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0403-031 (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 151812 13 i-irc 43'331 f?.: Date -��� /r-� Signature of Contractor A t" 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;.6r 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 STATE'FL1ND ' Policy No. 1705364.703 (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._" Pate- .��f ., iidi Applicant it r" . is 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 tfi"e 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 ]-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. �t f Signature (Owner/Agent) d.t�/ems �i /ted ! ¢ Date'+f 1��- -�> •F;'a BUILDING PERMIT PERMIT" 412 wZ DATE VALUATION LOT TRACT BI 236'U-147 JOB SITE ADDRESS APN OWNER x -' CONTRACTOR /DESIGNER / EN (NEER AMUA TAN C.ENTF�q Clk 92561 (76(t1349-9825 MIX 3 3 a USE OF PERMIT 2666 SF SFD. PSi IMIT DOFF BLOCK TUVA:Li.SlPOOL OR SRk DRIVE WkY APPE.CaACH REQ U1RES 3EPERATE PF,1t�9IMNSREC LION BY PUBLIC WORKS. 2001 C FX. TRACT COIIST11UCTIO14 MOM S1, PORCH/PAT,;O ' 74"7.00 S:' C,ARACIBICARPQC T 521.00 SF MWATM) COST OF C0M%MM7CT1O:ff 158,260MCONSTRUCT ION i FJP Pi.,s` N CHECK ME 1 � 1 •t10t3-43�-`S 1 � L �°iO3. 39 f FEB DEPOSIT 1431.110104,39.318 ; •$250.�U � WISCH111M.AL FEE 101-000-421-000 t :5:.50 � ELECTRICAL FZE 101.000.420.000 �35z,z3 PLL1M131'ou ME 101-0004.19-966 S T RONO MOTION FEE - AMID 101-006-241 -000 WIN OPLAD1140FEE af31-t14r{1-X23-1J00 $15.On a ;J DW3ELS.7€'i%1v IMPACT FEE S2,4wS,CG � PP, .CIS2, t LAM 101-000.441-345 $loa t3 t SUB -Tt'1T'AL C ONKRUaR014 A3`W P7. W MCK fU $4,481.70 LESS PRE -Ppm FUM 4250,00 D �CT'a°I FMMIT F9ES DME NOW MAR 16 1004 CITY OF LA QUINTA FINANCE DEPT. RECEIPT DATE BY DATE FINALED INSPECTOR "-3A4lel , ,r :, INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE I INSPECTOR BUILDING Set Backs APPROVALS L _�G9 MECHANICAL APPROVALS Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck -( „p Exhaust Fans O.K. to Wrap F.A.U. Framing Insulation _ _�G Compressor Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall -Int. Lath Y ,6 �/-Y—, 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 I I Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Q` Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans OX for Finish Plaster Sewer Lateral Pool Cover Sewer Connection el Encapsulation Gas Piping Gas Test Appliances Final Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fbdures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power U bt Final Utility Notice (Perm) COMMENTS: t, � O� 305 ©tv 3 �� P.O. BOX 1504 t ` APPLICATION ONLY �78-495 CALLE TAMPICO Building ,S Address T �� J✓�z� Z LA QUINTA, CALIFORNIA 92253 vwncr �fl En..via-a-D J►� � ., Mailing Address C' Con ractor Aaares r�I Ict �I �ut I h I�c *\ ,C," � - C� Zig Z I ) ('0 9 q 7 �i State Ljc.^ �� / 7 City 8 Classif. C.. Lic. # Arch., Engr. Designer � AddT6 bo �y S0 Tel. S C�ty�` t) C� IZ`jZ.�/,3 (State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. .. —'SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,8usiness 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 the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). 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 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 or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale.) IA I, as owner of the property, am exclusively contracting with licensed contractors to con. struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractors) licensed pursuant to the Contractor's License Law.) 1-1 1 am exempt under Sec. B. 8 P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION Ihereby affirm that I have a certificate of consent to self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company n Copy is filed with the city. O 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 (5100) 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 a 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 authorize representatives sof this city to enter the above- mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip 1 WHITE = BUILDING DEPARTMENT BUILDING: TYPE CONST. 'Vff"OCC. GRP.. / A.P. Number 4,? , -1 6 P. Z Y Legal Description Lz, �- 1S 1 Z Co 4- (L/ Project Description 6 C Sq. Ft�G � No. r No. DIN. _Size Stories 1 Units New' Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. >"� Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure LRA U TOTAL REMARKS cINeNCE DEPT. 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 Permit Validated by: Validation: sr YELLOW = APPLICANT PINK = FINANCE CERTIFICATE OF COMPLIANCE Desert Sands Unified School District 47950 Dune Palms Road Date 3/15/04 La Quinta, CA 92253 No. 25663 (760) 771-8515 z4 o BERMUDA DUNES r GC RANCHO MIRAGE d %�, INDIAN WELLS PALM DESERT y <(�.� LA QUINTA ,� -y INDIO r�` o f -;L Owner Ed Bemadino APN # 774-266-028 u Address 36 Timberland Jurisdiction La Quinta City Aliso Viejo Zip 92656 Permit # 0403-031 Tract # BLK276 Study Area Type Single Family Residence No. of Units 1 Lot # No. Street S.F. Lot # No. Street S.F. Unit 1 14/15 54960 Avenida Juarez 2666 Unit 6 Unit 2 Unit 7 Unit 3 Unit 8 Unit 4 Unit 9 U Unit 10 CComme 15/05- Refund issued as 521 sf garage was erroneously included in total sf of SM. Corrected sf of sfd is 2,139. 521sf x $2.14'= $1,127.78 refund to be mailed to address above. Original cert & letter rec'd from City. At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions under 5 00 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooldng, eating or sanitation) or replacement mobile ho mes. 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 2,666 S.F. or $5,705.24 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/Bank of America - Ed Bemadino Check No. 408811858 Name on the check Telephone Funding Residential By Dr. Doris Wilson Superintendent Fee collected /exempted b Sharon MCGllvrey Payment Recd 60.00 $5,705.24 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 o r abler payment identified above will begin to run from the date on which the building or installation permit for this proms 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 Districtfs) behalf, whichever is earlier. NOTICE: This Document NOT VALID if Duplicated Embossed Original -Building Department/Applicant Copy -Applicant/Receipt Copy - Ac:counting :1 Hry •r_b c,�e4 1 k :;�� I -K r I KS I HMtH 1 (,;HN ,^� • First American Title 11 R'5598(;8 /ESC#09617-09 771-266-028 V4KN RECOPD® MAIL'0 T— Ed Be=vaXdinto � P,AIn4 mmE.a Gy Baur Zv I —j TO 19496433665 DOC N 2000-304339 2111f lel2e" ea:pM PawA0.0e P600 I otr' 2 DOC T Tar 41d Ratlarded In Off iallat Rwotirdls CAunty or Rharalde Gwy t,, arra Asselmr, COAMAY Warp A 9499r4rr Bill N4y" 4'" W .cam abler I A.a ; W[e� A R 00°r lWvc IntuHR ualo rxt� Grant Deed-- ._ The undtrsigned grantor(s) declare(s)_ Documentary trbnger tax is $ 71-5 r ( 1{) cvtnputcd on Full value of property convoyed, Of ( ) tiompuzcd on full value lass value of liens and enc mbr9nc= rmnalnl lg at time of sato, ( } Unincorporated area:( 3 City olM _ .,,........,.w..._ r.. �..,_�_.........^__. _.__......... ( ) Realty not sola FOR A vtaLTjp sLE CONSIDERATION, rerAipt of which is h4r4by 8tlMO-le4Fd., Bill goner and Suzie Waw, }nisband and wife, as Jbiz�t, Tenants herehy GRANT(S) to Ed Bezr=dit]o , a maxxW mart as his sols and sepaMte Prt Y thin pruperly in p4verside Cwr►ty, State of CalifOrnia, WBLw bed &b: LEML MSCRIpTION A'T'IXM HMM ANA Ivo= A PARC HM006 R4 WIBYT "An Moil Tax Siatrmea.tc esti (�rauzee at adds above Dere Auguat 6 1999 STATE OF CALIFORNIA COUNTY OF Riverside on 6/25102 berotame, the nnder%WnU. a naleryNTI is island (oraatd Sulo; petlbMl�Y appatod Bill per ipilly lcnawn to me (or proved to me on the basis of PtWaGlmy cvldeneej to M ,Oe pennn(a) VlhWe name(`) iuMrc sub.cAl" to the+*Ml ji;sirOmam and acknravlWFA to the That fte(shcAhey etecuted thea same is t,i.N►erAheir a,ltbnrtxed o1pncisy(iet), and that by hisJlterAheiraigpOlure(e) All 4110- Itlsttumeol the porson(R), or the entity upon bahalrof which the perootl(a? acted. exceutal . atmmull. WIYN 4 -Cy! d and a��ICiGf. i� C 5ignah Nnur; (typwd or Primed) P-03 , PEG6Y BAUMGARDNER H CQMM. �1 ��fl{l14 pt rvARY PLMUCAWFORNIA A U RIMS10& COUNTY 1 my COMFIT W Nov. e, 2004 MAlill.TAX STATEMENTS AS A!<RWMI ABOVE DesOption: RiveMfde, CA Document --Year Doe1D 2002.394339 Page: 1 of I ober. 3-01-26-2004 02-17-12 PM Comment: (Tho am for olttclai 110126.1 Ae)l) ** TOTAL PAGP.R2 ** OCT -13-2004 01:39 PM e 9ul_ld/ar Contest `- 2./0Teleh7 2 "1 i N.. / r� e. M �, . �rltyinq Signature ante Firm: -4- Street Andress: Copies to: Builder, HERS Provider P.01 'OSTIC TESTING /b Thy ilder Name Plan Number Sample Group Number Sample House Number HERS Provider:G�¢�S; CltylStaterzIp: Z# Ai mfzt 60 9� 2S 3 HJRS RATER The house was:Tested 0 Approved as part of somplp testing, but was not tested As the HEIRS rater providing diagnostic testing and field verification, I certify that the houses identified on this form comgly with the diagnostic tested compliance requirements as checked on this form. 19 Distribution system is fully'ducted (i.e., does not use bulldinp cavities as plenums or platform returns in lieu of ducts) Where Goth 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, Jlt-MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage) Duct Pressurization Measured Test Results (CFM ® 25 Pa) q�bh values 3 job Test Leakage Flow In CFM f�/ 1 If fan flow is calculated as 400cfm/ton x number of tons enter here calculated value If fan flow is measured enter measured value here Leakage Percentage (100 x Test Leakage/Fan Flow) = 5.�1 7fv Check Box for Pass or Fall (pass=6% or less) je Q Pass Fail ' c I THERMOSTATIC EXPANSION VALVE TXV or Commission approved equivalent Yes ❑ No Thermostatic Expansion Valve (or Commission approved equivalent) is installed and Access is provided for Inspection El Yes Is a pass ass Fail ❑ MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT Q Yes. O No ACCA Manuel D Design requirements have been met (rater has verified that actual installation matches values in CF -1 R and design on plan. 2. 0 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 = M a Yes for both 1 and 2 is a Pass Pass Fail FROM SLADDEN PALM DESERT (FRO APR 23 2004 14:51/ST.14:51/No.6802770506 P i Slodden Engineering -.,D04692 6782 Stanton Ave.. Suite A. Buena Park, CA 90521 (714) 523-0952 Fax (714) 523-1369 39-725 Garand Ln., Suite G. Palm Desert. CA 92211 (760) 772-3893 Fax (760) 772-3895 Date Z� y Job No. 57,7 FIELD MEMO Project Name rl Client: 93"i Site Ad dress %a r) Job Phone Work Done 1 comments v� - Field Tech. Super. or Agent 24 hour notice requested to schedule Field Technician. Thank you for the opportunity to be of servioe. r INSULATION CERTIFICATE IC -1 Site Address Permit Number -- — �Ce um ran trees— t SAN BERNARDINO County Subdivision Lot Number Description of Installation 1. ROOF Material Thickness (inches) 2. CEILING Brand Name Thermal Resistance (R -Value) Batt or Blanket Type BATTS _ Brand Name JOHNS MANVILLE Thickness (inches) 12 Thermal Resistance (R -Value) - R_38 Loose Fill Type Brand Contractor's min installed weight/fta lb Minimum thickness inches . Manufacturer's installed weight per square foot to achieve Thermal Resistance (R -Value) 3. EXTERIOR WALL Frame Type WOOD A. Cavity Insulation Material FIBERGLASS Thickness (inches) 3 1/2 B Exterior Foam Sheathing Material Thickness (inches) 4. RAISED FLOOR Material Thickness (inches) 5. SLAB FLOOR/PERHAETER Material Thickness (inches) Perimeter Insulation Depth (inches) 6. FOUNDATION WALL Brand Name JOHNS MANVILLE Thermal Resistance (R -Value) R-15 Brand Name Thermal Resistance (R -Value) Brand Name ,Thermal Resistance (R -Value) Brand Name Thermal Resistance (R -Value) Material Brand Name Thickness (inches) Thermal Resistance (R -value) Declaration . I hereby certify thatitthecabo ulation was installed ' the building at the above location in conformance with the current EnergyEficiency Ss fo reside a 24, Part 6, California Code of Regulations) as indicated on the Certificate of Como, ere a le. , 2&3 A v %re,fj , APPLE VALLEY INSULATION, INC. Item #s Signature, Date Installing Subcontractor (Co. Name) OR General Contractor (Co. Name) OR Owner Item #s Signature, Date Installing Subcontractor (Co. Name) OR General Contractor (Co. Name) OR Owner Item #s Signature, Date Installing Subcontractor (Co. Name) OR General Contractor (Co. Name) OR Owner Compliance Forms August 2001 A-36