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04-6473 (SFD)BUILDING & SAFETY DEPARTMENT P.O. Box 1504. (760)-7.77-.7012 78-495 CALLE TAMPIC.O FAX (760) 777-701 T LA QUINTA, CALIFORN X_92 b INSPECTION REQUESTS. (760).777-71.53 BUILIN DG,'PERMIT Application Number ,� °i ' x'04-00006473" Date 10/16/04. Property Address --,. 5.2-700 AVENIDA VELASCO APIC... ... �\„��,_`�, ��-'`'°'� 773-295=011-14 -000000- . Application descript°idit,': DWELLING.- SINGLE FAMILY DETACHED ..Property Zoningu� .. ��...... , .:.:. COVE RESIDENTIAL., Applitation valuation 102139 .. Owner Contractor..,. BUILDING HORIZONS BUILDING HORIZONS 4260.0 .COOK .ST .#120. 4.2600 COOK. - STREET .PALM DESERT CA 92211 PALM .DESERT . :CA :92211 .. . .: :. ”. :.. (760)..30_=4748 WCC : CV . I:NS .' WC: :170545403. -72/01/04 :. .CSLB:. 812160 09:/-30/06 • .... ....: ... . _..• . .> ... : CCC:. . B. , ------ Structure'Information SINGLE FAMILY DWELLING -.---- Construction Type . . . . . TYPE V. -.NON RATED. Occupancy Type . . . ... . DWELLG/LODGING/LONG <=10." Flood Zone NON -AO FLOOD.ZONE Other struct info CODE EDITION 2001 CBC :. 4: BEDROOMS 3.,-00 FIRE SPRINKLERS NO GARAGE SQ. FTG .519.00 . PATIO SQ FTG :55..00 ::. . NUM BEROF UNITS' 1 !"00 FIRST FLOOR SQ FTC'. 1595':'0 0: Permit. . . . . . BUILDING PERMIT Additional desc Permit' Fee 650'.00 Plan Check Fee. :. 422.50. Issue Date . . . Valuation 102139. Qty Unit Charge Per.- Extension BASE FEE 6'39..50 3..00 3..5000 THOU BLDG 100,001-500,000 10.50 Permit .. . MECHANICAL. Additional desc - . :.. .Permit Fee'. 59.00 Plan Check Fee 14.75 Issue Date. Valuation 0 Qty. Unit .Charge Per Extension BASE FEE 15.00 1.00 9.0000 EA MDCH.FURNACE <=100K 9.00 1.00 9.0000 EA MECH B/C-<=3HP/10OK BTU 9.00 3.00 6.5000 EA MECH VENT FAN 19.50 TAllf P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT VOICE7(760) 777 -761"2 - FAX (760) 777-7011 INSPECTIONS (76.0)'777-71.53 Application Numbe : D N &!q -7s Date: Applicant: r _�It I Architect or Engineer:: Architect or Engineer's Address: Lic. No.: BUILDING PERMIT DECLARATIONS' LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that 1 am licensed under provisions of Chapter 9 (carrxrid6cing with Section 7000) of Division 3 of the Business and Professionals Code, and my License ' full force and eff License Class se No.�� . f Dale R 6,254 Contra or OWNERd3UILDER DECLARATION I hereby affirm•under penalty of perjury am exempt from the Contractors`. State License Law for the following reason (Sea 7031.5, Business and Professions Code: Any city or county that requires a permit to constrict. atter, improve, demolish, or repair any structure. prior to its Issuance, also requires the applicant for the pemJt to file a signed statement that he or she Is licensed pursuant to the provisions of the -Contractors' State license Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or.that he or she 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 dvd penalty of not more than five Hundred dollars ($500).): U 1, 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 (Seca 7044, Business and Professions Code: The Contractors' State License law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself or through his or her own employees, provided that the Improvements are not Intended or offered for sale. If, however, the budding or Wpwen*rd Is sold within one year of completion, the owner -builder will have ft burden of proving -that he or she did not build or Improve for the purpose of sale•). (� I, as owner of the property, am exclusively contracting with Incensed contractors to construct the project (Sea 7044, Business and Professions Code: The Contractors' " State. License Law does not apply to an owner of property who builds or improves thereon, "and who contracts for the projects with a cont actors) ficensed pursuant to the Contractors' State License Law.). (� I am exempt under Sec: ..B.& P.C. for this reason Date ( Owner WORKERS' COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations:. I have and will mamntain a certificate of consent to self46sure to 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 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 ,�,MJyworkers' compensation insurance Artier and policy number are: Carrier U -t• /U> Poficy Number 1 -7b1J01 !y3 _ 1 certify:that, in the performance of the work for whichstih:pdrmil Is issued, i straw not employ any person in any manner so as to become subject to the workers' compensation laws of California. and Wee that, if I dwuld become subject to the workere compensation provisions of Section 3700 of the Labor Code, l shall forthwith comply with those Date Applicant WARNING: ALLURE TO SECURE WORKERS` ENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CAVIL FINES. UP TO ONE HU14DRED THOUS DOLLARS (5100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the.performance of the work for which Oft per -A is issued (Sec. 3097, Civ. C.). Lenders Name Lender's -Address APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a pemdt subject to the conditions and restrictions set forth on this 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 application, the owner, and the applicant, each agrees to, and shall, defend, indemnify and hold harmless the City of La Ouinta, its officers, agents and employees for any act or omission related to the work being performed under or following Issuance of this permit. 2. Any permit issued as a result of this application becomes nun 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 canceration. I certify that 1 have read this application and state that the above information is correct 1 agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to friter . upon the above-mentioned property for inspection purposes. Date Signature (Applicant or Agent): • Page 2 Application Number 04-00006473 Date 10/16/04 Qty Unit Charge Per Extension 1.00 6.5000 EA MECH EXHAUST HOOD 6.50 --------------------------------------------------------.-------------------- Permit ELEC-NEW RESIDENTIAL Additional desc . . Permit Fee . . 96.21. Plan Check Fee 24.05_ Issue Date . . . . Valuation 0 Qty Unit Charge Per Extension BASE FEE 15.00 1595.00 .0350 ELEC NEW'RES - 1 OR 2 FAMILY 55.83" 519.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL 10.38 1.00 15.0000 EA ELEC TEMPORARY POWER POLE 15..00 Permit PLUMBING Additional desc Permit Fee 123.00 Plan,Check Fee-. 30.75 Issue Date Valuation . . . 0 Qty Unit,Charge Per Extension BASE FEE 15.00 9:00 6'.0000 EA 'PLB FIXTURE 54.00 1.00 15.0000 EA PLB BUILDING SEWER 15.00 1.00 7.5000 EA PLB WATER HEATER/VENT 7.50 1.00 3.0000 EA PLB WATER INST/ALT/REP 3.00 1.00 9.0000 EA PLB LAWN SPRINKLER SYSTEM 9.00 6.00 .7500 EA PLB GAS PIPE. >=5 4.50 1.00 15.0000 EA PLB GAS METER 15.00 Permit . . . GRADING PERMIT Additional desc-. Permit Fee 15.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 0' Qty. Unit Charge Per Extension ---------- BASE FEE 15.00 --------------------------------------------------------- Special Notes and Comments --------- '1595 S.F. SFD PERMIT DOES NOT INCLUDE BLOCK WALL, POOL/SPA OR.DRIVEWAY APPROACH ---------------------------------------------------------------------------- Other Fees . . . . . . . . ART IN PUBLIC PLACES -RES .00 DIF COMMUNITY CENTERS -RES 97.00 DIF CIVIC CENTER - RES 366.00 Page 3 Application Number 0.4-00006473. Date '10/16/04' ------------------------------------------------------------------------------ Other Fees ENERGY REVIEW FEE 42.25 DIF'FIRE'PROTECTION'-RES 97.00 DIF LIBRARIES - RES 225.00 DIF PARK MAINT FAC - RES 5.'00 DIF PARKS/REC -'RES 502.00 STRONG'MOTION (SMI) - RES 10.21 DIF;'STREET MAINT FAC-RES 15.00. DIF TRANSPORTATION -'RES' 1098.00 Fee summary Charged,' Paid Credited Due Permit Fee Total 943.2.1" 00 .00' 943.21 Plan. Check Total 492.05 :250'.00. .00 242.05. Other Fee Total 2457.46 .,00 .00, 245>7.46 Grand Total 3892.72. 250..00 .00' 3642.72 �t S?RREAML 6 V 7 3 S 7 P.O. BOX 1504 APPLICATION ONLY Building QIG0 78-495 CALLE TAMPICO Aririracc LA QUINTA, CALIFORNIA 92253 Mailing Address (.12_Lmp �2p 34.v.•c� 1 M � �� Vic. ��•Z�•+i.S 1411 "0-%L Zip BUILDING: TYPE CONST. IrM' OCC. GRP. LZ"'3 • ci — L A.P. Number 773-2 _dl5--_ G6 J Legal Description Project Description �•r �• State Lic. City O Sq. Ft. No. & Classif. Sl LG,=6 Lic. # �8�� Size IS 11 C\ Sto Designer Address Tel. <-_-7 ti4S 29 F,J^s KUv. YUCCA t)4ey I (-A I Lic. # 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, Business and Professions Code: Any city or county which requires a permit to construct, alter, 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). ❑ 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 and Profes- sions 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 im- provement 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, as owner of the property, am exclusively contracting with licensed contractors to construct the project. (Sec. 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.) ❑ 1 am exempt under Sec. B. & P.C. for this reason Date & Owner WORKER'S COMPENSATION DECLARATION I hereby 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 O 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 performarice of Yie work for which this permit is issued, I shall not employ any pers n in any manner a o become subject to Workers' Compensation Laws of Californi Date 2 �wner NOTICE A LICANT. If, afflirVaking this Certificate of Exemption you should become subject to the Workers' Comperfsation Provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby 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 applicant Date Mailing Address City, State, Zip WHITE = BUILDING DEPARTMENT No. Dw. New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ 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_ Issued by: Validated by:— Validation: YELLOW = APPLICANT INSPECTOR Date Permit PINK = FINANCE Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading 1\`. Driveway Enc. Infrastructure V k W Y ✓�A1; 0t,. rr.D�p� 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_ Issued by: Validated by:— Validation: YELLOW = APPLICANT INSPECTOR Date Permit PINK = FINANCE I • N�f iEp c / C �G «RANCHO MIRDUNAGE 0 Desert. Sands Unified School District,,' INDIAN WELLS � RANCNO MIgAOE � . PAW DESERT v 47-950 Dune Palms Road • La Quinta, California 92253 (760) 777-4200 ♦ lA`WINTA �a �Q INolO y� • July 26,2004 Mr. Todd Berg Acting Executive Director'. Boys& Girls Club Building Horizons 42-600 Cook St., #120 ; Palm Desert, CA 92211 Dear Mr. Berg: Thank you for your recent letter requesting a waiver of Developer Fees for the 2004/2005 projects located at: 52-680 Ave Velasco, La Quinta APN 773-295-010 52=700 Ave Velasco, La Quinta APN 773_295-011 Desert Sands Unified" School District is proud to support your organization and -therefore will grant exemption of developer fees for these two locations. We look forward to collaborating with you again in the future for the. benefit of the " children that we jointly serve. l Please.call me at (760) 771-8515 with any further questions or concerns. Best regards, Peggy Reyes Director, Facilities Services PR/bs J • RC DISTRICT - PLANNING. REVIEW FORM This form is to be used by CDD staff. for -review of single family dwellings -in .the RC (Cove Residential) District t.'per Section 9.50.090 of the Zoning Code. I.ts purpose is to determine: 1) that the proposed housing design does not duplicate the same architectural style of any house within 200 feet of the applicant; .and/or 2) if there is a need for the aPp;licant.to file .for Master Design Guidelines. If the applicant .does need to file*.a Master Design Guideline, please transmit this information to the •Building and SafetyDepartment as. part of your correction list. Please" attach additional explanations as necessary. APPLICANT: SITE ADDRESS ` `�D e APN 7 1 LCA SE NO.: lD LEGAL: LOT 1 y BLOCK lSZ%' UNIT S.C.@V.L.Q. CHECK AND APPROVED.BY: w Nis i 7— DATE: Inform the assigned Building plan checker upon -your assignment to this case. The CDD Executive Secretary maintains a log book to track applications and assign case numbers. REQUIRED ITEM . Y N COMMENT/CORRECTION Verify legal and APN information c Consistent with MDG on file (as applicable) .MDG filing required (5 filings since 9./3/98) Architectural variety within 200 feet of the surrounding area: Architectural design features Other Requirements: Umm i • L0- • MEMORANDUM t,{t OF. co T0: Building and Safety 0�2� FROM: Wally. Nesbit, Associate Planner, y`�A9 • DATE: 10/7/04 �T RE: CDD CORRECTIONS - RC 2004-1030; 52700 VELASCO (BUILDING HORIZONS) 1. If necessary; verify builder's authorization to use architect's plans prior to permits being issued. 2. 'Exterior colors are to be compatible with the surrounding homes. Attachments UpEg___ ed_by: Date Reso # 0 Planning Commission O City Council o ArCommu • y Dev. Dept. Initials Case No.. /jc w.iv3o Exhibit p With Conditions r .....:.�..'r:::.:•..:.:::•ii/.:r..':.�:":r:�./Y/:. r,r.:J: li .:':I/.1. Hl.�I, :•%'dr /.'.lrJ:/i yf/.'. ..../... r./f./_C..f_.... ....... r/.f/v _v_G'.✓.r.✓. ,./r. rY_/.r/.rJ .ar. .. _... _... .,.v_. ..r__..i .:..r. _ .._ INSULATION CERTIFICATE This is to certify that insulation has been installed in conformance with the current energy regulation, California Administrative Code, Title 24, State of California, in the building at 52-700 AVENIDA VELASC0, LA QUINTA, CA.. CEILINGS: TYPE: BATTS MANUFACTURER,- Certainteed THICKNESS: R-38, WALLS: TYPE: BATTS MANUFACTURER: Certainteed THICKNESS: R-19 - GENERAL CONTRACTOR: BUILDINGS HORIZONS. LICENSE #' < BY: TITLE:_ PARAGON SCHMID BUILDING PRODUCTS A MASCO Company LICENSE # 221517 BY: LE: ACCOUNT REP RES ENTIVE DATE: 'L?�-�? -. ./...,. iJ.�..::.::: :. ....:.:iii'; wi'::...nr:r ....�. ....w /... _...........J.,+.:..i.../..J.:..!vA.. .dM.a✓,.q. ,f :,.../i. /d �4.. .i ..J/n..Jr..r..r.c. r//,.c. _ .Y. rf... .r..J.r.. .... .. r_ n.. _.. ...... .... .... . ::: .....:.:.;:. .. .:.i .. .. �.,. /i r.. ..V_t J/diN fl..il.�... .Ji.- .. rl.. /P+i,J!✓i.- .../.. /l,, d.,......✓... �.. f...._... .. .... .:. �. ,... .._ .. ... INSULATION CERTIFICATE This is to certify that insulation has been installed.in conformance with the current energy regulation, California Administrative Code, Title 24, State of California, in the building located at 92.680 AVENIDA VE:LASCO, LA QUINTA, CA. CEILINGS: TYPE: BLOW MAUNFACTURER: Certainteed THICKNESS: R-38 WALLS: TYPE: BLOW MAUNFACTURER: Certainteed THICKNESS: R-19 GENERAL CONTRACTOR: LICENSE # BY: TITLE: PARAGO SCHMID BUILDING PRODUCTS A MASCO Company LICENSE # 221517 BY: ��GC° �~ E.- ACCOUNT REPRESENTIVE DATE: �3 � ZO 39t1d CIVIR-13 N09108Vd' bO£Z9C6O9L i S :6d SaOZr' !ji''3O -b INSTALLATION CERTIFICATE (page 1 of 13) CF -6R Site Address //D0 ( jj- i /k1AfC p Perron Number An installation certificate is required to be posted at the building site or made available for all appropriate inspections. (The information provided on this form is required; however, use of thisform to provide the information is optional.) After completion of final inspection, a copy must be provided to the building department (upon request) and the building owner at occupancy, per Section 10-103(b). HVAC SYSTEMS: . Heating Equipment Equip. # of Efficiency Duct Duct or Heating Heating Type (pkg. CEC Certified Mfr Name Identical , (AFUE, etc.)t Location Piping Load Capacity heat nmol and Model Number Systems f> F-1 R val uel (atti etc.) R val ue (Btu/hr) (Btu/hr) _01,_ Ito Cooling_Equipment Equip. CEC Certified Compressor # of Efficiency Duct Cooling Cooling Type (pkg. Unit Mfr Name and Identical (SEER, etc.)' Location Duct Load Capacity heat Wlmg) Model Number' Systems f2CF-I R valuel (atticetc-) R value (Btu/hr) (Rei/hr) Asa 9- o — / • , _ ; c opo s� ego 1. > reads greater than or equal to.. I, the undersigned, verify that equipment listed above is: 1)'is the actual equipment installed, 2) equivalent to or more efficient than that specified.in the certificate of compliance (Form CF -1 R) submitted for compliance with the Energy Efficiency Stan ards for residential buildings, and 3) equipment that meets or exceeds the appropriate requirements for mpuf4ctureoevices fro a Appliance/Efficiency Regtilations or Part 6), where applicable. Si lure, Date Installing Subcontractor (Co. Name) } OR General Contractor (Co. Name) OR Owner ATER HEATING SYSTEMS: Distribution If Recir- # of - Rated] Tank Effi- External Heater CEC Certified Mfr Type (Std, culation, Identical Input (kW Volume ciencyi Standby2 Insulation Type Name & Model Number Point -of -Use) Control Type Systems or Btu/hr) (gallons) (EF RE) Loss (0 R value e 2 For small gas storage (rated input of less than or equal to 75,000 Btu/hr), electric resistance and heat pump water heaters, list Energy Factor. For large gis storage water heaters (rated input of greater than 75,000 Btu/hr), list Recovery Efficiency, Standby Loss and Rated Input. For instantaneous gas water beaters; list Recovery Efficiency and Rated Input. 3. R-12 external insulation is mandatory for storage water heaters with an energy factor of less than 0.58. Faucets & Shower Heads: All faucets and showerheads installed are certified to the Commission, pursuant to Title 24, Part 6, Section 111 I, the undersigned, verify that equipment listed above my signature is: 1) the actual equipment installed; 2) equivalent to or more efficient than that specified in the certi:rc;te of compliance (Form- CF -1R) submitted for compliance with the Energy Efficiency Standards for residential buildings; and 3) equipment that meets or exceeds the appropriwz requirements for irwm[factured devices,"ftnm the Appliance Efficiency Regulations or Part 6), where applicable. Date:.:,......:. _ . ..,.�, 000.%Jjj i'dC;j6i (Co. iVawc) Vtl General Contractor (Co. Name) OR Owner COPY TO: Building Department HERS Provider (if applicable) Building Owner at -Occupancy Compliance Forms August 2001 A-23 CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7) . CF4R Project Title A // ' VP.,. r/.lam ��.9 I�SGU Date Otr Project es Bu ,dor Nama i ..Firm: Street Address: /Z— _,e-- � Copies to: Builder, HERS Provider . Plan Number Sample Group Number - Semple House Nu beer / HERS Provider: City/State/Zip:�,.? HERS RATER 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 with the diagnostic tested compliance requirements as checked on this form. comply 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 Pressurizat' T Measured ion est Results (CFM @ 25 Pa) values Test Leakage Flow in CFM If fan flow is calculated as 400cfiu/ton 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) ,�( ❑ �+[ - Fail _ THERMOSTATIC EXPANSION VALVE (TXV) Yes ❑ No Thermostatic Expansion Valve is installed and Access is provided for inspection ❑ Yes is a pass .. ~ 11MINIMUM REQVIREMENTS.FO.R.DUCT.-D.ESIGN COMPL-1ANCE -- Pastes Fail - CREDIT l' ❑ Yes ❑ No ACCA Manual D Design requirements have been met (rater has - ' verified that actual installation matches values in CF -1R 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 -IR. { ll Measured Fan Flow = ❑ ❑ Yes for both I and 2 is a Pass Pass Fall Compliance Forms August 2001 A-16 r Code Program STRUCTURAL OBSERVATION REPORT FORM STRUCTURAL OBSERVATION means the visual observation of the structural system, for general conformance to the approved plans and specifications, at significant construction stages and at completion of the structural system. Structural observation does not include or waive the responsibility for the inspections required by Section 108, 1701 or other sections of the code. Report No. This report includes all construction work' throunh )'�K day of MA.( C -VV g(1 Dz�- Pana Nn I of Project Address: , 1521 CO d/� V�P6Ca - ai',I C.i� Structural Observer of Record (SO ): KEN c. U tk ot� Phone No. of SOR: (9 0,0 Building Permit No.: Structural Observation performed by: Professional Lic./Reg. No. of Observer:.. 'lr�:�>-2 Phone No. of Observer: Cqo-,i ❑ Steel Moment Frame S ��' S JZt) ❑ Mat Foundation naeeoven erourn ioei n eueun nun nc�o rnuuernnue FOUNDATION WALL FRAMES FLOOR PORTION OBSERVED, IF NOT WHOLE 1 Footing, Stem Walls, ❑ Concrete ❑ Steel Moment Frame ® Concrete ❑ Mat Foundation ❑ Masonry ❑ Steel Braced Frame ❑ Steel ❑ Caisson, Piles, Grade Beams 1DWood ❑ Concrete Moment Frame ❑ Wood -54MRulaq /A.5[ kvz-/�p ❑ Retaining Foundation Hillside Special Anchors ❑ Other. ❑ Masonry Wall Frame ❑ Others: ❑ Others: ❑ Others: OBSERVED DEFICIENCIES: 2 CD .,� C` �Oc S -\171D I DECLARE THAT THE FOLLOWING STATEMENTS ARETRUE TO THE BEST OF MY KNOWLEDGE: 1. 1 AM THE ENGINEER OR ARCHITECT RETAINED BY THE OWNER TO BE IN RESPONSIBLE CHARGE FOR THE STRUCTURAL OBSERVATION IN ACCORDANCE WITH THE REQUIREMENTS OF THE CITY 2. I, OR ANOTHER ENGINEER OR ARCHITECT WHO I HAVE DESIGNATED ABOVE AND IS UNDER MY RESPONSIBLE CHARGE, HAS PERFORMED THE REQUIRED SITE VISITS AT EACH SIGNIFICANT CONSTRUCTION STAGE TO VERIFY IF THE STRUCTURE IS IN GENERAL CONFORMANCE WITH APPROVED PLANS AND SPECIFICATIONS; 3. ALL DEFICIENCIES WHICH REMAIN TO BE CORRECTED HAVE BEEN INDICATED ABOVE; 3 1$ C� SIGNATURE DATE MAR 18 2005 R,pFESSIpN ��0 Pip 1•\Nq�� CIVIL�� OF C AU STAMP OF STRUCTURAL OBSERVER OF RECORD IS ............. i • ,- Certificate of Occupancy R'= G OF 1 Building Y p & 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: 52-700 AVENIDA VELASCO Use classification: SINGLE FAMILY DWELLING Building Permit No.: 05-6473 Occupancy Group: R-3 Type of Construction: V-N Land Use Zone: RC Owner of Building: BUILDING HORIZONS Address: 42-600 COOK ST. #120 City, ST, ZIP: PALM DESERT, CA 92211 By: STEVE TRAXEL Date: 06-09-2005 Building Official POST IN A CONSPICUOUS PLACE • w_Q �,