0207-008, 0304-040 (SFD)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
483540 13 TUC 12V3112(
X
/Date ,? G 2 Signature of Contractor
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 y,rATp I�il 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:.. x - ,71.01 Applicant zz, - ✓4+ -�"
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. a
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. 4
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 i
correct. I agree to comply with all City, and State laws relating -to the buildin
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) �!_;��; Date"•
BUILDING PERMIT PERMIT#
'
DATE ^� VALUATION LOT TRACT
$94,$97.110} 3
JOB SITEC.
ADDRESS 77- CM.1a=F (NUMARUA
APN
77a-331-026
OWNER y
CONTRACTOR / DESIGNER / EN (NEER
C"•i.,�[:K.1E1.�.�`i'RRMSES
NICHOLM DEAN AIMAS
2311;, ALUMAMRO BLVD 0 034 9
713.1.20 CM --LLQ 17-V.r aDD
i27.i1;&rRa`.}1: EE CA 92505
LA. tatt:i�'5A CIA. 92253
�`V�vtl?1?7.^�tivn CBUi 5224
USE OF PERMIT
SR MLE F1iMRZ 7„►WELIMG
M D-P9k'MIT DOES NOT INCL' BLOCK `if Ai, 1111, POOL, SRA OR
DRUBMA'Y' APPROACH,
TRACT CONSTRUCTION 11513,09 SP
PORCHIPAT1O 150,00 SIF"
0ARAGE/C,ARPOWP, $3,1100 SF
=MUMD CM OF (MINSMUCTIC-M
CiaN>31 UCT'TOX PER 101-0( 0.418.000 $61100
PLAW CHECK ?KM L I -GIC -439-318 $519.81
ISR WO81T 10.1.000-139.318 4230.01)
MECHANICAL .= 101-000-421-000 $66.50
R1,ECTRICA1., ng 101i,000-410-000 111212
PLAMiNG ZE 101 -000 -419 -OW $13,00
c$9.46iCdl5Ratt�lCt1y11C
{112 UT1lU "81 101-0( 0.42 x -00(I $14.00
P9-F,C1S`X PLAN 101-000.441-345 $104.00
SUB TOTAL rwu.}Y&MTJC"1 IOI T AM PLAN 01111 ?O-11
$3,960-89
AT ?�?Z1<.°P ERE
•-
'POTW-117-i2mi"7[` it'.K ES TXTF NO
4.250.00
��b,`�3iDd3�A
:ANG 2
CITY OF LA QUINTA
FINANCE DEP% _
RECEIPT
DATE N�
BY, / ✓"��A
DAT FIN D
INSPEC
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
L
Combustion Air
Roof Deck
- G
Exhaust Fans
O.K. to Wrap
./ d
F.A.U.
Framinga
Insulation
_
//—
Q _ L�
Compressor
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final 03 �iL
BLOCKWALL APPROVALS
Final!-
steel
POOLS - SPAS
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 ConnectionQ
Encapsulation -
Gas Piping
_
Gas Test -
Appliances 3
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 PowerQ3(�
Final
Utility Notice (Perm)
COMMENTS:
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
47950 Dune Palms Road
Date 8/23/02 La Quinta, CA 92253
No. 23519 (760) 771-8515
Owner
Clarke Enterprises
Address
231 E. Allesandro Blvd. #348
City
Riverside Zip 92505
Tract #
BLK145 U15
Type
Single Family Residence
Lot # No. Street S.F.
Unit 1 13 7780 Calle Chihuahua 1513 Unit 6
Unit 2 Unit 7
Unit 3 Unit 8
Unit 4 Unit 9
Unit 5 Unit 10
Comments
A
o�o
Q BERMUDA DUNES r
Cn RANCHO MIRAGE d
INDIAN WELLS
�. PALM DESERT ,y
LA QUINTA
t�J�INDIO
Y O .YJ
APN #
773-331-026
Jurisdiction
La Quinta
Permit #
0207-008
Study Area
No. of Units
1
Lot # No. Street
S.F.
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 (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile
homes. It has been determined that 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
Education Code Section 17620 and Government Code 65995 Et Seq.
in the amount of $2.14X 1,513 S.F. or $3,237.82 have been paid for the property listed above and that
building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued.
Fees Paid By CC -Union Bank of Ca -Harlan Borcherding Check No. 7924565
Name on the check Telephone
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Yolanda Garcia $3,237.82
] Payment Recd Over/Under
Signature 1
NOTICE: Pursuant to Government Code Section 66020(d)(1), this will serve to notify you that the 90 -day approval period in which you may protest the fees or
other payment identified above will begin to run from the date on which the building or installation permit for this project is issued, or from the date on which
those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting
JUN -08-2003 03:38 PM
CATE OF FIELiD
Firm: u��£SOGI�9{ CS
Street Address; 79e'40 t�i'?Zfed C1YGLo�
P_02
CF -4R
�F3
Plan Number
Sample Group Number
3imp a House Number
HER5 Provider:
CitylStaterzip: `s! 1 til jn,6 G /y 9 ;z 2$.�
Copies to: Builder, HERS Provider
HER RATER COMPLIANCE STAT6bd9Nj
The house was: Tested ❑ Approved as part of Sample testing, but was not tested
As the HERS rater providing dlagnostic testing and field verification, I certify that the houses identified on this form
co ly with the diagnostic tested compliance requirements as checked on this form.
Oislribution system is fully'ducled (i.e., does not use building cavities as plenums or platform returns in Ileu
of ducts)
Where cloth backed, rubber adhesive duct tape Is Installed, mastic and drawbands are used In combination
with cloth backed, rubber adhesive duct tape to seal leaks at duct connections.
.MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT
Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage)
Measured
Ouct Pressurization. Test Results (CFM @ 25 Pa) values
Test Leakage Flow in CFM
if fan flow is calculated as 40octm/ton x number of tons enter , ,r,,
calculated value here A (� (J
if fan flow is measured enter measured value here
Leakage Percentage (100 x Teat Leakage/Fan Flow) = 5. r
Check Box for Pass or Feil (Peas=B% or less)
❑
ss Fail
THERMOSTATIC EXPANSION VALVE TXV or Commission approved equivalent
9(Yes ❑ No Thermostatic Expansion Valve (or Commission approved
equivalent) Is Installed and Access Is provided for Inspection
❑
Yes Is a pass
Pass Fail
❑ MINIMUM REQUIREMENTS FOR DUCT DES113N COMPLIANCE CRIEDIT
1. O Yes 0 No ACCA Manual D Design requirements have been met
(rater has verified that actual Installation matches values in
CF -1R and design on plan.
2. O Yes O No TXV is Installed or Fan flow has been verified. If no TXV, ��
verified fan flow matches design from CF -1R.
Measured Fan Flow =
O O
Yes for both 1 and 2 Is a. Pass
Pass Fail
Certificate of Occupancy
City of La Quinta
Building and Safety Department
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code,
certifying that, at the time of issuance, this structure was in compliance with the various ordinances
of the City regulating building construction or use. For the following:
BUILDING ADDRESS:
Use Classification: SFD
Occupancy Group: R-3 U-1
77-780 CALLE CHIHUAHUA
Type of Construction: V -N
Owner of Building: CLARKE ENTERPRISES
Building Offi
Address
City
By
Date
POST IN A CONSPICUOUS PLACE
Bldg. Permit No.: 0207-008
Land Use Zone: RC
231 E. ALLESSANDRO BLVD #348
RIVERSIDE CA 92505
KIRK KIRKLAND
6-9-2003
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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
s# Lic.. Pic, Exp. Date
X31431 ! � Pic,
Date 3 -02 Signature of Contractor
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.
(l�) 1 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 3T.ATE 7, ND Policy No. 22%13-026131
(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 withtho a provisions.,,
,D'ate: �' `j?- 4i Applicant .., � , - ' t
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application. w
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property forinspection purposes.
I Signature (Owner/Agent) T^, .` Date A steaJL
�. ,2 mit
BUILDING PERMIT
DATE 413A13 _tALUATION SIM LOT
JOB SITE ADDRESS 77-7W t'1 .LE �'HUT1iAWA
OWNER
MIN Phi DEVEG.JPM1Y11} i
1; XERSIDE CA 92505
USE OF PERMIT
I1 .ff-1-AVIE 118
PERMIT #
0304-046
APN
CONTRACTOR/DESIGNER/
TRACT VJAK 14'OV I t
773_3iI- 026
^31 laT. �.?F31i'i3S�n 1':3,i..'vD, Fl"!A -3,;8
R ` ER=1E C (i 921108
(909)541.3.2659 "1ZL!
G'tJ%j'`TSle1�`I'�F:.lA27I"tC;g1.t�S�SC3:�.::a�t1"uc`i`li:l�.':a t:t:��Y1�hNY31A�1%
I'$L'dL.IMli'i l' : tfc`.r�.'31'. irsi 1Wsl hat"1i
D
APR U 3 2003.
CITY OF LA GUINTA
RECEIPT DATE BY• DATE FINALED INSPECTOR
t. .C/ i r - ;lo i
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 Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I
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
newer Lateral.
Pool Cover
Sewer Connection
_
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS: -
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)