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0204-131 (SFD)CO NW O W'� C Z c�0 0 "T 1.— 0 tea~ CO) Z 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 ME 2 '_Signature of Contractor OWNER -BUILDER DECLARATION ®51.31/20 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). ( ) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business_ & Professionals Code). O 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: O 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 Exempt 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 provisions of Section 3700 of the Labor Code, I -shall forthwith comply with those provisions. Date:'; Applicant Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth op his application.. 1. Each person upon whose behalf this application is made & each per9on at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemni & hold harmless the City of La Quinta, its officers, agents and employee D 2. Any permit issued as a result of this application becomes null and void work is not commenced within 180 days from date of issuance of su permit, or cessation of work for 180 days will subject permit to cancellatio I certify that I have read this application and state that the above information correct. I agree to comply with all City, and State laws relating to the buildin construction, and hereby authorize representatives of this City to enter upo the above-mentioned property for inspection purposes. Signature (Owner/Agent) f .. Date `BUILDING PERMIT DATE VALUATION` LOT ��� TRACTJOB SITE ��� ADDRESS 77-340 G.'.4.�. LR �1�,)�" A<N APN OWNER CONTRACTOR/DESIGNER/EN INEER 47-750 ADAMS STRUT 6229 47.750 ADAMSSTRURT A228 L Q10 "dA CA 92253 LA.Ql3,i NTA CA 92253 (760)564-7620 Q010 020613 USE OF PERMIT SlNGM, TAMMY 13:Nl$s;%.X;Nata SkD - Prf"'P+gllf I3iS3i:S NOT YNi4:A=J9 HJ 0iX WALL :t` Ya OR H3IUVEWAY. AX' r�iOAM 98 CODE T(7.TRA(7. CON871]i13CTTON 1,$;.9.00 NF XWA�W'A°RSO 168.00 SF 0AJkA,(nW-A1*W)RT 1-3301) 01 TVKPk a (!d ibl' CDS T� '4 x7C 1 Lr"t1�ll PrIl( lr "AK S1;YNH"Ry G(7kW3'llilLlf-"iBC?lel YAE 101.000.418-M $621..". PLAN (MCK. FEE 101.OW439.318 $51:3196 FIM DR100srr 42%00 NWMI (':A W -U43 Hi.Er'>!1tICAT,IMP 101-000420-M $112,33 VIA)A1611dt3l=n ID;i-OW 10 -ow U121W £'I'm4a K01WW1+1?lfr �11''TD 101-0WMI-00 �5t.5Z GRADTW.V BI T+ tlt#.l.piJ ?3 fttt() l�.t� '111LIVY14H)HR IATb'At "1' 1f ... $ R,Q�E1vi.iDA VR33C1"9 ]tJ.�91ri lt?b,TJIAI 3�.i �311i1�t1� UkN U 1Jq U b RECEIPT: IDATE I BY ^y DOag r_/_ EOD2J I INSPECT9ft/ .JJ \p. INS�ECTIGN RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR WLDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings o � Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K to Wrap --4D F.A.U. Framing -40 Compressor Insulation •e 1L Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath •� �o Final Final BLL.00KWALL APPROVALS POOLS o SPAS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping d PLUMMNG 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 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 y Final " (U Utility Notice (Perm) 7z2tato 2<- k_/ COMMENTS: Building Address Owner r 'T,it* " r3 P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Mailing Address City Zip Contractor Address City Izip Tel, State Lic. Gity & Classif. Lic. # Arch., Engr., Designer Address Tel. City Zip I State Lic. # LICENSED CONTRACTOR'S DECLARATION hereby affirm that I am licensed under Arovl;lnns of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Prol�.s­liDr,s Code, and my license is in full force and effect. 51GNaTiIRE 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 fife 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 five hundred dollars ($500), C' 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 1 am exempt under Sec.-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 _ t7 Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) valuation 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. Date_ Owner NOTICE TO APPLICANT., If, after making this Certificate of Exemption you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby 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 Lender's Addra-- 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. 1 agree to comply with all city and county ordinances and stale laws relating to building r.onstluction, and hereby authorize representatives -of this city to enter the above- menliened property for inspectlorl purposes. Signature of appllcan _.Date Mailing Address City, State, Zip,_ APPLICATION ONLY ILDING: TYPE CONST. OCC. GRP. P. Number Legal Description Project Description Sq. Ft. No. No. Dw. Size Stories ` Units New O Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS 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 INSP r 1 f Issued by: Date Perml' lit I Validated by: Validation: V FIN -11 WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION �ejI Notice: Document Cannot Be Duplicated Date 5/3/02 No. 23194 Desert Sands Unified School District 47-950 Dune Palms Road La Quinta, CA 92253 760-771-8515 CERTIFICATE OF COMPLIANCE owner NameRandy and Sharon Bills N0.77340 City La Quinta street Calle Durango. Tract.# Lot:# APN # 773-161-023 Jurisdiction La Quinta Permit .# Ug # 0204-131 Zip 92253 Study Area Square Footage 1519 Type of Development Single Family Residence No. of Units 1 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 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: EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Government Code -53080 in the amount of 2.14 X 1,519 or $ 3,250.66 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 EastWest. Bank - Sharon Bills Name:on the check By Dr. Doris Wilson Superintendent Telephone Fee collected /exempted by Crystal Scott Payment Received _ $3,250.66 Check No. 324902341308 Signature 40TICE: Pursuant to Assembly Bill 3081 (CHAP 549, STATS. 1998) this will serve l o,nottty you that the 90day approval perlod'in which you may protestthe fees or other payment identified above will begin to run from the data on which the building or installation permit for this•project is sssued or on which they are paid to the'District(s) or to another public entity authorized to rolled them on the Districq's)(e) behalf, whichever is earlier. Collector: Attach a copy of county or city plan check application form to district copy for all waivers. Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting Certificate of Occupancy City of La Quinta Building and Safety Department This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code, certifying that, at the time of issuance, this structure was in compliance with the various ordinances of the City regulating building construction or use. For the following.- BUILDING ollowing: BUILDING ADDRESS - 77 -340 CALLE DURANGO Use Classification: SFD Bldg. Permit No.: 0204-131 Occupancy Group: R3 Type of Construction: VN Land Use Zone: RC Owner of Building: RANDY & SHARON BILLS Address: 47-750 ADAMS ST #228 City: LA QUINTA CA 92253 By: KIRK KIRKLAND Date: 8-1-02 Building Official POST IN A CONSPICUOUS PLACE t 10 2002 12:3.5 HR FIRS"1' AMERICAN TITLE 0 568 5951 TO 85b48601 rAd ons r c► eat° FOR A V>•IUW TOBIN Ones INN �n116 nl�ame af+diRe�M G to t4R, Y. tatirrlebRap SON t10� Eley a»I .,Mdln NO,,no Cauawb C4WW d Of im fbi Y'of Som l�iFeUtA aYV�R LI 01�id�. LOf tZ 1�ay>�y � d lff a. StM V m fll� Inf1�! 19� ice+ saw$°Tl4Pe' .Wt iS it 1 ofW eiR N0 6106- r�IWO n0l40 r vow ..J. r. drd�r: -000Sf7199 po/oY ,,.�.r.....w....�--.... .. n TO 39Vd P. 03 V- /Vtv 773-161 " 023 as�rt 109809909L 06:LZ Z00Z/6't/E0 b CALL E 0 M 24 ine /00 c� ?rhO I /3 22 O a%&I I _ @4 h 51 -Sts '30 /7 7 o B 51- 0.25AAc 2 SI- 16 Ex 9 SI -4 o SI -90 V22 O l5 3 v h /5O r(-8L"C' Q /0 S1- so 1- 14 / e J4„ 13,{ y,2 Bd 0 -- CALLS. 0 v I j J \ J S 09053 s/6/W $ 60 2G0 s� O O $° rM @/51-766 e X51-7.704 0.25AAc 2 h 23 O ^ �J Sl -7 0 h V22 O l5 3 v h 4 r(-8L"C' h v20 O �5 h V2/ /6 4 514 6 3 S1 -fro �C /9 @6 h h 20 (5) O 5 , Ig h -61- e4d sl -ts1; h SI -Y7 V /9 z /8 6 0 /62 h-4/8 7 � O 7 M P� 51-9�Cp h /4 0 S1- S1-il /oo h /7 O @ B V :0 51- 1/0 5l- Lt -'- h 160 @ 9F - Fq O C13,0 Sl-`�S5 /0 v M h /5 /O Sl -16o S/ -97o /4 // S1- 975 Q Zoo /oo ��7-/3©/2y85o �1.40I p 80 30 13o S° 07�3J4 0 $° rM @/51-766 e �► /dD /OO h 51-780 h 23 ^ �J 7 k=J 02,V h h 2/ ® (8"4 v h S -83 4 h v20 O �5 h 514 6 3 S1 -fro �C /9 @6 h X63 w /B msl_ , Ig h �V /7 ® ®B� h /6 ® 0 9 h SI -11/ /5 y© /046S c y 51-9�Cp h /4 0 SI.975 0 // h /IO /oo /2 V h /3 80 :0 L H S'60'S8 �/g h RC DISTRICT - PLANNING REVIEW FORM This form is to be used by CDD staff for review of single family dwellings in the RC (Cove Residential) District per Section 9.50..090 of the Zoning Code. Its purpose is to determine: 1) that the proposed house design does not duplicate the same architectural style of any house within 200 feet of the applicant, and/or 2) if there is a need for the applicant to file for Master Design Guidelines. If the applicant does need to file a Masher Design Guideline, please transmitted this information to the Building and Safety Department as part of your correction list. Please attach 'additional explanations as necessary. APPLICANT RANDY SHAW SITE ADDRESS 77=340 Calle Durango APN 773 - 161 - 023 LEGAL: LOT 12 CASE NO.: 2002-641 BLOCK 33 UNIT 2 CHECK AND APPROVED BY: Martin Magana DATE: S.C.@V.L.Q. Inform the assigned Building plan checker upon your assignment to this case. The CDD Executive Secretary maintains a log book to track applications and assign case numbers. REQUIRED ITEM Y N COMMENT/CORRECTION Verify legal and APN information Consistent with MDG on file (as applicable MDG filing required (5 filings since 9/3/9.8) G Architectural variety within 200 feet of _ �fTA APR the. surrounding area: 2 ' isUILDll��:, Colors Materials Architectural design features Plan ing t,otrnnl8st� ...,.,.._.r.r, CI city oun t Co ni d�eK Com. ' Other Requirements: I tials r OZ "G .«�,......,� C se E hibit 13 With Conditions �,,._...,.. Im 0 ONUff CITY OF LA QUINTA SUB -CONTRACTOR LIST `JOB ADDRESS ;14D "6 PERMIT NUMBER OWNER BUILDER This form shall be posted on the job with the BuildmgInspection Card at all times in a conspicuous place. Only persons appearing on this list or their employees are authorized to work on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance JUL-24-2082 03:18 AM r P.03 INSTALLATION CERTIFICATE ` CF-5R 7- r� Site Address 540 Pertttit umber DUCT LEAKAGE AND DESIGN DIAGNOSTICS DUCT LEAKAGE REDUCTION I'ir;i.uizanon'I'est IZe1Wlts (CFM @ 25 PA) l7 'Pest Leakage (CFM) _ l ;m I!' i'ci;i Fluw is ('alcul❑ted as 400 cfnvton x number of tons, or as 21.7 x Heating Capacity in Thousands of Whr, ether calculated value here If fan flow is measured, enter measured value here L.eakag,e Fraction = Test Leakage/(Measured or Calculated Fan Flow) = Pass if leakage fraction !� 0.06 [ Pass Fail ❑ Fur AEROSOL TYPE. SEALANTS ONLY -The following diagnostic testing wars completed: Duct Fan Pressurization at rough -in measured leakage (CFM) CHECK .kVI i'R FINiSHIIrG WALL: t ❑ }'�� ❑ No ❑ Pressure pan test or House pressurization test N'o ❑ Visual Inspection of Duct Connections ��/ ❑ ❑ Pass Fail 0--THERMOSTATIC EXPANSION VALVE (TXV) y�s, No Thermostatic Expansion Valve (or Commission approved equivalent) is installed and Access is provided for inspection ❑ Yes is a pass Pass Fail ❑ DUCT DESIGN N , ACCA Manual D Design calculations have been completed, Duct Design is on the plans and duct installation matches plans_ N ❑ Yes ❑ No TXV is installed or Fan flow has been verified. If no TXV, verified fan flow matches design from CF-IR. Measured Fan Flow = Yes for both I and 2 is a Pass Pass Fail ❑ 1 thr undersigned, verify that the above diagnostic test results and the work I performed associated with the tests) is in onnturmancr wiih the requirements for compliance credit, (The builder shall provide the HERS provider a copy of the CF•6R d1,11cd by the bLJ1dCr ernPIOyces or sub -contractors certifying that diagnostic testing and installation meet the requirements for .uinph,uitke cicdit j 1 <.., ignantre, Date 14, instal g Subcontractor (Co. Name) OR I'r; t, Ir n d General Contractor (Co. Name) 0 )11�, I U liui�, ing Departnttnl I IF16' Provider (if applicable) Bui:.dina Owner at Occupancy JUL-24-2002 03:17 AM P.02 TE OF FIELD WRIFICATION AND Project Tltle Project Addres§ Builder HERS rtifying 5lgnature V uERe Firm: Street Address: Copies to: Builder, HERS Provider NG CF-4R uate '� Build MVa Plan Number phone Sample Group Number Sample House Nurnbof HERS Provider:L�- city/State/21p:- +�x� HE R ER (;QMP61ANCE STATFb6ENT The house was: 0-' Tested d Approved as part of sample testing, but was not tested As the HERS rater providingg diaggnostic testing and field verification, I certify that the houses identified on this form comply with the diagnostic tested compliance requirements as checked on this form. J` Distribution system is fully 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 soul leaks at duct connections, MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage) Measured Duct Press urizatlon Test Results (CFM Q 25 Pa) values Test Leakage Flow In CFM —70 If fan flow is calculated as 400cfm/ton x number of tons enter calculated value here _ c� If fan flow Is measured enter measured value here Leakage Percentage (100 x Test Leakage/Fan Flow) Check Box for Pass or Fall (Pass=6% or less) tx. ❑ Pass Fail M THERMOSTATIC EXPANSION VALVE TXV) or Commission approved a uivalent C+Yes ❑ No Thermostatic Expansion Valve (or Commission approved equivalent) Is Installed and Access Is provided for inspection Yes is a pass ❑ MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT 1, C] Yes O No ACCA Manuel D Design requirements have been met (rater has verified that actual installation matches values In CF-1 R and design on plan, 0 Yes I3 No `CXV is installed or Fan flow has been verified. If no TXV, verified fan flow matches design from CFA R. Measured Fan Flow = Yes for both 1 and 2 is a Pass Pass Fail 0 ❑ Pass Fail