9806-157 (AR)LICENSED.CONTRACTOR DECLARATION
Y 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
uDate 1�Signature of Contractor
OWNER -BUILDER D
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
Scion 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.
STIVIT
(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 ofrthe abor
Code, I shall forthwithicom I with those' p' v�IslonS. 'r
\,Date: XW* 4 � pplic nt ,�r �� / �
Warning: Failure to secure Worke4�- Compensation coverage4js&nla wful 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 ffoinspection ppur�p'osess.
VoSlgnature (Owner/Agent) f✓- -- P Date
BUILDINGPERMIT PERMIT# CONTROL#
q%0.6- 157
DATE VALUATION S5.309.10 LOT TRACT 7984'
'
JOB SITE APN
ADDRESS Jil-J061RIS COU k 604-251-602
OWNER CONTRACTOR / DESIGNER / ENGINEER
79700 IFis M,
:1ati QUI N"I'A OA 92253
USE OF PERMIT
POBOX, 1325
}'f LIA, DIRSE11,1 i' C A. 92251
(760)771-5571 C31110 M8
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RECEIPT
SIOB-TOTM-i (.;(.:'t1+3SIAUCTION ANI, PLAN (>13 C:I 17-'-1.8
BY I DATE FINALED I I INSPECTOR
• s _.
a 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
OK to Wrap
F.A.U.
Framing —
Compressor
Insulation _a _ _ ,
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & 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
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
OX 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
47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515
CERTIFICATE OF COMPLIANCE
Date 6/19/98
APN # 604-251-002
No. 17202 Jurisdiction La Quinta
Owner NameDavid S. & Har6ld Fallis
No. 79-700 Street Iris Court
City La Quinta zip 92253
Tract # Lot # Square Footage
Type of Development Residential Addition
Comments
Convert thir-cl bay ot garage into 153 sq. ft. bonus room.
Permit #
Log #
Study Area
153
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
. .H 4-
0.00 X , 153 or $ 0.00 the property listed above and'th,,i6 il.d ng
permits and/or Certificates of Occupancy for this square footage in this proposed project -may new be issued -'t4
Fees Paid By David S. Fallis�`4
je�ephone ,360-5359.
Name on the check
By Dr. Doris Wilson
Superintendent ! ^r� -Z'
Fee collected /exempted by Juanita Green Exempt $0.00
Signature rl J /im, 7
Check No. N/A
NOTICE: Pursuant of Asserrrib jr Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 9D -day approval period in which you may protest the fees or other payment identified
above will begin to run from Plate 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 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
0
�uEL L3v2n►�r~r�
Ht & Lc
A!r Vents
7►' P. Pe.
TE
"g-- xi��
sZA&
R-38 Roof Batt lrfsuMfian
� 1
r
19�lu=
SELF �� NT Pee
04WAIA_� , aleo /z
R-13 Batt lnsu�otkon �--- " _- _� �" • '
q
t�'..' .. '�•'' ;�: ;,� Ln rrt L,.��d..{ 6
�:�r°v3 i--+ ' � s •_•�� a ;`��d�°gas
w' k`�
s �r
7.2 COMPLIANCE ANALYSIS ()F
AN ADDITION ALONE
Any addtoon — ihat is. the sum of all new
,xnditionco spaces and associated new extcnor
wails. cctlines. and floors within the budding —
may nc snow•n 'o meet the cncrc� tludi:ct as a
,tcparatc cnnn•. ibis proccaurc docs not involve
the cxtstine structure. except when c:uc:ulaung the
water hcaune cncrgy use for any addition in which
the total number of water hcatcrs in tic hwldine
incrcascs. The analysts may be pcnormca using
either a special prescnptivc packaec accordinc to
the size of the addition or with the point syctcm or
any approved computer pcnormancc me noa.
Table 7-1: Prescriptive Compliance of Additions-,
' Summary of Section 152(a)l Requirements of the Standards
COMPONENT 1(1) ft" 100--399 f " 500-999 ft"
>_ 1000 ft'
Insulation
Ceiling
R-19
Packager
Packaec
Packacc
Wall'
R-13
R-13
R-13
Packacc
Floor
R-13
Packa
Packagc
Packacc
Fenestration
U -Value
0.75,
0.75
Packagc
Packagc
% of CFAS
50 ft`
Pkg + Rcmovcdl
Pkg + Rcmovcd
Packaec
Shading
Na
Packagc
Packagc
Package
Thermal Mass
Na
Packa a
Packagc
Packaec .
Space Heating
Mandatory'
Packagc
Package
Packaec
&Cooling
(Nocicctnc)6
(Nocicctnc)
(Noclectric)
(Noclec-u1c)
Water Heating -
No Increase &
No Change
Na
Na
Na
Na
Replacement:
No Increase
Standard?
Standard
Standard
Standard
Increase
Allowed
:Wowed
AHowcd
allowed
w/Calculations
w/Calculation
w/Calculation
w/Calculation
1. Meet the component prescnpuve mquurment for Package D for slab -on -grade construcuon or
Package E for raised floor construction tsee Chapter 31.
'. "Heavy" and "Light Mass" mass walls may meet the Package D or E requttemcnis for mass wall
insulation instead of R-13 (see Chapter 3).
3. For compliance of additions and alterations only. dual glazed "gccnhousc•' windows and skylights
may be assumed to meet this rcquLmment.
4. The Package D or E fenestration area plus the area of any glazing removed because of the addition.
5. All mandatory measures for HVAC systems must be met tree Chapter 2).
6. So eiectnc resistance space heaung may be installed.
7. A standard water heating system is explained in Section 6.6.
S. If the total number of water heaters increases in the residence. then the entre extsaing plus addition
system must meet the water heaung cncrgy budget (see Chapter 6). Table 3-3 lists water hcaung
�vst:m combinations which have been pre calculated to comply with the water heaung budget.
7-4 Revised January 1992 Residential Manual
Table 3-Z15: Prescriptive Packages for Climate Zone 15
'
Package
Package
Package
Package
Package
Component
A
B
C h i
D
E
BUILDING ENVELOPE
9.6%
NR
NR
NR
NR
Insulation Minimums:
6.4%
NR
NR
NR
NR
Ceiling
R-30
R-38
R-49
R-38
R-38
Wage
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 Floor Perimeter
R-7
R-7
R-7
NR
NR
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%
Mmmum Total Nonsouth Facing Arca
9.6%
NR
NR
NR
NR
Minimum South Facing Area
6.4%
NR
NR
NR
NR
SHADING COEMCMNT'
South Facing Glazing
0.15
0.15
0.40
0.40
• 0.40
West Facing Glazing
0.15
0.15
0.40
•0.40
0.40
East Facing Glazing
NR
NR
0.40
0.40
0.40
North Facing Glazing
NR
NR
0.66
0.66
0.66
THERMALMASS
REQ
NR
REQ
20%
5%
D41-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 7
NO
NO
If Gas. AFUE-
78%
78%
78%
78%
78%
if Heat Pump.
Split System HSPF& =
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. SEERS =
9.7
9.7
4.7
9.7
9.7
DOMESTIC WATER HEATING TYPE
System must meet budget.
Meets
Meets
Meets
Meets
Meets
see § 151(b) and 151(()(8)
Budget
Budget'
Budget
Budget
Budget
LEGEND: NR = Not Required: N/A = Not Applicable: REQ = Required
See notes following Table 3-Z16.
Prescdptive Packages Revised January 1992' 3-35
_1171114cate of Comoliance: Residential
(Page or �) LF -1 R
Goi T' CL �oat.
oject Title / ��� �I� / ,
�.l �- / Budding Permit R
oieet Address,/ '�
G'/-� Plan ChecK i Date
Tel.phon.
xumentatlon Author Field Check i Date
Computer)
Clime . Zon. Entorcement agency use Only
3mpllanee Method (Package. Point SYstem or
!ENERAL INFORMATION 2
otal Conditioned Floor Area: 6-5— n
g" Plus -Addition Single Family Addition
;heck
Type: .L
:heck one or morel Muni -Family Existin
=ront Orientation: North / East / South / West / All Orientations
(Input orientation in degrees and circle one.)
Number of Dwelling Units:
:loor Construction Type: I Raised Floor (circle one or both)
3UILDING SHELL INSULATION
3omponent
Construction
Insulation Assembly Location/Comments
rype
R -Value U -Value attic. to qarage. lyoical. etc.)
Wall ..............
7'S
Wall ..............
Roof .............
Root .............
Floor .............
-
Floor.... ....
Slab Edge....
FENESTRATION
Fenestration
Area Fenestration
Orientation
(sf) U -Valu_ e_
Front..... ( )
7'S
Front..... ( )
Left....... ( )
Left ....... ( )
Rear ..... ( )
Rear ..... (. )
Right..... ( )
Right..... ( )
Skylight .......
Skylight .......
Shading Devices
Irttenor Exterior
(roller blind. etc) (ghadescreen. etc.)
Overhang
Framing Type
THERMAL MASS
Type/Covering Area Thickness
slab/exposed. tile. etc. (sf inches LOCation/Descn tion kitchen. bath. etc.)
S/4h
tt-mleed January 1292
�' certificate of Compliance: Residential
Pro)set TIIIa 7<1-
(Page 2 of 2) CF -1 R
HVAC SYSTEMS
Non: Input nywonic or comotrnso nydronnc data under Water Heatutg Systems, except Design Heating load.
Heating Equipment
Type (furnace, heat
puumo, etc.)
Minimum
Efficiency
(AFUE/HSPF)
Distribution
Type and
Location
Iduciyanic etc i
Dud or
Piping
R -Value
Thermostat
Type
6 /1-_?�
Cooling Equipment
Minimum
Duct
Type (air conditioner.
Efficiency
Location
Dud
Thermostat Configuration
heat pump. evao. aoolina)
(SEER)
(anic. etc.)
R -Value
Type (sold or oackage)
WATER HEATING SYSTEMS
Energy I External
Rated' Tank Factor or Tank
Water Heater Distribution Number Input (kW Capacity Recovery Standby' Insulation
Type Type in System or Btu/hr) (gallons) Efficiency. Loss (%) R -Value
/w
1. For small gas storage (rand input s 75.000 BOAr)• *Metric resistance and heat pump water hootio s. Inst Energy Factor.
For large gat storage water hooters Irated input 2 75.000 BtuRu). Inst hated Inout. Recovery Efficiency and Standby Loss.
For Insnntaneota gas water nesters, list Rated Input and Racova y Efficiency.
SPECIAL FEATURES/REMARKS (Add extra sheets if necessary)
COMPLIANCE STATEMENT
This certificate of compliance lists Me Wildi lg features and performance specifications needed to comply with Tille 24. Parts t and 6, of
the Cahlomia Code of Regulations, and the.adminstrattve regulations to tlnplement them. This certificate has been signed by the
individual mM overall design resoonsiauty. When ttus certificate of compliance is subtnlined for a single building plan to be built in multiple
onentations, any Vedlrlg feature tmt is varied is indicated cit the Special Featu mvRemarks section.
Designer or Owner (pw eusino," a pratesslons code)
Name: `fact Ts7` G GL%'S
TitltMFimt:
Address:
CA c
Telephone:
Lie. s: 01
(signature)
Enforcement Agency
Name:
Title:
Agency:
Telephone:
(signawwatamp) lam►
Rwlocrd.�.•: •-;Aq
Documentation Author
Nance:
TiOWFinn:
Address:
Telephone:
(signature) (dM)