+:'C� C�T:tIS i7Cfi.u`131.3^S:(�:i�s.ECJK :�.113ti"iiN� `
WC;Iz. 11114 loft If() 1U_;111V1t40 PIif2fvl't'4`
G .Fr. 10VALL
21,003I.
;7:�.0',�
c; 0Wrrlttl0V)N IEE 401 -NO -418-000 $ 114. 0
� Nr+� ;•riC; a €'r�,iN i -!,!!M -t1i}i -4223-00) $19,00
SUR-'SY)"! A1. C.0N,z i'R.UCM0N.A'ND'PlwV4 CUECK VNA 00
LESS PJIIE-PAID FRES, so.(m
TOTAL PERMIT 01JENOW �.3K.tl91
n
RECEIPT DATEI 7 BY + j DATE FINALED INSPECTOR
,� � / �� •�/�'�.' -,
INSPECTION RECORD
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 Wali Insulation
Condensate Lines
Party Wail Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
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 APPRO L6
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:
^
PbINT SYSTEM SUMM :CLIMATE ZONE 15 P -2R
.PPOJECT TITLE=Buettner ' DATE=3/25/89
JOB SITE=Ave. El Nido '
BUILDING DATA
'
`^ '
�
'
CONDITIONED FLOOR AREA= 3038 NUMBER OF STORIES= 1
- RAISED FLOOR SLAB
0 0TAL GLASS AREA 771 SQ.FT �%GLASS 25.37854
� .
. /
CHECK ALL APPLICABLE UNIT TYPE CONDITION(S)
(X) SINGLE FAMILY DETACHED (SFD) ( ) ADDITION ALONE
/
( y SINGLE FAMILY ATTACHED (SFA) ( ) EXISTING BUILDING
( )
MULTI -FAMILY (MF) ( ) EXISTING-PLUS-AbDITION
}
| SCORE CARD '
| .
MEASURES
POINT SCORES
'
1.CEILING INSU. 38
0
^
i
2.WALL INSU. 19
0
3.� %SED FLOOR INSU 0
0
4.SLAB EDGE INSU
5.INFI. RATION STANDARD
0
.
6.GLASS HEAT LOSS DOUBLE PANE U=.65
-11
SUM 1-6= (-11 >
7.SHADING (SHADE OPEN)
GLASS AREA
SC= 0
A. NORTH � �
0
�
321
B. EAST
0
108
. SOUTH
-1
144
E. WEST
-1
198
�.
'H. SKYLIGHT
'
0
0
S. SHADING'(SHADE CLOSED)
% GLASS
GC= .2552
A. NORTH
-1
10.56616
B. EAST
1
3.55497
C. SOUTH
2
4.739961
D. WEST
-1
6.517446
� E. SKYLIGHT SC= 0.77 /
0
0
9. INTERIOR THERMAL MASS 4.114549
3
10.EXTERIOR WALL MASS 0
0
SUM 7-10 =( 2 )
11.HEATING SYSTEM 0 S.E.
0
12.COOLING SYSTEM 10.5 SEER
9
13 WATER HEATING S.G.
0
'
TOTAL
POINTS 0
,
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