9704-063 (AR)LICENSED CONTRACTOR DECLARATION
I hOTeby 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. /
ate
License # 7� Z,ZI Lic. Class Exp. Date j , G��
��s./i��} ! , .
` Signature of Contractor �•
OWNER -BUILDER DEC 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.
( ) 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.
(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 provisions.4.�'
Date:+ w 2 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, 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 of this City to enter upon
the above-mentioned property for inspeection. purposes.,, -
Signature (Owner/Agent)��" �-''ell Date `%7
BUILDINGPERMIT PERMIT # CONTROL#
97114-{lt►3 4984
DATE VALUATION s •#� LOT TRACT
`7 ,.1"
I ADDRESS 7P-695SC4#iC .LOOM! R f1sxAl1� JOB SITE
APN i►"_21i;<_Ill6
OWNER
CONTRACTOR/DESIGNER/ENGINEER
RONALD D trmo res
DESERT DE;v1:1.cPM EN T INC
79695 VAR FLO ER"lA
41805 BOARUwA1,.i:
LA, OL1191- GA 9225 ►
PALM DFSVJCI' (]A 02211
(7fi(1jS'ti:-1101 C'X31.##
USE OF PERMIT
Al.).1)N
Al)() 133 S.F. t3LjNUS KQQ,bi
134)1St1S RCf0 -4 1530) S11,7
L+`R'fi;syA"CE9 C ST OF CO NXfRUC."HON
5.309.110
II'VA0111 1OVE SUMNlAR1'
PLAN 04FY'i4 FE'E, 1101401-439-318 552.0
,. .
4'10WTVI+1[10'10N FPV 401-OW)-11R4X)0 "I two
101-i)i)U--111-000 $1 s rto
�,,,,
1J.tst't'ttt 'At, f fsfA 101-tit7642(i -9) $li3.t.><,
.1,11, ►tvO IVllr ►'1`i( I`N FHE - 0*811') 101-01)0-2+414)(10 S.5-41
C
e --I
U_
0
a
StAVIVYYM, MN,,Tnt Jt- noNAND PLAN C''}tW);
$f0 ?4
111"'SS PRE -PAID
$000
l't11iA1. I' :R11i1'!' 1*'1(I .4 tlirl+; Nt.lw
5067.24
• I-�l rYl
RECEIPT
DATE
BY
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
F.A.U.
Framing 1A
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wail Insulation
Condensate Lines
Party Wail Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. 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
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:
Desert Sands Unified School District
Notice: 82-879 Highway 111
Document Cannot Be Duplicated Indio, CA 92201.619-775-3500
CERTIFICATE OF COMPLIANCE
Date 4/15/97
No. 15426
Owner Name Ronald D. Stevens
APN # 604-251-016
Jurisdiction La Quinta
No. 79695 street Star Flower Trail
City La Quinta zip 92253
Permit #
Log #
Study Area 233
Tract # Lot # Square Footage 153
Type of Development Residential Addition No. of units 1
Comments
onus 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.
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 8621101
Name on the check -
By Dr. Carol McGrew
Administrator in Charge
Fee collected /exempted by Pauline Pearson Exempt
Check No. n/a
Signature
$0.00
10TICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day 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
ollect them on the Dislrict('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
SS
C/)
High & LoN�,-,/ E
r Vents 0
0
>1 tir jhjt1Doors
1= I
/TLPH
R-38 Roof Batt lnsulatlo'n T.V.
50/40 SIdg Wclw.
Self Closing F.R. Door
(/7) Door Opener
TLPH
f�fzz= G.F.I.
R-13 Batt Insulation
F.Q. 02yU-)WU- To
Boune Room -153 sq ft
79-695 Star Flower Tr,
La Quinta Ca, 92253
C'TVO,.F LA QUINTA
SAFETY DEPARTMENT
DATE
A PUCABLE GO
P
BY
7.2 CONIPLI kNCE ANALYSIS OF
AN ADDITION ALONE
Any addinon — that is. the stun of all new
1=dittonca �zoaccs and associated new cztcnor
walls. cctlinrs. and tloors within the butldina —
:nav nc mown :o meet the cncrv% nuavct Is a
:�eparatc cnan•. rlus proccaurz docs not involve
the extsttna structure, except when caiculaung the
water heating energy use for anv addition to which
the total number of water heaters in the huildine
Incrcascs. ncc analvsts may he pertotmcd using
either a special prescnptive package accordtne to
the size of the addition or with the point systcm or
.tny approved computer penonnancc me,-,Ioa.
ti
1. Meet the component prescnpuve requirement for Pdckage D for slab -on -grade const ucuon or
Package E for rased floor construction (see Chapter 3).
'_. "Heavy" and "Light Mass" mass walls may meet the PackageD or E requtremcnts for mass wall
instiladon instead of R- 13 (see Chapter 3).
3. For compliance of additions and altcmaons only, dual glazed " grcenhoutsc'' windows and skylights
may be assumed to.meet this requirement.
4. The Package D or E fenestrauon area plus the area of any glazing removed because of the addition.
5. All mandatory measures for HVAC systems must be met (see Chapter 2):
6. No eiectnc resistance space heaung may be installed.
7• A standard water heaung system is explained in Section 6.6.
S. If the total number of water heaters increases in the residence, then the entre existing plus addition
system must mat the water heaung energy budget (see Chapter 6). Table 3-4 lists water hcsung_
.vsteru combinations whieh have been pre -calculated to comply with. the water heaung budget.
7-4 Revised January 1992 Residential Manual
Table 7-l: Prescriptive Compliance of Additions -
Summary bf Section 152(a)l Requirements of the Standards
COMPONENT
�
_ 1.01 ft"
1f111--199 ft"
500-999 tt" ,
>_ 1(N)0 ft"
Insulation
Ceiling
R-19
Packager
Package
Packaac .
Wall"
Floor
R-13
R-13
R-13
Packaa-c
R-13
Packacc
Package
Packat_:e
Fenestratir
U -Value
% of CFA
0.75 ,
<_ 50 ft`
0.75
Pkg + Removedl
Package
Pkg + Removed
Packacc
Package
Shading
Na .
Package.
Package
Packaec
Thermal Mass
Na
Package
Package
Packacc
i Space Heating
Mandatorv�
Package
Package
Packacc
&Cooling
(Noe1cctnc)b
tNocicctnct
(Noclectnc)
(Nocicetric)
Water Heating -
No Increase &
\'o Change
Na
Na
Na
Na
Replacement:
No Increase
Standard
Standard
Standard
Standard
Increase
-kUowcd
w/Calculations
Allowed
Allowed
allowed
w/Calculation
w/Calculation
w/Calculation
ti
1. Meet the component prescnpuve requirement for Pdckage D for slab -on -grade const ucuon or
Package E for rased floor construction (see Chapter 3).
'_. "Heavy" and "Light Mass" mass walls may meet the PackageD or E requtremcnts for mass wall
instiladon instead of R- 13 (see Chapter 3).
3. For compliance of additions and altcmaons only, dual glazed " grcenhoutsc'' windows and skylights
may be assumed to.meet this requirement.
4. The Package D or E fenestrauon area plus the area of any glazing removed because of the addition.
5. All mandatory measures for HVAC systems must be met (see Chapter 2):
6. No eiectnc resistance space heaung may be installed.
7• A standard water heaung system is explained in Section 6.6.
S. If the total number of water heaters increases in the residence, then the entre existing plus addition
system must mat the water heaung energy budget (see Chapter 6). Table 3-4 lists water hcsung_
.vsteru combinations whieh have been pre -calculated to comply with. the water heaung budget.
7-4 Revised January 1992 Residential Manual
r
Table 3-Z1S: Prescriptive Packages for Climate Zone IS
-
Package
Package
Package
;Package
Package
Table 3-Z1S: Prescriptive Packages for Climate Zone IS
-
Package
Package
Package
;Package
Package
Component
A
B
C
_ D-
E
BUILDING ENVELOPE
NR
16%
16%
16%
16%
Insulation Minimums:
9.6%
NR
NR
NR
,1R
Ceiling
R-30
R-38
R-49
R-38
R-38
Wit
R- 19
R-19
R-29
R-21
R-21
"Heavy" Wall
(R-5.5)
(R-4.5)
N/A
(R-4.76)
(R-4.76)
"Light Mass" Wall
(R-7.01
(R-6.01
N/A
N/A
N/A
Slab Fluor Perimeter
R-7
R-7
R-7
NR
NR2
Raised Floor
R-19
R-19
R-21
R-193
R-19
FENESTRATION
Maximum U -Value'
0.65
0.65
0.40
0.65
0.65
Maximum Total Area
NR
16%
16%
16%
16%
Maximum Total Nonsouth Facing Arca
9.6%
NR
NR
NR
,1R
Minimum South Facing Area
6.4%
NR
NR
NR
NR
SHADING COEFFiCMN74
=
South Facing Glazing
0.15
0.15
0.40
0.40
.0.40
West Facing Glazing
0.15
0.15
0.40
0.40
0.4.0
Fast Facing Glazing
NR
NR
0.40
0.40
0.40
North Facing Glazing
NR
NR
0.66
0.66
0.66
THERMAL MASSS
REQ
NR
REQ
20%
5%
INFIl-TRATiON CONTROL
Continuous Barrier
NR
REQ
NR
NR
NR
Air -to -Air Heat Exchanger
NR
REQ
NR
NR
NR
SPACE HEATING SYSTENe
Electric Resitance Allowed
NO
NO
YES
NO
NO
If Gas. AFUE=
78%
78%
78%
78%
78%
If Heat Pump,
Split System HSPFB =
6.8
6.8
6.8
6.8
6.8
Single Package System HSPF =
.6.6.
6.6
6.6
6.6
6.6
'SPACE COOLING SYSTEM
If Split System A/C. SEER =
10.0
10.0
10.0
10.0
10.0
If Single Package A/C..SEER9 =
9.7
9.7
9:7
9.7
9.7
DOMESTIC WATER HEATING TYPE
System must meet .budget,
Meas
Mats
Meets 0
Meets
Meets
see § 151(b) and 151(f)(8)
Budget
Budget
Budget
Budget
Budget
LEGEND: NR = Not Required: N/A = Not Applicable: REQ = Required
See notes following Table 3216.
Predcnptive.Packages Revised January 1992 - 3-35
.-rd icate of comalianca: Residential
(Daae I or''), CF -1R
Date
i Budding Permit R
oject Address
Plan Check Oate
xumentatlon Author relophone
L _ Fieid Check / Oate
k/9G AGS Climate Zone Enforcement Agency use Only
ampll nco Method (Package. Point System or Computer)
3ENERAL INFORMATION ,,/
.otal Conditioned Floor Area: /A /a ft2
:uilding Type: , _�( Single Family Addition
:heck one or morel Multi -Fa Existing -Plus -Addition
:vont Orientation: rwL North Ea i South/west / All Orientations
(Input orientation in degrees and circle one.)
vumber of Dwelling Units:
=1oor Construction Type: I Raised Floor (circle one or both)
3UILDING SHELL INSULATION
Construction
3omponent Insulation Assembly LocationiComments
pe R Value U -Value (attic. to garage. typical, etc.) -
Wall .............. R-/3
Wall ..............
Root ............. ATTi't
Root .............
Floor .............
Floor ... :.........
Slab Edge .... .14,---
FENESTRATION Shading Devices
Fenestration Area Fenestration Interior
Exterior Overhang Framing Type.
ny
Oriernation sf U -Value roller blind. etc.) (shadescreen. etc. !ves/no) (metallw°°dN(
Front..... ( ) � U.
l�i;Nd 2 D��2 ,�� Al s 1/�'niYL
Front.....
Left....... ( )
Left ....... ( ) -
Rear ..... ( )
Rear ..... (. )
Right..... ( )
Right..... ( )
Skylight ....... -
Skylight ....... -
THERMAL MASS
Type/Covering Area Thickness
(slab/exoosed. tile, etc) (st) (inches) LocatioryDescription (kitchen. balm. etc.)
i�53� 3 UFN
R.VAied Jams ton
Cdrtificate'of Compliance: Residential (Page 2 of 2) CF -1 R
I/•�vn�S D �� c� � _ 9 � .
Project Title
Date
HVAC SYSTEMS
Note: Input hyarOnne or comtlrned hydrome data under Water Heating Systems, except oesgn Heating Load.
Distribution
Heating Equipment Minimum Type aria Duct or
Type (furnace, heat Efficiency Location Piping Therrnostat
puurno, etc.) (AFUEJHSPF) (ductVattic etc) R Value TYpe
n
Cooling Equipment Minimum Duct
Type (air conditioner. Efficiency Location Duct
heat
Thermostat Configuration
pump. evao. cooling) (SEER) (attic. etc.) R -Value
Tvpe (split or package)
WATER HEATING SYSTEMS
Rated Tarek
Water Heater Distribution . Number Input (kW Capacity
Energy' External
Factor or Tarok
Recovery Standby Insulation
Type Type in System or Stu/hr) (gallons)
.
Efficiency Loss (%) R Value
1. For smau gas storsW frated input s 75.000 BoAr), electric, resistance and heel pump
For large gse storage water heetws (rated input 2 75.000 Stuft),
wet« hesters. list Energy Factor.
list Elated Input,
For lnstantanoous gas water•heetwe. list Rated input and Reowery EffiEfficiency.Reow"ry
Efficiency and Standt>y Loss.
SPECIAL FEATURES/REMARKS (Add extra sheets if necessary)
COMPLIANCE STATEMENT
This centfimte of compliance fithe ox"stox"features and performance speWcadons needed to comply wtdt Title 24. Parts t and 6. of
the Califorma Code of Regulations, and the adnurosuative regulations to implement them. This cenlhcate has been sl
indINT al wlth.overait design reswrisality. When crus cerntwe of compti )MICS Is submitted fora � b le
orientations, any shading teature that is vaned a Indicated in the Special FeatimeslRemarks secaon a building plan to be tx,dt in multiple
Designer or Owner (per susin.ea • Profteel to cc")
Name: �h «1LT l7FU/zLyih� nil
ride/Firm:
Address:
Telaphons:
Lie. r.
(dM)
emrcement Agency
Name:
Tide:
AgwW:
Telephone:
(sipnaauvstamp) (drib)
Rai
Documentation Author
Now
TideMinn:
Address:
Telephorne:
(tall (drib)