9604-156 (AR)LICENSED CONTRACTOR DECLARATION
CD 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
cV W Professionals Code; and my License is in full force and effect.
p Q co License # Lic. Class Exp. Date
;u31PA
W
Z ti /te Signature of Contractor
T O
H OWNER -BUILDER DECLARATION
HWl hereby affirm under penalty of perjury thabl am exempt -from the Contractor's
to License Law for the following reason:
Z ( ) 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).
co () I am exempt under. Section , B&RC. for this reason
ul
N Date Signature of Owner
O N -
00
d Q WORKER'S COMPENSATION DECLARATION
p a I hereby affirm under penalty of perjury one of the following declarations'
r <F—:" p O 1 have and will maintain a certificate of consent to self -insure for workers'
X W 9: compensation, as providedfor by Section 3700 of the Labor Code, for, the
O J Q
performance of the work for Which this permit is issued.
Cal Q 0 ( Y 1 -have and will maintain workers' compensation insurance, as required by
Q 0 Section 3700 of the Labor Code, for the performance of the work -for which this
li rn H .i> permit. isst1�l3: ll�ty`IVI&kers' compensation insurance cdM4— 1801%licy no. are:
1T Z Carrier Policy No.
00:
n 0
g (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
3 subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
D Applicant
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 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-aboveInformation is-
• correct: I agree to comply th;a�hCity; an"}slaws relating to the building
construction, and hereby a epresentatives o9his City to enter upon
the above mentioned�nro _� ni oection purposes(
Oignature (Owner/Agent) Date
BUILDING, PERMIT PERM'T# coNTR°`#
�944SO 3233
DATE 4129196 VALUATION $3,7:39.00 . LOT- TRACT
JOB ITE
ADDRESS 47-704) ELSENHO"R DR
OWNER -
CONTRACTOR'/ DESIGNER / ENGINEER
,f1 o-lAIY D.P0WELL
KrN S'f.IN11t•11 11
<ir7W EISENI-1 WEkDR•
42-34 Wxlwlil�l�;1'c��! �+i' 1'ii. F xi3ii4
LA Cjl.l N A ("A ' 922:3
PALM I)1:IWC CA 92260
(6t1.)j772-W46 CTILlt 23'11
USE OF PERMIT
A1ll�l': `(0N,
D K11fR00Pv1.ADDI`I`ION
F,ST IATED G'0NT OF C'Oj'aS7'R UC'7'ION
3,139.00
t'L/1�3C11k?C1:1�'t31% flli•df(}0-�;cl.^t;}� $,4i1.S►5
(X-N1SFRgJCrT0N Fa . 101-000-411:1-000
viE:CHA NI[CAL F iX 101-000-1421-000 13.061
ELECTRICAL PCE 10.1.016-420-000 Si 1 i, 68 '
i LUNIMING FER 101-•000-4 t'1 xtt) 1C 3:1>Qi
slip,.,I lyr,,-s .f, Cos i" UC ITON AND PL AN CHECK
-°S' 169.1:3
LFSS 1PK13-PAID I EL -S
$10.0ZAI1)
fDTAar 5'.�1:'d�.Mff 14I, 9 DUEtv4iVtt
$169.13
A P R 1996
SIJ
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR-
NSPECTOR_BUILDING
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air Y.
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
/ 9
Drywall - Int. Lath
S
Final
Final
POOLS - SPAS
BLOCKWALL
APPROV LS
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
/
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Slrovver' Pans
/,� (�
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas; Piping
Gas Test
Appliances
Final
COMMENTS:
a
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)
Tit4t444"
P.O. BOX 1504 APPLICATION ONLY
Building7&105 CALLE ESTADO
Address q7- �Ov LA OUINTA, CALIFORNIA 92253
Owner
A i ! v. LV..._BUILDING: TYPE CONST. OCC. GRP.
Mailing
Addres �� r✓ A.P. Number
City L - Zip Tel.
Legal Description
jContfaiptor Project Description
Address
'?7%O '
A' �
Zip Tel. -7- L O O (46
State Lic. City
& Classif. cJ 3 ILic.# 2 S e L Stories No.UniDw.
Arch., Engr.,
Designer y(,/ l New ❑ Adox., Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #
CONTRACTO 'S DECLARATION
I hereby of I 11 s under provisl a commencing with on
7000) of Div 3 of B al and Prof e, and my license is In full force nd
effect. 10
NA DATE
OWNER -BUILDER DECLARATION Estimated Valuation
reason: (�Sec.affirm that I am 7o31 5,8uslness and pt from.the Profesalons code:Anycity�or�county for
fiequiresna 37
permit to construct, after, improve, demolish, or repair any structure, prior to Ma' Issuance also
requires the applkan_I rot such permit to Bre a a�ned statement that he d licensed pursuant to PERMIT AMOUNT
the provisions o! the' Contractor's Lkense Law, Chapter �9 (co :a
kivfh Saotbn 7000) of
pulsion 3 of the Busliieas and permit to Code. or Mat. he ia� exempt therefrom, and the beats
br the aueped exemptbn. Any violation or Section
subjects me apprk:artrto a tZ09t.s Dy "any applicant for a permB Plan Chk. Dep.
civp_w'yofnorro
(95.01. plan Chk. Bal.
F�' I, as owner of, the property, or mq_employees with wages as their sole compensation, will
do the work, and the structure is not intended or offered for sale. (Sec. 7011, Buisness and Const.
Professions Code: The Contractor's License Law does not appy to an owner of property who
builds or improves thereon and who does- such work himself or through his own employees, Mech.
provided that such improvements are not intended or offered for safe. 1, however• the building
of improvement is sold within one year of completion; The owner -builder w� have the burden Electrical
of proving that he. did not build or improve for the purpose of sale.)
1, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing 33-00
siruct the project. (Sec. '7011. Business and Professions Code: The Contractors License Lew
does not apply to an owner or property who builds or improves (hereon, and who contracts for S.M.I.
such: projects with a'•contractor(s) licensed pursuant to the Contractors License Law.) Grading
I. am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date Owner Infrastructure
WORKERS' COMPENSATION DECLARATION
1 hereby affirm that I have a certificate of consent to self -insure, of a certificate of
Workers. Compensation Insurance, ora certified copy thereof. (Sec. 9800, Labor: Code.)
Policy No. Company
FI Copy is filed with the city. O Certified copy is hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION,FROM
WORKERS' COMPENSATION, INSURANCE
(This section need not be comp/efed If the permit is for one hundred donars (S100) valuation
or less.)
I certify that in the performance of thq work for which this permitys issued, I shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Caws otCaldornia.
Date -'Owner
NOTICETO APPLICANT: ff. 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 provistons.or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. ?Sec. 3097,.C1v# Code.)
Lenders Name
Lenders Address
This is a building• permit when properly filled out, signed and validated, and is subject to -
expiration it work thereunderis 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
Signature of applicant Date
Mailing Address
City, state, Zip
REMARKS
ZONE: BY:
Minimum'Setback Distances:
Front Setbackfrom Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
4w
C�v�n�M2,�.-
goo LA to
1
DATE
T
AND ALL APPLIQA.
BY
-Ivo Q 5ou 1+-uw �-
P(+Lc-r_ -Copy
Ale
[Cmm-xyt Nc-A-bp,-
ttL Cul
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,;Ivc-C,O
a
rAo
All
ru
74
41 - 700 E=s c -A -i k-\weo,
Z)u
Orrisu
0, -A
4efi
N)otre.: ';?coui Ae. Mec�ckpj , c. r\ I,- Y-\ A C -V
ct') OL\\
0-cl ql,e-jles
t ko be-
Fo�-*-J(,5 +o
To
Lp
7'
4'
y�-7DO E-*\sevi
Cl--l;--tr-w, -
-
n/ortk
g%,c,!' O
Tb mA4c h Co\o-¢..
0
Jfica'te of ComMiatlt:w: Residential
(Pane t Or 22) CF -1 R
oiect Title - Date
o 4!7- 7CO E 18e� 6-4erz
lect Address Building,Permit o
Plan Check/ Date
3cumentstion Author Telephone
Field Check / Date
ampliance Method (,Package. Point System or Computer) climate Zone cnforcoment,Agency use Only
3EN,19RAL INFORMATION
-otal Conditioned Floor Area: ftz
'uilding Type: Single Family 1, ---Addition
.heck one or morel Multi -Family Existing -Plus -Addition
=ront Orientation: North / East / South / West / All Orientations
(input onentanon in degrees and circle one.)
\lumber of Dwelling; Units:
:loor Construction Type: Slab / Raised Floor (circle one or both)
3UILDING SHELL INSULATION
Construction
3omponent - Insulation Assembly LocatiorVComments
rype R -Value U -Value (attic, to garage. typical. etc.)
Wall .............. (Z--13
Wall ......... .
Root ....... ...p
Roof .............
Floor ............. .
Floor .............
Slab Edge ....
_ Pic -,AL
FENESTRATION Shading Devices
Fenestration Area
Orientation (sf)
Fenestration
U -Value
Interior Exterior Overhang Framing Type
(roller blind. etc.) (shadescreen, etc.) lyes/nol (metal/,woodNin 1)
Front..... (d) -9-
Front ..... (' )
Left....... (►til)_
Lett....... ( )
Rear ..... (5) 3
.-75
Rear ..... ( )
Right..... ( E )
Right..... ( )
Skylight .......
Skylight .
THERMAL MASS
Type/Covering
Area
Thickness
(slab/exposed. tile, etc.)
(sf)
(inches) Location/Description (kitchen, bath, etc.)
ReWoW January 1902
Certificate of Compliance: Residential (Page 2 of 2) CF -1 R
Project tilt.
External
V_
Tank
Capacity Recovery Standbys'
Insulation
(gallons) Efficiency Loss (%)
R -Value
Date
HVAC SYSTEMS
Note: Input hydronic or competed hydmnic data under Water Heatuig Systems, eYoept 0esgn Heating Load.
Heating Equipment
Minimum
Distribution
Type and
Duct or
- -
Type (furnace. heat
Efficiency
Location
Piping
Thermos tat
pump: etc.)
.(AFUEIHSPF)
(ductsiattic etc)
R Va ue
—Type
Cooling Equipment
Minimum
Duct
Type (air conditioner,
heat
Efficiency
Location
Duct
Thermostat Configuration
pumo. evao. Cooling)
(SEER)
(attic etc 1
R -Value
Tvpe —(Split Or package)
WATER HEATING SYSTEMS
Water Heater Distribution
Rated'
Number Input (kW
in System or Btu/hrl
Energy'
External
Tank Factor or
Tank
Capacity Recovery Standbys'
Insulation
(gallons) Efficiency Loss (%)
R -Value
1. For small pas storage (rated input S 75,000 8
For large gas storage caster tu/hr), electric resistance and heat pump water heaters, list Energy Factor.
For Instantaneous gss water hheatereater Iratad rout 2 75.000 BtWhr), list Rated Input, Recovery Efficiency and Standby Loss.
s, list Rated Input and Recovery Efficiency.
SPECIAL FEATURES/REMARKS (Add extra sheets if necessary)
COMPLIANCE STATEMENT
This certificate of comp iance..lists the building features and performance specitications needed to comply with Title 24, Parts 1 and S. of
the California Code of Regulations, and the administrative regulations to Implement.them. This certificate has been signed by the .
individual with overall design responsibility. When this certificate of compliance Is submitted for a single building plan to be built in multiple
orientations, any shading feature that Is vaned is Indicated in the Special FeaturestRemarks-seccon.
Designer or owner (per Business 6 Prote66lons Cade)
Name: ICs,,.) �eiwl vt�ue rC
Tide/Firm:
Address:
Telephone:
Lic: tt:
(signs e) (deal
Enforcement Agency
Name:
Tide:
Ages:
Telephone:
(sipnatutarstamp)
(date)
Documentation Author
Name:
Tide/Firm:
Address:
Telephoner
(signature)
(dab)
FAIRWAY VILLAS HOMEOWNERS ASSOCIATION
4/24/96
TO WHOM IT MAY CONCERN:
Jan Neuman who is the new owner of a Fairway Villas Condo located at 47-
700 Eisenhower has petitioned the Board for approval to build a bathroom onto the
present structure.
The added structure will be located on the east side of the condo and Will
extend six feet beyond the present wall for an extension of eight feet.
The addition will match the present finish and color.
The addition as drawn by contractor Ken Stemmer was approved by each
member of the Board of Directors of the Fairway Villas Homeowners Association.
erry Go er
President
cc: Board Members Hansen and Davis.
Triad Enterprises
Desert Sands Unified School District
Notice: 82-879 Highway 111
Indio, CA 92201
Document Cannot Be Duplicated. 619-775-3500
CERTIFICATE OF COMPLIANCE
Date 4/30/96 APN # 646-150-028
No. 14395 Jurisdiction La. Quinta
Owner Name, Ken Stemmer Permit#
No. 47700 Street Eisenhower Dr. Log #
City, La Quinta zip 92253 Study Area 122.
Tract # Lot # Square Footage 48
Type: of Development Residential Addition No. of Units 1
Comments (bathroom addition
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 48 or $ 0.00
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 N/A ; ' Telephone
Name on the check
By Dolores A. Ballesteros
Superintendent _
Fee collected /exempted by Pauline Pearson Exempt $0.00
Check No. N/A
Signature PQ,01.AJ0A4eq
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