0305-300 (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
2517274 B RIC �p sf-y�:filCl lZi
Date Signature of Contractor'
/ � 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:
J ) 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'certificat'e 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
S ction 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 FUND Policy No. I6iF31?3
(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>prowslons:7'
Date: -`�-� % 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, Inde
& hold harmless the City of La Quinta, its officers, agents and emplo
2. Any permit issued as a result of this application becomes null and
work is not commenced within 180 days from date of issuance of kii permit, or cessation of work for 180 days will subject permit to cancel)
I certify that I have read this application and state that the above informal
correct. I agree to comply with all City, and State laws relating to the bu ding t
construction, and hereby authorize representatives of this City to enter ppon
the above-mentioned property forinspection purposes.
Date
`� .� �' r '•^� gra "may
Signature (Owner/Agent)y,�rr "� ,r
PERMIT#
BUILDING PERMIT
M
' t1:3U�3•-,30f3
DATE VALUATIONi_LOT TRACT ��x�
14e ' r ..
JOB SITE / / J
ADDRESS 51-8.33 AVjM.1.DA CIC7M.�l
APN
OWNER
CONTRACTOR / DESIGNER / EN (NEER
MY 1-1-11, T. BACK. MUrW]2L ES
N£.AL T. BATOFR L1TF1.PPJ9FS
SAN 73ERNA37:DINO C sk g^408
(909)BW1241 CESU: 4706
USE OF PERMIT
IV. 401.1"'1 FAWLY WMA, LK0
"Irn PEid'.A11T DOIM?:I0T zadCLliDF IELOCK WALL, POOL OR
DRIV•WAY A PPROACII
TRACT CONSTRUCTION 1,710.00 SF
PORCI-11PATIO 43.00 SP
CARAWCARPORT 463,00 SF
ES,nMATM COST OF CCiN&MMCT'Off
1012,$597.70
FTLRAWFUE 9UMKARY
CONSTRUCTION F&O 101-000.4,38.000 $650.00
PLAN CHECK FEE 10-000-4.39418 $539.93
IUE DEPOSIT 101-000-4.39.318 -2:230,00
MECHAINICPJ, F9Z 101 -000 -4211 -cm,
k+LEC:TRIc°J L'FEE 101.004-.420.000 $11171
PL UMBINQ FEE I Q I-C1(i0-+b9 9••000 $194.00
ST,1r,ONO MOT10114I - R'UUD I01 -WO -241.000 $10,2
QRADINCI FEE 101;,000-423-900 $15.00
DTs°V'ELOPER IMPACT FEE $4405.0
PRECISE PLAN $i0D,00
RM -TOTAL CONSTRUC'T101T AND PLAN CEM
e
rip -r- NOW
$3,770.90
SEP 18 2003
ITY OF LA QUINTA
FINANCE DEPT. .
RECEIPT
DATE .,p'
BY
D!! FINgy
INSP� B
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set,Backs
—
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
k
Combustion Air
Roof Deck
-
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
_
0.2 ioc-
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
I I
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
.,441 A& MEncapsulation
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 - rj
Final
Utility Notice (Perm)
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
47950 Dune Palms. Road
Date 8/8/03 La Quinta, CA 92253
No. 24797 (760) 771-8515
Owner Neal T. Baker Enterprises
Address 1875 Business Center Drive
City San Zip 92408
44�g 'V EDSc�o
zo
Q BERMUDA DUNES r
RANCHO MIRAGE
INDIAN WELLS
PALM DESERT ,y
�7 LA QUINTA^
RIN0 YJ
VV O
APN # 773152016
Jurisdiction La Quinta
Permit # 0305-300
Tract # BLK29 Study Area
Type Single Family Residence No. of Units
Lot #
Unit 1 4
Unit 2
Unit 3
Unit 4
Unit 5
No. Street
51833 Avenida Cortez
S.F. Lot # No.
1710 Unit 6
Unit 7
Unit 8
Unit 9
Unit 10
Street S.F..
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
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Patricia Barbuzza
Signature
Funding Residential
Payment Recd 0.00
$3,659.40 Over/Under
NOTICE: Pursuant to Government Code Section 66020(d)(1), this will serve to notify you that the 90 -day approval period in which you may protest the fees or
other payment identified above will begin to run from the date on which the building or installation permit for this project is issued, or from the date on which
those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting
June 23, 2004
City of LaQuinta
Dept. of Building & Safety
Re: Baker Houses:
'_ 51833 Avenida Cortez -- J
51849 Avenida Cortez
58860 Avenida Juarez
Pursuant to City requirements, I have performed Structural Observations of the house
framing for the above properties as pertains to the following items of work:
1. Anchor bolt size and spacing
2. Shear wall sheathing, nailing and blocking
3. Roof sheathing nailing .
4. Header/beam sizes
5. Strapping at wall openings
6. Beam hardware
7. Holdowns
It has been observed that the above items of work have been performed in accordance
with the approved plans.
It is recommended that the city give its approval to the work and authorize the contractor
to proceed with the remaining work.
4$clibe� m E 18932
- exp• 6�30��� �
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page 1 of 1) CF -4R
Project Title:Baker Enterprises Date: 2/02/05
Project Address: 51833 Avenida Cortez, La Ouinta 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
ertifying Signature D e
Firm: A.I.R. COMFORT SERVICES
Street Address: 68-i55 PELADORA RD.
Copies to: Builder, HERS Provider
HERS
System Number:
Sample House Number
HERS Provider: C.H.E.E.R.S.
City/State/Zip: CATHEDRAL CITY, CA 92234
R COMPLIANCE STATEMENT
The house was: T 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.
L7 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 400cfin/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) _
Check Box for Pass or Fail (Pass=6% or less)
2 THERMOSTATIC EXPANSION VALVE (TXV)
LT Yes ❑ No Thermostatic Expansion Valve is installed and Access is provided for inspection
Yes is a pass
Compliance Forms August 2001
Measured
values
❑ Pass ❑ Fail
2-fass ❑ Fail
Site Address
DUCT LEAKAGE AND DESIGN DIAGNOSTICS
❑ DUCT LEAKAGE REDUCTION
Permit Number
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)
Yes ❑ No Thermostatic Expansion Valve is installed and Access is
_
provided for inspection
0—/ ❑
Yes is a pass
Pass Fail
❑ DUCT DESIGN
I ❑ 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
❑ 1, 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 Signature, Date Installing Subcontractor (Co. Name) OR
Performed General Contractor (Co. Name)
COPY TO: Building Department
HERS Provider (if applicable)
Building Owner at Occupancy
Compliance Forms August 2001 A-25