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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
64l)1�� }3 S1�1/98
i
Date : ` 2 t- 2 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 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-inscke 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.
( 1 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.
t'f ! 1.... ,,
(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,
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I shall not employ„anytper s�o`n in°�any4+mariner so as to become subject fo 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
ode, I shall forthwith comply with those provisionsf
Date: », ,:, A•. �3 , Applicantf.••''..!� .
�. t..-
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. -
BUILDING PERMIT PERM' 9702- 7 °°NTR°`#
DATE .11I1 /a" 16
VALUATION 53190,) LOT , TRACT 4 7 4 2
ADDRESS 5X9.1.1 AV.K'JR1IIDA. Hk RRERRAA JOB SITEF
APN ..
OWNER CONTRACTOR / DESIGNER / ENGINEER
JAC ::SPININrk . KUR 7a. CONIS'['RUC:T:ION,
5391.1 AVE kli'RKERA 7A.W.14At"STAC.KRD,
LA QWNTA. CA 92753 PALM DE:SUIVI' CA 92260
(619)34"932 CB #. 4 547
USE OF PERMIT
ADEN
72 &P. /ifl 131'i'.i0 TO DiNi IG ROOM'
TRAM` r C^:, N"S TRUC 1'l y' N 1., 72.00 SF
ESTI ' Yr
4TRUCTION
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3,909.60
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
an permit issued as a result of this a licaton agrees to, & shall, indemnify Silt 'r1� �1I• t Cl.`i Cf�t.�`C�'!`iliN ,si f PLAN C_H-1:`CK
Y P PP 9 fY
& hold harmless the City of La Quinta, its officers, agents and employees. ass 1':1:.17P.1A1.,D rEfis,
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.-fCYCkL .PJ_P,RM1.T F EF -S 1)li KNtUW'
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. ^^
RECEIPT DATEDATE FINALED INSPECTOR
/ignature (Owner/Agent) �` - Date ^�
- --7777--
°� 1 M}7
$0.00
136.97
INSPECTION RECORD
A.;'
OPERATION
DATE
IN ECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVAL
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
Fined I INPOOLS
BLOCKWALL A FftOVALS
- SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground P1bg. 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
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Vottage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) "
COMMENTS:
Desert Sands Unified School District
Notice: 82-879 Highway 111
Document Cannot Be Duplicated Indio, CA 92201619-775-3500
CERTIFICATE OF COMPLIANCE
Date 2/26/97
No. 15294
APN # 774-163-022
Jurisdiction La Quinta
Owner Name Jack Spinner
No. 53911 Street Avenida Herrera
City La Quinta zip 92253
Tract #
Lot #
Type of Development Residential Addition
Comments
kddition to dining room
Permit #
Log #
Study Area 109
Square Footage 72
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 square 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 72 or $ 0.00 the property listed above an�d4hat building'
permits and/or Certificates of Occupancy for this square footage in this proposed proje t may now be issue
Fees Paid By n/a 1 Telephone
Name on the check 1
By Dr. Carol McGrew
Administrator in Charge
Fee collected /exempted by Pauline Pearson Exempt
Check No. n/a
Signature P-6 'ALA,
o _fl"R OI�tXI.
$0.00
tOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified
tbove will begin to run from the dale on which the building or installation permit for this project is, sssued or on which they are paid to the District(s) or to another public entity authorized to
allect them on the Dislrict('s)(s') behalf, whichever is earlier.
Collector: Attach a copy of county or city plan check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
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Certificate of Compliance: Residential (Page 1 of 2) CF -1 R
AvDDrl aJ j 612Ul 5A &!5l Q6_0 ea Fep� Z/9
Project Title Date
53 -s)I f Aveom Amu
Project Addreaa Building Permit 0
77 3 -2-4Z-3 Plan Check/ Date
Documentation Author ,1 Telephone
60a-- i 4L PV -S_ �o c �10�i1L�1 7 Z -10o p, ' 15 Field Check/ Date
Compliance Method (Package, Point System or Computer) Climate Zone Enforcement Agency Use Only
GENERAL INFORMATION
Total Conditioned Floor Area:
Building Type:
(check one or more)
Front Orientation:
tt2 •
Single Family "!oo" Addition
Mufti -Family Existing -Plus -Addition
North / East / South./ West / All Orientations
(Input orientation in degrees t;nd circle one.)
Number of Dwelling Units:
Floor Construction Type:a aised Floor (circle one or both)
BUILDING SHELL INSULATION
Construction
Component Insulation Assembly Location/Comments
Type R -Value U -Value (attic, to garage, typical, etc.)
Wall .............. 12 I Au- OL.w
Wall ..............
Roof .............. 12 ALL uew
Roof ............. .
Floor .............
Floor .............
Slab Edge....
.FENESTRATION: Shading Devices
Fenestration
Area
Fenestration Interior
Exterior Overhang
Framing Type
Orientation
(sf)
U -Value (roller blind, etc.)
(shadescreen, etc.) (yes/no)
(metal/wood,vinyl)
`Front..... ( )
Front..... ( )
Left....... ( )
Zin_
0. 75,
Left....... ( )
Rear..... ( )
Rear.....
2
< V.
tI r_TAL-
Right..... ( )
'
0.7 5
• W bO D
Right..... ( )
rtn,5
Skylight .......
Skylight .......
I CT C/�t_law�0.50 �)
THERMAL MASS—
Type/Covering
Area Thickness
(slab/exposed, tile, elcl)
(sf) (inches) Location/Description
(kitchen, bath, etc.)
JQF_:JE D ELoo R -12 . -3 ALL- Qego
Compliance Forms January 1, 1"'s
1111111111171
- Certificate of Compliance: Residential. (Page 2 of 2) CF -1 R
1r) D rtl ON ti . � PI ►J gest- F't: r-) Z6, /9z
Project Title Date
HVAC SYSTEMS
Note: Input hydronic or pombined hydronic.data under Water Heating systems, except Design Heating Load.
Distribution '
Heating Equipment Minimum Type and Duct or Heat Pump
Type (furnace, heat Efficiency Location , Piping Thermostat Configuration
pump, etc.) (AFUE/HSPF) (ducts/attic, etc.) R -Value Type (solit or packa0g)
Cooling Equipment Minimum Duct
Type (air conditioner, Efficiency Location Duct Thermostat Configuration • '
heat pump, evap. cooling) (SEER) (attic, etc.)- R -Value Type (solit or package)
Ex 15'(1 IJ 4
"WATER HEATING SYSTEMS
Energy External
Ratedl Tank Factor or Tank .
Water Heater Distribution Number. Input (kW Capacity Recovery Standbys Insulation
Type Type in System -or Btu/hr) (gallons) Efficiency Loss (%) R -Value
E2S I S:J ItJ�_
1. For small gas storage (rated input:5 75.000 Btu/hr), electric resistance and heat pump water heaters, list Energy Fac:or.
For large gas storage water heaters (rated input a 75.000 Btu/hr), 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 lists the building features and performance specifications needed to comply with Title 24, Parts 1 and 6. of
the California Code of Regulations, and the administrative regulations to implement them. This certificate has been signed by. the
s individual with overall design responsibility. When this certificate of compliance is submitted for a single building plan to be built-in r�ujple
orientations, any shading feature that is varied is indicated in the Special Features/Remarks section.
L
Designer
LL
Name: f
Tide/Firm:
Address: c
F
Telephone:
Lic, a:
(signature)
r Owner (per Business & Professions Code)
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467 A O
19 3 44 -G 32
-4 G -i 12 5 6
Documentation Author
Name: L/0-1. .L
Tide/Finn: KPOW0 P16CN b ;'5Ie
Address: P O -f3o x 176 1'
.(date) (signature)
Enforcement Agency
Name:
Tide:
Agency:
Telephone:
(signature/stamp) (date)
Compliance Forma
IM 777-
. g72S :3
January 1, 1995
(date)
Mandatory Measures Checklist: Residential MF -1 R
NOTE: Lowrise residential buildings subject to the Standards must contain these measures regardless of the c.-m.pliance
approach used. Items marked with an asterisk (') may be superseded by more stringent compliance recuirements
listed on the Certificate of Compliance. When this checklist is incorporated into the permit documents, tFe features
noted shall be`considered by all parties as binding minimum component performance specifications for t;.e
mandatory measures whether they are shown elsewhere in the documents or on this checklist only.
DESCRIPTION
Building. Envelope Measures
* §I50(a): Minimum R-19 ceiling insulation.
§150(b): Loose fill insulation manufacturer's labeled R -Value.
* §I50(c): Minimum R-13 wall insulation in framed wills (does not apply to exterior mass walls).
* §I50(d): Minimum R-13 raised floor insulation in framed Lars; minimum R-8 in concrete raised floors.
§150(1): Slab edge insulation - water absorption rte no greater than 0.3%, water vapor transmission rate no
greater than 2.0 perm/inch.
,§118: Insulation specified or installed meets California Energy Commission quality standards.
Indicate type and form.
§116.17: Fenestration Products, Exterior Doors and Infiilr:onlEAltration Controls
. a. Doors and windows between conditioned and uncone- oned spaces designed to limit air leakage.
b. Manufactured fenestration products have label with certified U -value, and infiltration certification.
c. Exterior doors and -windows weatherstripped; all joints and penetrations caulked and sealed.
§150(g): Vapor barriers mandatory in Climate Zones 14 and 16 only.
§I 50(f): Special infiltration barrier installed to comply with §151 meets Commission quality standards.
§150(e): Installation of Fireplaces, Decorative Gas Appliances and Gas Logs
1. Masonry and factory -built fireplaces have:
a. Closeable metal or glass door
b. Outside air intake with damper and control
c. Flue damper and control
2. No continuous burning gas pilots allowed.
Space Conditioning, Water Heating and Plumbing System Measures
§110.13: HVAC equipment, water heaters, showerheads and faucets certified by the Commission.
§150(i): Setback thermostat on all applicable heating sys;ers.
§1500): Pipe and Tank Insulation
.1. Indirect hot water tanks (e.g., unfired storage tanks u backup solar hot water tanks) have insulation
blanket (R-12 or greater) or combined interiorlexteria ;rsulation (R-16 or greater).
2. First 5 feet of pipes closest to water heater tank, ncn-recirculating systems, insulated (R-4 or greater).
3. All buried or exposed piping insulated in recirmla''r's sections of hot water system.
4. Cooling system piping below 55°F insulated.
5. Piping insulated between heating source and indite:; `ct water tank.
* §150(m): Ducts and Fans
1. Ducts constructed, installed and sealed to comply widh. UMC Sections 1002 and 11004; ducts insulated
to a minimum installed value of R-4.2 or ducts enc!csx' entirely within conditioned space.
2. Exhaust fan systems have backdraft or automatic dampers
3. Gravity ventilating systems serving conditioned space have either automatic or readily accessible,
manually operated dampers..
§114: Pool and Spa Healing Systems and Equipment
1. System is certified with 78% thermal efficiency, en-ce. switch, weatherproof operating instructions,
no electric resistance beating and no pilot light
2. System is installed with:
a. At least 36' pipe between filter and heater for future solar heating.
b. Cover for outdoor pools or ouidocr spa.
3. Pool system has directional inlets and a circulation our„p time switch.
§115: Gas-fired central furnace, pool heater, spa healer or f'eusehold cooking appliance have no
continuously burins pilot light. (Exception: Non-e!ectrical cooking appliance with pilot < 150 Etu/hr.)
Lighting Measures
§I50(k): 40 lumenstwatt or greater for general lighting in kittens and rooms with water closets; and
recessed ceiling fixtures IC (insulation cover) approved:
Compliance Forms
DESIGNER I ENFORCEMENT
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