0310-343 (SFD)F1
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 9 339 1Y3t' /' �►?'1 /ZC
/ Date //,�'%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 -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 STATE FUND Policy No. 1=185-03
(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, and agree) that if I should become
fr
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with thosseop�ovlsio
Date: r+' Applicant �� 01 -
Warning: Failure to secure Workers-•Comp'ensation 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 employ
2. Any permit issued as a result of this application becomes null and voi
work is not commenced within 180 days from date of issuance of s
permit, or cessation of work for 180 days will subject permit to cancellati
I certify that I have read this application and state that the above informatio -
correct. I agree to comply with all City, and State laws.relating to the buildi g
construction, and hereby authorize representatives of this City to enter up n
the above-mentioned property for Ifn pectlon-purposes.
Signature (Owner/Agent" )' - - Date �
z r
.-BUILDING PERMIT PERMIT 1t -
DATE s I —: VALb TION ' • -LOT 0 41 343 TRACT
JOB SITE
ADDRESS .r3.'� xli� ErSXTfH01V.z PIX
APN
774-171- M. 8
OWNER
CONTRACTOR/DESIGNER/EN INEER
? OWM FWANQE ASSOC
BP-AUCKMA1. 19C
P,t7. BOY, 134
PO BOX 5 ) 7
LA QUDITA CA. 92253
LJ, QiiWA: CA 42253
(750)409-5412 aBVA 230
USE OF PERMIT
1498 SF: SIrO PERMIT EX)ES1t0')I INCLL9.M BLOIrK.'yYfiL4 POOLAPrA OR
DRIV FWAY APPROACH
r
TRACT CO2 STRUCTION L4".00 ff-
P€?RCHIPA'TIO 50.00 51'
GARAGE(CAFtPORT 469,0+0 SF
- Etn TKD COST Off' CONS '£3's"Vn0 K
91,159.60
PZRMrf PEE, S1"TMt47ARY
CONSTRUCTION FEE 101.000-418-000 $603.50
;
PLATT CITMCK FEE 101-006-439-318 $503.31
FEE Ol+,i OBIT 101.000.439.318 42JO.00
MEC HANICA1, ISL 10'11-000-421-000 $59.00
Ei,1:.C'TI31CAL PHE 101-000-420-000 1110127
PLll2ER.Mlg0 FEE 101-000-X1151-000 V18.00,
i
STRONG MOTION FEE - itMID 101-000-.241.000 S9,12
O' itdO PE -Z 1 �,.fliii3-9^3-CJat1 $11.5.00
DEVELOPER IMPACT FEE $77,405.00
PUC IS9 PLAN 101.000-441-315 $1110.00
MM -TOTAL CONMUC11ON .fV.ND PLOW CIM, CK
$3,92,3.2"
x'`,35 F'R&y' AID FUS
-$250,00
TUrAL F -X rTt X1` FUS DV E 1YC81#4►.
&3;673.21.
NOV 10 2003 =
CITY C ::...`� _UINTA /
RECEIPT
DATE
�/- �,
BY ✓.`
�-
DATE FINALED
INSPECTPR
0
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Main Drain
Underground Ducts
Forms & Footings
Approval to Cover
Ducts
Slab Grade
Equipment Location
Return Air
Steel
Underground Electric
Combustion Air
Roof Deck
Underground Plbg. Test
Exhaust Fans
O.K. to Wrap
— - QG
F.A.U.
Framing
Gas Test
Electric Final
Compressor
Insulation
—
Vents
Fireplace P.L.
' Plumbing Final
Grills
Fireplace T.O.
Equipment Enclosure
Fans & Controls
Party Wall Insulation
O.K for Finish Plaster
Condensate Lines
Party Wall Firewall
Pool Cover
Sewer Connection
Exterior Lath
Encapsulation
Gas Piping
Drywall - Int. Lath
Gas Test
rinai
COMMENTS:
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
Temo. Use of Power
Final
Utility Notice
Final
Final 15o
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
APPROVALS
Gas Test
Electric Final
Waste Lines
/.p j 5-7
Heater Final
Water Piping
' Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
/,j. /.O
Encapsulation
Gas Piping
Gas Test
rinai
COMMENTS:
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
Temo. Use of Power
Final
Utility Notice
Date
11/10/03
No.
25182
Owner
Power Finance Assoc.
Address
P. O. Box 134
City
La Quinta Zip 92253
Tract #
Type
Single Family Residence
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
47950 Dune Palms Road
La Quinta, CA 92253
(760) 771-8515
APN #
Jurisdiction
Permit #
Study Area
No. of Units
4���ZF1EDsc�O
Q BERMUDA DUNES r
rn RANCHO MIRAGE (�
Nr INDIAN WELLS
PALM DESERT y
LA QUINTA
�INDIO
O
774-171-008
La Quinta
0310-343
1
Lot # No. Street S.F. Lot # No. Street S.F.
Unit 1 53-900 Eisenhower Dr. 1498 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 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 1,498 S.F. or $3,205.72 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-Valley Independent, Mike Brauckmann Check No. 297865
Name on the check Telephone
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exem ted by Patrici Barbuzza Payment Recd
$3,205.72 OverlUnder
Signature c�a _' �t,l;c�,oc_
NOTICE: Pursuant to Government Code Section 6602U(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 Disirict('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting
OCT. 9.2003 3=02PM
MCORDINa REMESTID BY:
First American Titre
ANAtAI MRr:CORDIM9lAtt_T0:
Poway Fh mco Anodatas. l:te. a COMMta
eorp "Na t
Order Nae 1199015
Egg" Noe NSA4"c
ARK: 774.711.007-2
N0.856 P. 1/2
S3.ggp 774-1-71- 007
GRANT DEED
THE UNDERSIGNED GRANTOR(S) DOC ARES)
DOCUMENTARY TRANSFER TAX IS $143.00
[ x ] computed on full value of propslty conveyed. or
[ ) computed on full value less value of Ileus or encumbrances remaining at time of sale.
[ j unincorporated area ( X ] City of La Quinta
POR'A VALUABLE CONSIDERATION, receipt of which is hereby admowledged,
Darrell Glenn Dwgranges
and Douglas Abbott Desgranges and Lucinda Deagranges, husband and wife
and Todd Michael Dwgpnges
hereby GRANT(S) to Power Finance Associates, Inc. a California corporation
the (oliowing descrlbed teal pmperry in the County of Riverside. Stage of California
Lot 17 and 18 of Block 247 of Santa Carmelite at Vale La Quinta Unit No. 23, in the City of
La Quints, County of Riverside, State of California, d6 per map recorded In Book 21k Palle(s)
25 of Miscellaneous Maps, in the office of the County Recorder of said County.
Dated: October 9, 2002
STATE OF CALIFORNIA
C,OUN of
On
a
me
(or prom to Rt4 on the baits of
aatisfat tory evidence) to be the pereon(s) whose netne(s)
4dare subscribed to the within Instrument and ad0towledged
to me that hablpa/fty executed the same in hinOwfilheir
authorized,capacity(tee) and that by ItlsflteNtitetr slonetufe(s)
on the inptrument the pemon(e), or the entity upon behalf of
wNctt the person(s), Ectad, executed the inemment.
W rrNESS my hand and oftwist seE l
Signsture P
Si re of �—
Darrell A{bnn Desglangee, HIS Attorney.
Darrell atomOesgra as. Her
i
' . )
Tdd& Midi I Desgranpes
6y.
Nmnq wd1111M Nywo CHI '01'134
- Certificate of. OccupancY
�
��
i M
'�
INt706C11A'IS
G OF�w Building & Safety. Department
a
s
This Certificate is issued pursuant to the requirements of Section 109 of the California Building
zs,
Code, certifying that, at the time of issuance, this structure was in compliance with the
N
provisions of the Building Code and the various ordinances of the City regulating building
4 ,
R
? construction and/or use.
BUILDING ADDRESS: 53-900 EISENHOWERI
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Use classification: SFD- Building Permit No.: 0310-343
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Occupancy Group: R3 Type of Construction: VN Land Use Zone: RL
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Owner of Building: POWER FINANCE Address; BOX 134
Ci ST, ZIP: LA QUINTA�CA 9253
City,
By: STEVE TRAXEL
" t
Date: 5/10/04
Building Officidl
POST IN A CONSPICUOUS PLACE
DEC 12 '03 12:32 FR TO 95648472
REPORT OF FIELD COMPACTION TESTS
19�40XMIAF� MAVEW
pill
P.03/03
NUCLE" GAUGE INFORMATION AND
DAILY STANDARD
CAIBRATION NUMBERS
VARIATION, PERCENT, -i-
CAUCA ADJUSTMENT X VAIGAnoN FROM
ELEVATION
OF TEST
CALIBRATION
COUNTS
FROM $NEM
PERCENT
COMPACTION
LAST USE
I
GAUGE TYP AMPBEII
MOISTURE:
MOISTURE
0106TURE;
MOISTURE:
$,�
MODEL NO.!
DENSITY:
DENSITY:
OENSITv!
DENSITY.
TEST
NO.
READING
OUOTIENTY
PCF
SOIL
10 NO.
TEST
OEPTH, IN
ELEVATION
OF TEST
MOISTURE
CONTENT,
96
WET
DENSITY,
DCF
DRY
DENSITY,
PCF
PERCENT
COMPACTION
COMMENTS
I
M_
f
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G.
o t'� PAP
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FD gT
TECHNICIAN_
-IMM N -ILL Mp IA. A UL MPLY WITN SPECIFICATIONS
BAGKFILL B _ COMPACTION PERCEMTACE DOES NOT COMPLY WITH SPECIFICATIONS
J 9ASE COURSE C - RETEST OF ogEVIOUS TEST
s - SUBBASE 0 -MOISTUaE !N EXCESS OF SPECIFICATIONS
• SOIL CEMENT E . MOISTUQE BELOW SPECIFICATIONS
� 3•wEi
NR7 %)F�ICr 'YELLOW INSPEC1 'INK fIFLD °11.F
** TOTAL PAGE.03 **
MAY -07-2004 07:10 AM
�� CER IFICATE OF FIE
rojecl Title
x,900
Project 6oress
dJ26 _
suiloer Cont ct
HERS Rater _
VERIFICATION AND DIAGNOSTIC TESTI
1,
none
no
Builder Name
Plan Number
Sample Group Number
P.02
CF -4R
G ung Signature ale Sample House Number
rm; .7"C �ssoG� e� HERS Provider; �'G •f- ASOG/l%YS
Street Andress: ?�� D ��'au SOV /����� Clty/State/Zip: LN 61f !?Z2i 1
Copes to: Builder, HERS Provider
H -ERS RATER r,0MP6IAN,9E ST EN
The house was: A 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 Yesting Results (Maximum 6% Duct Leakage)
Measured
Duct Pressurization Test Results (CFM @ 25 Pa) _ _ values
Test Leakage Flow In CFM_
If ran flow is calculated as 400cfm/ton x number of tons enter �
calculated value here Z v
If fan flow is measured enter measured value here
Leakage Percentage (100 x Test Leakage/Fan Flow) _ 6
Check Box for Pass or Fall (Pass=B% or -less) ❑
Pass Fail
t4THERMOSTATIC 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
Pass
Fail
❑ MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT
1 O Yes C] No . ACCA Manual D Design requirements have been met
(rater has verified that actual Installation matches values In
CF -1 R and design on plan.
�y
2. O Yes D 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 =
O
O
Yes for both 1 and 2 Is a Pass
Pass
Fail