0304-267 (SFD)U
H
V U)
(
w
O � M
LLJ
o CYZ
cflO'
I- o
-JUCID
F- LU
CL
U)
Z
M
1.0N
ON
U °1)
CL Q
Z
Q O
X LU0
00 <
4 rnH
1.4,Z
ob
r` p
Q
J
LICENSED CONTRACTOR DECLARATION T
I hereby.affirm under penalty of perjury that I am licensed under provisions of
Ch9pter 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
682901. Bii�' % 1 V31120
Date - 0 �> ^� Signature of Contractor—i1 �,/
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 gTAT FUAtIa Policy No. 329- 0fi19'iF%•f193
(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 of the Labor
Code, I shall forthwith comply with those provisions.
Date: ,1 c. Applicant 1 i ra: J
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
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.
x
fSignature (Owner/Agent) = % �= Date > ,/''� r'.
f ;
BUILDING PERMIT y' PERMIT#
OM
DATE VALUATION - ' , ', LOT 4' 7 TRACT
ZT .192
JOB SITE
APN
ADDRESS W-55". ANT.-,MA.U! ,
7.7441.1,017
OWNER
CONTRACTOR/ DESIGNER / EN INFER
THOMAS 'Buf-T-19
DAVID L.1iDDIN GTOW
R0. BOX 134
4 7 kC► MMMTA- rE VIR
LA Q TIN-fA CA 92253
Bri-RMMAMIN 13 101A 92201
((7603408-7528 CSLO . 3724
USE OF PERMIT
ST.NC1'..E FAWLY DVV01:.1140
1408 S.F. SY0 PKPLMIT DOES NOT 'INCI. UL)X; SILDCK `'a'IALJ,, BOOL OR
DRIV�V� 'ABY APPROACH
TRACT CONSTRUCTION 1,103.60 3F
PORCH/FiTTO36.00 SF
4♦RfryCARPOQp
or.
1+.. 'AIAT T) COST OF OOMb'':FRXIC1"100
CONSTRUCTION FER -1101 $585,50
PLA14 CHECK f7Z 101-000-439-318 $499.90
'
.1,EZ DEPOSIT 101 •�a��•���-°i 1 s-���u.t�o
AWZC F.A14ICAI, FM 101-000-421-000 Wso
RUCTRICAL ".1? :I 01.000.420.000 $108113
PLUMBINO FEE 101-000-419-000 $134.00
STRU?dpi MOTION WE - RESID 101-000.241.000 $8.71
CRADI'1 O "I1 101-0140-423-000 $315.00
DEVELOPER IMPACT FE
PRF,CISZ PLAN 101-000-44.1-•345 $100.00
� -s o , Cars�.� MMONAND PLAN. CHEM
I
c003'2dJlW,PKItW'1iIMES.i3�1'.F,.NOW
' LtT�i d f LA QUINITA .. ..
-'
FIVA'ICE DEPT.
;
RECEIPT
DATE
BY
DATE FIN D
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
—IF
Exhaust Fans
O.K. to Wrap
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 Lath1
Drywall - Int. Lath
Z
Final
Final
- —a
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
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
OX for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
7 Q
'Encapsulation
Gas Piping
Gas Test
Appliances
:Final
COMMENTS:
Final
Utility Notice (Gas) ZW
ELECTRICAL APPROVALS
Temp. Power Pole —(J
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
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.
in the amount of $2.14 X 1,408 S.F. or $3,013.12 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 Sy CC/Valley Independent Bank - David Addington Check No. 287217
Name on the check Telephone
Funding Residential
By Dr, Doris Wilson
Superintendent
Fee collected /exempted by S"on/ McGilvrey $3,01.3.12 $0.00
,, A / l�1/ JP Payment Recd Over/Under
Signature
V
NOTICE: Pursuant to Government Code Section 66020(d)(1), this will serve to notify you that the 90 -day approval period in which you may protest the fees or
other payment identified above will begin to run from the date on which the building or installation permit for this project is issued, or from the date on which
those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting
JUL 21 '03 15:28 FR
ff
- Infortna,40n
mToBuild On
Enginit;effng • Conwiling - Testing
TO 9-7777011 P.02i07
REPORT OF FIELD COMPACTION TESTS
TESTED FOR: DAVE ATTINGTON PROJECT: 53595 AVE DIAZ
POWER FINANCE LA QUINTA, CA
PO BOX 134
LA QUINTA, CA 92253
DATE: July 10, 2003 OUR REPORT NO- 073-30270-2
—77
TEST DATA: (1) very Eine silty sand. OPT. MOIST. = 10.0%
TEST
TEST
NO.
DEPTH
a
s"
2
811
3
8'1
4
. 8II ......- --
MAXIMUM COMMENTS'
SOIL ID LAB DRY >q WATER VN -T DRY PERCENT Spec . 90'c Min
ELEVATION NUMBER DENSITY CONTENT OEN:;ITY DENSITY COMPACTION
... -- -- ...._ _—
FG 1 120.0 8.9 124.6 114.4 95.3 I1 - A
FC 1 120.0 9.2 126.7 116.0. 96.7 1 - A
FG 1 120.0 9,0 127.7 1 117-2 97.7 1 - .A
FG 1 - 120.0 9.1 125.5 115-0 95.8 1 - A
f
i I
TESTLOCATION_ House pad --53-595 Ave Diaz
1 SE corner
SW corner
3 NW corner
4 NE corner
NOTES: TESTS PERFORMED PER ASTM D2922-96 E ASTM 03077.96 "COMMENTS: I, FILL MATEF:IAL A. 7EE5T RF_SLT$ COMPLY WITH SPECI�rCATIONS
DENSITIEg HOWN: Lbs. per cubic foot 2, BACKFILLL a..P CEN MPACTION GOES NOT COMPLY
WATER COj�TENT Percent of dry weight- 3. BASE COURSE WITH SPE IFI�tTI Ng
PERCENT COMPACT10N: Besed on maximum dry 4. SUBBASE C. RETEST OF PR V1 �TTEST
density obtained on Sample indicated by 55. SOIL CREME IT E. MOISTURE BELOW $ FFSPECIFI CATIONS
soil ID number,
* (1) ASTM D1557-00 METHOD A
TEST INSTRUMENT: STANDARD COUNT M: D:
REMARKS: PSI did not monitor the material placement. ADJUSTMENTDATA M: D'.
Respectfully submitted,.
TECHNICIAN: Juan Nunez Professional Service Industries, Inc.
Tr1ESE TF67 RESULTS APPLY ONLY TO THE SOCC11C LOCATIONS NOTED AND MAY NOT REPRESQNT ANV OTHER LOCATIONS OR ELEVATION'
REPORTS MAY NOT BE REPRODUCED, EXCEPT W FULL. WITHOUT WRITTEN PERMIESION BY PROFESSIONAL SERVICE INDUSTRIES, INC,
Professional Service Inclustries, Inc. • 42.240 Green way, Suite C • Palm Oesen, CA 922:1 • Phone 760/341-5790 • Fax 760/341-5794
PSI A•100,2 (pF .
NOW -19-2003 07:18 AM
1
P.01
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING t..r'-4K
dI
Pro'eet Title Date
Proiac dd ass B Ider Name
Bullder Cont t Telephone Plan Number
HER Rater Telepho a Sample Group Number
r,ir_1m:
fyinggnature to Sample House Number
61 _.TC�SpGI�� HERS Provider:
StreetAddress: 7��LD b�rr�cf OVd �l'GGq� _ City/State/Zip: L41 Muir a co
Copies to: Builder, HERS Provider
ibEgs MTCR COM ACE STATEMENT
The rouse 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.
com with the diagnostic tested compliance -requirements as checked on this form. ;t
Distribution system Is fully*ducted (i.e., does not use building cavities as plenums or platform returns in lieu.
f 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.
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 400cfm/ton x number of tons enter
calculated value here
If fan flow Is measured enter measured value here
Leakage Percentage (100 x Test Leakage/Fan Flow) = 7► J�
Check Box for Pass or Fall (Pass=6% or less) ❑
Pass Fail
THERMOSTATIC EXPANSION VALVE (TXV) or Commission approved equivalent
10
l� Yes ❑ No Thermostatic E=xpansion Valve (or Commission approved
equivalent) Is Installed and Access is provided for Inspection
Yes Is a pass
❑ MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCES CREDIT
1. ❑ Yes ❑ No ACCA Manual D Design requirements have been met
(rater has verified that actual installation matches values in
CF -1 R and design on plait.
,
2. ❑ Yes O No TXV is installed or Fan flow has been verified." If no TXV,
verified fan now matches design from CF -1 R.
Measured Fan Flow
Yes for both 1 and 2 Is a Pass
e ❑
Pass Fail
d O
Pass Fail
M
Certificate'of Occupancy
Twyot
Building & Safety 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: 53-595 AVENIDA DIAZ
Use classification: SFD
Occupancy Group: R3 Type of Construction: VN
Owner of Building: POWER FINANCE ASSOC. INC
fbr�,t
Building Official
Building Permit No.: 0304-267
Land Use Zone: RC
Address: P.O. BOX 134
City, ST, ZIP:. LA QUINTA CA 92253
By: KIRK KIRKLAND
Date: 1-8-04
POST IN A CONSPICUOUS PLACE