9704-088 (RER)LICENSED CONTRACTOR DECLARATION
I here r affirm under penalty of perjury that I am licensed under provisions of
.diapter 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
DateSignature of Contractor, /JJJjJ=^'
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that 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 Policy No.
s section need not be completed if the permit valuation is for $100.00 or less).
f�
I certify that in the performance of the work for which this permit is issued,
1 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 hall forthWRh�comply with tho. provisios.
Or
Date: 1 Applicant
Warning: Failure to secure Woeers' 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
& hold harmless 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 obis City#to enter upon
the above-mentioned property for:irispection purposes. ,
Signature (Owner/Agent) Date�f
BUILDING PERMIT PERMT# °°NTRD #
�//jj���►
5027.
DATE �►f�f�'j VALUATION xg•� LOT TRACT
JOB SITE
ADDRESS 79-66858TARFLOVre)6tT4'tML
APN wig-Irr1S•IJI�,%
OWNER
CONTRACTOR/DESIGNER/ENGINEER
Jt.lDfft11` ct0E LE, ,r
RF.99 ..PT DEVFT,0P1\49.N1f, INC.
'19683 STAk FI..OWERL I•'R.
418I5 BOAR )WALK '
LA Qiifi*!TA CA 02253
PALM .C)ESHRT CA 02211
(760)802-1101 C63LO
USE OF PERMIT
R h N4 )1.J
CON 4.i U Akb I3AY (_)F 0Ai+jWW-' N I 0 ;roc NUN R001%i. +*" s40W: THUS
1140M /S .R(DON) I ALL NUT .t3?:11.5".0 t OR Sl.EKPI NO PURPOSES, "" *
HONUS It001. l 153.00 SF
rfXfVNIA.T ED COST OF t»t NSTRUC]RON
3129110
1ibCIRMi'.1 PEf StaMMARV
PLAN tSiWKl±'W3
('X)N',rRT1MON FR:R 101AM4184W
XIECHA.NiCM, PaX $1.5.00
11LEC'1-jtiC;AL. F ki 14I 1)Gf)»<i20-(kh) b2t0s
8'r0N0 Mc;►11ON. 141 ?-KES,ID 10 1 AN -241 -000
C"
®
C2
t1
CZ
fiE,lit-'Yi fj�:1f, �`f i�i4'18.i t�;1'jF'yy f��1111�1,11iV C,.I1F K, �^
$10?.14
I'ass PaE..0m1? FEES
$0,00 _.
Tfft'Ala PYRNOT 1f fl;ll.% 01 JC N0W .
$169,54
RECEIPT
DATE
BV
DATE FINALED
INSPECTOR
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 j
F.A.U.
Framing14—
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
ZQW
Final
Final
BLOCKWALL APPROV LS
POOLS - SPAS
Steel
Set Backs
Electric Bond .
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final 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
Encapsulation
Gas Piping
Gas Test
Appliances
Final
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)
COMMENTS:
Notice:
Document Cannot Be Duplicated
Date 4/22/97
No. 15448.
Owner Name Judith K Rowley
No. 79685
City La Quinta
Desert Sands Unified School District
82-879 Highway 111
Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
Street Star Flower Trail
APN # 604-251-017
Jurisdiction La Quinta
zip 92253
Permit #
Log #
Study Area 233
Tract # Lot # Square Footage 153
Type of Development Residential Addition No. of Units 1
Comments bonus room
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 or replacement mobilehomes.
It has been determined the above-named owner is exempt from paying school fees at this time due to the following
reason:
Residential Addition 500 Sq Feet or Less
EXEMPT
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of
0.00 X 153 or $ 0.00 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 n/a Telephone >862-1101
Name on the check
By Dr. Carol McGrew .�
Administrator in Charge
Fee collected /exempted by Pauline Pearson
Signature t, � _i_ 2 Q V r Q 01 � &0'y�
Exempt $0.00
Check No. n/a
OTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90day approval period in which you may protest the fees or other payment identified
bove will begin to run from the date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to
ollecl them on the Districl('s)(s') behalf, whichever is earlier.
Collector: Attach a copy of county or city plan check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
.2�!'� c �T v QIAJr5 2� ` M IA.)
SS �5� l 7/3-
! + Self Closing FR. Door
High 8 Lo i +
Air Vents O +
1213LAir ibbDoors
�
Door Opener
'LPH TLPH
CITY O LA Q U I N T
-Z Batt Insulation BUILDING & SAFETY DEPARTNI. NT
+ CONDITIONALLY
ACCEPTED FOR CONSTRUCTION
-R-38 Roof Batt Insu!0lon SLI??EC; T TO INSTALLATION AS PER
AND ALL APPLICABLE CODES
50/40 Sldg Wdw.
D.A
Bouns Room 153 sgLf
79-6W'Star Flower 7r.
La 9LInta Ca, 92253
_ QFEj� cX'1
:ttificare of comaiiancem: Residential (Pace I Or 2) CF -1 R
' Data
Budding Permit is i
Plan ChecK Oats
Field Check / Date
ampll nu Method _(Package, Pont System or Computer)
Climate Zona Bntoroement agency use Only
!ENERAL INFORMATION
otal Conditioned Floor Area: 1_ ft2
IVWing Type: C Single Family Addition
:heck one or more) Multi -Family Existing -Plus -Addition
:vont Orientation: North / East / South/west / All Orientations
(Input onenta9on in degrees and circle one.)
Number of Dwelling Units:
loor Construction Type: Raised Floor (circle one or both)
SUILDING SHELL INSULATION
Construction
3omponent Insulation Assembly Location/Comments
Tvoe R -Value U•Vafue (attic to garage. typical. etc.) .
Wall ..............
Wall ..............
,Root.; ...........
Roof .............
Floor .............
Flout...: ....
Slab Edge
....
FENESTRATION
Fenestration Area
Orientation (sem
Front..... ( )
rronlE.... ( )
Lett:...... ( )
Left ... ( )
Rear ..... ( )
Rear ..... (. )
Right..... ( )
Right..... ( )
Skylight .......
Skylight........
Fenestration
U -Value
THERMAL MASS
Type/Covering Area
(slab/exposed. tile. etc.) (sf)
R.9riied January 1922
Shading Devices
Interior
(roller blind. etc.
Thickness
Exterior
etc.
Overhang
ves/nol
etc.
Framing Type
Certificate of Compliance: Residential (Page 2 of 2) CF -1 R
Pro/etit Title
Oats.
HVAC SYSTEMS
Nota: input hygron,e or ooMomed hydMMC data under Water Heating Systerns. except 0e8gn Heating toad.
Heating Equipment
Distribution
Minimum _Type and Dud or
Type (furnace, heat
Efficiency Location Piping T
Thermostat
purno. etc.)
(AFUE/HSPF) (ductsrar(c etc) R Value Ther
SPECIAL FEATURES/REMARKS (Add extra sheets if necessary)
COMPLIANCE STATEMENT
This cemticate of compliance Ilsts the budding features and performanm. spegticatons needed to compty with ride 24. Parts t and 6. of
the Californa Code of Regulations. and the adininsua0ve regulations to unptement them. This certificate has been signed by the
inClividuat with overall design res0o igAty. When ns certificate of compllanoe Is %&meed for a single building plant to be built in multipie
orien2tions. any stnadntg feature that is varied is indicated in the Special Features/Remarits secnon.
Designer or owner (per euslneee a vreieas a,a cede) Documentation Author
Name: �Sl'/z7— D�y�� /jli2n%�1o.rG Name:
rift/Firm:
rtt.rF.e,,:
Address: 1 w!}
Address:
Telephone: 7,/D ^
Lir- s: %"7 Ca
(del
��ZentAgency-
Nam:
Tide:
Age":
Telephone:
(swiaumstamp) (�)
Telephone:
(+rel. (dM)
Cooling Equipment Minimum Duct
Type (air conditioner. Efficiency Location Duct
heat
Thermostat. Configuration
purrio. evac. cooling) (SEER) (attic. etc.I R -Value
a4�Y1 fi'
Tvpe (sold or package)
WATER HEATING SYSTEMS
RatedTank
Water Heater Distribution Number Input (kW Capacity
Energy' External
Factor or Tank
Recovery Standby' Insulation-'
Type Tree in System or Btu/hr) (gallons)
Efficiency i Loss (%) R Value
t. For smom pas storage tratad input s 75.000 Bu tr). electrle resbtattce and heel pump
For tarpe.gss ato►age water heaters (rated input 2 75.000 Stift).
crater heaters, list Energy Factor.
list hated Input. Redww"
For Instantaneous gas water _hesters. list Ratted Input and Recovery Etfteianey.
Efficiency y
and Standby Loss.
SPECIAL FEATURES/REMARKS (Add extra sheets if necessary)
COMPLIANCE STATEMENT
This cemticate of compliance Ilsts the budding features and performanm. spegticatons needed to compty with ride 24. Parts t and 6. of
the Californa Code of Regulations. and the adininsua0ve regulations to unptement them. This certificate has been signed by the
inClividuat with overall design res0o igAty. When ns certificate of compllanoe Is %&meed for a single building plant to be built in multipie
orien2tions. any stnadntg feature that is varied is indicated in the Special Features/Remarits secnon.
Designer or owner (per euslneee a vreieas a,a cede) Documentation Author
Name: �Sl'/z7— D�y�� /jli2n%�1o.rG Name:
rift/Firm:
rtt.rF.e,,:
Address: 1 w!}
Address:
Telephone: 7,/D ^
Lir- s: %"7 Ca
(del
��ZentAgency-
Nam:
Tide:
Age":
Telephone:
(swiaumstamp) (�)
Telephone:
(+rel. (dM)