0305-148 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
tChapter 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
682,901 B 12/3 1,+0,
Date✓� r Signature of Contractor 'j J€
f tiG.
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&RC. 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 RTAT;.EUtz, D Policy No. IN— RIM`! "03
(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' : t Applicant—
Warning:
pplicant 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 D
& 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 i
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 forinspection purposes. r,
e
Y
/Signature (Owner/Agent)_. --�` --•�D Date fes,. /i��.�'j`7•,
PERMIT #
BUILDING PERMIT�_�
.•
DATE VALUATION. r"a`�`�.0 wC5•A"�i LOT 1 TRACT.
Ilk
r Ea
JOB
ADDRESS ��1 t-�N t�1 CAU'S ITO4.: A LIF
APN
OWNER
CONTRACTOR / DESIGNER / EN (NEER
THO1w I; rRyli f-1,114
DAVID y L. Q)3_WGT(y:t1}'
R01 1 X43Ufii�''r��.CJa
• is
prop)+I08 s-28 t:`BVII
USE OF PERMIT
FANCI. Y' 7 gIVI Li:2 0
S14'i.t1% NII) Yil.,Kv tl2 L;UZ4 NtOT If 4;,.,Y,;.S,%i ti.vrtli.E., i�dl\t.l�:siT6e1. K
t'RACT 3F
F, GOR,",EVP AT K3 1178.00 SF
336.00 d F
.
CCINO'f'RUMN90N I~ k 3€'t-9'=00.418-0 7 ;i,59
PLAN CHECK FVg1 10 is { 0,t,.3-439-3 03 $519.05
FEE C UOSiT 3.'2 -01--10-43 9-3 t.3 4230.Ca
'M•,G:I-IA4iIt�Af:;r:
I?Ut::'1`RU ::F LiEV, 101-una,=nt'i-o".0 $1112121
Z 0W3 kI01014 FFt%-0SIU 10! -0,00.1.41.000
t:'I'RCISE. PLAN 10; -DOG-441 -1343 �If➢al.on
33T.IB-170 3•AT.• �.'',OW i;C01 AM PLAN C."s'IFt.:It:
0 la b M"PIN1%FEK14
43I�J�i:;C!
NOW
JUN lg 2003
CITY OF LA QUINTA
FINANCE DEPT
RECEIPT �fi✓•
DATE
BY
DA E FINAL%E
INSPE
t V
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms &•Footings
- —
Ducts
Slab Grade
-
Return Air
Steel
p IF Alz
Combustion Air
Roof Deck
-0 V
Exhaust Fans
OX to Wrap
F.A.U.
Framing
G
Compressor
Insulation
p 3
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
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 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 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 eg
Final
Utility Notice (Perm)
COMMENTS:
1,,41906 &WsiWf ArAWI @ �OA�LG�lNAf ::
P�•�T�f
Y,
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 Irving, 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 1,514 S.F. -or $3,239.96 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%Valley Independent Bank - David Addington Check No. 287274
Name on the check Telephone 760/408.7528
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected
Signature
$3,239.96
Payment Recd
So.00
Over/Under
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 COMPLIANCE
Ft�sc
Desert Sands Unified School„ District
eAr-,17/�yo
47950 Dune Palms Road
CC BERMUDA DUNES r
Date
6/18/03
La Quinta CA 92253
00) RANCHO MIRAGE (-J
INDIAN WELLS �.
No.
24568
760 7718515
) -
r_ PALM DESERT
LAQUINTA �y
.
'4IN0
Qy�
Q
Owner
Thomas Buffin
APN #
773-292-011
Address
P. O. Box 134
Jurisdiction
La Quinta
City
La Quinta Zip 92253
Permit #
0305-148
Tract #
Study Area
Type
Single Family Residence
No. of Units
1
Lot # No. Street
S.F. r Lot # No.
Street S.F.
Unit 1 12
77570 Calle Nogales
1514 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 Irving, 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 1,514 S.F. -or $3,239.96 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%Valley Independent Bank - David Addington Check No. 287274
Name on the check Telephone 760/408.7528
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected
Signature
$3,239.96
Payment Recd
So.00
Over/Under
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
JAN -22-2004 08:21 PM
CERTIFICATE OF
Wno
P.02
TESTING CF -4R
Builder Name
Plan Number
Sample Group Number
Sample House Number
Firm; 'r ,G, 4-WSSdce;147 &C - . _ HERS Provider; -2Z5_4L
Street Address; 7�1. Q ,0y&1'FDYs t✓ r./,� .� City/State/Zlp: Zu
Copes to: Builder, HERS Provider
HERS RATER COMPLIANCE STAIEMENT
The house was: 00 Tested ❑ Approved as part of sample testing, but was not tested
As the HERS rater providing diagnostic testing and field verification, I certify that the houses Identified on this form
cornpJy with the diagnostic tested compliance requirements as chocked on this form.
L® Distribution system is fully'ducted (i.e„ does not use building cavities as plenums or platform returns in lieu
f 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
Duct Pressurization Test Results (CFM ® 25 Pa) values
Test Leakage Flow in CFMj
If fan flow Is calculated as 400cfm1ion x number of tons enter
calculated value here A� 07)
If fan flow Is measured enter measured value here
Leakage Percentage (100 x Test Leakage/Fan Flow) =.
Check Box for Pass or Fall (Pass -6% or less)
Pass Fall
THERMOSTATIC EXPANSION VALVE (TXV) or Commission anoroved eauivalent
0(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
1. ❑ Yes O No ACCA Manual D Design requirements have been met
(rater has verified that actual Installation matches values in
CF -IR and design on plan.
2. ❑ Yes ❑ No TXV is Installed or Fan flow has been verified. If no TXV,
verified fan flow matches design from CF -1 R,
Measured Fan f=low =
Yes for both i and 2 is a Pass
171
Pass Fail
C3 ❑
Pass Fail
JUL 21 '03 15 29 FR TO 9-7777011
Inforjnatlon
mT0Build 4n
Engineerfng • Consufting • Testing
P. 06/0?
REPORT OF FIELD COMPACTION TESTS
TESTED FOR: DAVE ATTINGTON PROJECT: 77570 CALLE NOGALES
POWER FINANCE LA OUINTA, CA
PO BOX 134
LA QUINTA, CA 92253
OATS: July 02, 2003 OUR REPORT NO.: 073-30259-2
TEST DATA: (1) Very fine grained silty sand. OPT. MOIST. _: 11.0$
TEST
NO.
TEST
DEPTH'
ELEVATION
SOIL ID
NUMBER
MAXIMUM
LAB DRY *
DENSITY
WATER VIET
CONTENT DENSITY
DRY
DENSITY
PERCENT
COMPACTION
COMMENTS -
Sp6C . 90t Min
1
8"
FG
1
115.0
8.6 1::2.1
I
112.4
97.7
1 - A
2
811
FG
1.
1
1
I .
115.0
115.0
115.0
8.7 123.2
9.2 ; 1':4.3
8.9 i 1::2.5
113.3
113.8
112.5
98.5
99.0
97.8-
1 - A
1 - A
1 - A
3
8"
FG
FC
4
8"
TEST LOCATION: House pad -- 77-570 Calle Nogales
1 WEst end of pad
2 I South end of pad
3 East end of pad
4 i North end of pad
NOTES: TESTS PERFORMED PER ASTM D2922-96 & ASTM D3017-96 'COMMENTS: 1 FIL MATERIAL A. TEST RESULTS COMPLY WITH SPECIFICATIONS
DENSITIES SHOWN: Lbs. per cubic foot 2. BA KFILL S. PERCENT COMPACTION DOES NOT COMPLY
WATER CCONTENT: Percent of dry weight, 3. [3A E COU SSE WITH gP CCIFI ATIpoNS
PERCBfJ7 COMPACTION; Based on maximum dry 4. SU C.
RETEST �F P EVIpUS TEST E
Soil IDS^ubmbere0 On sample Indicated Cy s. SOIL NT E. MOISTURE BELOW SSSPEC FICAT�ONS TIONS
* (1) ASTM D1557-00 METHOD .A
TEST INSTRUMENT: STANDARD COUNT M: 0:
REMARKS: PSI dial not monitor the material placement. ADJUSTMENT DATA M: D:
Respectfully submitted,
TECHNICIAN: Juan Nunez Professional Service Industries, Inc.
THESE TEST RESULTS APPLY ONLY TO THE SPECIFIC WQCATIONS NOTED AND MAY NOT REPRESENT ANY OTHER LOCATIONS OR ELEVATIONS.
REPORTS MAY NOT BE REPRODUCEO. EXCtPT IN FULL, WITHOUT WRITTEN PERMISSION BY PROFESSIONAL SERVICE INOUSTRI£S. INC. -
PSI A-100.2 (4)F Professional Service Industries. Inc. - 42-240 Green Wey, Suite C • Palm Desert, CA 92211 • Phone 760/341-5790 • Fax 760/341-5794