0305-301 (SFD)LICENSED CONTRACTOR DECLARATION
U) I hereby affirm under penalty of perjury that I am licensed under provisions of
F– Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
C14 W Professionals Code, and my License is in full force and effect.
O =) M License # Lic. Class Exp. Date
W
Z Date•e; ! - ` Signature of Contractor,:-,
r– I.–
CIO OWNER -BUILDER ECLARATION
W W r- I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ a 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). 1 `
M () I am exempt under Section , B&P.C. for this reason
L
a
N Date Signature of Owner
O' r.1
,It �U>Q WORKER'S COMPENSATION DECLARATION
.:Z
o
Q W 1 hereby affirm under penalty of� perjury one of the following declarations:
p () 1 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 U n(() I have and will maintain workers' compensation insurance, as required by
O U Q Section 3700 of the Labor Code, for the performance of the work for which this
(I: � Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
�a
J (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 pro`visio'ns. �• �r^' '
Date: Applicant r`r2
1
w•'
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
y addition to the cost of compensation, damages as provided for in Section 3706
i 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, indem I
& hold harmless the City of La Quinta, its officers, agents and employ
2. Any permit issued as a result of this application becomes null and vo
work is not commenced within 180 days from date of issuance of s h
permit, or cessation of work for 180 days will subject permit to cancella
I certify that I have read this application and state that the above informatio 1 is
correct. I agree to comply with all City, and State laws relating to the buil ing
construction, and hereby authorize representatives of this City to enter u
the above-mentioned property for insp+ection,p_urposes. r
Signature '(Owner/Agent)'r�`.!%' Datel •�rr�
r ,
BUILDING PERMIT PERMIT#
1�JiD���A_h
DATE VALUATION LOTt� TRACT �y}
4�J.t•in�.i }.: 4' f i13):UML J
„7
JOB SITE
ADDRESS f `��4�1F.
APN i •�'y�D�i l
OWNER
CONTRACTOR/DESIGNER/EN (NEER
E ►nITEVU (;ENi}?ZZ :ESA:? VE .
W:iiiV'Y3&;RKA.RDWO ICI., 551401
SAIN BU' 'iAR•i3.90 CA t.'y.i,03
(VQ9'884-7Z41 M1.;4 4706Z
USE OF PERMIT
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ff�t} l3N ���: ��f�•• •
'Y's2ACT C'ONSTRUCTI,. V 10110.00 SP
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OF ('0]l`v , YRI J'(;TI YN
i0a,5,97.T0
CONST]RUC T..'a G 175T 101 -•01,* -41 VM
PLA.14L`i:-tECKFEE 10 11 18 $114.(4
'f� E.DE'POW 1.0 -000.439:,11e-5230.r0
101•• 00-421 5 r
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.
i,`! RUW? MOTION ME, - F1,11SI0% '101-000-24 1 -0(* ',
0PA.i. INIG -000423-000 W.Wl
DEVVEWPER NP.A.CT Rtfi $ZOS.W
PRECtda PIAN f.0t•00 r-�S41.3��3 }rr,.ai'3
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SEP 18.2003 `
CITY OF LA QUINTA
FINANCE DEPT.
RECEIPT
DATE
.r
BY f
D2 FIN D
INSPECT,0
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—
Cf
Vents
Fireplace P.L.
Grills i
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
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:.
Final
Utility Notice (Gas) f
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)
Building
%i�rffl�ICV
P.O. BOX 1504
/j , , „ 78 495 CALLE TAMPICO
h (�(�C LA QUINTA, CALIFORNIA 92253
Mailing 1
Address —'� 5 rN C's S (,e y -'A -{
City Zip Tel.
Bain fSe.rnar ' C)a a 4
Contractor
Address
1 (71-1 S, C_ m
ty lZip
State Lic.I L;Ity
& Classif. Lic. q
Arcn., tngr.,
Designer
Address Tel.
CityI Zip I State
Lic. p
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,Susfness and Professions Code: Any city or county which requires a
permit to construct, eller, 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).
F] 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.)
I 1 I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. iSec. 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 contractor(s) licensed pursuant to the Contractor's License Law.)
I'! I am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
1hereby 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
(l Copy is filed with the city. ❑ 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 ($100) 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
Ihereby 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 -of this city to enter the above-
mentioned property for inspection purposes.
Signature of a0plicant Date
Mailing Address
City, State, Zip
WHITE = BUILDING DEPARTMENT
0305-3BC
APPLICATION ONLY (/
BUILDING: TYPE'CONST. OCC. GRP.
A.P. Number 1 i\ �r) I 1
Legal Description
Project Description LOT �J" BGK ,25
Sq. Ft. No. No. Dw.
Size l Stories ' Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
"��
Q-7
Infrastructure
MAY 7 t-
--7//////
tr
""NAtir`; . fiij �l
��pr -
TOTAL
REMARKS
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:
YELLOW = APPLICANT PINK = FINANCE / .
Comments Certificates 24797, 24798 & 24799 paid with Cashier's Check #2015081736 ($10,978.20).
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 1,710 S.F. or $3,659.40 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 C/C-Bank of America, Rick Webb Check No. 2015081736
Name on the check Telephone
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exem ed by Patricia Barbuzza Payment Recd
$3,659.40 Over/Under
Signature
NOTICE: Pursuant to Government Code Section 66020(d)(1), this will serve to notify you that the Wday 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
June 23, 2004
City of LaQuinta
Dept. of Building & Safety
Re: Baker Houses:
51833 Avenida Cortez
51849 Avenida Cortez )
58860 Avenida Juarez
Pursuant to City requirements, I have performed Structural Observations of the house
framing for the above properties as pertains to the following items of work:
1. Anchor bolt size and spacing
2. Shear wall sheathing, nailing and blocking
3. Roof sheathing nailing
4. Header/beam sizes
5. Strapping at wall openings
6. Beam hardware
7. Holdowns
It has been observed that the above items of work have been performed in accordance
with the approved plans.
It is recommended that the city give its approval to the work and authorize the contractor
to proceed with the remaining work.
18932
- exp• 6`30��� �
�wII. �P
�rFOF CiO"i �
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page l of 1) CF -4R
Project Title:Baker Enterprises Date: 2/02/05
Project Address: 51849 Avenida Cortez, La Quinta Builder Name: Neal T. Baker Enterprises
Builder Contact: Rick Webb Telephone: 909-228-0918
Plan Number: N/A
HERS Rater: Rick A. Madlin Telephone: (760)325-6125
ZZ 0"'rte W'4z��
ertifying Signature D e
System Number:
Sample House Number
Firm: A.I.R. COMFORT SERVICES HERS Provider: C.H.E.E.R.S.
Street Address: 68-155 PELADORA RD. City/State/Zip: CATHEDRAL CITY, CA 92234
Copies to: Builder, HERS Provider
HERS RA ER COMPLIANCE STATEMENT
The house was: 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 comply with the diagnostic tested compliance requirements as checked on this form.
The installer has provided a copy of CF -6R (Installation Certificate).
❑ Distribution system is fully ducted (i.e., does not use building cavities as plenums or platform returns in lieu of 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)
Duct Pressurization Test Results (CFM @ 25 Pa)
Test Leakage Flow in CFM
If fan flow is calculated as 400cfm/ton x number of tons enter calculated value here
If fan flow is calculated as 0.7 x condition floor area enter calculated value here
If fan flow is calculated as 21.7 x heating output btu capacity in thousands/hr enter calculated value here
Leakage Percentage (100 x Test Leakage/Fan Flow) =
L7 THERMOSTATIC EXPANSION VALVE (TXV)
E<s ❑ No
Check Box for Pass or Fail (Pass=6% or less)
Measured
values
❑ Pass ❑ Fail
Thermostatic Expansion Valve is installed and Access is provided for inspection
Yes is a pass Rl—ass ❑ Fail
Compliance Forms August 2001
CF -6R
Site Address
DUCT LEAKAGE AND DESIGN DIAGNOSTICS
Permit Number
❑ DUCT LEAKAGE REDUCTION
Pressurization Test Results (CFM @ 25 PA)
Test Leakage (CFM)
Fan Flow
If Fan Flow is Calculated as 400 cfm/ton x number of tons, or as 21.7 x Heating Capacity
in Thousands of Btu/hr, enter calculated value here
If fan flow is measured, enter measured value here
Leakage Fraction = Test Leakage/(Measured or Calculated Fan Flow) =
Pass if leakage fraction < 0.06 ❑ ❑
Pass Fail
❑ For AEROSOL TYPE SEALANTS ONLY - The following diagnostic testing was completed:
Duct Fan Pressurization at rough=in measured leakage (CFM)
CHECK AFTER FINISHING WALL:
❑ Yes ❑ No ❑ Pressure pan test or House pressurization test
❑ Yes ❑ No ❑ Visual Inspection of Duct Connections ❑ ❑
Pass Fail
THERMOSTATIC EXPANSION VALVE (TXV)
[B Yes ❑ No Thermostatic Expansion Valve is installed and Access is / 1:1provided for inspection Z
Yes is a pass Pass Fail
❑ DUCT DESIGN
1 ❑ Yes ❑ No ACCA Manual D Design calculations have been
completed, Duct Design is on the plans and duct installation
matches plans. .
2. ❑ Yes ❑ No TXV is installed or Fan flow has been verified. If no TXV,
verified fan flow matches design from CF -1R.
Measured Fan Flow =
❑ ❑
Yes for both 1 and 2 is a Pass Pass Fail
❑ I, the undersigned, verify that the above diagnostic test results and the work I performed associated with the test(s) is in
conformance with the requirements for compliance credit. [The builder shall provide the HERS provider a copy of the CF -6R
signed by the builder employees or sub -contractors certifying that diagnostic testing and installation meet the requirements
for compliance credit.]
Tests ignature, Date Installing Subcontractor (Co. ame) OR
Performed General Contractor (Co. Name)
COPY TO: Building Department
HERS Provider (if applicable)
Building Owner at Occupancy
Compliance Forms August 2001 A-25