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0211-173 (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 #t Lic. Class Exp. Da�te ( Date ; f�f ���` 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, ashprovided 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 �ITAre Policy No. !�f>�D3-70D2 (This section need not be completed if the permit valuation is for $100.00 or less). ( ) !;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: I Applicant � ✓ Warning: Failure to secure Wor ers 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 :fb tF 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. o(pursuant to any, permit issued as a result of this applicaton.;agreesto;`&.shall, indemnify & hold harmless the City of La Quinta, Its officers, agents and employees. 2. Any permit issued as a result of thisapplication' becomes null and void if "work is not commenced within 180 aays'fiom 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/Agent).-- Date , 7 t ` ' BUILDING PERMIT PERMITN (MI-173c�� DATE J / VALUATIONLOT TRACT JOB SITE APN ADDRESS &-4M. A V lt)Aa l..7, �J7:� �-4�i R OWNER CONTRACTOR/DESIGNER/EN (NEER :513 0AMENXt7ABE.R3�etUDAS 5V37(11WKWIDA1LAM7.?MSt,1:1JA0 LA QTS"N`I'.++.. C;'A. 922.53 LA Q INTA CA 9, 2253 (760)568.1404 CBL -N. 6255 1XNDEL V KH T URIM, RX USE OF PERMIT 1511 10T. S114041,'F1AlR IL11 0WXfi..�,1 0. Perrn4hdue%'NC.1`J'inchidim ffin t Wa ,.: Fence6, Poe! Q014'p% /A snpat'ate germ is regWre3 € ,r &ivrwuy appmaL& f roan the Publtc 'LVe►& TRACT (:OMST-RiJC:TION 1152;.1 O 121, jPORC.H/PAT110 54,00 Si`r f3A11AOL,WA RPORT B.� 7M COW OF 6.P1 N.", ,F'..7a?`iJ�.l.:4Ji�9 :�R.C'� .30 ey}5 �p �p��ES12M ^g ^y� req FIM .GAY&���L,117..Z�IM sCJ�A7lI8JU , V \ ONOTRUCTION,9 � 101-01010-418-000 $04100 PE,AN t;Pll<,X'K ME 101.000-439-M 152M14 V, MDEl IT 101-0004"S9418 4250106 'k USC.HANICtiA.b, P9Z 101-M-0-421-000 $99.00 iTJIdEECTRICAL M 101-300.420.000 $11.00 PLUid113M FFZ 101-000-419-000 $133450 S`i'fi.C3W MOTION "M - IWID 101-000-241-000 $9,24 t33tAt, )1JFA FEE 101,000.4,23-000 .$15.00 )a ©S ER IMPACT FRE PRIXIISF 1'•;t," 1,01-000-441-345 51140.00 SUR -TOW, CON STFUMIONAND ITLAN CT17GACK TA,001.34 PM JAN 0 6 20J *"Ty OF LA a UIN 4A FINAtd_CE E)Fp RECEIPT DATE BY 4j,, -, DATE FINALED INSPECT /s f .- INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS. MECHANICAL APPROVALS Set Backs J Underground Ducts Forms & Footings _ Ducts Slab Grade 7, 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 Wail Firewall Exterior Lath Drywall - Int. Lath Final BLOCKWALL APPROVALS Final_ steel . �4 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 - _ C Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection J4 65 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_,�Q3 / Final Utility Notice (Perm) �� `3 COMMENTS:- OMMENTS:Final Date 1/6/03 No. 23996 Owner Contemporary Homes Address 53895 Avenida Juarez City La Quinta Zip 92253 Tract # Type Single Family Residence CERTIFICATE OF COMPLIANCE Desert Sands Unified School District 47950 Dune Palms Road La Quinta, CA 92253 (760) 771-8515 4���F�Dsc�o Q BERMUDA DUNES C/I RANCHO MIRAGE (� INDIAN WELLS PALM DESERT .y ^ LA QUINTA INDIO �^ YYY O l APN # 774-143-021 Jurisdiction La Quinta Permit # 0211-173 Study Area _ No. of Units 1 Lot # No. Street S.F. Lot # No. Street S.F. Unit 1 53895 Avenida Juarez 1521 Unit 6 Unit 2 Unit 7 Unit 3 Unit 8 Unit 4 Unit 9 Unit 5 Unit 10 Comments 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 $2.14 X 1,521 S.F. or $3,254.94 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 - Mark Kellogg Check No. 8168005 Name on the check - Telephone 760-568-1404 Funding Residential By Dr. Doris Wilson Superintendent Fee collected /exempted by Crystal Scott $3,254.94' $o.00 Payment Recd„ Over/Under Signature teE 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 Certificate of Occupancy U ��INf'►r� OF Building y p & Safety Department This Certificate is issued pursuant to the requirements of 'Section 109 of the California Building Code, certifying that, at the time of issuance, this structure was in compliance with the provisions of the Building Code and the various ordinances of the City regulating building construction and/or use. BUILDING ADDRESS: 53-895 AVENIDA JUAREZ Use classification: SFD Building Permit No.: 0211-173 Occupancy Group: R-3, U-1 Type of Construction: VN Land Use Zone: RC Owner of Building: CONTEMPORARY HOMES Address: 51370 AVENIDA BERMUDAS City, ST, ZIP: LA QUINTA By: KIRK KIRKLAND Date: 7-1-03 Building Officia POST IN A CONSPICUOUS PLACE lu �nterlipvzai *Tomes 9cozpozated P 4'96 4 CERTIFICATE CF -4R OF FIELD VERIFICATION AND DIAGNOSTIC TESTING �3 Date • Project.Title �- 2 L�+C �e,�7Pa�:110✓✓� ��� Builder Naini Proje Adddre�s ,,LL�� Telephone Plan Number Bui-d(8r Cont ct �1 T lep one Sample Group Number ;HE*Rsater � f7)g Signature D e Sample House Number HERS Provider; Firm:, �C• -�" 4 Street Aodress: -7 O I L — City/State/Zip: Copjes-to: Builder, HERS Provider HERS RATER-COMRUAN.C.E.S:T.ATEMEPL _:_. telil' g a �#ie#tf $rtitc i s t�.ttfaCl-w—. = s rdentafted o ifits r . C� - — _ �8 I.: -Q-u ratn sat —_i@� --- - -- t�dt' — — _ _ -Mot — Fed=tie=^_oes_ of-use_i fding caul{es_aww mz- W. -- _ -_ --- __ —_ -- ----=— - _-_— -_ _ Le e=cio t b_ c 6 a+�►di a tyre c# tape ratiedrmas-ftc JU. %r L�i3r � r� r v cY;► Tc-cr► 7=n:r1 r -T eco F R ?i LrTtg1 C M #� 9C-R'a: - — — =r�-�- t_;onsesits=+tf__i3LaZ _ --- _— — -- -- __--=— �rtSr}si�riatffgE— =— _- u' 00 4 15a►iage 5J& ADO �b�c�d5t L��c VVttl�}!5 Check Box for Pass or Fall (Pass=6% or less) ,rte ❑ G'o�te�npozaz 7%nea ��cazpazated Pass Fail 1!U THERMOSTATIC EXPANSION VALVE (TXV) or Commission approved equivalent P(Yes ❑ No Thermostatic Expansion Valve (or Commission approved .equivalent) Is installed and Access Is provided for Inspection Yes is a pass ❑ MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT t 0 Yes ❑ No ACCA Manual D Design requirements have been met (rater has verified that actual Installation matches values in CF=1 R 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 -1 R. Measured Fan Flow Yes for both 1 and 2 is a Pass I N/N ❑ ❑ Pass Fail PRODUCT 9039 USE WITH 9380 ENVELOPE B To Reorder: 1-800-225-6380 or www.nebs.com PRINTED IN U.S.A. K 4964