0012-126 (SFD)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 .
b�ate�l `- �!1►� Signature of Contractor } /,L 0)
I
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 avid 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
rSection 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 - r Policy No. f 64 cJs,; 1;utf- L,
w �L'>
(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' compensatiop provisions of Section 3700 of the Labor
Code_, I scrall fQ�rthwith complyw hjthloselp ovistons..1 I
Applicant • / ; ,/ S u X",
e..
s d _. t,
Warning: Failure to secure Workers' Compensation coverage isnlawful 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"fo
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
cAstruction, and hereby authorize representatives of this City to enter upon
the above=ntioned property for ins,�ec i(c n purposes. ��
me
gnatuf(e (Owner/Agent) +'/ffrr tA_ = ��Date Jf;�z
BUILDING PERMIT PERMIT#
0012-126
DATE .VALUATION LOT TRACT
..� 4 ` C� `:tt4,1r,F„1C 1
JOB SITE
kADDRESS 5. -q :E }iVZNWtA, R �i
APN
7734324-022
OWNER
CONTRACTOR/ DESIGNER / EN INEER
0:1 'Y 1"AML,Y .C1 lril
GRADY C:e3NFSJYitiJC'1 ON
1915 1A0RM BLVD
1915 MOREN ADIND
SAM EGO CA 92110
SAN %3ZG0 CA 92'1110
(819)276.5271 Mo
USE OF PERMIT
0.1 R.FAMILY Ta'4�..Z„T..WO
1733 S.F. St0 PEI:.'MIT DOE.`a 1.dOT MCL,UDE P3I OCX WA.U4 4 POOL OR
H.
DRIVEWAY APPROACH.
TRA.0"r C7JNOTRUC`f ION 1.732,00 f1F
PORC;I: PATIO 96.00 S
0ARAMCA RP RT 492:00 IYP
`
CONS TRUC'J I(M ME 19) -000.4.1 B-000 $657.00
PLAN CHECK Y EE 10.1 _000-M-31 8 049.0
I?a'T) 014111T 101.000-439-313 4139100
1 W,HANIC.ALFEE 101-000-421-000 $59.00
EWCTFUCPA1 nE 1DI-000.4201«000 Ej25,40
PLI UIbII,iINIDFEE 101-000.419-000 $130.00
STROW0 50Th N RE - RIVID 101 -000 -241 -ON 510,50
ORADIANQ FEF, 11131-(1Q0- 23-000 $15.OD
lex"` ELOPER IMPACTFEE A::403,00
PRECISE PLAN 101•-000-441-3345 $100.00
ii'CM0N' AN1)
i,C151.55
A.W. Ct'".iLC.�3X
U
ISM 1 RI -PAM t.. ".3
-$250.00
1JUL 2 1 2003
.1 :E'1±.'1�,ii'x F+'iR! S DUE NOW
_
CITY OF ACU MTA
FlNAhCF E)EPT.
RECEIPT
DATE
BY "`� .� _ _
DAT FINALED
INSPECTOR
W
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
Set Backs
APPROVALS
MECHANICAL APPROVALS
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
Framing
/
F.A.U.
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 L_ _
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground PIN. Test
Final
Gas Piping
PLUMBING APPROVALS
Waste Linesl v
Gas Test
Electric Final
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
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power Q
Final
Utility Notice (Perm)
COMMENTS:
CERTIFICATE OF COMPLIANCE �e
Desert Sands Unified School District �q�cs��o
47950 Dune Palms Road Q eERMU0A0UNES r
Date 7/21/03 La Quinta f INDIAN WELLS CA 92253 RAN AN WELLSMIRAGC7
�
DESEFrr
No. 24728 (760) 771-8515 �ij? PALM LAQUINTA y
�INDIO
O
Owner
Grady Family Trust
APN #
773-324-022
Address
1915 Morena Blvd
Jurisdiction
La Quinta
City
San Diego Zip 92210
Permit #
0012-126
Tract #
BLK159
Study Area
Type
Single Family Residence
No. of Units
1
Lot # No. Street S.F.
Lot # No.
Street S.F.
Unit 1 9
52925 Avenida Herrera 1732
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, 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 $2.14 X 1,732 S.F. or $3,706.48 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 OC/Washington Mutual Bank - Michael Grady Check No. 551511551
Name on the check Telephone
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by
Signature
Barbuzza
Payment Recd
$3,706.48
$0.00
Over/Under
NOTICE: Pursuant to Government 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 Duplicated
Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING
Project Title
Project Ad ress
*J17 )/
Contact Telephone
Gap- dill K7610)'1/?- 5- 72
HERS Rater I .Telephone
Firm:
Street Address: 79bl Q ffr-14F,, 4 C/YL
Copies to: Builder, HERS Provider
91105
Da
rg 61w -
Builder N me
Plan Number
Sample Group Number
CF -4R
Sample House Number
HERS Provider: C HES R ✓
City/State/Zip: L u eP0)17/-4
HERS RATER COMPLIANCE STATEMENT
The house was: 62rTested ❑ Approved as part of sample testing, but was not tested
As the HERS rater providing diagnostic testing and field verification, I certify that the houses identified on this form
comply with the diagnostic tested compliance requirements as checked on this form.
distribution system is fully ducted (i.e., does not use building cavities as plenums or platform returns in lieu
of ducts)
421 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 leaks at duct connections.
MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT
Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage)
Measured
Duct Pressurization Test Results (CFM @ 25 Pa) values
Test Leakage Flow in CFM J
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 -7
Leakage Percentage (100 x Test Leakage/Fan Flow)
Check Box for Pass or Fail (Pass=6% or less)' ❑
Pass Fail
THERMOSTATIC EXPANSION VALVE (TXV) or Commission approved equivalent
v6 Yes ❑ No Thermostatic Expansion Valve (or Commission approved
equivalent) is installed and Access is provided for inspection
Yes is a pass
❑ MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT
1. ❑ Yes ❑ 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.
2. ❑ Yes ❑ 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 =
6R�- 1:1
Pass Fail
a/w
❑ ❑
Yes for both 1 and 2 is a Pass Pass Fail
1010
Certificate of Occupancy
OF'T1'Building Y p & 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 andlor use.
BUILDING ADDRESS: 52-925 AVENIDA HERRERA
Use classification: SFD Building Permit No.: 0012-126
Occupancy Group: R3 Type of Construction: VN Land Use Zone: CR
Owner of Building: GRADY FAMILY TRUST Address: 1915 MORENA BLVD
City, ST, ZIP: SAN DIEGO CA 92110
By: KIRK KIRKLAND
! Date: 3-17-05
Building Official
POST IN A CONSPICUOUS PLACE