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0304-054 (SFD)U) � , tv w O :) M d u7 ' W �it� oZr` co0o' wwc�o �a U) Z L0 N ON 0 °) as T Q 0 XW �L- m U U O o_ LO .0) Z co 5 �O Q J R1 LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty bf perjury that I arri 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 773280 B Date -� Signature of ConfractZd 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 tlie 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 R'X1?PIPT Policy No. (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,th'ose,,"provisions. r ' jDate. rZ/;i Applicant~'•g' • ' r�� - ,1 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, 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 vpid-if e 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 cancellfiori� .I I certify that I have read this application and state that the above informa I correct. I agree to comply with all City, and State laws relating to the b I in construction, and hereby authorize representatives of this City to enter up tlYe above-mentioned property for)'inspection purposes. Signature (Owner/Agent P//%�Hv .��i° Date PERMIT # r BUILDING PERMIT - _,� DATE . i VALUATION q y }a •-e LOT TRACT JOB SITE ADDRESS 54- 4255 ANHA�Mi . P,f-'0.+s�R• IZA. OWNER CONTRACTOR /DESIGNER / EN (NEER 2214.1? Y37EM00D P.Q. DO '. F 6 SANITA ANAL CA l.ls ()"(PSTA CA 92253 (7 015@i�d=Pt'2;9 'am* t 2o.''s"i USE OF PERMIT 1951 &;, 31111% PERMI1' lPFS t)1DCAd-1 4 - (lIVE SAYpPyIV{HI. 1040R:;HIPATIO IKLY>k 15lt' 469,00 sV,. ' k :1�9 �t?:17M' F7+"t}f.tTviCTC�7 vCr'+SS'1'RUCTION FEE 101 <00411 8-00 FEE DEPOSIT 191.00.4 39-'2418 42W -10 ivli l a;PlNli`�h I P. �� �ifi�^�.Z t _000`.Ilfa 1 L<�`•C"i'bllt"dsi.1 FE, M � .. ,`3 kii<1litC► 1;4 t ..�i P'1°rJla3'S.(:+rt� d�E 1fi"-tir?t�-�•1'.t)00 STRONG MOTION FEZ, R92"M 111.1-0100441.060 911.2 . £4P.�s1�Ci? f3 PSE 1014)00-423 -WO $15.00 1:�;�,'�J�•F..rJ1'�f.Y, iA,��`�:�`i' .F7�T< � $2',,,r>f�,t7� PPIE•+. )SR•:PLAId4itl.,00 :t-4� 1. 34.5 �S�3Zr. tia Si M-TO7'A,1("XIMTRl ..)'G:Ttox r w PLAM cm,EcK 5�4,G�5.1f3 l:2121115.3 MIT.s 4115( -00 M1.Y. CUAL 11J31J1U 3!T E.S DUE J.'",O S0,839A0 j 4PR 1 2003 rRECEIRTE QUINTA AT A u BY DATE FIN EO INSPEC OR 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.IC to Wrap 0 F.A.U. Framing Compressor Insulation — 65 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 BLOCKWALL APPROVALS Steel POOLS - SPAS Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Pibg. 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 - Q O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test 6 Appliances :. Final Final D3 UU14 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: Building Willi/ fd' .114J AVoI&PAJ (,1 I P.O. BOX 1504 /1 V g � 78 495 CALLE TAMPICO �/ ( "l LA QUINTA, CALIFORNIA 92253 Owner (6W Mailing ' Address�„a(l t APPLICATION ONLY ` BUILDING: TYPE`'COONST. OCC.GRP. A.P. Number //� Tel. )I1T "/ /e X�/� 190 (� 'i�(/S 36Co Legal Description ­yi 7yCity Zip Tel. ci l State Lic.City & Classif.12 if zv Lic. # Arch., Engr., Designer Address Tel. City IZip I State I Lic. # `.1 LICENSED CONTRACTOR'S DECLARATION I hereby affirmAhat Iagvficensed under proyf'scmnss of Chapter 9 (commencing with Section 7000) of Divisid 3 of-�lhe Business an Pro. �ysjon�s'Co(de, and my license is in full force and effect. % ����.-� SIGNATURE I'” 'r DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5.Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its Issuance also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500). 1 ' 1, 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, Buisness and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building orimprovement is sold within one year of completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale.) 1 1 1, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) 11 1 am exempt under Sec. B. 81P . for this reason Date wn WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company f 1 Copy is filed with the city. 177 Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed it the permit is for one hundred dollars ($100) valuation or less.) I certify that in the performance of thg 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. Date Owner NOTICE TO APPLICANT: It. after making this Certificate of Exemption you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY Ihereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Lender's Name Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby -authorize representatives of this city to enter the above- mentioned property for inspection purposes. ,✓�'- I Signature of applicant ��,!� •.. Date Mailing Address City, State, Zip Project Description Sq. Ft. �/ �I No. No. Dw. Size Y �iP Stories Units New fV Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INS-C1,TOR A . I I Issued by: Date �Permit Validated by: MAR I 2C1131 Validation: WHITE = BUILDING DEPARTMENT YELLOW = APPLICANT PINK = FINANCE 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: 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 1,851 S.F. or $3,961.14 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 C/C 1st Bank/ Sharon Bills - Check No. 67624 Name on the check Telephone Funding Residential By Dr. Doris Wilson Superintendent Fee collected /exed by Patricia Barbuzza $3,961.14 $0.00 71Payment Recd Over/Under Signature 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 RC DISTRICT - PLANNING REVIEW FORM (fo� This form is to be used by CDD staff for review of single family dwellings in the RC (Cove Residential) District per Section 9.50.090 of the Zoning Code. Its purpose is to determine: 1) that the, proposed housing design does not duplicate the same architectural style of any house within 200 feet of the applicant, and/or 2) if. there is a need for the applicant to file for Master Design Guidelines. If the applicant does need to file a Master Design Guideline, please transmit this information to the Building and Safety Department as part of your correction list. Please attach additional explanations as necessary. APPLICANT: 4,9 r7 .SITE ADDRESS: APN J - S� - Qd—/ CASE NO.: y1 LEGAL: LOT BLOCK UNIT. S.C.@V.L.Q. CHECK AND APPROVED BY: DATE: Inform the assigned Building plan checker -upon your assignment to this case. The CDD Executive Secretary maintains a log book to track applications and assign case numbers. REQUIRED ITEM Y N COMMENT/CORRECTION Verify legal and APN information Consistent with MDG on file (as applicable) MDG filing required (5 filings since 9/3/98) Architectural variety within 200 feet of the surrounding area: Architectural design features Q roved b : e fanning Commisslon ..-----► -�--"" p ity Council ----w- " ommunity Dev. Dept. ------ Ca Ex a No. --"---r"" ibit Other Requirements: ------ 5 y- 7 cw vAffie-yp CITY OF LA QUINTA SUB -CONTRACTOR LIST JOB ADDRESS �� r'J PERMIT NUMBER OWNER This form shall be posted on the job with the Building Inspection Card at all times in a conspicuous place. Only on this job. Any changes to this list must be approved by the Building Division prior to commencement of work of building permit. For each applicable trade, all information requested below must be completed by applicant. persons appearing on this Failure to comply will re: BUILDER Q list or their employes are authorized to wor .ilt in a stoppage of work and/or the voidanceO,9ro) "On File" is not an acceptable response. it Trade / Classification Contractor State Contractor's License Workers Compensation Insurance City Business License Company Name Classification (e.g. A, B, C-8) License Number (xxxxxx) Exp. Date (xxx/xx/xx) Carrier Name (e.g. State Fund, CalComp) Policy Number (Format Varies) Exp. Date (xx/xx/xx) License Number (xxxx) Exp. Date Ixx/xx/xx) EARTHWORK (C-12) 0A PU5 iY hAlv ! L. 1 ov/o - (fzr ) 1-6 (.P_34(6 i '• 'O CONCRETE (C-8) FRAMING (C-5) �+ ��- �P-T . 01 L�.3 5 `63 . STRUCT. STEEL (C-51) MASONRY (C-29) 12u b PLUMBING (C-36) L.La 9k) i�: f 5 G- 3 Lc tel.. Y -Jr'1"& p!. No. ��t� 3'J- 1• �� LATH, PLASTER (C-35) WC2002-6Sa (. -?-1 -03 DRYWALL (C-9) �t `i �. tD 0 HVAC (C -20)4.A- (jlj- q 5:3/ Iy S 'P" AU �� 7��7 02- ZELECTRICAL ELECTRICAL(C -10)r.- Vi 7d S /0 03 ROOFING IC -39) SHEET METAL (C-43) FLOORING (C-15) Z1:6A_r_L/.rte -8 cJ S Nb '(c� 4ez!!P _. .._"._ -....�...."_-_ .. ® 2- GLAZING GLAZING (C-17) INSULATION (C-2) G Ix I'D Gam' f-' w 6/_:-a5'63 ri SEWAGE DISP. (C-42) Do 2s-? 6 -L' PAINTING (C-33) CERAMIC TILE (C-54) 11 1 ( 11 (( I CABINETS (C-6) FENCING (C-13) I I 1' t I LANDSCAPING (C-27) POOL (C-53) 0 d u -IN' VP Ins 0- OCT -02-2003 01:52 PM Imo.02 CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING CF -4R Project Title Pro�le %t �ddress Sull�me / C- i2— Builder Cont ct Tele hone . Plan Numler HERS Rater Telephone SImpie Gi yup Number /�- y d C ifying Signature �T'."_ Sample House Number Firm:STC. saGi rr�� HERS Provider; J.G,/��o�_i..� Street Address: 7,&110 �O>'d:FOKI l Clty/State/zip: ZN • Copie; to: Builder, HERS Provider HERS RATER COMPLIANCE STATEMENT The house was: 4 Tested ❑ Approved as part of sample testing, but was; not lestec, As the HERS rater providing diagnostic testing and field verification, I certify that the houses identified on this (arrn co?y with the diagnostic tested compliance requirements as checked on this form. Distribution system is fully ducted (i,e., does not use building cavities as plen0118 or platform return,; in lieu et ducts) Where cloth backed, rubber adhesive duct tape is installed, mastic and drawbands are ui;ed in combination with cloth backed, rubber adhesive duct tape to seal leaks at duct connections. ❑ MINIMUM REQUIREMENTS FOR DUCT L,EAKA13E REDUCTION COMPLIANCE CREDIT Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage) Measured Duct Pressurization Test Results (CFM 25 Pe) values Test leakage Flow in CFM 1:/n If fan flow is calculated as 400cfm/ton x number of tons enter t f calculated value here. L� If fan flow is measured enter measured value here Leakage Percentage (100 x Test Leakage/Fan t=1ow) Check Box for Pass or Fail (Pass=6% or less) �] Pass Fail THERMOSTATIC EXPANSION VALVE (TXV) or Commission approved equivalent Zill"Yes ❑ No Thermostatic Expansion Valve (or Commission approved equivalent) is installed and Access is provided for Inspection Yes is a pass ❑ ass Faii MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT 1 0 Yes D No ACCA Manual D Design requirements have been met (rater has verified that actual installation matches valuEts In CF -1 R and design on plan. 2. O Yes O No TXV is Installed or Fan flow has been verified, If no TXV, ) /U� 4 verified fan flow matches design from CF -1 R. ° Measured Fan Flow = Yes for both 1 and 2 is a Pass G] 01 Fess Fai, Q Ioddc,Gn Engineering C � 6782 Stanton Ave., Suite A, Buena Park, CA 90621 (714) 523-0952 Fax (714) 523-1369 39-725 Garand Ln., Suite G, Palm Desert, CA 92211 (760) 772-3893 Fax (760) 772-3895 ' Date Job No. FIELD MEMO Project Name lG --�t� �" Client: L_'e. CA Site Address 5 y_1-1 0 rr °•-c' -d I' Job Phone " Work Done _ C7 �- Test Summary / Footings Inspected Test No. R_ — Location Elev. Dry Density Moist % % Relative Compaction Ref. Max pcf Moist % lr /Y — _�, I! 1 Comments 141, Fisld Tech. Super. or Agent r 24 hour notice reque [ted to schedule Field Technician. Thank you for the opportunity to be of service. "'T•' cl 568E ZLL 09L .4jesep"Wj ed uappe t s e02:80 60 61 Rew Certificate of Occupancy 4 IHoMIM,+s G OF - 9► y p Building & 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 and/or use. BUILDING ADDRESS: 54-425 AVENIDA HERRERA Use classification: SINGLE FAMILY DWELLING Building Permit No.:0304-054 Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RC Owner of Building: RANDY BILLS Address: 54-865 AVENIDA OBREGON City, ST, ZIP: LA QUINTA, CA 92253 By: DANIEL P. CRAWFORD Date: October 9, 2003 Building Official POST IN A CONSPICUOUS PLACE It�,