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LICENSED CONTRACTOR DECLARATION
I hereby 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.
License # Lic. Class Exp. Date
f //
Date � ! � 6 -Signature of Contractor,%
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'owne� 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 sT.ATF F1)14D Policy No. 229- 0017-24303
(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 provisioris of Section 370,0 of the Labor
C,ode,, I shall forthwith comply with those provisions. f f
Date: j I s Applicant
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 building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for,inspection purposes.
, ate
f
Signature (Owner/Asent)` �' �� wf G 4 �< / D
• BUILDING'PERMIT PERMIT#
^
DATE •„ ^ VALUATION TRACT
` LOT TRACT
.JOB SITE -
ADDRESS �rT/GO y 1�1Li;A1 Fi�'*A
APN
37 0 I
OWNER',
CONTRACTOR / DESIGNER / EN (NEER
POWER MWANCT
DAVM L. ADD1NGTON
1-1.0. BC1X 134
41-'780 MtlsGT'C OL? DA
Us QULT.M CA 922S3
f3ERMUD.t'i1;lUNES CA 92201
`160)408-7528 CBLA 372A
USE OF PERMIT
o4t" yx Ffimur Dwn- mfor
1909 S.P. SM- PE -3;U 11T DOPS NOT R4C•Lt)OF BLOCK W:At:L, P001AVk
OR DRIVEWAYAPPROfiCH
'1`w'iACT C,0143TRUC"TION SF
POP-r—WR4T1C3,; 3+1.46 SR
GARAC ICt.ARPORT 493,00 3F
Y:•4�6.¢MATED cost 'iJX,' 001191l;S.M/i.k..LOd!
CONSTRUCTION F89 101.000-413.000 54w,30
-
PLAN CHECK FEE 101 -000,439-318 $577.30
d � DEPOSIT 101.000.439.313 4290100
MZCilfaNld;.,,A IL V310: 101-000-4.21-000 $:3.00
EGRC'1`RIC.AL FRE 1411.000-420.0042 S125.03
1a#.La'01131,901"Ite 101-000-419-000 $142.00
3Tlto11140 MOTION Mr - Ti>'MID 101.000.241.000 %11,36
C1'u O1340YE-F- 101-000-423-000 $15.00
DiWELOi'M1MPACT TTI; $2,05,00
PRECISE Pi.A1d 101-000-441-345 $1.410.11(1
LMA i.�l 4014S.A1` D i�1.,19i>1 Ck1E(�. -
$4,137.24
p 3 .VRE-PAID PW3
4'2.50.0
MAR 19 200VM pmMl rS I'VE IN QW
CITY OF LA QUINTA
FINANCE DEPT.
$3,087.24
RECEIPT
DATE r 1 ' n
BY 1�
DATE FINALED
INSPECTOR
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs O
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap �-/ �O�
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 - IM. Lath '
I
Final
Final U' moo"
BLOCKWALL APPROVALS 1
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
C
Underground Plbg. Test
Final I
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
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
CERTIFICATE OF COMPLIANCE 'S ,XFIED -
Desert Sands Unified School District BERMUDA�4.'),<ko
S
47950 Dune
, Palms Road Q
Date 3/19/04 La Quinta, CA 92253 RANCHO MIRAGE Cf
INDIAN WELLSLM DESE
No. 25711. (760) 771-8515 PALA QUINTAT
. %INDIO y7ti
0
Owner Power Finance APN # 773-064-011
Address P.O. Box 134 Jurisdiction La Quinta
City La Quinta Zip 92253 Permit # 0403-210
Tract # Study Area
Type Single Family Residence No. of Units 1
Lot # No: Street, S.F. Lot # No. Street S.F.
Unit 1 12 51240 Avenida Herrera
Unit 2
Unit 3
Unit 4
Unit 5
Comments
1905 Unit 6
Unit 7
Unit 8
Unit 9
Unit 10
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, 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:
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 $2.24 X 1,905 S.F. or $4,267.20 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 CCNIB-Alissa Waggoner-Aiton Check No. 305388
Name on the check Telephone
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Yolanda Garcia Payment Recd
$4,267.20 Over/Under
Signature
NOTICE: Pursuant to Government Code Section 66020(d)(1), this will serve to notify you that the 9D -day approval period in which you may protest the fees or
other payment identified above will begin to run from the date on which the building or installation permit for this project is issued, or from the date on which
those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original - Building DepartmentlApplicant Copy - Applicant/Receipt Copy - Accounting
07=41 AM
P.01
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING CF4R
��y6
Date
Builder Name
Firm: +✓ .G �d' s v�f
Street Address; 7 ®Y
Copies to; Builder, HERS Provider
Plan Number
Sim -pis Group Number
Sample house Number
---._Ader: _-TC SSBG
CltylState/Zlp: L 6! Ae to rgI64Y eVZZ:5�1
HERTERgOMPWaNCE SI&TFMENrt
The house was: Tested i3 Approved as part of sample testing, but was not tested
As the HERS rater providing diagnostic testing and field verificatlon, t certify that the houses identified on this form
comgly with the diagnostic tested compliance requirements as checked on this form.
®' Distribution system I$ fully'ducted (Le., does not use bulidingr cavities as plenums or platform retums in lieu
f 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 leeks at duct connections.
4110�MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT
Duct Diagnostic Leakage Testing Results (Maximum hyo Duct Leakage)
Measured
Duct Pressurizatlon Test Results (CFM @ 25 Pa) values
Test Leakage Flow In CFM /a
If fan flow is calculated as 400cfmAon x number of tons enter 070calculated value here
If fen flow is measured enter measured value here
r /
Leakage Percentage (100 x Test Leakage/Fan Flow) ? >?
Check Box for Pass or Fall (Passa6% or less)
ass Fail
ZTHERMOSTATIC EXPANSION VALVE (TXV) or Commission approved equivalent
ryes ❑ 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
I . 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 poen.
2. ❑ Yes Q No TXV Is installed or Fan flow has been verified. If no TXV,
verified fan flow matches design from CF -1 R.
Measured Fan Flow =
O D
Yes for both 1 and 2 is a Pass
Pass Fail
Certific to of Occupancy
Q
O Buildin . � & SafetvDe ar�tment��� � p
This Certificate is issued, pursuant to the requirements .of Section 109 of the. California- Building
Code, e°s, .t Eying that, at the time of issuance, this strUcture was in ::compliance v+rfth the
provisions of the Building -Code and the various ordinances of the City regulating building:
construction and/or use.
BUILDING ADDRESS: 51-240 AVENIDA HERRERA
Use classification: SINGLE FAMILY DWELLING = Buildirq Pettl'tit No.: 0403-21 d
Occupancy Group: R3 Type of Construction: V f� - Land Use Zone: RC
Owner of Building- POWER FINANCE Address: POWER FINANCE
City, ST, ZIP: P.O. BOX 134
By: KIRK KIRKLAND*
Date,: OCTOBER 27, 2004
Building. Officia
POST INA CONSPICUOUS PLACE