0403-279 (SFD)LICENSED CONTRACTOR DECLARATION
I her.?by 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
Dater ` GlSignature of Contractor,
-� a ....
Z
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 BXF.MP'T 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�pro'visions of.Section 3700 of the Labor
Code, I shall forthwith comply witli'those
- provision
Applicant %D
9'11 Datr �,
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 'urposes.
r n
Signature (Owner/Agent) rte`,1i1 7✓�,� " Date
BUILDING PERMIT PERMIT#
0403-2 79
DATE VALUATION LOT TRACT
r254MI S111,497 .20
JOB SITE
ADDRESS v'�4,460 AVENWA VAU.&T0
APN
OWNER
CONTRACTOR/DESIGNER/EN (NEER
i
1'`'AT D01•W.RTY°fC0V1. i7F
LFGACY HOWS
2214 9. RlDGEWOOD ;'
P101 BOX 696
3MIx1.MIA CA _ 9705
.LAQi DTPA CA 92253
/
(760Y564-,i82O CLI 02063
USE OF PERMIT
€ I NGT.11 FA1' ILY DWETJ. G
F. SMOERMIT DOES NOT INCLUDE' ALOCIC: iWALI., POOL PA
OR DRIV WAY APPRIDACH. 71'5% R.9.0U1.TD PLAN CHECK .FEE FOR
I+6.lfJ.`PdVIX PLANS OF SAE%TYPE,
TRACT CONSTRUCTIO.R 1,851.00 3P
Pe.112.MPiATIO 135.00 aka
G41'?,RA.WCARFORT 409,00 8F
ESTI &rED COFT OF IG:0I017.RUC.. ON
12114_97.20
I�p"I`T" FEF. 9bWA4NRY
CONSTRUC'1IakJ FEE '101.000.418.000 "gi.30
PLAN CHECK FEE 101-000-439-318 $141.7;
'
FEE DEPOSIT 101-000-439-318 4250,00
MFCY3AN.Iq.AL PET, 101-000421400 66.50
ELECTRICAL FRE 101-000-420-000 $.I23.07
PLiYM51,90 rg1F 101-030-419-000 $130.00
TR01"tO MOTION FE - RESIN 101.000-241.000 sitis
GRA17INO FEE 101-000-i23=000 $15.00
DEVELOPER IYAPACT FEE $�i35,01
PRECISE PLAN 101-000-441-345 $1110.00
BUB -A :k�l'.3T'R.iTC'1" om Ate' Py_Ax amcr,
$3,6.73.59
D LESS RR&PAW F'.E-.�'s
Ur
-WO.00
F q�t yy ��jj7p. ��g¢77r�yy �t+�,v�, `` 7�3 �r T.7 „�g�
.t a A,E'�-LT.L07r) & 3S� ,S tJL?d :EX0W
�y s7y y+,��
$3,42--4m
CD'3,42-4 Y
51004
CITY OF LA QUINTA
FINANCE DEPT
r
RECEIPT
DATE
BY
DATE FIN
INSPECTOR
L
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Q
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
L
Combustion Air
Roof Deck
— ��
Exhaust Fans
O.K. to Wrap
_
F.A.U.
Framing
Compressor
Insulation
Q�
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL
APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. 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
Encapsulation
Sewer Connection
Gas Piping
Gas Test
E3,
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low VoRage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power - Ca
Final
Utility Notice (Perm) ,,
Date
3/19/04
No.
25719
Owner
'
Pat Doherty/Cove Dev
Address
2214 N. Ridgewood
City
Santa Ana Zip 92705
Tract #
Type
Single Family Residence
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
• 47950 Dune Palms Road
La Quinta, CA 92253
(760) 771-8515
Lot # No. Street
Unit 1 54460 Avenida Vallejo
Unit 2
Unit 3
Unit 4
Unit 5
q���sc�o
Q .BERMUDA DUNES r
Cn RANCHO MIRAGE
a INDIAN WELLS v
�.� PALM DESERT ,y
LA QUINTA
10-QINDIO L�
APN # 774-245-011
• Jurisdiction La Quinta
Permit # 0403-279
Study Area
r No. of Units 1
S.F. Lot # No. Street
1.851 Unit 6
Unit 7
Unit 8
Unit 9
Unit 10
S.F.
Comments Credits of $73.20 each from,Cert #25707 and 25708 applied to CC#71015 in the amount of $4,0000 totals
$4,146.40. $0.16 overpayment paid in cash.
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:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to
Education Code Section 17620 and Government Code 65995 Et Seq. 3
in the amount of $2.24 X 1,851 S.F. or $4,146.24 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 Cc/1 St Bank - Sharon Bills Check No. 71015
Name on the check
Telephone 760/880-3446
Funding Residential
By Dr. Doris Wilson
Superintendent '
Fee collected /exempted by S2Section
CGilvrey Payment Recd $0.16
$4,146.40 Over/Under
Signature G `"
NOTICE: Pursuant to Government Code20(d)(1), this will serve 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 Districtfs) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting
•
FROM SLADDEN PALM. DESERT ' (MON)APR 12 2004 11,17/ST.11.16/No.,6802770360 P 1
005091
Sladden Engincaring
6782 Stanton Ave., Suite A, Buena Park, CA 90621 (714) 523.0952 Fax (714) 523-1389.
39725 Garand Ln., Sulte G, Palm Desert, CA 92211 (760) 772-3893 Fax (760) 772-3895
Date.
~ Job No.
FIELD MEMO
Project Name �j{ #�*�' �X Client.
Site Address 5 4 -r-il�'� z 14.110 (14, f 410
Job Phone
Work Cone
Test Summary / Fnatlnes tnanected
Not
Location �. `'
Flev.
Dry
Density
Moist
%
% Relative
Compaction
Ref. Max
pcf
Moist
'j
&.14
1 7
ri
Comments
Super. or Agent
Field Tech.
24 hour notice requested -to schedule Field Technician, Thank you for the opportunity to be of service.
RM
OF FIE
P.02
STING CF -4R
Date
Bullderlaeme r '
Calan Number'
Sample Oroup Number
Sarnpie House Number-
Firm:
umberFirm:C.OGi �'% MFRS Provlder;
Street Address, 79f'-Vl�DY� trlYG CltyfState/Zip. y 0u1hr
Copies to, Builder, HERS Provider
HERS RATER C9MPL1ANCJ STATEMgNT
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
Golly with the diagnostic tested compliance requirements as checked on this form,
Distribution system is fuily: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,
7MINiMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT
Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage)
Measured
Duct pressurization Test Results (CFM (M 25 Pa) values
Test Leakage Flow In CFM _
If fan flow is calculated as 400cfm/ton x number of tons enter
value here___
calculated
If fan flow Is measured enter measured value* here.
Leakage Percentage (100 x Test Leakage/Fan Flow) ;
Check Box for Pass or t=ail (Paas=e% or less)"`
�
IDess Fail
x
OrTHERMOSTATIC EXPANSION VALVE (TXV) or Commission approved equivalent
Yes ❑ No Thermostatic Expansion Valve (or Commission approved
�r
P
equivalent) is installed and Access is provided for Inspection
Yes is a pass
Pass . Fail
❑ MINIMUM REQUIREMENTS FOP. DUCT DESIGN COMPLIANCE CREDIT
1. Q Yes a No ACCA Manual D Design requirements have I4een met
(rater has verified that actual Installation matches values in
C Fr1 R and, design on pian.
2. d Yes Q No TXV is installed or Fan flow has been verified, If no TXV,
verified fan flaw matches design from.CF•IR,
Measured. Fan Flow=
d
Yes for both 1 and 2 is a Pass
Pass Fail
a- �- Certificate of Occupancy
U - • �IG`I f/�
G� OBuildin & Safet Department
F 9► Y p
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: 54-460 AVENIDA VALLEJO
r
Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0403-279
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Occupancy Group: R-3 Type of Construction: V - N Land Use Zone: RC
Owner of Building: COVE DEVELOPMENT Address: 2214 RIDGEWOOD
i
City, ST, ZIP: SANTA ANA, CA 92705
By: KIRK KIRKLAND
l �d Date: September 9, 2004
Building Official
t
POST IN A CONSPICUOUS PLACE