9707-140 (RER)LICENSED CONTRACTOR DECLARATION
I hereby affirrtt 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
lii`1Oil 13t1A0197
' «0E9i
, Date ^'ZEz"'°� Signature of Contractor /
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 i -r 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
!SV ject to the workers' compensation provisions of Section 3700 of the Labor
v4
ode, I shall forthwith comply with thos provlslons
Date: T 0-r l Applicant +- = /�
r ,..r.
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 ats
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, represen atives of this City to enter upon
the/above-mentioned property to spection purposes. ,
/SIgnature (Owner/Agent) �v- > .. �" •� Date7"T�"9'%,•
f ✓ 4Z:L C
BUILDING PERMIT PERMI���}�T��� CONTROL#2
O
DATE �/�(} VALUATIONyt93(b,{ LOT TRACTJOB
SITE
ADDRESS 7€i-710IRVVINZitRMC
APN b1ia�2.i�9�k"7
OWNER
CONTRACTOR / DESIGNER / ENGINEER
78780 11MIN Uk
VO BOX 1042)
LA, QUih!'? A CA 1.41253
P&Oki yi-s it CA 9x 255
7tit)177-2-15-V C 81,;# 165.3
USE OF PERMIT
PIONO3 ROOM, M.00 131F
y:��;;2� �{, y�y. g� {}��
PEI jt hi; Vi l 4JJi 71
PLAIN 4 t•)f CK 141€',
rt'i��,i`[�t3�rf'r�`�'t,fl��� it3i•-(h'3(�•�(�-(lf�}i? �.4'(tf�t
C73/iic`tC.6�i,.r+h4 til=�i0f1.*4
i2tfa 7 t� « )..n
9`1`CYN &fUrION f- f, RE :1r� 10t-0001241-000
[.►� -'i 'ArR '�'YNO!' :fFCsTa) AND PLAN c i? j :
g 1997 LESS M-1 AID FFES
Mon
4iAM P,:tt_t�M.,1}'#:C,S Du k, NOW
.17t
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
JCompressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. L th
✓!/li1
Y1114 7
7It
1
Final
Final
IVPOOLS
BLOCKWALL PPROVAL
- SPAS
Steed
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
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
Notice
ELECTRICAL APPROVALS
Power Pole
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Tema. Use of Power
COMMENTS:
Notice:
Document Cannot Be Duplicated
Date 7/28/97
No. 15888
Owner Name Steven H. Ferraro
Desert Sands Unified School District
82-879 Highway 111
Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
N0.78780 Street Irwin Cir.
City La Quinta
Tract #
Lot #
Type of Development Residential Addition
Comments
APN # 604-232-017
Jurisdiction La Quinta
Permit #
Log #
Zip 92253 Study Area 233
convert 3rd car bay ot garage into a hobby room
Square Footage 200
No. of Units 1
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 200 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 r -- Telepho'ne ,772-1530
1
Name on the check
M �
• '� H, -moi '
By Dr. Doris Wilson
7
Superintendent
Fee collected /exempted by Pauline Pearson Exempt "$0.00
Signature
PAA.A-'
Check No. n/a
40TICE: 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
ibove 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
collect them on the District('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
\) i
y•��f-ev� � law � Ferraro
f:
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rem .
d °f,
0
�� 5e1� Glos�ev
Tire r 0,
r)rl wall
-w(
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g G�o�e
COh�rC1C�`r �VS�C`f S0�•• Cor<ti�.
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PcJ w. D etev i . CG• 4225r-
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m
opt
oy
rr
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Replace
501,40
'P.-c—
So KLIO -5bleJ
ASJkc .Eek
glAcs
rtiYica e? of comaiiance: Reside�tiai (Page I or _'1 CF -1 R
Date
oject Title
ojeet Address Budding Permit r
Plan ChecK i Date
ocumentation Author Telephone
Field Check /Date
�mpilaneo Method (Package. Point System or Computer) Climate Zone Enforcement Agency use Only
1ENERAL INFORMATION
.otal Conditioned Floor Area: 200 n2
luilding Type: Single Family V/ Addition
:he(k one or more) Multi -Family Existing -Plus -Addition
:vont Orientation: ( North / East uth / West / All Orientations
(Input onentao i roes and cirde one.)
vumber of Dwelling Units:
=loor Construction Type: lab / Raised Floor (circle one or both)
3UILDING SHELL INSULATION
Construction
:.omponent Insulation Assembly LocatiorvComments
Type R -Value U -Value (attic. to garage. tyotcal, etc.)
n-'�
Wall ..............
Wall .............. /I .l eJ r
Root .............
Floor .............
Floor...:.........
Slab Edge ....
FENESTRATION Shading Devices
Fenestration Area Fenestration Interior Exterior Overhang Framing Type
Orientation (st) LI -Value (roller blind. eta) (shadescreen. etc.) (ves/nol (metal/woodNim
Front.....
f=ront.....
Left ....... ( ) -
Lett ....... ( )
Rear .....
Rear ..... (. ) L
Right..... QC) �;:LV 175 s
Right..' . ( )
Skylight .......
Skylight .......
THERMAL MASS
Type/Covering Area 'Thickness
slab/exoosed. tile, etc. (st) (inches Location/Desdri tion kitchen, bath. etc.)
UE J V wy L I V�Ta �3U�� fiM E 04 AV
zvAied January 092
Cailificate of Compliance:
Residential
"Y
(Page 2 of 2) CF -1 R
(sold or package)
Project Title
External
Tank
Oats
HVAC SYSTEMS
Capacity
Note: Input nyQMC or domomed hyamme Cate under Water Heating Systems, except Oesgn Heating Load.
Heating Equipment Minimum
Type
TDype aures n Duct or
(furnace, heat Efficiency
Location Piping Thermostat
umo. etc.I (AFUE/HSPF)
(ducts/attic etc.) A Value TVpe
Cooling Equipment Minimum Duct
Type (air conditioner, Efficiency Location
heat pumo. evao. cooling) (SEER) (attic. etc.I
WATER HEATING SYSTEMS
Water Heater Distribution Number
T....
Rated i
Input (kW
or Btu/hrl
Duct
Thermostat Configuration
R -Value
Type
(sold or package)
Enemy'
External
Tank
Factor or
Tank
Capacity
Recovery
Stancibyt Insulatiort
(gallons)
Efficiency -
Loss (%) R -Value
For sntsw u std
g IrateO input S 76.000 Bttrrhr), eteoVie redaunice and Mat pump tester heetan. list F-nugy Factor.
For 181111111088 storage water heaters bated input a 75.000 Btwtu). Inst Rated Input
For instanteneoae gas erstw-hesters, list Raul Input and Recovery Eflieiericy. For EMdenry and StanCDy Loss.
SPECIAL FEATURES/REMARKS (Add extra sheets if necessary)
COMPLIANCE STATEMENT
This cernficate of compliance lists the building features and performance specdicaoons needed to comply wrath Title 24. Parts t and 6. of
the California Code of Regulations, and ate adnasaaove regulations to unpement them. This certificate has been signed by the
individual with overall design resoonsloitiry. When tins ceraticate of complance Is subrmtted for a single building plan to be built in multiple
orlierltaaons. any shading teaturo that Is vaned a indicated In the Spm FeatureyRemartts $man.
Oesigner or Owner (p« eeaneee • poieealms, code) Doeumentetlon Author
Name:
rdtvFin„
Address:
Telephone:
Lie. s:
(sgnaan► (des)
Enforcement Agency,
Name:
Tide:
may:
Telephone:
(tupnaturwstarrip) ( )
PAV
"ante:
TIOWFrm:
Address:
Telephone.
(si0tiaarto) (dift)