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0401-410 (AR)LICENSED CONTRACTOR DECLARATION I hereby affirm Funder penalty of perjury that I am licensed under provisions of -- Chapter 9 (commencing with Section 7000) of Division 3 of the Business and N W �/ Professionals Code, and my License is in full force and effect. O =) M License # Lic. Class Exp. Date ti W C8 .MC oZ r— /ate j r Signature of Contractor ✓� CDO`�_ r` H o OWNER -BUILDER DECLARATION cD dW I hereby affirm under penalty of perjury that I am exempt from the Contractor's N License Law for the following reason: Z_ ( ) 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). C•') () I am exempt under Section , B&P.C. for this reason U N Date Signature of Owner ON rn Q WORKER'S COMPENSATION DECLARATION C) - Cr I hereby affirm under penalty of perjury one of the following declarations: L O ( ) I have and will maintain a certificate of consent to self -insure for workers' X W compensation, as provided for by Section 3700 of the Labor Code, for the O � Q • performance of the work for which this permit is issued. m Q C)(�) 1 --have and will maintain workers' compensation insurance, as required by O (-)Q Jc'tion 3700 of the Labor Code, for the performance of the work for which this dLO permit is issued. My workers' compensation insurance carrier & policy no. are: Z Carrier 07A.TI<~ FUND Policy No. 13425�6-2003 Cb —) �O Q (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 Dode, I shall forthwith comply with those provisions:._ ate: a / Applicant 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. 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 purposes. G�Signature (Owner/Agent) • Date s BUILDING PERMIT PERMIT040.1410 DATE VALUATION � LOT - TRACT JOB SITE APN ADDRESS 54-360 iAVn�.[Wa)A ej�r`.• RUZ 774•^23 OWNER I CONTRACTOR/DESIGNER/EN INEER AOBMZT C%!'aLDNrIA .CCWI;r R1' V,ia+T.i IDA COi.NC.l4L"�Yi.H :54-360 AfaRD.A UFAR Z 43.320 JACK 014 LAQUIN—rA Cdr. 92201 DR.1310 CA 92201 ® (160)567. VIO CSI-- 4403 I USE OF PERMIT 22Ft Y. DETACRtiD 1AIVINO A.ItPA AND 455 SY.'OA .= PERMIT DOM NOT INCLUDE BLOCK WAIL, .P0011SPA OP. DRAMWF AY AI'I'13.0 kIL PLAM AN) PZPWAIT AIM F0:2. NEW ADDITION ONLY. I TRACI t°OMTP.UC1T014 228.00 BF Cr?iFt.AGWCAsRPOV 455.00 5P' ERMA"ATIM CONT O:ie COMMUC110N 21 t2'9B: �D 1 int. iv M. SUMMARY CONSTRUCTION WE 101.000.418-007 s325.I10 PLAN CHECK FER 161-000-439-318 06-7.13 WCi AWIC:'A.LFEK 101-000--42:1-000 $39,36 Si.1�.CTRICAL Y T. 101-000-420-707 $39.38 FLU MBING FEE 101=000.419-000 $66,00 S:['FF.t9NO MOTION FEL° - RE -11D 101-000-241-000 $113 ►�IFla-i't'JT.PJ..l^ONS"TRLTI:,71013•. AND PtAiTC CH=, w639.36 rk DUE ROW MAR 312004 e CITY OF LA QUINTA FINANCE DEPT. ExPLeEp 11 f 1/ot CSIc'' p�Jc25s� RECEIPT DATE BY DATE FINALED INSPECTOR -o •_o �/ 7 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 Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Heater Final Water Piping L 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 COMMENTS: It� �'OQ ;►T Ej�.�t,R�D ASE To AdA� � laJOQ.K / g N gl7lc6 =E t2E��" z-ceµrT _O� 4 Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fudures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) Date 3/30/04 No. '25747 Owner Robert Valdivia Address 54-360 Avenida Juarez City La Quinta Zip 92253 Tract # Type _ Residential Addition Lot # No. Street Unit 1 Unit 2 Unit 3 Unit 4 Unit 5 Comments Detached Casita CERTIFICATE OF COMPLIANCE Desert Sands Unified School District 47950 Dune Palms Road La Quinta, CA 92253 (760) 771-8515 S.F. 228 Unit 6 Unit 7 Unit 8 Unit 9 Unit 10 4C J�IFIEDSc�O �oQ aERMUDA DUNES Cn RANCHO MIRAGE �J INDIAN WELLS v V^ PALM DESERT y LA QUINTA 4INDIO O APN # 774-233-005 Jurisdiction La Quinta Permit # 0401-410 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 $2.24 X 228 S.F. or $510.72 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 Cash - Joe Valdivia Check No. Name on the check Telephone Funding Residential By Dr. Doris Wilson Superintendent Fee collected /exempted y Shar McGilvrey Payment Recd $0.00 e $510.72 Over/Under Signature C 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 x A x Bin # r �� of La City Quinta Building 8E Safety Division P.O. Box 1 SO4, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit 11 ( Project Address: Owner's Name: o9&Z7- A. P. Number: 7 7A _23 3. do 5 Address: Leeal Description: 4City. ST, Zip: Contractor. 0 FTelephone: Address: ption: City, ST, Zip: X, Telephone: State Lic. # : City Lic. #: Arch., Engr., Designer. Address: City, ST, Zip: Telephone: r. -•,' ...f .." ,` State Lic. #: Construction Type: Occupancy: Project type (circle one): New Add'n Alter Repair Demo Sq -FL: #Stories: # Units: stimatcd Value of Project: Name of Contact Person: ,4:�//lkf /� E Telephone # of Contact Person: 3 2 / % S APPLICANT: DO NOT WRITE BELOW THIS LINE M Submittal Req'd Ree'd TRACKING PERMIT FEES Plan Sets Plait Check submittedItem plait Check Deposit Amount Structural Cala. Reviewed, ready for corrections5,-(' 3` Q Truss Cala Called Contact Person � �pq6 5x Plan Check Balance Energy Cala. Plans picked upi►IFAf "NdWbil ?v yov`� I&JA $ /p 0 Construction Flood plain plait Plans resubmitted KH 3-10 mechanical Grading plan Y' Review, ready for correctionslssue Electrical Subcontaetor List Called Contact Person Plumbing S.M.I. Grant Deed Plans picked up H.O-A. Approval Plans resubmitted Grading IN HOUSE:- '"' Review, ready for correctio�ssne Developer Impact Fee A.I.P.P. Planning Approval. Called Contact Person Pub. Wks Appr Date of permit issue School Fees �l fc- L3� Total Permit Fees ON 3 l0 ©ti/ �Rc f 1 r iF /-.1(✓; ,M + yo",4� L, &7- �1vYlor R((Y 147f"e� tz"d r'N14 4, Ra fi£^^f To / 4 / '2�Cq�.uis.�„� n (/�lDS; ✓J 7V, pN3-/2 2QSvl,.-.'i'R` ��a N+T fvcl.de Qed1,we.5 4kit.S0A/,4�6y To nn vP10r�.�J McSfr.� f%✓f3td4 rjZ,,�Wevt 70 vS%'� n..d �. P/ j o„ /a/ e a o N 3 LA A"o cvnt,-,- f P/C 0 NSE -- P� 2 J, µwt CAITG� — we- Nt�t �1 T ✓PJL �yy kA cT %1�®s,'��,�, �L, t 3� tali_ -L L:. ; if x x is Bin # City of La Quinta Building a Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # 010/— 4110 Project Address: 52-51,0 It Z Lf LQL-'LI)7 Ca, yn Owner's Name: �U> 6/ LQ& A. P. Number: Address: Sy_3� AUt ,y - Legal Description: City, ST, Zip: ZI-f- QvJ-tJ iA ck 9ZZ 3 Contractor: 6?fi 11h&MLA CU,U E7�: Co U Address: y - 32p G 5o,J 1 FTelephone: - ( Project Description: ��� 1, 4LL City, ST, Zip: t)Sb L� ZZ6 Telephone: 76p State Lic. # : Di City Lic. #: Arch., Engr., Designer: 2 41q# rf Address: 7111 City, ST, Zip: r o n r9e t-1417, Telephone: "`''' ' a' x ' Construction Type: Occupancy: State Lic. #:�h Project type (circle one): New Add'n Alter Repair Demo Name of Contact Person: U �D�j/�,� Sq. Ft.: (� # Stories: # Units: Telephone # of Contact Person: -/To j(, Z o —5 %6rff stimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rec'd TRACKING I PERMIT FEES Plan Sets Plan Check submitted �� Item Amount Structural Calcs. Reviewed, ready for corrections b) Iq Plan Check Deposit Truss Calcs. Called Contact Person /� Plan Check Balance Energy Calcs. Plans picked up (3 Construction Flood plain plan Plans resubmitted 6 Mechanical Grading plan 2"' Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person %t)51d�b MSF JA *7"19&oq Plumbing Grant Deed Plans picked up rJ015 py S.M.I. H.O.A. Approval Plans resubmitted i3Y P, a t C ` 2-/3'0V Grading IN HOUSE:- ''' Review, readv for correctionslissue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Lr�� RSM cad Total Permit Fees V. /vv 1 ► r i C, 6>tcCoA-11/.-, ,AICA- & 1DPIQ y Co„1 rtf� -/- /4wwae'Y ��; an, I� SSvI� P/�i—i9d°P�; r7 fiATps G✓q (l l,/AJ B���/r u#74 JCERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 1 of 3) CF -1R 'LIVING AND GATZi�GE 2- 11- 0-q Project Title S`q3 CO AUE 3UARE.Z LA QUINTA CA Project Address PERRY RICE DRA7-\SMIaN Documentation Author Telephone M\CKf- GE 15 Compliance Method (Package or Computer) Climate Zone GENERAL INFORMATION Total Conditioned Floor Area Z Z 8 ft- Average Cei Conditioned Slab Floor Area ff X DETA C NED Building Type: X Single Family Addition (check one or more) Multi -Family Existing -Plus -Addition Front Orientation: WEST North / South / East / est All Orientations (input front orientation in degrees from True North and Number of Stories ' Number of Dwelling Units: Floor Construction Type: Siab/Raised Floor (circle one or both) RADIANT BARRIER (required in climate zones 2,4,8-15) BUILDING ENVELOPE INSULATION Plan Check / Date Field Check i Date PN(LA QUINTA BUILDING & SAFETY DEPT. APPROVED FOR CONSTRUCTION one) tie) 9 a9.�'y BY ; 7 Required for this submittal_ yes _no Component Type Frame Type Cavity Sheathing Total R- Assembly Location/Comments wd = wood Insulation Insulation Value' U -Factor' (attic, garage, typical, etc.) stl = steel R=Value R -Value Wall W p I Wall Front Roof W Roof 18 ' Floor Floor Slab Edge Left ror prescriptive compliance t otal K -Value and Assembly U -Factor are not required for a wood -framed wall that meets cavity R -value insulation requirements for the Prescriptive Packape FENESTRATION 4hariincr T)PvirPc Fenestration #/T a/Pos. Orien- cation Area (ft) Fenestration Fenestration Exterior U -Factor SHGC Shading Att. Overhangs/ Fins Front U�1 U . 9 0 18 ' Front Left N' 9, 5 U y 0` a„ Left Rear Rear Right Right Sk light Skylight Compliance Forms August 2.001 A-2 y CERTIFICATE OF COMPLIANCE: RESIDENTIAL (P e 2 of 3) CF -1R LIVING AND GAiZi�GE ADDI�IDN 2- II -04 Project Title Date HVAC SYSTEMS Note: Input hydronie or combined'hydronic data under Water Heating Systems, except Design Heating Load. Distribution . Heating Equipment Minimum Type and Duct or Heat Pump Type (furnace. heat Efficiency Location Piping Thermostat Configuration pump. etc-) (AFUE or HSPF) (ducts, attic, etc) R Value Tvne (split or package) ..HEAT P.U.MP 0.78 A ►TIC R 4.2 DAI• WG"T PAL K AGE Cooling Equipment Minimum Heat Pump Duct Type (air conditioner, Efficiency Location Duct Thermostat Configuration heat hump, evap. cooling) (SEER) (attic etc) R -Value Type (split or package) HEA l PUMP AITIL R 4.Z DA`I-NIGHT PACKAGE SEALED DUCTS and TXVs (or Alternative Measures 11 Sealed Ducts (all climate zones) (Installer testing and certification and HERS rater field verification required) ❑ T"s, readily accessible (climate zones 2 and s-15 only) (Installer testing and certification and HERS Rater or field verification required) 11 Refiigerant Charge/Air Flow (climate zones 2 and 8-15 only) (Installer testing and certification and HERS Rater or field verification required) OR O Alternative to Sealed Ducts and TXVs (see Package C or D Alternative Package Features for Project Climate Zone) Climate Zone Window SHGC Window U -Factor SEER Heating WATER -HEATING SYSTEMS Energy' External Rated' Tank Factor or Tank Water Heater Distribution Number Input (ew Capacity Recovery Standby' Insulation DE TVDe in S LLCTUCstem orBtolhr ons) Efficiency Loss °/ R -Value _ t Cil �ll;V�j fi 000_ For small gas storage water heaters (rated inputs of less than or equal to 75,000 Btu/hr), electric resistance, and heat pump water heaters, list Energy Factor. For large gas storage water heaters (rated input of greater than 75,000 Btu/hr), list Rated Input. Recovery Efficiency and Standby Loss. For instantaneous gas water heaters, list rated input and recovery efficiencies. SPECIAL FEATURES (add extra sheets if necessary). Package C and D: TXVs, Sealed Ducts, Radiant Barriers (see installation requirements for radiant barriers in Section S.13 of the 2001 Residential Manual). Package C: thermal mass (thermal mass type, covering, thickness, and description). Compliant;e Forms August 2001 A-3 CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 3 of 3) CF -1R LI VIMG AND GASIFIGE 2- 11-09 Project Title - - - - - - - Date COMPLIANCE STATEMENT This certificate of compliance lists the building features and performance specifications needed to comply with Title. 24, Parts 1 and 6 of the California Code of Regulations, and the administrative regulations to implement them. This certificate has been signed by the individual with overall design responsibility. 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. The undersigned recognize that compliance using duct sealing and TXVs requires installer testing and certification and field verification by an approved HERS rater. Designer or Owner (per Business and Professions Code) Name: PERIL I RICE/ DRAF 151�1AN Title/Firm: Address: / Documentation Author P�R.RY RILE/ORAE TSNAN Name: Title/Firm: Address: G S P A5 E0 . Lh R E D 0 N 0. Telephone.. - Teleyhone Lie. #: 2-13-09 (sipature) % (date) (signature) ® k—Olt do Enforcement Agency �; I Name: Tide: Agency: — Telephone: — (signature / stamp) (date) CP►TVIE DTIA L C►TN CP1 CTCo01 321 -7857 Z-13- OU (date) t6 -0 Compliance Forms August 2001 A-4 TZ PN TJ l R NJ—) T3 N TZ fZ I I E FL N D -T !E TLO D F T'L' k lel -I:t 5 MDTE RT, (�, 5 0/6 0E GLNSSTO FLOOrL, Prescriptive Package for Additions s 100 ft <500 R= <1000 fe All Additons Package Alternate Packages Alternates Package Alternate Package Alternate Ceiling elation R-19 R-19 R-38 R-38 R-38 R 38 R-38 R 38 Wall Insulation. R-13 R13 R-13 R-13 R-13 R-13 R-21 c R-21 Raised Floors (wood) -R-13 R-13 R-19 R-19 R-19 R-19 R-19 R-19 Radiant Barrier N/A N/A Required Required Required Required Required U-Factor2 .. 0.75 0.40 0.75 0.40 0.65 0.40 0.65: �E 0.40 _ SHGC 0.40 0.30 0.40 0.30 0.40 0.30 0.40 0.30 MkXimum Total Area of Glazing X50 ft <50 ft 16% plus 16% plus 16% plus 16% plus 16% 16% removed' removed' removes' removed' SEER' (split/package) N/A 13.0/13.0 10.0/9.7 13.0/13.0 10.0/9.7 13.Q/13.0 10.0/9.7. 3.0/ 0 TXV N/A N/A Required N/A Required N/A Required N/A N/A. 0.78 0.78 0.78 0.78 0.78 0.78 0.78 HSPF` (splWpackage) N/A 6.8/6.6 6.8/6.6 6.8/6.6 6.8/6.6 6.8/6.6 6.8/6.6 6.8/6.6 Tight Ducts N/A N/A rN N/A Required N/A Water Heating F.FI 0.53 0.53 0.53 0.53 Required N/A (Recirc not permitted) 0.53 0.53 0.53 �'( 0 53 . Notes: ' Applicable only to new water heaters where the EF = Energy Factor. number of water heaters in the dwel ' is in creased 50 Gallon maximarm 2 Dual -glazed greenhouse windows and skylights are assumed to meet the applicable U -factor requirements. ' Glazing area is limited to 16% of the area of the addition plus the area of an becausof ' when heating and/or cooling will be extended to an addition from the Y �g removed because of the addition. s T� cow may be used for additions less than 100 fe in order to allow systems'. the existing eq`�' need not comply. glazing area greater than 50 ft MDTE RT, (�, 5 0/6 0E GLNSSTO FLOOrL, 08/06/2003 10:42 I i tp_ , rya:. 9099552022 BS RECORDS County of Riverside BUILDING -AND SAFETY 11EPARTMENT a� •aAaYTY °e Records Division T. . Ingram, i 4080 Lemon Sftet, zw Floor P.O. Box 1629, R/versider GA 92502-1629 Telephone (909)955-2017 Fax (909)I►55.2022 Dato: August 6, 2003 To: DEBBIE CONRAD , Fax 0: (760) 777-7011 From4. Building and Safety, Itecards Numb�r of pages (including cover sheet): i Re: 44360 AVENIDA JUAREZ ALL PERMITS FOUND, 1963 -PRESENT i 6 PAGE 01 s Adminlstr4lon-4080 Lemon 5t -PO Box 1440-Riverside,CA 92502-14.40•(909) 955 -2000 -Fax 955-2023 1