0304-053 (SFD)LICENSED`CONTRACTOR DECLARATION4
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
Date ! " '' �- a Signature of•,Coniracto �7
OWNER -BUILDER DECLARATION .
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.
4 Code).
O I am exempt under Section B&P.C. for this reasoni+.'
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the fol Iowing tdeclarations:
( ) 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 EXEMPT 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 7 0 of ifie Labor
,Code, I shall forthwith comply with Jth�ose,prgvisions.
Date ; —/ - Applicant" i� , ✓ _ �� .
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as,a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes -_�--
Signature (Owner/Agent) -s��'` �' bate
- PERMIT #
BUILDING PERMIT
y•�, �,tr�g r LOT TRACT
DATE VALUATIONi f
j .. T x lstlP6cfi7 1�
JOB SITE
ADDRESS :k�QgT. Hf� ,..
APN
OWNER
sr
CONTRACTOR / DESIGNER / EN (NEER
COVE DEVs' OPUl"A 'I'
2214 FDCs>ENWt7M
P,0, BOX 696
�.Ai�Z't�..2 NA, CA
U r"IMNT."k CA 92.,'-33
(76o)W-7820 cla.6 021161.3
USE OF PERMIT
IRAN IlY
1;ifJ.t .7`,tr. �FiJ 3'd:TC, eLr iviLl.ldad •.i1V�<6r Ldp IP.fui.: i4'.:f.Ll,� F.s..�i.1:AK - ..
AP@PFrL;3.�iCH-15%i�'I D'C''z%f� t'•1,.,3�`• 1_FiE�'l Fk:1C+ [AOR kTULTIPT-8
/7M �P^,Jr�'I��.�*�p:�/y1.�'?
i/' y�1 t•:Lu'1!IV!'A 4JIr il.�w�l:r 1 "f�dG� .
TFdACT O. N'STPUCTION ;,.831:1'0 BF
PC3RC:i'v`!:?va.TFv^ 4a,t1Q >'sf'
'
41M00 9F
,i: esI Ci`a#�.$�°:C�I�I►�;i"[IC"S�:Fv�
fiii7y^,5.30�
PERMIf VVE ow.+.MMei' 'E.i
PLAN CHECK tt'PE $Z. .6
FEE DIEPWI i 01 _00C --44`.S---3 18
MFCk1a4.N1C:.AI,
ELECT RIC:A.' 4 ME 101 00&42T-000 000 ' $S d 2,'07
PttfP11 :Ntl N'EL 101.000141&__0 0 $130.04
13TF£ONO 14 O—TiON F ER, -1kF,. ID 10.1 AVO -24'. -,000 SU -03
OR'AD.11100FF
f3'EVEWPER,1MPMrP>_, UAOS.e00
` •,
IsR CX;3E Pk.t1N I01=0W,-64,F..'1 lS
. ►'>i},B. ' SI)TAT, CO1~1MUC`.41101: :e 11 1,3 P'LiIT Gk'1�C,°.Fm.�'
�, �Ay6ga 1. -
25,0100
t.
APR l:8 203
CITY OF L,-
r
RECEIPT
DATE {�� �x��'BY
r
DAT FINALED
SPECT
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
'Q
F.A.U.
Framing
— .Q
Compressor
Insulation
6
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
j _
Drywall - Int. Lath
.bC
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
r 4
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
v p
Encapsulation
Gas Piping
Gas Test
U
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
J.
ELECTRICAL APPROVALS
Temp. Power Pole = s0 03
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) �O
.t
P.O. BOX 1504 APPLICATION ONLY
Building 78-495 CALLE TAMPICO
Address LA QUINTA, CALIFORNIA 92253
Owner -4-
t' -
Mailing
Address ��j r /
BUILDING: TYPE*CONST. OCC. GRP.
A.P. Number
�-7
egal Description ! 7 L// J�� /
6 -� Project Description • 1c
�Aty
Zola
Contracto
dres
i
iG
Zi
��
Tel
Tel
State Lic.
& Classif. '� 2_0
City
Lic. #
No.
Siziz Ft. (�5 SNo.tories
Se i3 � Stories Unitss
Arch., Engr.,
Designer
New Add ElAlter ❑ Repair ❑ Demolition ❑
Address
Tel.
City
Zip
State
Lic. #
LICENSED CO TRACTO DECLARATION
I hereb al ' t I am licensed r pr ions of Chapter 9 (commencing with Section
7000) of ' ision 1 the Busines r s ion Code, and my license is nIn full force and
effect.
S GNA DATE
L OWNER -BUILDER DE LARATION -
I hereby affirm that I am exempt from the C nlractor's License Law for the following
reason: (Sec. 7031.5.Business and Professions ode: 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.
I, as net 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, Buisness and
Professions 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 improvement 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 i I, as owner of the property, am exclusively contracting with licensed contractors to con.
Strutt 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 contracror(s) licensed pursuant to the Contractor's License Law.)
i 1 1 am exempt under Sec. B. .for is r ason
Date O
WORKERS' 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
f 1 Copy is filed with the city. IJ 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 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.
Date_ - Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation 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 it and county ordy' ces and state laws relating to building
construction, and here au 19rize repress t5t' es jos city to soler the above-
mentioned property f inspe ton purposes
Signature of appl' nt � ��' Datw
0` �v
Mailing Addres
City, State,
Valuation
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
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 INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
WHITE = BUILDING DEPARTMENT YELLOW = APPLICANT PINK = FINANCE
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District zQ_c?SuU.�o
47950,Dune Palms Road
Cq - Q a RMUDA DUNES r
Date 4/16/03 La Quinta, CA 92253 RANCHO INDIAN WELLS MIRAGE
d
No. 24333" (760)-771-8515% � PALM LA DUINTA y
• INDIO
Owner Cove Development • . APN # 7.74-245-009.,
Address 2214 Ridgewood Jurisdiction La Quinta
City Santa Ana YZipW Permit # 0304-053
Tract # 290 Study Area
Type Single Family Residence No: of Units
Lot # No. Street S.F. Lot # No. Street SY.
Unit 1 16 54420 Avenida Vallejo 1851 Unit-6
Unit 2 Unit 7
Unit 3 Unit 8
Unit 4 Unit 9 '
Unit 5 - Unit•10
Comments
r .
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:
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 1,851 S.F. or $3,961.14 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 nowbe issued.
Fees Paid By C/C 1st Bank/Sharon Bills, - . Check No. 67,625
Name on the check . . . Telephone 880-3446
Funding Residential
By Dr. Doris Wilson =
Superintendent.
,v
Fee collected/exempted by Patric' •Barbuzza $3,961.14 1$0.00 t
Payment-Recd Over/Under "
Signature
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 Distric t('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original- Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting
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 per Section 9.50.090 of the Zoning Code. Its 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 applicant 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 Safety Department as part of your correction list. Please
attach additional explanations as necessary.
APPLICANT:
SITE ADDR,E/;
APN
CASE NO.: ���
LEGAL: LOT. BLOCK UNIT ZG S.C.@V.L.Q.
CHECK AND APPROVED BY: DATE:
3/z V /o
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
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:
C ru^� .yt� -o
AMI
Wed DX f
inning COQ6"
y Council ••. ••• •"... .
iu
O PI
C3 Ci
Case
X:,
No. -
C ung Signature Dat Sample House Number
HERSProvider;G_��SSBG/�i'S
Street Address; 29i�'62,. �p, �2i" _- CltylStatelzip: OwInret G '0 9.�7,,O
Copies lo: Builder, HERS Provider '
HERS RATER COMP61ANCE.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
co ly with the diagnostic tested compliance requirements as checked on this form.
Distribution system is fully'ducted (I,e„ does not use building cavltles as plenums or platform returns in lieu
of ducts)
Where cloth backed, rubber adhesive duct tape Is Installed, mastic and drewbands are used In combination
09
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)
Measured
Duct Pressurization Test Results (CFM 25 Pa)" values
Test Leakage Flow in CFM
If fan flow is calculated as 400cfmlton x number of tons enter
'calculated value here Lam'
If fan flow is measured enter measured value here
Leakage Percentage (100 x Test Leakage/Fan Flow) _. . (,4 1p
Check Box for Pass or Fail (Pass=Wor less) El
ass Fail
THERMOSTATIC EXPANSION VALVE (TXV) or Commission avvroved couivalent
Yes CI No Thermostatic Expansion Valve (or Commission approved
af,
JAN -22-2004 07:06
E�a►,, '
❑ MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT
P. 02
1. 0 Yes d No ACCA Manuel D Design requirements have been met
(rater has verified that actual installation matches values in
CERTIFICATE .OF -FIELD VERIFICATION AND DIAGNOSTIC TESTING CF -4R
2. ❑ Yes 0 No TXV is installed or Fan (low has been verified. If no TXV,
/
verified tan flow matches design from CF•1 R.
Project TitleDate
Measured Fan Flow =
❑ ❑ -
Yes for both 1 and 2 is a Pass
Pass Fail
prolecg/daress
V
Builder ame
Builder Cont ct
Telephone
Plan Number
.�ir►-, n,-M,0J.
l
kV - 57.2 �
HERS ater
T leph ne
Sample Group Number
i
C ung Signature Dat Sample House Number
HERSProvider;G_��SSBG/�i'S
Street Address; 29i�'62,. �p, �2i" _- CltylStatelzip: OwInret G '0 9.�7,,O
Copies lo: Builder, HERS Provider '
HERS RATER COMP61ANCE.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
co ly with the diagnostic tested compliance requirements as checked on this form.
Distribution system is fully'ducted (I,e„ does not use building cavltles as plenums or platform returns in lieu
of ducts)
Where cloth backed, rubber adhesive duct tape Is Installed, mastic and drewbands are used In combination
09
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)
Measured
Duct Pressurization Test Results (CFM 25 Pa)" values
Test Leakage Flow in CFM
If fan flow is calculated as 400cfmlton x number of tons enter
'calculated value here Lam'
If fan flow is measured enter measured value here
Leakage Percentage (100 x Test Leakage/Fan Flow) _. . (,4 1p
Check Box for Pass or Fail (Pass=Wor less) El
ass Fail
THERMOSTATIC EXPANSION VALVE (TXV) or Commission avvroved couivalent
Yes CI No Thermostatic Expansion Valve (or Commission approved
equivalent) is installed and Access Is provided for Inspection
Yes.ls a pass
Pass Fail
❑ MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT
1. 0 Yes d No ACCA Manuel D Design requirements have been met
(rater has verified that actual installation matches values in
CF -1R and design on plan.
2. ❑ Yes 0 No TXV is installed or Fan (low has been verified. If no TXV,
/
verified tan flow matches design from CF•1 R.
Measured Fan Flow =
❑ ❑ -
Yes for both 1 and 2 is a Pass
Pass Fail
'47�7
0
07/22/2003 18:43 7605648601 R C BILLS PAGE 01
Jul 23 03 10:17a sladden palm desert 760 772 3885 P.J.
•'�� � if
Sladden Engineering
6762 Stanton Ave., Suite A, Buena Park, CA 90621 (714) 523-0955; Fax (714) $23-1369
38-725 Garand Ln„ Suite G, Palm Desert, CA 92211 (760) 772-3&0 Fax (760) 772-389.5 i
Dat®
Job No. SZZ. - 32 SS
FIELD MEMO
Project Name --4o-wog- *UFZ'o ^,
Site Address o
Job Phone
Clitarrt:
Work Done—
V-WISW TGS'nw 1+utA%4)01D.3
Test Summary / Footings Inspected
Test
No.
Location
Elev.
bry
[tensity
Moist
%
% Relet re
Comped on
Reif. Max
pef
Moist
%
° .
5Yn.`C40
c -t- Y
132-
1.9
99
1135'
It
y.l
ISS
-5'Y-
-111--
r 11L-._
Field Tech. Sup �r, or Agent
24 hour notice requested to schedule Field Technibian. Thank yoti for the opportunity to be of sevice.
STRUCT...STEEL (C-51)
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CITY OF. LA QUINTA SUB -CONTRACTOR LIST
., _
'� f��
JOB ADDRESS
�/ [,J
PERMIT NUMBER OWNER BUILDER
li
This form shall be
posted on the job with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their employes
are authorized to wo �
on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance O)
O)
of building permit.
For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response.
IW
1IW
/Classification
Contractor
State Contractor's License
Workers Compensation ;Insurance
City Business License
�•� /
i OW 7
Company Name
Classification
License Number
Exp. Date
Carrier Name
Policy Number
Exp. Date
License Number
Exp. Date
�v
DRYWALL (C -9)L
I-�o'r7i,
(e.g. A, B, C-8)
(xxxxxx)
(xx/xx/xx)
(e.g. State Fund, CalComp)
(Format Varies)
(xx/xx/xx)
(xxxx)
(xx/xx/xx)
EARTHWORK IC -121
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CONCRETE (C-8)
RUQFING `IC -391::
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PLUMBING (C-36)
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RUQFING `IC -391::
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FLOORING (C715)
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INSULATION:IC-2).:Ar
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CERAMIC: TILE .IC. -54) `it
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`, it c
,- Certificate,of-Occu anc 0.p y
IN RATM T4
G� OF9�� ' Building & Safety Depa* artment
This Certificate is issue_ d. pursuant to the requirements of Section .109 of the California Building.
Cole, 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: 54-420 AVENIDA VALLEJO
Use classification: SINGLE FAMILY DWELLING'S ` Building Permit No.: 0304-053
Occupancy Group: R-3 Type of Construction: VN' • Land Use Zone: RC
Owner of Building: COVE DEVELOPMENT Address: 2214 RIbGEWOOD .
City, ST, ZIP: SANTA ANA, CA
By: KIRK KIRKLAND. j
Date: January 27, 2004
Building Official
POST WA CONSPICUOUS PLACE
N