0312-305 (SFD)LICENSED CONTRACTOR DECLARATION
I hefLy 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.
Licensee4 Lic.'Class Exp. Date' .
. ' 736920 'A �,.�, 3/31105.
,/Date 'L •� //% /Signature of Contractor' /P5�
.OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason: 1
( ) 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,
(Sec. 7044, Business & Professionals Code)..,,,,( ,) I; as, owner -of the property, am exclusively contracting 'with licensed
contractors oto 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 her 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. Policy No.
STATE FLIND
(This. section need not tie completed if the permit valuation is for $100.00 or less).
O 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 these provisions.
' Date: x177,4 Applicant -
Warning %: Failure to secure Work Fs' 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 applicator 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 budding
construction, and hereby authorize representatives of this City to enter" ""'
the above-mentioned property for inspection purposes. ,,
Signature (Owner/Agent) ` Date
PERMIT #
BUILDING PERMIT_-
-
DATE • VALUATION LOT ' * '"� � 1 +�+ TRACT'
,..
JOB SITE' ,, "
APN
ADDRESS �.�-��i�+°�' �.�i ,�'��k?i �.Teiat� �',
��:.i-•�i �� 1
OWNER
CONTRACTOR? DESIGNER / ENGINEER
U & l'Sl.)O'..iXl.':TB:A7g .1.1-,
WR'SJ®d\.L :Alomw '
CA 92255:4
Y.AQVRO-A, CA 92233
USE OF PERMIT
S). in • le.AM' S.M,M17 :0OX"^a NOT INCol.i OLe BL,0CIC`6fA1.L% r004 SPA
OR RIVYWAY AP1'ROA4� :11
TRACT C(MISTRUCTION
PORCHIPAT10 19.00 Sir
I�F?.C3:Ifari;r'1PwD7 AN.ttii 3F
i
j
:I�rr`"1 i1 OTATED MN Ir 0913' C.'C?NMUC'.WK
-.133A08.10
tvC?1 :3TRUCCTION FEE - 101 400 41 U-000 '• .. � _ fi�4�.�� .
Y .
PtaXN CYrli`;fX Mel $57!.21
FFI,, DXPOSIT _ 101-000-439-2M,8 42500
:c1lGCIMlCAL FRY, 1(11-i3Dt3�$ili-fats(? $ti&.'�ti
EL,1?01R IC:AL YE?9 101,000-420'00,
FLE)It! 8ITdO ME11J9 - Cita-1 ]: '.fi 0 .' . , -.$125,23
$1XI10
e .
r`3'TTt,C7NG N101110H VFT Ii? 101.OGO-'moi-000
upAma, nm? 103 -000-425400 ' t�15:D2►
"
1) EYE.G0P1,411. IMPAC s FE Ir
,t
PIdJ&t:ISL� I'1�.4# 1(92 •'f3flt3•-�'1.1 :"s�i"� �109.�t1
} � .
ST1"Ia•''.C'0TAL l',CX\RM,'Z[TC1:1.C31q AMD PLAN C1 WK
,`'t,t36,13i
D Q 1;,..Fe PR"FlaiTD I''ne
/ryy gip `� ��'+ y�((�jy�y�9�r �`q [{,-[g`��}�p
9.114
.riCf:flll
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• . �f 1'IsL .C'� E'RA'd1J. 7: � DEO3'OO
FEB( 61004
CITY OF LA QUIN'ra
F1 CE 00y.
_5
RECEIPT
DATE (r ,[BY
DA E IN%L
INSPECTO
T
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
- 7/
Underground Ducts
Forms & Footings
44
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
_
Exhaust Fans
O.K. to Wrap
Q
F.A.U.
Framing
Insulation
-Q �%
Compressor
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 v�
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
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
/ QG
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole e
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) "(J
COMMENTS:
Building % Z
Address G,
Owner
maim=
Address A0. 13
City
4
u�!'II,rGv
P.O. BOX 1504 APPLICATION ONLY
78-495 CALLE TAMPICO
/ LA QUINTA, CALIFORNIA 92253
Is -f64 jA AS t4
y
a 411 s
J
State Lic. City
& Classif. 7`�_ Lic. q
�'9
Arch., Engr.,
Designer
Address
City I Zip I State
Lic. N
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Suslness and Professions Code: Any city or county which requires a
permit to construct, after. Improve, demolish, or repair any structure, prior to'fts Issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to
the provisions of the 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 thealleged 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).
17: 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.)
1'1 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.)
17 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm thatA 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
C1 Copy is filed with the city. 0 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, 1 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 Address
This is a building permit when properly filled out, signed and validated, and is subject to
. expiration if work thereunder is suspended for 1110 days.
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
` construction, and hereby authorize representatives -of this city to enter the above-
mentioned property for inspection purposes.
Signature of a0plicant Date
Mailing Address
01y, State, Zip
BUILDING: TYPE'CONST. OCC. GRP.
A.P. Number--? -?3 2 -73 -015--
Legal
15-.Legal Description _qg�t_P G
Project Description 5' (7, 4/
REMARKS
Sq. Ft. 2 �
Size
No.
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑
Repair ❑ Demolition ❑
Front Setback from Center Line
Rear Setback froTt Rear -Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by:
Date Permit
Validated by:
Validation:
Estimated Valuation
(/
PERMIT
AMOUNT
Plan Chk. Dep.
7 0 �—
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
r
a
c�-
TOTAL
REMARKS
r;
ZONE:
BY:
Minimum Setback
Distances:
Front Setback from Center Line
Rear Setback froTt Rear -Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by:
Date Permit
Validated by:
Validation:
WHITE = BUILDING DEPARTMENT YELLOW = APPLICANT PINK = FINANCE
3 �
J
CERTIFICATE OF COMPLIANCE
Desert Sands United School District z4� ry y, 60
47950 Dune Palms Road
Q BERMUDA DUNES r
Date 2/6/04 La Quinta, CA 92253 V) RANCHO MIRAGE d
INDIAN WELLS ti
PALM LI;TNo. 25483 (760) 771-8515 Ny
�INDIO l�
Owner S&J Associates APN # , 773-273-015
Address P.O. Box 1484 Jurisdiction ,La Quinta
City La Quinta Zip 92253 Permit # 0312-305
Tract # Study Area
Type Single Family Residence No: of Units 1
Lot# No. Street S.F. Lot # No. Street S.F. .
Unit 1 5 52385 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/carports, covered patios/walkways, residential additions under
500 square feet, detached accessory'structures (spaces that do not contain facilities for living, sleeping, cooking, eat+ng 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 1,918 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 projectmay now be issued. "
Fees Paid By CC/Pacific Western Bank -Mark Kellogg. Check No. 209362
Name on the check Telephone 760-380-1725
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Yolanda Garcia Payment Recd
$4,104.52 Ever/Under
Signature
NOTICE: Pursuant to Government Code Section 66020(d)(1), this will serve to notify you that the 90 -day approval perioc, 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 projects 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
1
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. Itspurpose 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 a& part of your correction list. Please
attach additional explanations .as necessary.
APPLICANT: S �T n5,SOC DYI:' 6YL&V
SITE ADDRESS: 3 E5 Vi Jla
APN CASE NO.: `7lq
LEGAL: LOT S BLOCK ? / UNIT l S.C. aV.L.Q.
CHECK AND APPROVED.BY: DATE: `
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 9/3/98)
Architectural variety within 200
f et of heed bsrrounding area:Apl2rr. flats
0 Planning Commission
0 City Council
/kcommunity Dev. Dept. T11e
Initials
Case No. Ss+ 03-91 9
Exhibit
XWi*deskjn4eatufes-
RA4n`
n
r
F
Other Requirements:
-
_.- M
SEP -15-2004,. 67 :50 AM
r . CERTIFICATE OF FI
ATION
TESTING
A
P. 05
CF -4R
Pro' ct Adc ess Builder Nam4 ,
EW�tae Cont ct Telephone Plan Number i ;r
HERS Rater Telephone Sample Group Number
ifying Signature. 'oath Sample House Number
Firm: IrC HERS Provider: �G,J i�Sol'/aTtS
Street Address: Srw._1:119 Z Cl%G tv City/State/zip: Z `•{/rr _ ('1' �� 3
Ccpies to-. Builder, HERS Provider
HERS RATER'COMP E STAT M
The, house was: Pr Tested'' ❑ Approved as part of sam* testing, but was rot tested
As .the HERS rater providing diagnostic testing and field verification, I certify that the houses identified on this form
comp y with the diagnostic tested compliance requirements as checked on this form.
V.Distribution system Is fully'ducted (i,e,, does not use building cavities as plenums_ or platform returns"in lieu
of ducts) �r
Where cloth backed, rubber adhesive'duct tape Is Installed, mastic and drawbantds 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 Diagnostle Leakage Testing Results (Maximum 6%0: Duct Leakage)
Measured
Duct Pressurization Test Results (CFM Q 25 Pa) .Values
Test Leakage Flow In CFM 7
if fan flow is calculated as 400cfm/ton x. number of tons enter �,�-��
calculated value here l,
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)- ❑
res ` Fail
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. _
0 Yes D No ACCA.Manual D Design requirements have been met.
(rater has verified that actual installation matches values in
CF -1 R and design on plan.
e / 1
2. ❑Yes 0 No. ' TXV Is Installed or Fan Flow has been verified, If no TXV, l
verified fan flow matches design from CF -1 R. .
Measured Fan Flow
Yes for both 1 and 2 .is a Pass. _ Passe. Fail
�
- � te of
:;
:to
,oCertifica
:r
14
U
ILAIM
19a
F Building & Safety Department
W -I
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.
44
14
BUILDING ADDRESS: 52-385 AVENIDA VILLA
Z
I.k
Use classification: SINGLE FAMILLY DWELLING Building Permit No.: 0312-305
Occupancy Group: R3 Type of Construction: VN Land Use Zone: RC
Owner of Building:. S & J ASSOCIATES Address: P.O. BOX 1404
City, ST, ZIP: LA QUINTA, CA 92253
By: KIRK KIRKLAND
Ale—
Date: October 18, 2004
Building Official
POST IN A CONSPICUOUS PLACE
-Wi