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0305-260 (SFD)LICENSED CONTRACTOR DECLARATION YI 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 778280 Y � /�s�:�13 t 121; r Date r ►Signature of Contractor �� A� 'e 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 Sianature 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 17i:i'T 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 Section3700 of the Labor Code, I shall forthwith comply with those rovlslons. Date:plicani ..--f ✓� 3 ��` 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 appljcation 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, ` r ,Signature (Owner/Agent), Date'✓, 14 0 PERMIT # BUILDINi-PERMIT bfl DATE VALUATION LOT �- TRACT 4'.:°- ,r $1i.ti,7.8t5.� 10 1r37LK ih't} / � ..� JOB SITE _ W APN ADDRESS .4-44ir1.r'1.`i�11r.I�i�A M?��'%�..RA ! i���� OWNER CONTRACTOR / DESIGNER / ENGINEER COW DEVET-OMT-'t r UIGACY HONrEMS ' 2214 N .tWC3GUs"Vr*001) 4 )-7 50 .&DAMS S IRM 02273 SA I�1..P:�'�A CA L A QLJWTA CA. X22 �3 C/60)564-7820 CBL4 07063 USE OF PERMIT ONG.#L.E 1:''AMTLY IND L:%NO 1851 S.F. SF0 PERMIT DOES 140T I1 CI,UDE SL.00Y:. W.00A, POOL OR. DRIVEWAY APPROACH I TRACTCONSTRUCTION d,85i.G© S.% r �. 'P0RCWRAT'10 4+4.00 SF f 0ARAWCARPORT 469,40 3F R4MA490 COST 0.41 CO�"TCTION .1101 36,u0 pER�pVIr}AW�VMpK{d CONSTRUC TION 'NT1i 1.01-000418.000 $678.0 I PLAN CHECKFEE '101-000-43-9-318 $561.19 ITER DEPOSIT 101.000-439--318 -8250.00 a 1VPCHAf TICAL IVE 1 Gi -Q00-421-000 $59.00 ; ELECTRIC.4LdTX 1(i7-000-420.000 $122167 J PLUMBING M- E 101-000-419-000 ST'RO1,ft'1 MOVOW FEE • RI±,SID 101.000.241.000 $1,1.03 � ORADINCI P71F, $1'5.00 i DEV'Ei OPM i1yJPACT FEE 87,41:5.00 � � PRECISE PLAN 101-000-441-34.,x, $100.00 B-TCnAL C0NMUM` N AW)PIAN CHEM $4,07.89 LFZS PRE-PAID:1� 8S 4250.00 3 20U3TM.., ��'ERMT.'L S DUKNow 11;FINAANCE IaA .89 LA QUINTA DEPT. ; RECEIPT 33 DATE I /I �3 c'-3 BY D TE F ALE INSPECTOR J INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Ll V I Combustion Air Roof Deck . o $ Exhaust Fans O.K to Wrap r F.A.U. Framing Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wali Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath - Final Final BLOCKWALL A P OVALS 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 - 2 — 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 2 Appliances Final COMMENTS: 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) Building Address Owner. Mailing / Address 22l Zip T414t " P.O. BOX 1504 APPLICATION ONLY �� D �/�+ 78-495 CALLE TAMPICO '/ C rc4 LA QUINTA, CALIFORNIA 92253 o IZio ITel. LDING: TYPE'CONST. OCC. GRP. A.P. Number_ t �Z•(J�°3 rt l Description_ Project Description State Lid .City & Classif. 2� Lic. # Arch., Engr., Designer t:%/ � K� Address Tel. -r� CityI Zip I State Lic. # LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license Is in full force and effect. SIGNATURE DATE OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractors 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 thathe 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 ($500). I: I, as oner 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 or improvement 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.) I I I, as owner of the property, am exclusively contracting with licensed contractors to con- slrucl 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.) I'l I am exam t under Sec. B. & P.C. for this reason Date 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 fl Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) valuation or less.) I certify that in the performanc g work for w ' s per it is issued, I shall not employ pers in any marine to become b' to the orkers' Compensation Law lilor Date NOTI TO P I N I 11 r making this Certificate of E prion you should become subject to I e Workers' Compensation provisions of the L r Cotle, 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 ordinanc and state laws relating to building construction, and here aur orize repr tativ . f this city to enter the above. mentioned property f ns n purpo Signature of a1i01' aJ., Date - Mailing Address City, State, Zip Sq.I Size Zo No. No. Dw. Stories ( Units Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. 0 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 fro Side Setba P _ om rop Line�_, FINAL DATE tIVIINSPECTOR Issued by:— Validated by: Validation: WHITE = BUILDING DEPARTMENT YELLOW = APPLICANT PINK = FINANCE Date 6/23/03 No. 24607 Owner Cove Development Address 2214 N. Ridgewood City Santa Ana Zip CERTIFICATE OF COMPLIANCE Desert Sands Unified School District 47950 Dune Palms Road La Quinta, CA 92253 (760) 771-8515 APN # o BERMUDA DUNES r V] RANCHO MIRAGE INDIAN WELLS , i, PALM DESERT ,y , LA QUINTA V.?R INDIO .^ 774245022 Jurisdiction La Quinta Permit# 0305260 Tract # BLK290 Study Area Type Single Family Residence No. of Units 1 Lot # No. Street, S.F. Lot # No. Street S.F. Unit 1 10 54445 Avenida Herrera 1851 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 patiostwalkways, 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 1,851 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/C1st Bank - Sharon Bills Check No. 68148 Name on the check Telephone Funding Residential By Dr. Doris Wilson Superintendent Fee collected /exemd by Patricia Barbuzza $3,961.14 $o.00 r A Payment Recd Over/Under Signature i `944;�- 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 1�en/ RC DISTRICT - PLANNING REVIEW FORM 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 aspart of your correction list. Please attach additional explanations as necessary. APPLICANT: SITE ADDRESS: �T ' �7�� APN CASE NO.: LEGAL: LOT(_ BLOCK UNIT Z<. 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 O Planning Commission O City Council 1Wrr_0MMURibo riev, Dept Ir -A2, 0 Initials Case No.,<c 123 - st; With Conditions Other Requirements: 1 ? ✓... �i� i 7 !%('flfTi✓`` L C-L.(Il\ r! , ....earnljl �la�; / �NAtY' Illi IRii iiFK .i i/M �tiv...—..v -_.. _\✓—'_ ..`Z � �!.. �._._ a a—as■va■ ■ c.-. �-�- 1111E ie�i. his form shall be posted on the job with the Building Inspection Card at ali times iii a ions icucus '�i'ace. Only persons- a,"`,'.'?�r:r, t c:^ S ty iigt �; til, T �' r - 7 - it employe s are authorized to wo on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a s• -oppage of work and/or the voidance0 of building permit. For each applicable trade, all information requested below. must be completed by applicant. "On File" is not an acceptable respc ,nse. Trade / Classification I Contracior State Contractor's License Workers Compensation Insurance gyp- Date (xxlxxlxx) Ci Business License Company Name Classification (e.g. A, B, C-81 I License Number (xxxxxx) Exp. Date (xx/zxlxxl Carriar 14:a.:,g (e.g. State Fund, Ca(Cornlri Policy Number (Fcr,:iat ba^es) License Number. txxxx) Exp. Date Ixx/xx/xx) I EARTHWORK (C-12) �� hL/l: -A^d ` (Q� ` -zft CONCRETE (C-8) j j FRAMING lC STRU CT. STEEL (C-51) MASONRY (C-29) , �J:�l "o� -G �Zf'�; �® - fid- 0 &,C)0.1 Gtr ti i `aY b � PLUMBING (C-36) �j`t' J/ f �/ / IMT 1 !'� t4ki- Gfr/,�.G� ('moi.-%t►'�. a r-ST3ra'Lt! �r 3 Iii /.� a •r -.� �' LATH, PLASTER (C-35) D3 a DRYWALL (C-9) i `i1f.l i (� 'Q 4 !-�LCU%C--S �i HVAC(C-20) fNif, w C- �V ") y3 �i'3/.+1 5N� �s i�`7 TIG7 QZ 0 �d��Q'Q J © ELECTRICAL (C-10) , ` is i' r (;'- /d �( 7� 8 %' � :ROQFING IC-39):- ET- METAL IC -43). FLOORING 1C-15)� :W'e_ - t GLAZING (C=17) . INSULATION. (C-2) �SCHMW GG1 C K U t Z C -Ly 0 SEINAGF DISP. 1 C-42) PAiNTiNG (► -33) .. . ,� tt- ^i'ni � '�- "1'7 k � _ 1v� ► -S .off ' 0 CERAMIC TILE (0-54) 1 i l !! i ' ( ( CABINETS IC -6) F1=NCIRIG IC-�.3) 1 l ■ LANPSCAPING (C-27 POOL (C-63) 11 11 t i i Y-1 i 2 1A 40SIaddem Enr, inuring ?Emg 6782 Stanto i Ave., Suite A, Buena Park, CA 90621 (714) 523-0952 Fax (714) 523-1369 39-725 GarE�nd Ln., Suite G, Palm Desert, CA 92211 (760) 772-3893 Fax (760) 772-3895 Date11 0 Job No. �%-L- - FIELD MEMO Project Name Client: Site Address 5 ' —14q �A-v e g. 2r414-r"OL Job Phone Work Done –� �" � a � IL-Ql�^'\ ��'�l C •�.t.t7✓� Q+•f n � /l.�N- 7 G�/� 5�"� Test Summary / Foc tangs Inspected Test No. Location �%� Elev. Dry Density Moist % % Relative Compaction Ref. Max pcf Moist % ---- - �, Zv.�� 7• i9 /2-2- 59 - .a J Comments iefd Tech. Super. or Agent 24 hour notice requested to schedule Field Technician. Thank you for the opportunity to be of service. T"Cl S613E ZLL 09L 4jasep wTed uappeTs e0E:B0 60 92 ZnC NOV-11-2003 07:18 AM ProjeccctTltl��e, /illi Ire %f/iYYe Plan Number Sample Group Number P.03 Cr, 4R Sample House Number ifymg Signature Firm;G. d- SDG HERS Provider: Street AoCress: 7 ,tura OV I City/State/Zlp; Zu tY�itd Copes to: Builder, HERS Provider HERS RATER C MPLIANCE ST TE T 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 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) 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 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 / r� Leakage Percentage (100 x Test Leakage/Fan Flow) = 7; / 7 /- Check Box for Pass or Fail (Pass=6% or less) Fs Fail 13 '. iTHERMOSTATIC EXPANSION VALVE (TXV) or Commission approved equivalent 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 0 Yes ❑ No ACCA Manual D Design requirements have been met (rater has verified that actual Installation matches values in CF -1R and design on plan. 2. 0 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 = Yes for both 1 and 2 is a Pass Pass Fail A/M Q ❑ Pass Fail OCT -28-2004 09:58 AM Firm: sre, d• SsDGi�e� Slreel Address; 44DY,r Lr G6w Copies lo: Builder, HERS Provider HI—RS _RATER COMPLIANCE STATEMENT P.02 Bullder,'Name ` Plan Number Sample Group Number Sample House Number HERS Provider; X, r5$50 -6A %7: Cityl,State/zip: CA U&0 The house was: Tested d Approved as part of sample testing, but was not tested - � As the HERS rater providin diagnostic testing and field verification, i certify that the houses identified on this form comply with the diagnostic ested compliance requirements as checked on this form, ' Distribution system is fully ducted (i.e., does not use building cavitles'es plenums or platform returns -in lieu of ducts) Where cloth backed, rubber adhesive duct tape Is Installed, mastic and drowbanda 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%'Duc;t Leakage) y Measured Duct Pressurization Test Results (CFM @ 25 Pa) values A r Test Leakage Flow In CFM -T�I If fan flow Is calculated as 400cfrnAon x number of tons enter calculated value here c,77V If fan flow is measured enter measured value here r Leakage Percentage (100 x Test LeakagelFan Flow) = 7AP ,►, Check Box for Pass or Fall (Pas; =6% or less) , Q Pass Fail Z! THERMOSTATIC EXPANSION VALVE (TXV) or Commission approved equivalent .tel Yes C) No Thermostatic Expansion Valve (or Commission approved 7 equivalent) Is installed and Access is. provided for inspection ` ❑ Yes is a pass Pass Fall ❑ MINIMUM REQUIREMENTS FOR DUCT DES113N COMPLIANCE CREDIT 1. Cl Yes ❑ No ACCA Manual 0 0eslgn requirements have been.met (rater has verified that actual Installation matches values In CF•1R and design on plan 2. C7 Yes ❑ No TXV is installed or Fan flow has been verified, If no TXV, verifled fan flow matches design from CF -1 R. _ Measured Fan Flow ❑ ❑ ' Yes for both 1 and '2 is a Pass Pass Fait i �0j Certificate of Occupancy .� G OF'f19 Building & Safety Department v k This Certificate is issued pursuant to the requirements of Section 109 of the California Building I Code, certifying that, at the time of issuance, this structure was in compliance with the Y� 9 p provisions of the Building Code and the various ordinances of the City regulating building construction and/or use. =z BUILDING ADDRESS: 54-445 AVENIDA HERRERA Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0305-260 4 i h Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RC 4 ' Owner of Building: COVE DEVELOPMENT Address: 2214 N. RIDGEWOOD� . C o A 4 City, ST, ZIP: SANTA ANA, CA „ r By: STEVE TRAXEL ' & Date: December 2, 2003 x Building Official ' POST IN A CONSPICUOUS PLACE ` _