0401-339 (SFD)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
7'11134 b E31:. '� �,"�01,': lla(
/ �`
Date i 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 penaltyi 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:
Carver 'STATE FU1.4D Policy No. I tSJt"13"-03
(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, aril agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with thos*VY ovisions:-.---
Date: -•" 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 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 forinspection"purposes.
Signature (Owner/Agent) -^"" `� Date.
!f
BUILDING PERMIT PERMIT# _1 �^
1 t0 -�
DATE - tVALUATION LOT TRACT
JOB SITE
ADDRESS J� �e o�S aSEUM.X DRIVE
APN 774-16"2.0
OWNER
CONTRACTOR / DESIGNER / ENGINEER
POWER FINANCE
BRATJCK1vW4X WC
P,O. BOX 134
0-855,WQs -1f_1gC.1rMX Z"1'#2.27
1,A,QTM.A. CA 92253
U. QTT.di.i.rfi. CA 92.^x53
'
C160)485-9269 CBL # 23V
USE OF PERMIT
x+.14 Q yffLY I)VM LIY4C+
1419 S.F. SFPJ P91ZMTT.1DaM'X0T 1NCLUDIX. BLk)C"1° VTA.f..t, P00USPA
OR DRIV.IMINT4kV APPROACH
T.RAC T C010TRUCTION 1.o11I,QES
:i�f3RCHIPA.TTO 19.00..
4CITY
480,00L
QAR-40 �:.��.Rs3ORT 480,00 FEB 0
:200
OF i.'i IN ' iCFT.
E�'M%4_. Wff1D COIST 011' CONS � <. 01lT
��;�, .��►
CONSTRUCTION FEE 101,-000.418.000 $08130
PIA14 {:1`1E4"K FEE lOi-000-439-318 $57.1.21
YEE DEPOSIT 101-000-439.318 425101.00
1FsP, VI I.X01CAL F&I-Y 101.000-421-000 $66.50
ED1k,(.-MC AL ME 101-000-42t1-000 5125.31
Pd..11M111140 ME 101-000-419-000 $124.90
STR.OM MUM ,FRE - RESID in.] -000-241-00.0 x11.30
OR.AINNO .nZ 101-000-423-000 $15.042
ISL EVOPER OVAC T FEE 62,A65.0'4
PlIEC1SK PLAN 101-000-44-345 $100.00
.SUB-'TOTAT CONSUR`fXe'I R iN MD PLAN CHECK .
$4,106.82
LEM.5 PRE -PATO RETES
-$250.00
TOTAL PERM 3 IS DUE 1YOW
&3,f;56.-62
RECEIPT
DATE:^ - { �(
yBY
DAZVIN?
YV� l
INSPECT
c
RC 1, ZLk
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
—
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
VCombustion
Air
Roof Deck
- U— (]
Exhaust Fans
O.K. to Wrap
_
/
F.A.U.
Framing
-27
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
Final
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 APPRO ALS
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
- ; 0
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 G .
Final
Utility Notice (Perm) 2it'/`
COMMENTS:
Date
2/2/04
No.
25452
Owner
Power Finance
Address
PO Box 134
City
La Quinta Zip 92253
Tract #
Type
Single Family Residence
Lot #
Unit 1 9
Unit 2
Unit 3
Unit 4
Unit 5
Comments
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
47950 Dune Palms Road
La Quinta, CA 92253
(760) 771-8515
No. Street
53885 Eisenhower Drive
S.F.
1918.Unit 6
Unit 7
Unit 8
Unit 9
Unit 10
4���1Fi�scyo
z c� t1�UUrj„ o
Q BERMUDA DUNES r
RANCHO MIRAGE
INDIAN WELLS
PALM DESERT 7
LA QUINTA
�INDIO L�
O
APN #
774-165-020
Jurisdiction
La Quinta.
Permit#
0401-339
Study Area
No. of Units
1
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
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 1,918 S.F. or $4,104.52 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 -Mike Brauckmann Check No. 301850
Name on the check Telephone
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /e=Al�
McGilvrey Payment Recd $0.00.
$4,104.52 Over/Under
Signature
NOTICE: Pursuant to Government Code Section 66020(d)(1),.this will serve to notify you that the 90 -day approval period in which you may protest the fees or
other payment identified above will begin to run from the date on which the building or installation permit for this project is issued, or from the date on which
those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting
Certificate of Occu ancp Y
U ��IGI�IfI��
5
G� OF'Building & Safety Department
-This Certificate is issued pursuant to the requirements of Section 109 of the California Building
Code, certifying that, at the time of issuance, this structure was in compliance with the
provisions of the Building Code and the various ordinances of the City regulating building
construction and/or use.
BUILDING ADDRESS: 53-885 EISENHOER DRIVE
Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0402-010
Occupancy Group: R3 Type of Construction: VN Land Use Zone: RL
Owner of Building: POWER FINANCE Address: PO BOX 134
City, ST, ZIP: LA QUINTA CA 92253
By: KIRK KIRKLAND
Date: AUGUST 17, 2004
Building Official
POST IN A CONSPICUOUS PLACE
r
r .
UG -16-2004 10:57 AM
CATE OF
Project Agdress
A
ale
7/;-f/0
Builder Name
Plan Number
__J. Im
HERS.Rater Telephone Sample Group Number
P.01 /
fAi�'� 'x
•'I'y
CF -4R
nl ying Signature Date Sample House Number
Firm:.rcHERS Provider: �G •�%�SSdG/��S
City/State/Zip: Z N 4 /n� 0 '7Z � 3
Street Address: ?�i�' Q-�/4,�TDY�rC/1Y ��
Copies to: Builder, HERS Provider
H APER OMPLIANCE$IATEMF.Nl
The house was: Tested ❑ Approved as part of sample testing, but was not tested
As the HERS rater providingdiaggnostic testing and field verification, I certify that the houses identified on this form
com with the diagnostic ested compliance requirements as checked on this form.
V 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
4 with cloth backed, rubber adhesive duct tape to seal leaks at duct connections.
ZMINIMUM 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/lon x number of tons enter
calculated value here
If fan flow Is measured enter measured value here ��//
Leakage Percentage (100 x Test Leakage/Fan Flow) = /v
Check Box for Pass or Fall (Pass -a% or less) ❑
Pass Fail
THERMOSTATIC EXPANSION VALVE (TXV) or Commission approved equivalent
2 Yes ❑ No Thermostatic Expension Valve (or Commission approved
equivalent) is installed and Access Is provided for Inspection❑
Yes Is a pass ass Fail
❑ MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT
t . O Yes O No ACCA Manuel D Design requirements have been met
(rater has verified that actual installation matches values in
CF -1R and design on plan.
2. ❑ Yes O No TXV is Installed or Fan flow has been verified. If no TXV, k/
verified fan flow matches design from CF -1 R.
Measured Fan Flow =.
' O O
Yes for both 1 and 2 Is a Pass Pass Fail
Feb.13. 200411 9:27AM2 FRCONTEMPORARY TO 95686072 N0.4386 P.P. 23
• REPORT OF FIELD COMPACTION TESTS
arh RIpoRr NO.: cUBNft Roga
DATE.7z,1/6y -- PI1wwrs �•Tjt(« %1s._1., .��. I- n 1
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COMPACTION MOISTURE
REQURIEMENTS. % 'f REQUIREMEAITS.
GENERAL 4o"MN:
TEST READING
NO_
QUOTIENT/
PCF
SON.
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TEST
DEPTH• IN
ELEVAPON
OF TEST
MOISTURE
CONTENT.
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4 . WOBAZe 0 - MOWWPE IN MESS OF SPEC191CATIONS