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0302-054 (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 Date �! '� Signature of Contractors 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 ' ik API, 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 tpe workers' compensationptoqsions of Section 37 0 of the Labor Code;l.sh II fo hwith comply with t se�9 vi ione Applicants 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 & holdharmless 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 propefor in pection `p rpo es. Date M 6 S Signature (Owner/Agent)r -BUILDING PERMIT PERMIT# DATE VALUATION LOT 0'()2-0811 TRACT ,,.11 Bi 31'ri,27 f JOB SITE f APN ADDRESS 73 1.115- Ffj OWNER j 1 CONTRACTOR/DESIGNER/EN (NEER 1 3CTC, DAMSON E3,1 C DAMSON °53-x`75 A:�'1+ I11AMAT ERO 53-8775 AVY—NIMAl'/,AD R0 LA QMNTiA Cie, 92253 LA 1LMj _'M ... CA 92,213 (160 771«336.2 MLO 5454• USE OF PERMIT 1.4LL901w9 J�,'.1�,jS.V1.f�.�1.l{p.,�,7j,!�iYj rji�ll,dq t�fJ•`fr/ L� Si�d3 = 1519 S.V PEItMIT D0VZ11OT YNC:LUMP HLDCK. NVA.11-, POOL CIR, DRrVXWAY APPROACH T X01' CON"3'1'i1 A.7fIN 3.,5?9,00 alp PO1M1=1fPAT.IO 18-5.0 SP GfARAGRUCARP(yRT $3100 VF M, COST -OF �.��.C��".��aXa•,'16"�.t�d ;399W y� ��.•� q q a, y, q•� ¢p �Ej5'I'3��1!its.�'d k"]3,(6aN.1 J:�717 .P1 C'1�8J�AGdA1�J,8 RY WA nk NSTRt1CTIO1 FE9 101-tMO418.000 $631,10 PL" cHr CK: AVELO 101-000-439-316 $511i33.73 E DEPO x 101-000-4-39-318 -W6.00 10EC'HANIC.A:° P'?Y, 101-000-421-000 % tt.5® EL .ECTrdC.ALr T'I & 101-000-420.000 V 111.0 FI;,i.lMiilld0. FITI 101=000-419.000 $113.00 rMONO MOTAM 14IJ? • _''' 1.0 lU1-0, 111-2411-000 KA O At?11 G FEE 10:1-000-423-000 $15.00 DEVE1,t;i'ER IMPACT TU ', S210M04 PRI&CV-3E PLAN 101-000441-345 gFOL.ID© r E313 . °!`A1 c`CiAt 'fTt TC7 IC1�� P1 3 CK $3,95.0.20 PRE11-METI -73 4251.00 r0MARla"ITS T :IP10041 `I+AIE �ti113..I?: 3�f��V $3,`X00,20 4 2003 CITY OF LA GUINTA FINANCE DEPT. RECEIPT DATE �%p, / BY`9 " - DAT EZ NAUED� fL/"�� V_J INSPEC OR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs G _ QA711 Underground Ducts Forms & Footings d Ducts Slab Grade Return Ait Steel V1 Combustion Air Roof Deck – ( . p 39 T_ Exhaust Fans O.K. to Wrap _ F.A.U. Compressor Framing O Insulation �Y Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath —� Drywall - Int. Lath�y� Final _ Final ZG f 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 Waste Lines Q / Y Water Piping Gas Test Electric Final Hk;ater Final Plumbing Final Plumbing Top Out Shower Pans S— 2 03 Equipment Enclosure O.K. for Finish Plaster Sewer Lateral _ Sewer Connection L Pool Cover 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) At the present time, the'Deseit 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 1,519 S.F. or $3,250.66 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/Palm Deserst National Bank- Erick Davidson Check No. 085135 Name on the check Telephone 760-771-3362 Funding Residential By Dr. Doris Wilson Superintendent Fee coil Signatu $3,250.66 0.00 Payment Recd 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 VIED Desert Sands Unified School District "� 47950 Dune Palms Road zq�co Q BERMUDA DUNES r Date 3/4/03 La Quinta, CA 92253 (n RANCHO MIRAGE d No. 24199 (760) 771-8515 INDIAN DESERT (�i� PALM DESERT LA QUINTA , ,� V �INDIO © YJ Owner Erick Davidson APN # 773-315-001 Address 53875 Avenida Madero Jurisdiction La Quinta City La Quinta Zip 92253 Permit # 0302-054 Tract # B173,U17 Study Area Type Single Family Residence No. of Units 1 Lot # No. Street S.F. Lot # No. Street S.F. Unit 1 1 77465 Calle Nogales 1519 Unit 6 Unit 2 Unit 7 Unit 3 Unit 8 Unit 4 Unit 9 Unit 5 Unit 10 Comments At the present time, the'Deseit 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 1,519 S.F. or $3,250.66 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/Palm Deserst National Bank- Erick Davidson Check No. 085135 Name on the check Telephone 760-771-3362 Funding Residential By Dr. Doris Wilson Superintendent Fee coil Signatu $3,250.66 0.00 Payment Recd 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 . CITY OF LA QUINTA SUB-CONTRACTOR LIST`�' 3IY1'03 " JOB ADDRESS PERMIT- NUMBER - ' OWNER .. ��� kmo UILDER 6ZkCV, DAy�,WY%). This form shall be posted on the job with the Building Inspection Card at all times in a'•conspicuous`place. Only persons appearing on--this list or their employees are authorized to work on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance of building permit. For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response. Trade L`ClassificaUon Contractor :;, ; :....:.. .:' :.;.; St ate:Contractor: s Lic ::. :: _. ense .,. , :_..,:. :. : ....:. ........ Workers:Compensation lrisurance City:Busmess.License` Company Name Classification (e.g. A, B, C 8) License Number (xxxxxx) Exp. Date (xx/xx/xxl Carrier Name (e.g. State Fund, CalComp) Policy Number (Format Varies) Exp. Date (xx/xx/xx) License Number (xxxxl Exp. Date (xx/xx/xx) EARTHWORK IC 121 �. DAq I /JSOJ 10 ?� G�7 /b 31 63 A/ 5 5 3 • • o¢ CONCRETE (C 8) h FRAMING (C=5) , / /( / STRUCT STEEL MASONRY (G 29)-."N-, %! 11 1 t r e PLUMBING (C 36) LATH-'PLASTER(C 35} DRYWALL (C-9) ,, /tv '7fgHVAC - .57 gr- l 3t vY ELECTRICAL;IC 101:< s a93 C%' � S?�� �/�►J e1 '— �— s�-/®•Q3 ROOFING (C 39) SHEET METAL IC 43) iOGi�}_ �s *%�r�� g�� i a ( S�i�Le �11� ' 7-0)- / 0 s� 113 Jo c( FLOORING (C-15) ) � r7,ACJl0CzZN "�%jGf7G% �3/� rJ �l?"/7�,� 0-31-63 -t�•O� GLAZING IC 17) ;/( /( e N INSULATION :IC 2) (! l[ SEWAGE 'DISP (C PAINTING *(d-' (l ( (r CERAMIC TILE (C 54) [ CABINETS 16-;61 FENCING (C' 13) / / LANDSCAPING (C 271 POOL (C 531 CERTIFICATE OF FIELD VERIFICATION Pro'ect Tit v v 7' C X 9 RJ1,1,/,1,,e Z—c,�y Projec Address d Builder Cont ct Telephone �m t�ar�o�� HERS,Rater T 3 TESTING CF -4R GZy/50� Builder Name Plan Number Sample Group Number 96rtifying Signature Dat4 Sample House Number Firm: J -e. HERS Provider: �f,-%�S�oG/�%S Street Address: %8��0 ��'�G1 7oY4 CYG( ¢� City/State/Zip: L9 Oct a 61Y q.-Zj 3 Copies to: Builder, HERS Provider HERS RATER COMPLIANCE STATEMENT The house was: vrTested ❑ 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 comgfy with the diagnostic tested compliance requirements as checked on this form. 21 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. 10 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 CFM?S If fan flow is calculated as 400cfm/toh x number of tons enter calculated value here If fan flow is measured enter measured value here Leakage Percentage (100 x Test Leakage/Fan Flow) Check Box for Pass or Fail (Pass=6% or less) ❑ _ Pass Fail 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 ❑ Yes is a pass Pass Fail ❑ MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT 1. ❑ 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. ❑ 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 Flow = ❑ ❑ Yes for both 1 and 2 is a Pass Pass Fail coil Certificate of Occupancy p 444 G 0F9ti Building & 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: 77-465 CALLE NOGALES r Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0302-054 Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RC Owner of Building: ERICK DAVIDSON Address: 53-875 AVENIDA MADERO City, ST, ZIP: LA QUINTA, CA 92253 By: KIRK KIRKLAND Date: September 22, 2003 Building Official a POST IN A CONSPICUOUS PLACE S, tom. COACHELLA VALLEY WATER DISTRICT CASH RECEIPT DETAIL -! ; 84874 A 1/ lived From: aj ? Date- - � �2- , ess: — -S/ 3 r7x C?Ar l )unt No. / / C i�i % / t(s) Tract' 7 ceAddress - e% _ G.A. Code •f teter(s) $ ervice(s) ackflow(s) ouse Laterals) etector Check(s) leterSurcharge anitation Capacity Charge J, f ,.��, gc- I I.S.B.F.C: smporary Construction Meter <S urn on Charge ncollected Account - Name spection Fee - Tract - Fee - an Check Fees Water I Sewer - Tract - :)nd Payment - A.D. - Bond Assmt. 1 ustomer Deposit then smarks: )y to: i f ey r TOTAL 26 c w;ri Pill pbui,T Water Service Cashier l