0304-294 (SFD)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
ate { % -,Signature of ContractoKe
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
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 MEMPT 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 's6 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.'
,Date:a i f1Applicant� ^�" dY •✓'-��
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, indemni
& hold harmless the City of La Quinta, its officers, agents and employee
2. Any permit issued as a result of this application becomes null and void D -
work is not commencedwithin 180 days from date of issuance of su
permit, or cessation of work for 180 days will subject permit to cancellatio
I certify that I have read this application and state that the above information
correct. I agree to comply with all City, and State laws relating to the buildin
construction,,and hereby authorize representatives of this City to enter upo
,the above. mentioned property for inspection purposes.
Signaturea(O.wner/Agent) -+• i�,`� Date
BUILDING PERMIT PERMIT#
DATE/J('--YALUATION_ a� ,r �dJ�;d'i„u 'LOT TRACT. 04Z�$90
JOB SITE '%`F^'{�• �A V.IL3.TR'D Yi ALWO
APN ;i'74-21 Z 1 f
ADDRESS
OWNER
'CONTRACTOR / DESIGNER / EN (NEER
:ej�`�'ti�'s.�Lj `>S'I)l.��.'i'�(T�:C`?�a�s.�l`F` . •.
:
t♦tl. RMICY\Oy
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-w,dP0
' A-7,750
82
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r'•it1 iyy�l+,%11 �i1•�
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.
.USE OF PERMIT
c l
~
t p::•l "7:ri i raJ•�R iu: C.1hW[,l• S.H'"�.la�i. t,Y t IJ +v.win:.vAruv��, vv.n'�Ley a .. «. n.. -
i ,,
`�iy'y^t5�».t~:TC�(al�+tS�'pR.VCT1014 S Z:A�..lg�."M
€TM, A:IFfCAR P0 RT i Se:or! iii?
1.9rrKATKD 0057 tXr c!CnN +�rf?,'[_1C':t'10A
3 :E 1. 0
CONS' RUKI_€ION PEE 101'000. 418-F1Vr
PW34 CHW-le, i'egir 101-•inou.439-.'3'! P,
FEF, DEPOSIT 101-000-439-31F,9.3fIF, 42fl+kQ
10, 1t,Gi.fiJ-421 —0, 00 50
U 1 r 100420 000 %E2167
~.tri f331i �f FEE 3 00
DxVEDOPER Mr -ACT rH �7,h ,cry
PrIVVII.L.It PLAN
1rb) pA,:;,tt: f. k.F :CIC.'tis
:. A'LG. Pai"if.l! A0.79
\.+• w•'v
MAY. 0 6 2003
.CITY OF LA OIJINITA
FINANCE wN;5 .
RECEIPT
DATE �P� ��
BY
DATE FINALED
INSPECT0a
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Q 5
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
O.K. to Wrap
_
Exhaust Fans
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall 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 Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
�,
Waste Lines
Gas Test
Electric Final
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
&Y
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) G
COMMENTS:
TAtyl 0:30 4
4 4a"
/ �� P.O. BOX 1504 APPLICATION ONLY
Building�`%% // /C.�C;� N`j95 CALLE 504P APPLICATION
Address 7 �/ (((/// TA, CALIFORNIA 92253
`� " /' BUILDING: TYPE'CONST. OCC. GRP.Maili-
� cr) lT� ChJ0/0
Addr;;;�2./-�/ & eg'&I-A.P. Number // ,,,,��•�-- /� —� �,r
Zip Tel.
Legal Description
Contractor Project Description ,
Address
116, s-
Zip
Tel.��
State Lic.
& Classif.
City
Lic. #
Arch., Engr.,
Designer
Address
Tel ; ,// J�
i� T `l
City
Zip
State
Lic. #
.LICENSED CON CTOID:CLARATION
I hereby affi that license��p
of hapter 9 (commencing with Section
7000). of Div' ion he BusinesCo e, and my license is in full force and
effect.
.�
GNAT / 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 live hundred dollars ($500).
i.! 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, 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 1 I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct 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 Seca B. & P.C. for this reason
Date Owner
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
Sl Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed it the permit is for one hundred dollars ($100) valuation
or less.)
I certify hat in the perforecep work for ch}Ms ermitis issued, I shall non
employ y per 'n in any mato rk s 'fin to he Workers' Compensation
Laws f ' or i
Daten�
"T, T A LI NT. a making fh s Ce to o1 Fxea tion you should become
subje 1 fo a orkers' mpensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
Ihereby 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
Lenders Address '
This is a building permit when properly filled out, signed and validated, and is subject to
expiration it 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 sof this city to enter the above-
mentioned properly for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
Sq. Ft. / �/ No.
Size l 0 Stories
New Add ❑ Alter ❑
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
No. Dw.
Units
Repair ❑ Demolition 13.
AMOUNT
2S I r?O
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 zoo
47950 Dune
� Palms Road ¢ BERMUDA DUNES r
Date 5/6/O3 r La QUmta CA 92253 rn RANCHO MIRAGE d
9 _ �. INDIAN WELLS- �r
No. 24402 (760) 771-8515 �,nPALM UINT �y
V:TINDIO
151
1^
VVV ® YJ
Owner Cove Development APN # 774-245-010
Address 2214 N. Ridgewood Jurisdiction La Quinta
City Santa Ana Zip Permit # 0304-294
Tract # BLK290 Study Area
Type Single Family Residence, No. of Units 1
Lot # No. Street SY Lot # No. Street S.F.
Unit 1 15 54440 Avenida Vallejo 1851 ' Unit 6
Unit 2 Unit 7 ,
Unit 3 Unit 8
Unit 4 Unit 9 '
Unit 5 Unit 10
Comments
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:
K
r EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to
Education Code Section 17620 and Govemment 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 now be issued.
Fees Paid By„C/C 1st Bank/ -Sharon Bills check No. 68060
Name on the check Telephone 880-3446
Funding Residential V t
By Dr. Doris Wilson " ;
Superintendent
Fee collected /exe ted by, PZat Barbuzza $3,961'.14 1$0.00
Payment Recd ' Over/Under
Signature - µ
NOTICE: Pursuant to Government Code Section 66020(d)(1), this will serve to notify you that the 90 -'day approval period in which you may protest the fees or
other payment identified above will begin to run from the date on which the building or installation permit for this project is issued, or from the date on which
those amounts are paid to the District(s) or to another public entity authorized to•collect them on the District('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy -;Accounting
-- �.,...., ...cur- rrcui•�: ,
Feb-1a-oi 02:64PM Pros-Ojp p�p08i�c tlrt&
reorras� 1 i r-ss8 A. o�ioa F-8er
EXMIT"Als
773-215.004.
MqP M pns wR=18 P�AA"pV� LA QVINTi� UNIT NO. t, AS SXoWN IW
774.075407 (, S. RBCOIRDS 0?' ltdVaim8 count,
LOT 7 B14M g7
MAP ON gq g M OR rA M7A;AT VALE LA
E 19, RAl•+8,g JO AND; l op MAP QUM'R'A IOVIT NO. ! S, A$ SHiD.9VY,f BY
774-073.�g i RJ3l�OilDS OF 111 p,� GOLwY
• �' t9 aIAOK 18S OxSA1VTi� �A AT VALE
' O'►=' IN 800x.19. PAGM8 30 AND 31 CW hWq &BLA Q �+OtI�goWq :Og WTA IJNCT NO hlB. AS $1MOWN By
1t1y8bSri?II q.
���C 185OF SANTA Oq .
MAp aN FR81ri H SRA AT VALE LA QtnWA VNYC No. 16, +48 SHOWN 8Y
OQK 1 PAQ88 30 ANA 31 OF MAPS, Rg�RDS. �, ��R91AE COUNpy.
7744"40
21S DF BANTA �A AT YALE LA
K 19; PAQ$ 38 OF , QMNTA UNITNO.20. AS SMDWNBY
774099.006 'r OF Pjvmtsm C;O%ftm.
LOT 10 BLOCK 219 OF SANTA Tl A AT VALE
MAP ONR" jN M*OK 19, PAGg 98 OF LA Q�TA 0Mr No. 20. AS SHOWN 10Y
Mme& XsAMRa$ Op R1VS'i SWs COSY
774.111-003
LOT O N BLOCg 192 OF 1.0. PAQA �
MAP ON AT VAL1l'LA QUMVTA UM T' No 19, AS KNOWN M r
PH,g M pOOK 19. 89 3$ AND 34 OFMW4 UMRM OF aly g AUNTY
77112.004
LOT O PA 191
8 OP WrA CARMM�A AT. VAU LA
MAP QA1 FILE M 800K l9;1►AGE3 33 AND 34 OF QUMTA �1Nt1'T!0 19. AS SHOWN BY
�j 770.173.023 8'' OF RiV$RfS1pB COUNTY
T I I SLACK 24g OF SANTA CSA AT 1 AJ LA
� ,,e{i FILE M4 BOOK 20, PAGE 2$ OF MA", BEOMC!s F Rlvm=E Q SHOWN 8Y
774.173-024
IAT 12 "M 24901 BANTA CAttMM=A AT LA QisMl°A UNlTNO. 23,
MAP ON MM.E MBOOK 29, PAQB 29 OF MM3, �RDB OF Wv8R41D$ COL Y SOWN 8Y
h &* 77x•$45-00➢
n p t a ..,, LaT 16 BU= M OF &Q0A CARMUM AT VALE LA QURrrA UNIT NO. 26, AS SHOWN Sy
MAP ON FA,B IN BM 20, PAM 50 OF MAPS. RU=V2 O8 R1ymSID$ cOtwN.
4.245.010
IAT 1S BLOCK 200 OF 9 A CARMRLITA AT %IAL$ LA QUARA UNIT NO.26, AS SHOWN BY
MAP ON N . PACS& 90OF MAP.% R,QB OFRiM M08 COUMV
440411
LGT 14 ALOCK 290 OF SAKPA CARhMLITAAT V LA QUWA UNIT NQ. 26, AS SMWN BY
.MAP ON FUS IN ROOK 24 PAGE SOOF MAMB. R1 RM. Op R[g+1um COUNTY.
DUMP0O fde,CA oocwneni6Yeor.. DQV 2002 7243471 Page. 2 of
Order. AM -is -MM 02-4149 PAS com"nr.
CERTIFICATE OF FIELD VERIFICATION
DIAGNOSTIC TESTING
Project Title
" I-ZW Ar- d L 6Z
Proje
Address
Gilaa yah
Builder Cont ct Telephone
�.r �av�o,/�
HER Rater elephone
> 1-'7-11 Ile �
Da
�
4 c. d
Builddr Nam
Plan Number
Sample Group Number
CF -4R
�Wrtifying Signature Oate Sample House Number
Firm: HERS Provider: �f �S�oG/rl%S
Street Address: 7 P", 0 ,X"d-Fa Clr , City/State/Zip: L9 (..Yf,{/h.ra CAY '7,2 3
Copies to: Builder, HERS Provider .
1.
HERS RATER COMPLIANCE STATEMENT
The house was: PTested ❑ 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 ply with the diagnostic tested compliance requirements as checked on this form.
Distribution system is fully'ducted (i.e., does not use building cavities as plenums or platform returns in lieu
of ducts)
tJ Where cloth backed, rubber adhesive duct tape is installed, mastic and drawbands are used in combination
_ j� with cloth backed, rubber adhesive duct tape to seal leaks at duct connections.
JCJ MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT
Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage)
Duct Pressurization Test Results (CFM @ 25 Pa) Measuredvalues
Test Leakage Flow in CFM / S
If fan flow is calculated as 400cfm/ton x number of tons enter
calculated value here 07D
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) ❑ ,,`�
Pass Fail
THERMOSTATIC EXPANSION VALVE (TXV) or Commission approved equivalent
PYes ❑ No Thermostatic Expansion Valve (or Commission approved `
equivalent) is installed and Access is provided for inspection ❑
Yes is a pass Pass Fail.
❑ MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT
1. O Yes O No ACCA Manual D Design requirements have been met
(rater has verified that actual installation matches values in
CF -1 R and design on plan.
2. O Yes O No TXV is installed or Fan flow has been verified. If no TXV,
verified fan flow matches design from CF -1 R.
Measured Fan Flow =
Yes for both.1 and 2 is a Pass Pass Fail
rt ficate of
�-- o OccupanCY
�TDHR1YAii2. ��� .
1982 l
1
G� of ��ti � Building& Saf
ety, 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: 54-440 AVENIDA VALLEJO
Use classification: SFD
Occupancy Group: R3
Owner of Building: COVE DEVELOPMENT
Building Permit No.: 0304-294
Type of Construction: VN Land Use Zone- RL
Address: 2214 N. RIDGEWOOD
City, ST, ZIP: SANTA ANA CA
By: KIRK KIRKLAND
Date: 12-12-03
POST IN A CONSPICUOUS PLACE