Loading...
0312-304 (SFD)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Qh 1pter 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 '736920 3131/05 Date �� ��=� Signature of Contractor— OWNER-BUILDER ontractor 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 Policy No. 9TATY. ,� UND * J $76409-20- 2 (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 thostproftions. . Date: 1-14(l j `'A pplicant 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 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 buildin construction, and hereby authorize representatives of this City to enter upo the above-mentioned'property for i , sppection purposes. Signat ure (Owner/Agent) I, Datez%�r�� BUILDING PERMIT PERMIT# DATE VALUATION LOT TRACT JOB SITE APN ADDRESSr.`L.�����1�4��IEFt�A 'il .Z% OWNER CONTRACTOR DESIGNER EN,61NEER 07 1 JkSISO/MIruy CUM 1TKIAPISpyYSO3N XJ.0.'BQX 1484 i 5 MQ,As4'MMAR KMN�i.SIM UAL. QU TA Chi q2253 Li'tt QUD-T A CA 922$3 C/60)568.1404 MIN 6255 USE OF PERMIT S'FFJ - LCAT 3. RFMI F DOLS N01 INCLUDE B1,OWX WALLS. nSiL7A,, :S.PA. OR MVEWA`/ APPROACH, 79% REDUCTION TO PLAN 'CI;RC K FF -14 S?'+.Ili TO M..eJVOPLY, IUISUANCsE OF VXP; i11. -AH 'i'WIV, � t fR.�.t� L°�;*I�1':K�CT3�iA1 S,a1�.0�3-fly PCDIR°C;HMATIO 10.00 Sig' (Mi3.!`4 EXIATUIORT 4PA00 O ` '. .t#7.r C110S r 0_9 COSMJMON 1231W8.10 •�q4�A' a� pry;;•t. S"2L.Yri.L\!?:1�•R d1 H3..C. sCAmAm C:O1+#S1'MICTION VEM 301 -000,418400 SQUID PLAN CHECK ME 101-000439-318 39-318 S142,20 F&F DEPOSIT 101-000-439-318 4230.00 Il9WCl'1AN ICAL. f�l;C' 101%!,000421-000 U6.30 LLII T F.1C A1,1PTY— , . _ 1.01-000-4211.000 P)..Y1I•I31'NC3I3I `•-. . 101-000-419-000 taNO MOTION FER • M -831D 101-000-241-000 $1L38 C9RADING!MEL 101 $15.00 DWSLOPERIMPACT FE Ed $2140100 nP. iSFPI.Ai+f x :pi -000 41„.45 $Etis�,00 SUe,IX fALL C01.1181X (! 1-10 ' AND PLAN Ci1T�^�,���ta��'j $3,08.4�P1LESS ��^ �jyy _ Tp DIYE POW &q,428AX .CI�I n106E�o Y RECEIPT DATEA BYr;/ 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 0. K. to Wrap / . .�� — - O Exhaust Fans F.A.U. Framing Compressor Insulation 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 — 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 `!)- dr Encapsulation Gas Piping Gas Test 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) l�lJ-vim .i yya 4'4 Q�c z P.O. BOX 1504 Building / l 78-495 CALLE TAMPICO Address 7 .2 q �1 J / Q LA QUINTA, CALIFORNIA 92253 Mailing. r f'/,1 111 Address y( City Zip IG (-?L,)A �< q- 7 S L.L . iaaares . /� !/s 11q / I v, y s_rFr , c,.. La S3 State Lic. 7.3 402,6 City 8 Classif.Lic. q Arch., Engr., Designer 0�/ f civncep S Address Kel. City( Zip ( State Lic. N LICENSED CONTRACTOR'S DECLARATION 1 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 etfecL 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, Business- and Professions Code: Any city or county which requires a permit to construct, atter, Improve, demolish, or repair any structure, prior toffs Issuance also requires the applicant for such permit to rile a signed statement that he k 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 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 rive hundred dollars (E500). I-. 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, 8ulsness and Professions Code: The Contractor's License Lew does not apply to an owner or property who builds or improves thereon and who does such work himself or through his own employees, provided that such irirprovements are not intended or offered for sale. If, however, the building orimprovement is sold within one year of completion, the owner-busder will have the burden of proving that he did not build or improve for the purpose of sale.) I l 1, 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 doesnot 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.) I l 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 Cl Copy is filed with the city. O 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 lass.) 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 Workets' 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 180 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 Fonstruction, and hereby authorize representatives -of this city to enter the above. mentioned.property for inspection purposes. Signature of aOplicant Date Mailing Address City, State, Zip APPLICATION ONLY .DING: TYPE"CONST. OCC. GRP. Number -7-7 -2-73-0 -3 d Description w �, t�2 fct Description S � It - Sq. Ft. 21 �rD No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ ttimated Valuation PERMIT AMOUNT Plan Chk. Dep. o^� Plan Chk. Bal. Const.- Mech.. Electrical Plumbing S.M.I. �f Grading e Driveway Enc. " V Infrastructure [ TOTAL REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Swback from Center Line Side Setback f.-om Property-L-ine-- - FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validation: WHITE = BUILDING DEPARTMENT YELLOW = APPLICANT PINK = FINANCE IZl 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 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 inforrhation to the Building and Safety Department a& part of your correction list. Please attach additional explanations as necessary. • I ,, J APPLICANT: D bl dl 01 es SITE ADDRESS: 5 J_ 3 OvP. APN'7 7 73 - 0/3 CASE NO.: Sao LEGAL:. LOT 3 BLOCK UNIT ll.. S.C.@V.L.il 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). i. .MDG filing required (5 filings since 9/3/98) ; Architectural variety within 200 fet of th s rrounding.area: Da �► roveT Rho 0 Planning Commisslon ' O City Council 1;rCommuny Dev. Dept. 3 ° (nitials Case'No. 03 -9 z® Exhibit Other Requirements: j �x SEP -15-2004 07:50 A•M r P. 07 " CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING. CF -41 �2 -,J±3 A. Project Title • Date q /�latG}/✓4e.✓1 I h.e� Project Address Builder.,Ne,T��T Builder Cont ct Telephone Plan Number HERS aterale7hne Sample Group Number ifying Signalu Dat Sample House Number ' Firm.. C �-,,OSSae it r s HERS Provider: TC 4 OG/u7Gl Street Address. 7 4/0 �I'=/L� DY� IYGLq„� City/State21p: 4 6! 24 zna r C '722S3 Copies (c:,,Builder, HERS Provider HERS RATER PQMPLIANCE ATATEMENT The house was:- Tested ❑ Approved as part of sempte testing, but was not tested •. As the"HERS rater providing diegnostic testing and field verification, l certify that the; houses identified on this form, form com y with the diagnostic tested complience.requlrements as checked on this Distribution system is fully ducted (i.e., does not use building cavities as plenums or platform returns in lieu f ducts) here cloth 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,' .} g(MINIMUM REQUIREMENT'S FOR DUCT LEAKAGE REDUCTION COMPLIAMCE 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) Check Box for Pass or Fall (Pass=B%.or less) ess. ❑ Fail THERMOSTATIC EXPANSION VALVE (TXV) or Commission approved equivalent . 9(YesF❑ No, Thermostatic Expansion Valve (or Commission approved equivalent) is installed and Access is provlded'for Inspection " ❑, Yes Is a pass ass Fail ❑ MINIMUM. REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT t .0 -Yes O. No ACCA Manual D Design. requirements have been met ` - (rater has verified that actual installation matches vaivas in CF -1 R and design on plan. 2 ❑ Yes ❑ No TXV is installed or Fan flow has been verified. If no TXV, verlfled fan flow matches design from CF -1 R.. - Measured Fan Flow C] O Yesfor both 1 and '2 is a:Pass Pass Fail _ . /; � �w � -t11 � � 0 Certificate of Occupancy T 0 Building & Safety'Department t This Certificate is issued pursuant to the requirements of Section 109 of the California Building is 1, 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 11. construction and/or use. BUILDING ADDRESS.' 52-293 AVENIDA VILLA Use classification: SINGLE FAMILLY DWELLING Building Permit No.: 0312-304 Occupancy Group: R3 Type of Construction: VN Land Use Zone: RC Owner of Building: S & J ASSOCIATES Address: P.O. BOX 1484 City, ST ZIP: LA QUINTA,'CA 92253 By: KIRK KIRKLAND Date: October 18, 2004 Building Official POST IN A CONSPICUOUS PLACE AM