0308-159 (BLCK)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Imo— Chapter 9 (commencing with Section 7000) of sivision 3 of the Business and
(V W Professionals Code, and my License is in full_foybe and effect.
C =) c) License # Lic. Class'/ Exp. Date
r-- W� 746)93 ? BC1tYLATC
oZ r- ,,Date nature of Contractdr
CO 0 n,:
J U �p OWNER -BUILDER Dl CLARATION
W W I hereby affirm under penalty of perjurytha{ I am exempt from the Contractor's
~ U) License Law for the following reason:
Z_ ( ) 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).
V) () I am exempt under Section B&P.C. for this reason
LO
N Date Signature of Owner
O�
Q WORKER'S COMPENSATION DECLARATION
o cr I hereby affirm under penalty of perjury one of the following declarations:
r H O O 1 have *and will maintain a certificate of consent to self -insure for workers'
X W L=. compensation, as provided for by Section 3700 of the Labor Code, for the
mJ Q performance of the work,for which this permit is issued.
I have and will maintain workers' compensation insurance, as required by
(i SeOon 3700 of the Labor Code, for the performance of the work for which this
a rn Z permit is issued. My workers' compensation insurance carrier & policy no. are:
ob 5 Carrier STATE F1913T� Policy No. 046-010000232-02
t\ d
QJ (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 Calif9rnia, and agree that if I should become
subject to the workers' compensatiop 6rovisions of Section 3700 of the Labor
Code,,l.shall forthwith comply with te provisions.
Rate 7 T -)-V 3�pplicant
Warning: Failure
��to secure Worker ' Compensation coverage is unlawful and
shall subject an employer to crimin penaities 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 agreg to comply with all City, and State laws relating to the building
construction,/' fid hereby authorize representatives of this City to enter upon
the above- Honed property for inspection.purposes.
_ __ �, ,
,,-,Sig (caner/Agent)-�� Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT. TRACT
JOB SITE
APN
ADDRESS AT y �T¢�wnT�i
-
OWNER
CONTRACTOR / DESIGNER / EN INEER
CrHfri3 WOVID
A & M C0 I`!' '(TC'rf0N
P.O. BOX 366
7"70 CAUE, CA1,1Z
LAQTJD.4TA CIA 92233
'L' AQi3Ii+li'.A CA. 92253
(760)564.4832 C.B1141. 626
USE OF PERMIT
GED -IN AL t3Ul:rDII•Ir3•
50 L.F. 18" Iv.P:'PA NINU WA IA, 90 L.P. 6' EILOCI` WAI;13 34 LF.
S' SbOCI; WAL" RLL ORCO SYSTEM
6 FT, WALY, ".00 LF
5 N'f. 'W.ALL. 35.00 I.F
K'srmA'flm)COST or t''iy.F7s31:RUMON
:5,{1437.7:5
P.W.Wr FEE SUhD 4ktY
CONSTRUCTION FEE 1011-000-4184030 030 $43,01
'x
RM-T(nAL C+ N191RL &_ft0X ANDPLAN CBECK
$63.00
1AESS PRE -PAID .F'i.Z&V
$000
ID e _F11LL P RMT.r MIS 17•o :. q0W
$0100 .
AUG 13 2003
CITY OF LA QUINTA '
RECEI
Y
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
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wail 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 PI . Test
FIrW
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
-
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:
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 9.50.0.90 of the Zoning Code. -Its purpose is to determine: 1)
that the proposed housing 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 Master Design Guideline, please transmit .
this information to the Building and Safety Department as part of your correction list. Please
attach additional explanations as necessary.
APPLICANT:
SITE ADDRESS: -%o�n
0
APN %3 % - CASE NO.:,
A
O
Ar
toi
C
E
LEGAL: LOT / 2 BLOCK G 2- UNIT S'- S.C.@V.L.Q.
CHECK AND APPROVED BY: �C�,i DATE:
,e
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.
x
REQUIRED ITEM Y N COMMENT/CORRECTION
Verify legal and APN informations
Consistent with MDG on file (as.
applicable)
,MDG filing required (5 filings
since 9/3/98)
Architectural variety within 200
feet of the surrounding area:
Architectural design. features `s
uirements: DARPlanning Commission
City Council
Community Dev. Dept. e, 27
ials �—
seNo. 2Gos-SX9
i'
XWith Conditions -5%& A�'+o
XWith Conditions -5%& A�'+o
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING CF -4R
Firm: -1 _G. d',I�SSDG/�fI es
Street Address: 70aO ,O!'46 Fod CiMt,
Copies to: Builder, HERS Provider
Builder Name
Plan Number
Sample Group Number
Sample -House rNumber
HERS Provider:
City/State/Zip: L4? Ou/n-r Ce 922- 3
HERS RATER COMPLIANCE STATEMENT
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
corwly with the diagnostic tested compliance requirements as checked on this form.
Distribution system is fully'ducted (i.e., does not use building cavities as plenums or,piatform returns in lieu
Uof. 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.
J1 MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT
Duct. Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage)
Measured
Duct Pressurization Test Results (CFM Q 25 Pa) values
Test Leakage Flow In CFM^
If fan "flow is calculated as.400cfm%ton x number of`tons enter 11
calculated value here /b
If fan flow is measured enter measured value here
Leakage Percentage (100 x Test Leakage/Fan Flow) =
Check Box for Pass or Fail (Pass=6% or less)
❑
.
Pass Fail
9
THERMOSTATIC EXPANSION VALVE (TXV) or Commission approved equivalent
Yes ❑ No Thermostatic Expansion Valve (or Commission approved
equivalent) is installed and Access is provided for inspection
❑
Yes is a pass
Pass_ Fail
❑ MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT
1. ❑ Yes ❑ No ACCA Manual D Design requirements have been met
(rater has verified that actualinstallation matches values in
)
CF -1'R and design on plafl,
/
2. ❑ Yes ❑ No TXV is installed or Fan flow has been verified. If no TXV,
verified fan flowmatches design from CF -1R.
Measured Fan Flow =
❑ ❑
Yes for both 1 .and 2 is a Pass
Pass Fail
Certificate of Occupancy
T4ht 4 4 Q"
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: 77-720 CALLE DURANGO
Use classification: SINGLE FAMILY DWELLING
,Building Permit No.: 0308-159
Occupancy Group: R3 Type of Construction: VN Land Use Zone: RC
Owner of Building: CHRIS LLOYD
Building Official
Address: P.O. BOX 366
City, ST, ZIP: LA QUINTA, CA 92253
By: KIRK KIRKLAND
Date: December 16, 2003