9601-001 (AR)'d
LICENSED CONTRACTOR DECLARATION
I hereby affirm 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. 3z
License # Lic rC160 B Exp. Date cif g
+Date/ SignatureofContractor' ,..;n%-, /,,_ 0 �`�. F � %,�
I �
1
OWNER -BUILDER DECLARATION
I hereby affirm 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.
(This section`n'ee' no a completed if the permit valuation`is 041 .DO 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 ..
e provisions.
Date: �..n . �� Applicant<'•<--& ,("
. �- s. .�
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 application agrees to, & shall, indemnify
& hold harmless the City of Indian Wells, 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 wcrk 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 building
construction, and hereby authorize representatives of this City to enter upon the
above-mentioned property for inspection purposes.
Signature (Owner/Age►a a) er/1, !i ? Date
A`cx
BUILDING PERMIT
PERMIT« �
�Ofi01-11ft7t
DATE 113f
VALUAT�N $16,'90 ft LOT
TRACT p'
h
JOB SITE ADDRESS
APN
5-2-553 Ai°F VILLA
77X303-015
OWNER
CONTRACTOR
QUINN Ct3NST12 i:1MION
HOItIO.PRE G & KIMBE RLEY AFAN
525 THON,NHILL
52553 AVENIDA VfLLA.
PALM SPRINGS CA 92264
DID107 CA 921.01
DESIGNERIENGINEER
USE OF PERIVIUDy oN
I3edrwni and I.udlttuotn UdditiOlL
FEE DESCRIPTION
FEES
TRACT CONS:17RUC11 N 300.00 Sr
ESTI.'1A'FED COST OF CGINS`iRZlMON
16,290.60
P:ElEdM1'�' �'N.E �i[1MM.�11�Y
Pf,AN CI4ECK 1±F- 101-000-4-19-31 R S i AO
COINS- RUCTION FER tO1-0100-413-000 $189,00
Mt CHti IACr1L FEV, 1091.-000-421.000 $15.00
El.I•:t;TR1CAL PRE 101.000-420-000 $25.50
,KUMBING rM 101-000-4194)00 $39.00
VF ONG NIOTIOaN FEE - R.FS11) 100-M-2414)00 5.1,63
SUIS-TMA1. CON51,72UC` ION AND PLAN CHECK
$378,13
LESS PRE -PAID FEES
$0.00
D '1: t' I, PERMff FEWS DUE NOW
f
$378.113
r JAN 0 3 1996
, ay
RECEIPT
DATE BY
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 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
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
Util' • ^lotice (Perm)
Desert Sands Unif ed School District
Notice: 82-879 Highway 111
Document Cannot Be Duplicated Indio, CA 92201619-775-3500
CERTIFICATE OF COMPLIANCE
Date 1/4/96
No. 14012 Jurisdiction
Owner NaineNonofre & Kimberley Man
No. 152553_ % Street 'Villa J
City La Quinta Zip 92253
Tract # Lot #
Type of Development Residential Addition
Comments
& bathroom addition
APN # 773-303-015
La Quinta
Permit #
Log #
Study Area
Square Footage 300
No. of Units 1
At the present time, the Desert Sands Unified School District does not collect fees on
garages/carports, covered patios/.walkways, residential additions under 500 sq.iare 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:
Residential Addition 500 Sq Feet or Less
EXEMPT
This certifies that school facility fees imposed pursuant to Government Code 53080
in the amount of 0.00 X 300 or $0.00
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 n/a
Name on the check
By Dolores A. Ballesteros
Superintendent
Fee collected /exempted by Pauline. Pearson Exempt
Signature .. n P IA, n n tyvA
Telephone
f
V( 00
Check No. `/a
Collector: Attach a copy of county or city plan check application form to district copy for all wavers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
r*ririca;e v� �orri�iiance: Resiaentoal i
P a a e t or _) CF -1 R i
Date
oi;xt nue
9`i 3
Budding i
oject Address dding Permit a
I
Plan C,hecK / Date
xumentatlon Author Telephone I
Field Check /Date
ompiiance Method (Package. Point System or Computer)
Climate Zone Entorcement agency use Only
3ENERAL INFORMATION
'otal-Conditioned Floor Area: 3o0 ft2
'-wilding Type: t� Single Family /Addition
:heck one or morel Muni-Fa5Q, Existing -Plus -Addition
-vont Orientation: North /(Eas South / West / All Orientations
(Input onentanon in degrees and circle one.)
Vumber of Dwelling Units: I
loor Construction Type: Slab Raised Floor (circle one or both)
BUILDING SHELL INSULATION
Construction
3omponent Insulation Assembly LocatiorvComments
rype R Value LI -Value (attic to garage. typical. etc.)
Wall .............. (Z-13 (,lbr(;c-
Wall ..............
Root .............. TMP,F-( W.1 r —
Root .............
Floor.....
Floor .............
Stab Edge ....
FENESTRATION Shading Devices
Fenestration Area Fenestration Interior Exterior Overhang Framing Type
Orientation (af) U Value (roller blind. etc.) (shadescreen. etc.) !Yesinol (metaitwoodNinyl)
Front..... ( )
Front..... ( )
Left....... (5) .?S
Left ....... ( )
Rear ..... (W) 33.3 .55
Rear ..... (W) 4.0 . 75
Right..... ( )
Right..... ( )
Skylight .......
Skylight ....... 9,D
THERMAL MASS
Type/Covering Area Thickness
(slab/exposed the etc) (st/) (inches) Location/
D2aCTriptlo/n (kitchen barn. etc.)
Revised January 1992 \
t
.Certificate of Compliance: Residential (PagE 2 of 2) CF -1 R'
Project Tit e
Data
HVAC.SYSTEMS
Note: Input hyaronic or combined
hydronic data under Water Heating Systems. except Design Heating Load.
Distribution
Heating Equipment
Minimum Type and Duct or
Type (furnace, heat
Efficiency Location Piping Thermostat
pumc. etc.)
r---7 r i---77-7—
(AFUE/HSPF) fducts/anic etc) R Value Tvpe
Cooling Equipment Minimum Duct
Type (air conditioner, Efficiency Location Duct Thermostat
heat pump, evao. coolinol (SEER) (attic etc) R Value Tvpe
ry i
WATER HEATING SYSTEMS
Configuration
(sold or oacka
Energy • External
Rated' Tank Factor or Tank
Water Heater
Distribution Number Input (kW Capacity Recovery Standby' Insulation
Type Tvpe in System or Btu/hr) (gallons) Efficiency Loss (%) R Value
1. For small gas storage (rated input S 75.000 Btu/hr), electric resistance and haat pump water heaters. list Energy Factor.
For large gas storage water heaters crated input 2 75.000 awbr), list Rated Input. Recovery Efficiency and Standby Loss.
For Instantaneous gas water heaters, list Rated Input and Recovery Efficiency.
SPECIAL FEATURES/REMARKS (Add extra sheets if necessary)
COMPLIANCE STATEMENT
This certificate of compliance hats the building features and performance specifications needed to comply with Title 24, Parts 1 and 6. of
the California Code of Regulations, and the adminlstrabve regulations to Implement them. This certificate has been signed by the
individual with overall design responsibility. When this certificate of compliance Is submitted for a single building plan to be built in multiple
orientations, any shading feature that is varied is Indicated In the Special FeaturestRemaNs section.
.Designer or Owner (per Business A Professions code)
Name:
Title/Firm:
Address: --52_,2—
Telephone:
Lie. a
(signature)
Enforcement Agency
Name:
Title:
Agency:
Telephone:
(slpnaturerstamp) (date)
Rwlsed January 1902
Documentation Author
Name:
ride/Firm:
Address:
Telephone:
(signature) (1:111111119)
Ti'T 4 4 Q"
78-495 CALLE TAMPICO — LA QUINTA, CALIFORNIA 92253 – (760) 777-7000
FAX (760) 777-7101
TDD (760) 777-1227
December -18, 1997
Honofre G &1imberley Afan
52-553 Avenid ilia
La Quinta, CA.-, 92253
RE: Addition Permit #9601-001
Dear Mr. & Mrs. Afan
The purpose of this letter is to inform you that your Addition Permit #9601-001, for the project
at 52-553 Avenida Villa, has expired. In accordance with 1994 UBC section 106.4.4, no further
work may be performed until a new permit has been issued.
Please contact Daniel P. Crawford Jr., Building Inspector I, at (760) 777-7012 to obtain any
information you need regarding a new permit and/or any required inspections. Should you
choose not to complete the project, we would then have to pursue any or all of the following
actions:
1) Abatement of the project through the City Attorney's Office and Code Compliance Division.
2) Notice of non -conforming structure placed upon property profile.
3) Action filed with Contractor State License Board. Optional if Owner/Builder.
Please contact us at your earliest convenience prior to 10 working days to resolve this issue, and
for any questions you may have.
Sincerely,
Mark Harold
Buildin & Safety Manager
Daniel P. Crawford r.
Building Inspector I
cc: file
dpc
MAILING ADDRESS P.O. BOX 1504 LA QUINTA, CALIFORNIA 92253