0306-010 (RER)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
/.1�r 4fi
'B NX
al��it
Date v a� Signature of Contractor
OWNER -BUILDER DE ARATION
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.
1, ( ) 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'` a�'19%> 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 manne so as to become subject to the
workers' compensation laws of Cali ornia nd agree that if I should become
subject toowkers'compensati ovi io s tion 3700 of�the Labor
Code,PPply wit t_iJ v' io . /G6)nUd'vD,Bte:A licanWarn' g:ecure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation; damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person. at
whose reqest and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& .hold harmless the City of La Quinta, its officers, agents and employees.
2. An`y permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and S e laws relating to the building
construction, and hereby authorize repre ativ of this City to enter up n
the above-mentioned prope ISA/ig� es. y�
Signature (Owner/Agent) ((/; Dat ; v
PERMIT#
BUILDING. PERMIT
C�;,�
DATE VALUATION + LOT • TRACT
JOB SITE
APN
ADDRESS 00-6"N) 6") S?:4,a KfMA,1-TAVS
. f.. -Ole
OWNER
CONTRACTOR / DESIGNER / EN (NEER
I,A,QTJl 'A•. CA. 92253
CA .'•/2410
USE OF PERMIT
CONY VN..'ii`."114 Ou`36 D CAR CtAkAM 1141'0 O1.�FIC.1�;1 WPXhti1IV PVtR
rhls l Crypt EF> Pls, NI'Ve. of 00
kro(T�'i•::?AYi );��;13roiJS itwlt°ia� ta�3Ns�'�x `,s`4E�.0� ,i�F
13 5^ma"SaRD COa+'Tt 0 I COMIM•SiCIF1019
I1"992M
CONST RIXI ; low "If 10.1 -0110,416 -OW
MUCHANICAL FEE' 1101-000-41 1�0011) V.,$-00
i?z.�ti'T'2JCaaYr•t�;7� 'tf`il-t�ff4•45�:?••�it3C ��:I.t311
•. ,
STRONG )WY$Y N 14,' w - 1'i.FXIU 101 a/ 00,141-W) 511431
Ulm
lll'� 0 3
it CITY OF tom. QUIN"!H
2-90.8"
RECEIPT
DATE
By
FIN
IN OR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings44 4;z
Ducts
Slab Grade 74L
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing d
Compressor
Insulation 3
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath414
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 4&Heater
Final
Water Piping T
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
OX for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
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)
Coachella Valley Unified School District
P.O. Box 847., Thermal, CA 92274
(760) 398-5909 — Fax (760) 398-1224
Project Name:
'44 u,4 �2' (0 - 3 - 03
This Box For District Use Only
DEVELOPER FEES PAID
AREA:
AMOUNT
LEVEL ONE AMOUNT:
LEVEL TWO AMOUNT:
MITIGATION AMOUNT:
COMM/IND. AMOUNT:
DATE:
RECEEPT:
CHECK N:
INITIALS:
CERTIFICATE OF COMPLIANCE
(California Education Code 17620)
Date: Jung 3, 2001
Owner's Name: William Read & Marty Armstrong Phone No.
Project Address: 80-688 SPani sh Bay La Olti_nta. 0,21
Project Description: _ addition of off/bedroom
APN: 775-310-018 Tract #: 98960 Lot #'s: 18
Type of Development: Residential XXXX Commercial
Total Square Feet of Building Area: 240 sq. ft.
Industrial
Certification of Applicant/Owners: The person signing certifies that the above information is correct and makes this statement
under penalty of perjury and further represents that he/she is authorized to sign on behalf of the owner/developer.
Dated: t� �� Signature.
*********************************
SCHOOL DISTRICT'S REQUIREMENTS FOR THE ABOVE PROJECT HAVE BEEN OR WILL BE SATISFIED IN
ACCORDANCE WITH ONE OF THE FOLLOWING: (CIRCLE ONE)
Education Code . Gov. Code Project Agreement Existing Not Subject to Fee
17620 65995 Approval Prior to 1/1/87 Requirement
Number of Sq.Ft. 240
Amount per Sq.Ft. $ 00
Amount Collected $ 0
Building Permit Application Completed: Yes/No
By: Carey M. Carlson
Asst. Supt., Business Serv.
Note: any addition of 500 sq. ft. or less,
is exempt from Developer Fees.
Certificate issued by: E1yi ra- Mattson Signature:
Office Technician
NOTICE OF 90 DAY PERIOD FOR PROTEST OF FEES AND STATEMENT OF FEES
Section 66020 of the Government Code asserted by Assembly Bill 3081, effective January 1, 1997, requires that this District provide (1) a written notice to
the project appellant, at the time of payment of school fees, mitigation payment or other exactions ("Fees"), of the 90 -day period to protest the imposition of
these Fees and (2) the amount of the fees. Therefore, in accordance with section 66020 of the Government code and other applicable law, this Notice shall
serve to advise you that the 90 -day protest period in regard to such Fees or the validity thereof, commences with the payment of the fees or performance of
any other requirements as described in section 66020 of the Government code. Additionally, the amount of the fees imposed is as herein set forth, whether
payable at this time or in whole or in part prior to issuance of a Certificate of Occupancy. As in the latter, the 90 days starts on the date hereof. This
Certificate of Compliance is valid for thirty (30) days from the date of issuance. Extension will be granted only for good cause, as determined by the School
District, and up to three (3) such extensions may be granted. At such time as this Certificate expires, if a building permit has not been issued for the project
that is the subject of this Certificate, the owner will be reimbursed all fees that were paid to obtain this Certificate of Compliance.
MV:c/mydocs/devfees/certificate of compliance 09/30/02
May 28 03 02:53p Keith Brinson 760 779 0488 p.2
05/28/2003 12:10 7605642329 PGAWES7 PAGE 01/01
FAIRWAY'S ASSOCINHON0
May 22, 2003
Mr. Wiliam Read
Ms -Martha Armstrong
0 -688 Spanish Bay_ 1`
La Quixrta CA 92253
RE: Golf Garage Conversion/Window Installation
Dear Mr. Read & Ms. Armstrong:
At the May 19, 2003 Architectural/Landscape commit~ ee meeting the plans that you
submitted for your golf cart garage conversio>a and the installation of a window were
approved.
If you have any questions please contact me.
70nna
ly,
M actio, CMCA
Association Manager
DM/ncp
Post Office Box 1658 •.La Quinta, California 92253 • Phone (760) 564-3858 • Fax (760) 564-2329
CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 1 of 3.) CF -1R
jest Title Date
Pro ct Building Permit #
Doc(�h/on uthor _ Tel
Plan Check / Date
— 11%ti ` � 1 `l v Field Check / Date
Compliance Method (Package or Computer) Climate ZonT e —
- Enforcement Agency Use OMy
GENERAL INFORMATION
Total Conditioned Floor Area L o fe Average Ceiling Height: �� ft
Conditioned Slab Floor Area
Building Type: Single Family Addition
(check one or more) Multi -Family Existing -Plus -Addition
Front Orientation: Q North / South / East / est / All Orientations
(input front orientation in d from True North and circle one)
Number of Stories
Number of Dwelling Units:
Floor Construction Type: C Slab/Raised Floor ircle one or both)
RADIANT BARRIER (required in climate zones 2,'4,8-15) Required for this submittalyes no
BUILDING ENVELOPE INSULATION
Component
me Type . Cavity Sheathing Total R- Assembly Location/Comments
Type
I'!
= wood Insulation Insulation Value' U-Factor(attic, garage, typical, etc.)
Front .
steel R -Value R -Value
Wall
Wall
Roof
Roof
-
,V
Floor
Floor
Slab Edge
Skylight
For Prescriptive compliance Total R -Value and Assembly U -Factor are not reouired for a wood -framed wall that meets cavity R value
insulation reouirements for the Prescriptive Package.,
FENESTRATION
Shadin Devic `
Fenestration Orien-
—g/MTC/Pos. talion
es
Area Fenestration Fenestration Exterior Overhangs/
ft2 U -Factor SH GC ShadingAtt. Fins
Front
Front .
Left
Left
Rear '—
Rear
Right
Right
Skylight
Skylight
r
Compliance Forms
August 2001
A-2
CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 2 of 3) CF -1R
Project Title Date -
HVAC SYSTEMS
Note= Input hydropic or combined hydintric data under Water Heating Systems, except Design Heating Load
Distribution
Heating Equipment . Minimum Type and Duct or Heat Pump
Type (furnace, heat Efficiency_ Location _Piping Thermostat Configuration
:.v
Cooling Equipment Minimtrm Duct
Heat Pump
Type (air coriditioner. Efficiency Location
Duct
Thermostat
Configuration
heat pump. evm coolin) (SEER attic etc.
R -Value
Type
lit orpackage)
SEALED DUCTS and TXVs (or Alternative Measures)
❑ Sealed Ducts (all climate zones)
(Installer testing and certification and HERS rater field verification required)
❑ TXVs, readily accessible (climate zones 2 and 8-15 only)
(Installer testing and certification and HERS Rater or field verification requited)
❑ Refrigerant Charge/Air Flow (climate zones 2 and 8-15 only)
(Installer testing and certification and HERS Rater or field verification requited)
,
OR
❑ Alternative to Sealed Ducts and TXVs (see Package C or D Alternative Package
Feattrres for Project Climate Zone)
Climate Zone Window SHGC . Window U -Factor
-SEER
Heating
t) -
Q> .
WATER HEATING SYSTEMS
4
Energy'
External
Rated'
Tank
Factor or
Tank
Water. Heater Distribution Number Input (kw
Capacity
Recovery
Standby' Insulation
TvDe Type in System orBtn/hr)
(gallons
Efficiency
Loss % R -Value
1. For small gas storage water heaters (rated inputs of less than or equal to 75,000 Btu/hr), electric resistance, and heat pump water heaters, list Energy
Factor. For large gas storage water heaters (rated input of greater than 75,000 Bta/hrh list Rated hiput, Recovery Efficiency and Standby Loss.
For instantaneous gas water heaters, list rated input and recovery efficiencies.
SPECIAL FEATURES (add extra sheets if necessary). Package C and D: TXVs, Sealed Ducts, Radiant
Barriers see installation requirements for radiant barriers in Section 8.13 of the 2001Residential Manual).
Package : thermal mass (thermal mass type, covering, thickness, and description).
Compliance Forms August 2001 A-3
CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 3 of 3) CF -1R
COMPLIANCE STATEMENT
This certificate of compliance lists the building features and performance specifications needed to comply with
Title 24, Parts 4 and 6 of the California Code of Regulations, and the administrative regulations to implement
them. This certificate has been signed by the individual with overall design responsibility. When this certificate
of compliance is submitted for a single building plan to be built in multiple orientations, any shading feature that
is varied is indicated in the Special Features/Remarks section. The undersigned recognize that compliance using
duct sealing and TXVs requires installer testing and certification and field verification by an approved HERS
rater.
Designer or caner (per Business and Professions Code) Documentation An o
Name: ) 1 lU Name:
TiUe/Finn:''---
_TT TiUe/Fimr:
Address: Address: I
Telephone: Telephone:
Lic. #:
C
(si �) s date)
rl
Enforcement Agency
Name:
Tifl-
Agency:
Telephone:
(signature / stamp) (date)
r
y
Compliance Forms August 2001 ! A-4
0i
MANDATORY MEASURES CHECKLIST: RESIDENTIAL (Paege 1 of 2) MF -1R
Note: Lowrise residential buildings subject to the Standards must contain these measures regardless of the compliance approach used
Items marked with an asterisk (') may be superseded by more stringent compliance requirements listed on the Certificate of
Compliance. When this checklist is incorporated into the permit documents, the features noted shall be considered by all parties as
minimum component performance specifications for the mandatory measures whether they are shown elsewhere in the documents
or on this checklist only.
Instructions: Check or initial applicable boxes when completed or enter N/A if not applicable.
DESCRIPTION
)pe Measures:
' § 150(x): Minimum R-19 ceiling insulation.
§ 150(b): Loose fill insulation manatacturer's labeled R-Vahre.
• §150(* Minimum R-13 wall insulation in wood fumed walls or equivalent U Factor in metal frame walls
(does not apply to exterior mass walls) ',
•
§150(d): Minimum R-13 raised floor insulation in hawed floors
§ 1500): Slab edge insulation - water absorption rate no greater than 03%
greater than 2.0 =ntlinch. , water vapor transmission rate no
§118: brat Mon specified or installed mcets iatirolation quality standards. Indicate type and fon.
§ 116-17: Fenestration Products, Exterior Doors, and Infiltration/Exfiltration Controls
L Door and windows between conditioned and unconditioned spaces designed to limit air leakage.
2. Fenestration products (except field-isbricated) have label with certified U -Factor, certified Solar Heat
Gain Coefficient (SHGC), and infiltration certification.
3. Exterior doors and windows weatherstripped, all joints and penetrations caulked and sealed
§ 150(g): Vapor barriers mandatory in Climate Zones 14 and 16 only.
§ 150(t): Special infiltration barrier installed to comply with § I51 meets Commission quality standards.
§ 150(e): Installation of Firephu=, Decorative Gas Appliances and Gas Logs. '
1. Masonry and factory -built fireplaces have:
a Closeable metal or glass door
b. Outside air intake with damper and control
c. Flue damper and control
2. No continuous burning gas Pilot lights allowed.
Conditioning, Water Heating and
Measures:
§ 110-§ 113: HVAC equipment, water heaters, showerheads and faucets certified by the Commission.
§150(h): Heating and/or cooling loads calculated in accordance with ASHRAE, SMACNA or ACCA.
§ 150(i): Setback thermostat on all applicable heating andlor cooling systems_
§1506): Pipe and tank insulation
I. Storage gas water heaters rated with an Energy Factor less than 0.58 must be cxtemafly wrapped with,
insulation having an installed thenal resistance of R-12 or greater.
2. First 5 feet of pipes closest to water heater tank, non -recirculating systems, insulated (R-4 or greater)
3. Back-up tanks for solar system, unfired storage teaks, or other indirect hot water tanks have R-12
external insolation or R-16 combined internal/external insulation.
4. All buried or exposed piping insulated in recirculating sections of hot water systems.
5. Cooling system Piping below 55° F insulated-
6.
nsulated6. Piping insulated between heating source and indirect hot water tank.
DESIGNER I ENFORCEMENT
Compliance Forms August 2001
A-5
MANDATORY MEASURES CHECKLIST: RESIDENTIAL age 2 of 2) W -1R
Note: Lowrise residential buildings subject to the Standards must contain these measures regardless of the compliance approach used.
Items marked with an asterisk (s) may be superseded by more stringent compliance requirements listed on the Certificate of
Compliance. When this checklist is incorporated into the permit documents, thb features noted shall be considered by all patties as
minimum component performance specifications for the mandatory measures whether they are shown elsewhere in the documents
or on this checklist only.
Instructions: Check or initial applicable boxes when completed or enter N/A if not applicable.
DESCRIPTION DESIGNER ENFORCEMENT
Space Conditioning, Water Heating and Plumbing System Measures: (continued)
• §150(m): Ducts and Fans
1. All ducts andplenums installed, sealed and insulated to meet the requirement of the 1998 CMC Sections 601,
603, 604, and Standard 6-3• ducts insulated to a minim installed level of R-02 or enclosed entirely in
conditioned space operdags shall be sealed with mastic, tape, aerosol sealant, or other ductclosu : system
that meets the applicable requirements of UL 181, UL 181A, or UL 181B. Ifmastic or tape is used to seal
openings greater than 1/4 inch, the combination of mastic and either mesh or tape shall be used Building
cavities shall not be used for conveying conditioned ain Joints and seams of duct systems and their
components shall not be sealed with cloth back rubber adhesive duct tapes unless such tape is used in
combination with mastic and drawbands.
2. Building cavities, support platforms for air handlers, and plenums defined or constructed with materials
Other than sealed sheet metal, duct board or flexible duct shalt not be used for conveying conditioned
air. Building cavities and support platforms may contain ducts. Ducts installed in cavities and support
Platforms shall not be compressed to cause reductions in the cross-sectional area of the ducts.
3. Joints and seams of duct systems and their components shall not be sealed with cloth back rubber
adhesive duct tapes unless such tape is used in combination with mastic and drawbamds.
4. Exhaust fan systems have back draft or automatic dampers.
S. Gravity ventilating systems serving conditioned space have either automatic or readily accessible,
manually operated dampers.
6. Protection of Insulation. Insulation shall be protected from damage, including that due to sunlight,
moisture, equipment maintenance, and wind but not limited to the following: Insulation exposed to
weather shall be suitable for outdoor service e.g., protected by aluminum, sheet metal, painted canvas,
or plastic cover. Cellular foam insulation shall be protected as above or painted with a coating that is
water retardant and provides shielding from solar radiation that can cause degradation of the material
§ 114. Pool and Spa Heating Systems and Equipment
1. System is certified with 78% thermal efficiency, on-off switch, weatherproof operating instructions, no
electric resistance beating and no pilot light.
2. System is installed with:
a. At least 36" of pipe between filter and heater for future solar heating.
b. Cover for outdoor pools or outdoor spas.
3. Pool system has directional inlets and a circulation pump time switch.
§ 115: Gas fined central finrnaces pool heater., spa heaters or household cooking appliances have no
continuously bunmg pilot light (Exception• Non=electrical cooking appliances with pilot < 150 B
§ 118 (f): Cool Roof material meet specified criteria
Measures:
§150(k)1.: Luminaires for general lighting in kitchens shall have lamps with an efficacy of40 lumens/watt
or greater for general lighting in kitchens. This general lighting shall be controlled by a switch on a readily
access�bte lighting control panel at an entrance to the kitchen
§ 150(k)2.: Rooms with a shower or bathtub must have either at least one luminaire with lamps with an
efficacy of 40 lunim /watt or greater switched at the entrance to the room or one of the alternatives to this
requirement allowed in § 150(k)2.; and incandescent recessed ceiling fixtures are IC (insulation cover)
approved.
Compliance Forms August 2001 A-6
NC.
Brinson Deve mens -Inc,
CUSTOM HOMES tDTINOVATIONS
WK# (760) 7734487
KEITH D BRINSON CELL# (760) 409-3506
Fax# (7601779 0488
kbrinsauyp@aol.com
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APPROVED
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