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0301-179 (SFD)_N tJJ O =) M Q r W� � tY o Z 0 o co J r` IW- a U) . Z M L0 N 0 � Z �- f- O X W Y= Qk �. ,-d tl' T' Pt d g LICENSED CONTRACTOR DECLARATION 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 ,✓ f31 J!i e sr ]lCt Dat -© Signature of Contractor , P -�`' OWNER -BUILDER DECLARATION4 t 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 v 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 9TA gip, FUAJD Policy No. . 229- t3O3StW`F 2%4 (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 tho a provisions. 4 , •Date r%� � Applicant s /o ' � 1 ! r�aV' fT ✓r 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, indemnity & hold harmless the City of La Ouinta, 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 a4r o ize representatives of this City to enter upon the,above-mentioned property fo inspection purposes. [ �, Signature (Owner/Agent: �-� Dat.64- 1k - BUILDING PERMIT PERMIT# Mfl1_-a'T9 DATE — VALUATION ' LOT TRACT JOB SITE ADDRESS .�17 � i k� ill. APN 174--lZ i-0 .65 OWNER CONTRACTOR / DESIGNER / ENGINEER R0, BOX 134 41.770 int".i?i+/.43•�3'. E DSR. I:.,A Qpam& CA 92253 k FFUvr DA DI 2 CA q5 220 l (.-M)408.7528 C.B1: f 3724 USE OF PERMIT Cif, MMFLY DWELU t.1 1431 SASIM, PERMIT IX3ES NOT INCLUDE ,10,WC K WAL1, POOL, OR DRIVEWAYAPPROACH TRACT CONSTRUCTION SF POIi.MPA TIO INA SP 0AIR.A0rXAMPORT 487,00 S ESTIM `IME.0 Cobv or CONSTROCUON CONS", UCTIOV PER 103.000.416.011X� R590.14.0 PLAN CHECK FEE 101-000.43--316 $40,12 FEE DD -021T 101-000-439-316 4250100 'MECHANICAL PTE 101-000-421.-000 $53.50 &UTRICA.L FEF 101 -000 -420 -MM MM33 FLUAII.r'la INO F'FE 101-.000-41.9-000 1131.15 STi RO140 MOTION FEE - R.F.MID 101.000.241.000 $811ty €SRADI3aIO ME% 101-0610.42 -000 $0.00 LAYL01,0PER IMPACTOU 53,04.00 PREC13Z PI -A34 101.000-441-M Y .-TOAp1 SLIP.-TOTALAYCp1t.WANy?fT CilCi g: l,90N .ry L2CTy1CID.� 1y . 1117 `svw.oo , PERM YS DUE NOW F1_.i3 f RECEIPT DATE 7 �r,�� BY, �_ DATE FINAL�v _ 7I INSPECT INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs - (� Underground Ducts Forms & Footings T/ Ducts Slab Grade (/7 Return Air Steel Combustion Air Roof Deck �� �,C� Exhaust Fans O.K. to Wrap)- F.A.U. Framing ,5 _ 0 -� S Compressor Insulation e -J3 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 Plbg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines 3�—U3 �`� Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure. Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection �f� 3 ��t` 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 Final Utility Notice (Perm) COMMENTS: Certificate of Occupancy City of La Quinta Building and Safety Department This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code, certifying that, at the time of issuance, this structure was in compliance with the various ordinances of the City regulating building construction or use. For the following: BUILDING ADDRESS: 53-575 AVENIDA HERRERA Use Classification: SINGLE FAMILY DWELLING Occupancy Group: R-3 Type of Construction Owner of Building: THOMAS BUFFIN -7--&04—t Building Official ►yia 1 Bldg. Permit No.: 0301-179 Land Use Zone: RC Address: P.O. BOX 134 City: LA QUINTA, CA 92253 By: KIRK KIRKLAND Date: JULY 18. 2003 POST IN A CONSPICUOUS PLACE Tract# Study Area Type Single Family Residence No. of Units 1 Lot # No. Street S.F. Unit 1 53575 Avenida Herrera 1431 Unit 6 Unit 2 Unit 7 Unit 3 Unit 8 Unit 4 Unit 9 Unit 5 Unit 10 Comments Lot # No. Street S.F. At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions under 50,0 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 1,431 S.F. or $3,062.34 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 CC/Valley Independent Bank -David Addington Check No. 278121 Name on the check Telephone Funding Residential By Dr. Doris Wilson Superintendent Fee collected /exempted by Sharon McGilvrey $3,062.34 0.00 Payment Recd Over/Under Signature /7 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 JUL-14-2093 06:45 AM ERTIi~ ICATE OF FIELD VERIFICATXON AND Project Title 4-2-4- �� /�1,� �,�v,►�., �., l� nGna rwtw ing Signature ' Virm:.TC Street Address' 29aJ2 P.01 TESTING CF -411 Datil " Builder Name Plan Number Sample Group Number Sample House Number HERS Provider: /JG/,�� /�s� oG1u 5 City/State/zip: L y Copes to- Builder, HERS Provider HERS RATER COMPLIAN E S AT • EN The house was: Tested ❑ 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 nom y with the diagnostic tested compliance requirements as checked on this form. CX Distribution system is fully'ducted (i.e., does not use building cavities as plenums or platform returns 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 teaks at duct connections. JK 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_ If fan flow is calculated as 40ocfm/ton x number of tons enter /l calculated value here If fan flow is measured enter measured value here _ t_eakage Percentage (100 x Test LeakagelFan Flow) = �� Check Box for Pass or Fall (Pass=6% or less) ❑ ass Fail I THERMOSTATIC EXPANSION VALVE TXV or Commission approved equivalent Yes 17 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 1 0 Yes C1 No RCCA Manual D Design requirements have been met (rater has verified that actual installation matches values in CF -IR and design on plan. 2. ❑ Yes 0 No TXV is installed or Fan flow has been verified, if no TXV, 111)H verified fan flow matches design from CF -1R. Measured Fan Flow = 0 a Yes for both 1 and 2 is a Pass Pass Fail