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�• ' LICENSED CONTRACTOR DECLARATION,
I hereby affirfn�under penalty of perjury that I am licensed under provisions of 7/Y•.
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 ?
sa 13 HIC 08/31/2(
Date 4 � a�--� 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 i 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. 1,57/5557-02
(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 1 rovisions of Sec Ion 3r 00 of the Labor
Code, I al forthwith comply with th'd pow�s ion
,Date: Applicant ✓L (-A%'
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 propertyafo— inspe6fin purposes. J i
Signature (Owner,Agent) if �,'I/ Date !j!
M
BUILDING PERMIT PERMIT#
0401-709
DATE VALUATION LOT TRACT
$11 MOW= �8 ' NIX20.4
JOB SITE
APN
ADDRESS g 1 N,C)4+� i� iVL
174-284-13.11n
OWNER
CONTRACTOR / DESIGNER / EN (NEER
]UM -1 SCOTT
PA.CrEC I.1O.MES
F.O. BOX 1023
'77.564.A C011N TTY CLUB DRIVE, BUTIa? 115
LAqm� h,n . CA 92253
PALM DOMKit CA 92211
(7$0408-34.95 CBLO 2953
USE OF PERMIT
SIRG E FAVI r
2007 S.F. SFD PERMIT DOES NOT INC1,UDE LOWCK WALL PODIASPPa
OR DRIVEWAY APPROACH
TRACT CONSTRUCTION 11007.00 or
PCIRC".H/PAT1O 115.00 SF
(SA11AGF CAft.1=OR'1` 4".00 Sig
EY.-') ATJPM COST alp CO:PI MRUCHON'
PET d:r.. +M a, Ssrlll 4 AAY
CONS T 1il1CTIaN FIKS 103-000-418-000 3.000-41€1.000 $709.50
RI AN CHECK FEE 101-000..439-318 $597.14
ME DEPOSIT 101.000-439-318 4250.00
M ECHANIC &L FEE 101-000-421-000 $45.50
r.1,ECTRIC'.A1, FEE 101-000-420.000 $127M
PLUMBING F to 101-000.419-000 $166.00
STWHIO MOTTOIN FEE - REMID 101-000-2,41-000 $11195
O5,.,t DIINO PELF: 10-1-00 "'123-000 $15.00
DEVELOPER IMPACT "AM $2,405,00
PRECISE PLAN 101-000-441-34:5 $100.00
S "-TOT111- C01MRIf671014 AAIB P:C.&W C1 CR
,197.a�8
n LESS PPS -PAID 1 5
4250.00
JAN 2 3 2004
CITY OF LA QUINA B
FINANCE DEPT.
RECEIPT
DATE ,,..
BY----%,
DATE FINALED
INSPECTOR
_ 0011,11 -
OPERATION
'r
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.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
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 APPROVALS
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
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
Final
Utility Notice (Perm)
COMMENTS:
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 ,
7823234 :8 Mc 001.31/2(
Date
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).
( ) 1, 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 FL114D . Policy No. 157057-02
J
(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 those provisions.
Date: 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 for inspection purposes.
Signature (Owner/Agent) Date
BUILDING PERMIT ?ERM`Tk
DATE �ty VALUATIONLOT , TRACTP� Ay.
ADDRESS :§v- �i �i' �� .1'� f JOB
APN 774•^e284-020
OWNER
CONTRACTOR / DESIGNER / ENGINEER
RPM -TAM 4r.1.5 SCOL 1'
1'ACmc ii4�
P.0. POS 1023
77564 A Ct71 ITrR,Y CLU9, -D R1 VF, :Un.WE 11:4
LA QjXJTA CA !'.953
PAUMMmwf CA 92211
(760)408.3495 081k 2953
USE PERMIT
F
Z(W? S.R SM) PU MMT DOES NOT 7r.+CLUDE, BLOCK 1;vhL,1, POOL.T. RA
O� NW11V WAY APi'ROACH
..r
TRACT CONSTRUCTION 1,0�.Q0 SIS
P"..;I'RCi PATIO 313.00 SF
0ARAf73�lIWARPORT 457.00 SP
E"SHMM-D COOT, OF CONSIRUCTrION
FKRUT,1<:fi ER SUAM►�rL, r� RY
t".C3N4i"l'al,1C'3.';(�3W �'>`'!° ].(?J �f]C115 A•l6�tiCQ 5"109.50
VLAN MF. & YEZ $991.14
PEE DEPOSIT 101-15100-439-318 425(1,00
FAAVCHAWJCAL Fes+: 101-000.421-000 $65.50
3&LIEC`1'PdCAL 11, ER 101.000.420-000 SIV 8p
VIA AAH€00P-Ept 101-0300-4-19-000 $166.90
STRONG MOTION IT i . REBID 101-000.241.000 $11.95
{11!iADING FF11; 101-000-42 -000 $15.00
D,EVtcPER IV -PACT ,FEE S2,405.00
PIRCISIE PLAN 101-000-441-345 S 100.00
AT
.JB -TOTAL Ct3MRUC`fl.011.AHD 1-PLAYT CHLECK
$4,19'(.98
M93 P1&P.AID FMIZ
4250,00
RECEIPT
DATE
BY
D 1N LED
INSPECT
GC; L
i
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Roof Deck
Combustion Air
Exhaust Fans
O.K. to Wrap OG
F.A.U.
Framing v
Compressor
_
Insulation
Fireplace P.L.
Vents
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath _
Drywall - Int. Lath ��ICO
Final
Final
BLOCKWALL APPROVALS
POOLS o 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
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
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVAL
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) 7 arm_
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 2,007 S.F. or $4,294.98 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/1 st Bank - Richard Scott Check No. 71282
Name on the check Telephone
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted Karon MCGllvrey Payment Recd
$4,294.98 Over/Under
Signature Alt4c__,
NOTICE: Pursuant to Government Code Section 66020(d)("is will serve to notify you that the 90 -day approval period in which you may protest the fees or
other payment identified above will begin to run from the date on which the building or installation permit for this project is issued, or from the date on which
those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting
RECING REQUESTED BY:
New C ntury Tine Company - Riverside
ORDE NO.: 2336856
ESCRO NO.: 33031017-M$
AND EN RECORDED RAIL TO:
Richarc L. Scott
ClaudiaI Scott
P.O. Bc x 1023
La Ouli ta, CA 92253
®®C tip 2003®901736
` 11/14/2003 08:00A Fee:10.00
Page 1 of 2 Doe T Tax Paid
Recorded in Official Records
County of Riveraide
Cary L. Orso
Asmeasor, County Clark 8 Recorder
! PIIIP llll! I!!I IlIP! !I!! !!1111! 11!11 II! 56111 Il1I !111
M s U
PAGE SIZE
CA'CORNOCOA SIAF 'USC
A R L
COPY
LONG
REFUND I NCNG EXAM
GRANT DEED
( ) computed on full value of pr rty conveyed, or
( ) computed on full value less li or encumbrances remaining at time of sale
( ) Unincorporated Area
FORVALUABLE CONSIDERATION„
an unmarried woman
here GRANT(S) to Richard L. Scott
the following described real property in
Lot 8, Plock 303 of Unit No. 28 of the E
50 of Vaps, records in the office of the
—October 7, 2003
STATE F CALIFORNIA
COU OF B
On 10111103 before me
/0
SF
THE NIIJERSIGNED GRANTOR(S) LARE(S) that documentary transfer tax is $66.007
pt of which 6s hereby acknowledged, Jacqueline M. Mayo
Claudia J. Scott, Husband and Wife as Community Property
Unincorporated Area, County of Riverside, State of California:
Carmelita at Vale La Cluinta, as per Map recorded in Book 19, Pages 59 and
my recorder of said county.
TkV -
Person ly appeared , `f 0' _
�ed(:seal.
to me on basis of satisfactory
7eviden) t0 be the per50se nai
e a subscribed to the�trument and acknto mt e/tjKy executed the CfBh : r•,hK/her/t►�Eir authaclty), that by ty�/her/t�ir o (�J on a instruersonor entity upon beha ofy-a person( actedthe ium�l f eC+�:" 9 „In;'' ` "i ✓
WITNE S my hand and offi
Signatu e _
I (This area for official notary seal)
Grant Died - Individual (290) 08-03 1 MAIL TAX STATEMENTS AS DIRECTED ABOVE
- Certificate of Occupancy
G� OF"IBuilding & 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: 54-655 EISENHOWER DRIVE
Use classification: SFD Building Permit No.: 0401-299
Occupancy Group: R3 Type of Construction: VN Land Use Zone: RC
Owner of Building: RICHARD SCOTT Address: P.O. BOX 1023
City, ST, ZIP: LA QUINTA CA 92253
By: KIRK KIRKLAND r
_
Date: 7-9-2004
Building OfficiA
POST IN A CONSPICUOUS PLACE
JUL—Oe-2004 06:46 AM
Oct
vaw
sumer Name
Plan Number
Sample Group Number
0
IngSigee nt �.._ Semple House Number
-ism: .T�-4-�,�s�G� �c HERS Provider c.,
�� 69
5lreet aocress: ��' ra�/�ar/ Ct&L City/State/Zip: � u hr C 9 :.53
Copies to: Builder, HERS Provider
HERS RAJJR COMP41ANCE §TATIldINT_
The house was: §& Tested - ❑ Approved as part of sample testing, but was not tested
Ns the HERS rater providin diagnostic testin® and field verification, I certify that the houses identified on this form
corrply with the diagnostic ested compliance requiremente as chocked on this form.
rlslr.butlon system is fully'oucted (I,e„ does not use bulidirig 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 leeks at duct connections.
MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT
Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage)
Measured
Duct Pressurization Test Resuits (CFM Q 25 Pa) �ryvcallves
Test Leakage Flow in CFM y / 0 j L
if fan flow is calculated as 400ctm/ton x nurn bar_of.tons. enlet-
calculated value here
If fan flow is measured enter measured value here j
Leakage Percentage (100 x Test Leakage/Fan Flow) _. S e '15 !"
Check Box for Pass or hail (Pass=8% or less)
ILog
THERMOSTATIC 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 REQUIREMPENTS FOR DUCT DESIGN COMPLIANCE CREDIT
1. 0 Yes 0 No ACCA Manuel 0 Design requirements have been met
(rater has verified that actual Installation matches values in
CF -1 R and design on plan.
❑ Yes M No TXV is Installed or Fan flow has been verified. if no TXV,
verified fan flow matches design from CF -1R.
Measured Fan Flaw a
Yes for both 1 and 2 is a Pass
Z' ❑
Pass =ail
Pass Fail
NIX
MO
Pass Fai°