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0305-285 (SFD)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Fes- Chapter 9 (commencing with Section 7000) of Division.,3 of the Business and 04. U) Professionals Code, and my License is in full force and effect. O =) ch License # Lic. Class Exp. Date �CYIn y W 1682901 }3 ' (r i Z ,D to e�.f� /�+I t1 Signature of Contractor xll'1i` 'i"�' 0'0 �� ebT t I 11 '(p J U r OWNER -BUILDER DECLARATjloN WW . I hereby affirm under penalty of perjury that 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 t 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). ' O I am exempt under Section. B&P.C. for this.reason N j . Date Signature of Owner 0 � .:. Q WORKER'S COMPENSATION DECLARATION' o I hereby affirm: under penalty' of perjury one of the following declarations: H 0 (.) 1 have andfwill maintain a certificate of consent to self ,in for workers' X w compensation,'as,provided for by Section 3700 of the Labor Code, for the 0J Q performance of the work for which this permit is issued. Q V: ( ) I have and will maintain workers' compensation insurance, as required by O U `Q: Section 3700 of the Labor Code, for. the •performance of the work for which this cl:�' F -w permit is issued. My workers' compensation insurance carrier'& policy no. are: ZCarrier 7) STA!FE 1r1,11d,' `. Policy No. ' 9• DDf 9 9•IDi) `• Cd J (This section need not be completed, if the permit valuation is for $100.00 or less). rt () 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 3bde, I shall forthwith comply with those provisions: 'f Date: - f , ,i. Fs . Applicant f r i <r—Y 1`;'fi e 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 Ccde,.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 Is_ application. 1. Each person upon whose behalf this application is made &each perso whose request and for whose benefit work is performed under or pursua o - • any permit issued as a result of this applicaton -agrees to, & shall, indem i R- & hold harmless the City of La Quinta, its officers, agents and employ es. t . 2. Any permit issued as a result of this application becomes null and vo d if : work is not commenced within 180 days from date of issuar . .of ch permit, -or cessation of work for 180 days will subject permit to cancella ion— `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" f A the above-mentioned property f Ir nspection purposes. o,lo,: ,�j j/S g ature (Owner/Agent) Date%�/��f I f `f PERMIT # •�"BUILDING PERMIT DATE - f VALUATION LOT•. r TRACT ^.orfs Klt�l,tT.�3. 4 JOB SITEr f _ �' APN ADDRESS ry AAVf 774-133-01 4" OWNER CONTRACTOR / DESIGNER / EN (NEER L't+IMEL lvif? VIR,.US P-A%qD L ADDW11'T LAQUMA, CA 92253 BERMUDA D11=1 (1A 92211 t (760)4.084 528 CflLfk 3724 USE OF PERMIT 1918 3.1':' SF0. PZ.i:Aq'1T DOES Aib'.f'DtC i;UDE BLOCK WAX4— POOL OR. TRACT CONSTRUCTION 3F ' PORmi/PA110 38.00 SP . GARtAC.?T�,lW,Ft OR.T 490.00 3F S'f ZI�Yt�I:'�':[b r`O��"Z Obi' CONS C XON' 114,06 2 PY',�MT F , SUYRtEA1IV CONSTpIXTION FEE :. 101.000.418.000 u93.60 ' .. PL -%N CHECK FPM 101-001T439�318 $71,24 FEE DEPOSIT 1X91-O.�DE1�f"�_31 S -3"150,00 lyl=HAN1CA,L FFI 101 -000 -4211 -coo ELK -'T WALFER .. tui -000.1420.000 s16s. PLUT+Ai3NO FEE 101 -000 -419 -WO $124.00 , STRO1dt .MOT1011a FSE - RUM 101-000-241.000 $11,41 . C}P:!#I9i'NG FF E 1;E71:-OCtt�a423-sJ00 $13:9'3 " ' " DEVE.LOPERIltiPAC T,FEE, Ai?EC1SF PLAM .:. J01 -01D0 -"I-!34 .' $iflD.rp ,(!0Ni3°rRTJcT110kTA!vD:PLta�.C.HE�IC .. &� ,'103.48 JJSLM3 S SV:i"1T,l 9z1/d' C '� 3 .2 6' 2CITY 1'. "'1u250.OV'..JUN OF LA QUFINANCE DE RECEIPTDATE/ �� BY ""^1 D FINAL D INSP 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 d Exhaust Fans OX to Wrap F.A.U. Framing 3 Compressor Insulation v Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath ze Drywall - Int. Lath Final Final - O 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 O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test ,p Appliances Final COMMENTS: 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) — d CERTIFICATE OF COMPLIANCE Desert Sands. Unified School District 47950 Dune Palms Road o ' Q BERMUDA DUNES r - Date 6/26/03 La Quinta CA 92253 - C/1 RANCHO MIRAGE t7 w f •?I INDIAN WELLS ti No. 24626 - (760) 7,71-8515 PALM DESERT C -Z' - LA QUINTA ` INDIO Q70 y Owner Evenel Mervilus APN # 774-133-016 Address 51955 Ave. Rubio Jurisdiction La Quinta • . City La Quinta Zip 92253 t Permit # 0305-285 Tract .# ' BLK 242 Study Area . Type Single Family Residence No. of Units,* 1 Lot # No. Street S.F. Lot # No. Street S.F. Unit 1 4. 53573 Avenida Villa 1918 Unit 6 Unit 2 Unit 7 . Unit 3 Unit 8 Unit 4 Unit 9 Unit 5 Unit 10 Comments At the present time, the Desert Sands Unified School District does not collect fees on garages/carpoits,_covered patiostwalkways, residential additions under 500 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cookng, 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: 71. 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 $2.14X 1,918 S.F. or $4,104.52 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 By CC/Downey Savings, Anna Gonzalez `check No. 59500002940 Name on the check µ t , k Telephone 760/91.03135 Funding Residential Y By Dr. IDoris Wilson .. • Superintendent - Fee collected /exempt ha cGil • ey ,' $4,104.52 50.00 Payment Recd . Over/Under Signatur NOTICE: Pursuant to Gdvemment Code Section 66020(d)(1), this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified above will begin -to run from the date on which the building or installation permit for this project is issued, or from the' date on which those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier. - NOTICE: This Document NOT VALID if Duplica-ed.. ' Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy- Accounting FEB -29-2004 ©7:33 .PM CERTIFICATE OF FIELD Project Title r + Uddr�ass %'/ > �,. Builder Contact , HE=RS Rater LIFICATION AND DIAGNOSTIC TESTING - CF -4R Date f } • Builder Name T Telephone Plan Number . Talehone Sample Group Number .,1 �i_ ^ Firm: HERS Provider; r n•Street Address; .7fdao SAV Ed l <y�& , City!$tatkip zo Owe* Copies to: Builder, HERS Provider _ i 'HERS RATER COMP61ANCr: STATEMENT` rr i -f ..The house was: Tested ❑Approved as part of sample testing, but was not tested A As the KERS rater providing diagnostic testing and field verlflcatlon, I certify that.the houses identified on this form com + y with the diagnostic tested compliance requirements as checked on this form. Oistribution system is f_ully'ducted (i.e., does not use building cavities as plenums or platform returns in lieu :~ �'°f ducts) k E W here 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 (Maulrnum 6% Duct Leakage)' Measured .J ' Duct Pres urtzation Test Results_(CFM 25 Pa),y r .` _ ,values Test Leakage Flow -In -CFM- If fan flow is calculated as 4d0cfm/ton x number of tons enter calculated -value here If fan flow is measured enter measured value here Leakage Percentage (100 x Test Leakage/Fah,Flow)'- Check Box for Pass or Fail (Pass=6% or less) ❑ - . Pass. Falb THERMOSTATIC EXPANSION VALVE (TXV) or Commission approved equivalent ti , Yes Q No . Thermostatic Expansion Valve, (or Commission approved • equivalent) Is installed and Access is provided for Inspection ❑ , Yes is a pass ' pass Fail Q MINIMUM REQUIREMENTS FOR DUCT DE51C3N COMPLIANCE CREDIT ' - ' C1 Yes 0 No ACCA Manuel D Design requirements have boon met _ s ' (rater has verified that actual Installation matches values in ,a= C F-1 R and design on plan. O Q - 2. - Yes No TXV is Installed or Fan flow has been verified, If no TXV, r Y verified fan flow matches design from CF -1 R. • a i Measured Fan Flow 13' a .4 Yes for both 1 and 2 is a Pass ` :Pass` Fail' - e 4 4J `+ (OLE IS x -P.oloe 1 F / 7. 1--' r vtf-' C -A) SEP 19 '03 12 48 FR TO 95646122 P.01i01 .REPORT �OF FIELD r ICOMPACTIOiV..T• ��'S:,=�. F, RR�PORTNO •�- O Z CLIENT: .OF PROJECT: '.SOIL ID VISUAL CLASSIFICATION OF SOIL I MAX. DRY DENSITY. PC;;!- OPTIMUM MOISTURE,'% t _ ltd . r• �;'o. .. COMPACTION' MOISTURE GENERAL LOCA-11ON: REOU1RSMEN T S. % 9Q REQUIREMENTS. 14,4 L ,t r�ST I READING �' QUOTIENT/' I SOIL T$ST CLEAR GAUGE INFORMATION AND Sh :' DAILY STArtOARD CAytenAY10N NUMBERS VARIATION, PeACENT:+i GAUG I AOJUSYMExY Ye vARtATtON FROM fCattBRA7:DN ...' COUNTS FROM SHEETS LAST u5F GAUGE TYPE PSELL MOtSTVRE I 'MOtSYURf� MOtSTUx& MOtSTUR6: , MODEL SO.: ��� DENSITY; DENSm': DENSITY: oe?gsn r.. '.SOIL ID VISUAL CLASSIFICATION OF SOIL I MAX. DRY DENSITY. PC;;!- OPTIMUM MOISTURE,'% t _ ltd . r• �;'o. .. COMPACTION' MOISTURE GENERAL LOCA-11ON: REOU1RSMEN T S. % 9Q REQUIREMENTS. 14,4 L ,t r�ST I READING �' QUOTIENT/' I SOIL T$ST =LEVATMN MOISTURE WET/D.�iY PERCENT I COMMENTS 'n=0• PCF f 10 NO. DEPTH, IN OF TEST CONTENT, DENS'TY, COMPACTION f { % I PCp AJ coje-y"of— cep All, i sIgo PERCENTAGE I VIA ;!:',.' ` i.. ,,.�,',,,�,i. �. , r Y:"%...; :ate ; ,kjri: •; ' 77 ':\`;. ..ttf�=,\iK"'G%: r..��" :4� "'� i•a- o.�";� Vit,' • h_3�, t. TOTAL , .. Certificate of Occupancy Tilf 4 4Qa&rw 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:. 53-573 AVENIDA VILLA Use classification: SINGLE FAMILY DWELLING Occupancy Group: R-3 Owner of Building: EVENEL MERVILUS Building Official Type of Construction: VN INA us Building Permit No.: 0305-285 Land Use Zone: RC Address: 51-955 AVENIDA RUBIO City, ST, ZIP: LA QUINTA, CA 92253 By: KIRK KIRKLAND Date: March 12, 2004