0206-205 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Ohapter 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
J ,
675709 � �/ j W13 /03
Dater Signature of Contractor`^—
r
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). '
"( f.
_) 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.
(t) 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 AWIMCM ?SRO X' " Policy No. 3$AN.'154 0
(This section need not be completed if the pe m t 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 Seton 3700 of the Labor
Coda,_I shall forthwith comply with,�those'provisions. r Ae , „
Warning: Failure to secure Workers' Compensationcoverage 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 applicati
correct. I agree to comply with all Ci
construction, and hereby authorize r
the above-mentioned property"fornsl
Signature (Owner/Agent)t-
state that the above information is
State laws relating to the building
ntatives of this City to enter upon
purposes.
Date"",
BUILDING PERMIT PERMITrY -
-
02%405-
DATE / VALUATION d ,C tt 7 f5 LOT�f p • TRACT
-+ 9 Lp l
1b eS1S7i�r.L.ti ^�
� 24
. .+'�ff7 `�
r
JOB SITE �_ �1
ADDRESS W,t9YI
APN
;62-420-10"M
OWNER ,
CONTRACTOR/DESIGNER/EN (NEER
3 0, 0 '11034 .KAI . l A'l Y ta"T-M 200
3':+MMAN OF W t,HOTw ;r ON
V-11 92606 06
IRVATE CA 92606
(.9A9)ENr -6199 C'aU MIS
USE OF PERMIT
SIS a }.,OT fit, PLAN 7dPL .PBR UT d?S)XS 1I0T INC.i.,I,1DL 8 0,CK
WALLA P001.4 SPA OR DfRIVEfi AYAF'PROAt."N "
CUSTOM CONUTRUCTION 31,119100 VW
PORCH/PATIO 754.00 SY
0AMMYCAMPORT 7,03,00 1VF
ZYMAID?CONT or, CONIaRUTIOT 2681439..110
PERWITIM SUMMARY
CONSTRUCTION FEE 101.000.418.000 S1,241.00
PIAN CHECK MP " :01-000.4.39-318 $11001.26-
MECHANICAL,� 1101-000421-003 $136.$0
L1,:Ii;CTRICAi: FEE 401-000'420-000 $16510
S'LkxNIRIN0 M. F" 10'1 -0t10 -415P-010 $1131175
ST1 ONCI MOTION • RE= 102000.241-000
0Fi05. WO FEss 101-000-423.000 � cb.Bta
DF,VP,+,,Ola1•- IMPACT =Z
AWr 04 PURLICv FLA.0 ER - RESIT r/0-000.40.000. �i'A1.titi
'f+RXN DEPOSIT 101-W"39-318 4750.00
D�?0 a'RE-PAID FUS •�7Stl.00l
JUL 2 4 2002 �
t. CIT:Y0FLAQUIN'TA
r FINANCEDEP1,
..€i .
iRECEIPT
DATE ry `,
BV «°
T�rlE
SPECTOR
It
J
01
INSPECTION RECORD
' OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings dl/A
14 W;)-
Ducts
Slab Grade
I ZZ
Return Air
Steel
Combustion Air
Roof Deck
Q'ji
Exhaust Fans
O.K. to Wrap
/
F.A.U.
FramingCompressor
_
Insulation
QVents
fZ
^
Fireplace P.L.
Grills
Fireplace T.O.
_
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
ILI-
Final
Final
POOLS - SPAS
BLOCKWALL
_
APPROVALS
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
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
/
Pool Cover
Sewer Connection
/ f/
Encapsulation
Gas Piping
Gas Test
/
/ 4 C9
Appliances
j
Final °•
`
COMMENTS:
Final
Utility Notice (Gas)1yj
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F.1.
Smoke Detectors
Temp. Use of Power
Final .�
Utility Notice (Perm)
FROM :LA CALA TR
04/24/2003 13:41 F.93 949 442 6198
ISG}:�►[�1�1���7:St1�Y�'a
Western Pacific Ilauninet
Coachella Valley Valified School District
P.O. Bog 847, Thermal, CA 92274
(760) 398-5909 — Fax (760) 398.1224
Project NAlfte= La Ca 1 a
Owner's vnmt:: [estern Pa
project Address_ 51-230 L99er,
Project Description' n
M& Box For District fisc Only
DEVELOPER F21S PAID
Apr. 24 2003 02:57PM P1
1Z 00 2
AR&U-
AMOUW
I.WiM CMAMOUNT
fTWQOUINr:
F
W'r1QA*(lWAK0JW*n
, ta4At1Ne,,wotmm
—w
PATS!
R
CHUCK N:
rM9)AL3:^_
CERTIFICATI: OF CQWLIA V'CE
(California Educafion Code 171120).
Date: November 6. 2002
troika Rio:
3 Quinta: CA 92253
APIN: 762 420 024 4 ;Got #'s:
Type of Develop COW 621 Industrial _
-
2ntal Square Feet of BuRdEng Area: 2654
Certifiastion of Applican ,'Owtners: The #arias signing certifies that the ebOvE inf!oamatiOD is correct and makes this stair=,rit
,,t6= penalty Vperjwy rad finthw tcptesenm that lwhho i5 authwtized to sign va beaxalf of the owner/develop•
]Dzted: 5iguatet:e:-C _
kdtRR l:*sirk:-f fie*4#tort rttt,r #t<3•k k+4k4 b U'p'N rtttit t<&kk W
SCHOOL nlsTx ccs RrIQLMUEN T FOR THE ABOVE PRGJ=T EfAVE DZEN OR WILL $E SATISFIED IN
ACCORDANCE Wn79 ON 39 OF rJ3E FOLLOWING: (CIRM ONEj
FAucadou Coda Gov. Code Projeet
17620 65995 Approval
Number v[ Sq -T t. . 2654
Amount per Sg.n S _
Amount Colbwtcd g
Building Permit Application Completed: Yes/NO
gy: CrareV M. Cas san
ASA. S1lpt. SusiD= Sexy.
1 10
I Ho- 3ubjt:ct to Fee i
A�strm�nt Exlsralg { i :
Prior to 111/87 � `f IB.e uire�ieq)4 ; ,4
NOT iS5
Noie:�
MiTIG�ATIMe
moiV-vem r ga len ares e�� es a e
.. - - -- --
Ct'rciffcxtt: Wiled by: i Ia rc e l a Valdez 5igzunrre
FaCilities Clerk
Section 46024 of EhoGovtrntnent f'odc assisted by Ssaembty>a t: 3M, et12Ct4VlEaanumy 1, 14!y, requires thattbls Distrix gro9ici aken natiCa to
the pradmt appolabt, at tine chane of payment of ccbool fees, mitiptioa poymeat or o_i:er erutu,os (,Fees'), at isle 90 -day period to bratuR me trrposltion of
ti:oec pep and {'3j the amaasrt of the Loos. Theresom In aeeardanea with r„etion 66020 ofthe G xvernmeat code and other appliatblo 1Aw, this T26tiee spall
sorra to advise Y*u that the 90 -day protimt period is regard to sorb Fovc or the validity thcrcof, commcncm wikb the peyn"t orvio focs or performance of
e -ns other rC(laat'kSllrslts agdescn�ed in s¢tioa 4t; 7 OEtka Govarattaettt cod.ti Additionally, the amount ofthe fom imposed is as heceln set forth, %TWher
parable at MIS since or In whole aria part prior txi issuance of n ar'ortl Renta ar Occupancy. As iia tate tatter, the 40 days ,tarid on the date b a cof• This
CtrMBeate of Coillpliaim to vaNd£ar �`t- L`• (30) dVe fi oo, the data ofisauaxe. Exwociott will be Ev t only for good cause, as detereiined by the School
pi,strict; and ap to tkrce M SIICh eMnsioes maybe granted• At such tSme as chis Cmtiresm aspires, Ifs building permit has not been issued for tho project
star i, the subject of this C�fiwte, Ilia awtite will be rdmbaarscw all fees that were rod to ate Ainthi, Ce,tificatc of Comptlancc.
:.!'C'::1rl09/30/02
07/22/02 MON 16:19 FAX 714 4426188 1@002
JUL 2a 2UO2 11:02f9M SD FACILITIES 7&y81224
p.2
July 22, 2002
COACHELLA VALLEY UNIFIED SCHOOL DISTRICT
97-2Z C> II CH 5= * P.0. KXa. +o 399.5137 # FAX CM) M5,IaQ
Wcstern Pacific Rousing, Inc.
16940 Von Karman Avenue, S1dm 200
Irvine, CA 92606
Re: Mitigation Payments to the Coachella Valley Unified School District —La Cala
Lot 24
1-�^. 3kyj= fa �TtTp
The Coachella Valley Unified School Disuict ("District") entered into a Mitigation Agreement
("Agreemcne') with Rielly Homs Madison, LLC ("Rielly'), dated November 6, 1598. The terms of this
Agreement are applicable to Western Pacific Housing, Inc. as a result or its ptrdhase of certain property subject to
the Agreement ("Property") from Rielly Homes Madison. LLC.
In accordance with the terms of the Agreement, Mitigation Payrmcots and 00 r aA&muan Payments, a.s
adjusted purh` ant to the Marshall & Swift Class D Wood Frame Construction Cost Index, are currently in the
amounts of 54.36 per square Boot of aM=able space up to a maximum of $8,854.88, respectively.
We understand that Western Pacific Housing, Inc. desires to obtain a building permit from the City of La
Quinta as to a specific pnrtion. of the Property. The Mitigation Payment applicable to the portion of the Property for
Much building parry its are aunwtly sought amount to $8,1i54M. The description of the applicable portion of the
Property and the calculation of the Mitigation Paytncnts applicable thereto are furtber set :forth in Attachrat:nt "A" to
this correspondcrtcu.
Pursuant to the Agrc=eK payment of the above -referenced Mitigation Payments must be paid to. the
District prior to issuance of any Certificate of Usc and Occupancy by the City of La Questa. This convSpondence
maybe used, in lieu of a Certificate of Compliance, to obtain the desired building permits from. tte City of La
Quinta. When the District receives the Mitigation Payments due for the applicable Property, the District shall issue
a Certificate of Compliance for the Property for which the Mitigation Pa}anaam have beers paid. The Certific. to of
Compliance should their be used to obtain a Certificate of Use and Occupancy from the Cary of. La Quinta.
As a retniiider; thW City trfLo Quints mesl not issue a Certijlcarti of Use -and decupa—ncv without � 7
cu'nfirmadon that a Ccrirficate of,Compliance has been issued for the applicable portion off- d c Property. -However.,
min the event that a C=tiftcatc of:Uw and Occupancy is issued wiihaut payment ofMitigtalion Paymm s to the _
District as set forth in the Agreen>emt, Western Pacific Housing, Inc_ mast pay i e District. within thirty (30) days
aftar,requost by District, the applicable Mitiption Payrueats, plus Statutory ,interest, together with the izts-rof --
collm,tion of the Mitigation Payments, including all attorneys' fees,
07/22/02 MON 16:13 FAX 714 4426188
JUL 42 2002 11:02AM SD FRCILITIES
[a 003
71NSa1224 P. 3
Mr, Scott McKhann
July 22, 2002
Pagc 2
Plem contact the undersigned ifyou have any questions or camrnents regarding; tws matter,
Sincercly,
E. Eug a Vorwallcr
Director of. Facilitics
cc: Tom Hartung, Buildintg & Safcty Director, City of La Quinta
Kathy Jenson, City of La Quinta
Alex Bpwiu, 'BA WG
Fadlities and Maintenance and Operations Departments
t)Wct AdminLstration AAntat
83-733 Avenue 55, Thenrta1, CA 92274
(760)398-5909 FAX (760)398-1224
CdU.SDJ EVC: CanccPL)lUARlcc
P
07/22/02 MON 16:14 FAX 714 4426188
JUL. Z2 2002 11:02RM den FACILITIES
1@001
76981224 p. 4
Mr. Scott McKhazin
Judy 22, 2002
Page 3
Attachment "A"
Tract No. W No. Froperty Description* APN No. of DU Mitigation Amount Total Dae
28838-4 24 81-23t1Legends Way 762-420-024 . 1 $8.854.88 $8,854.68
TOTAL. DUE: $8,854-88
Facilities and Maintenanoc and Operations Departrmnts
District Adrninistration Annex
83-733 Avenue 55, Thermal, CA 92774
(760) 39&-5909 FAX (760) 398-1224
CWSWEVC: Concapondrnee
t M
NOV.05.2002 02:22 i760233402i MAYER R00,F1tg3 #3694 P.001/001
r Corporate Office:
P.O. Box 462890 ® ® ® Phone' (7601737-8888
Escondido, CA 9_7046 — FAX:. (760) 737-0350
License. 4 6&3591
WESTERN PACIFIC HiOUS1NG
LA QUTNTA
760-564-7022 (FA)Q
• 11-5-02
Attn: JOHN
r
Roofine on "LF..GENDS (4) P.G.A. WEST" Ph 4 LOT #4024
Mayer Roofing has supplied and installed " 12 " O'hapin cloaked ftf�tats-„ , on.lot # 4024
at 81-230 LEGENDS WAY, Tile vents have been installed per manuflicturers
specifications.
Note: Fxact vent locations are detennined by braider
RESPECTFULLY SUBMITTED
SCOTT- .BEECHAM
OPERATFONS MANAGER
Mayer Rooting, Me.
Page I of I
558 Library Strccr . Sun Fernando, CA 91340 193 UrHngc Street . R.iverside, CA 92502
(8181838-GOEi4 ..i FAX (K18183li-4x93 (909)•782.0601. FAX (909) 782-0804
NOV-01-2002 12:20 'WESTERN INSULATION 909 686 Slob P.02,CCQ
T IST �JLA'T°IO T, LaPo
4211 Lathma Street, Riverside, CaLforaie 92501
TeL (9091 686-8760 Fax (909) 686-8786
INSULATION CERTIFICATE
THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH
THE CURRENT ENERGY REGULATION, CALIFORNIA ADMINISTRATIVE CODE, TITLE 24,
STATE OF CALIFORNIA, IN THE BUILDING LOCATED AT:
TRACT: LA CALA
LOT #: 24
SITE ADDRESS. 81.230 LEGENDS WAY — LA QUINTA CA.
EXTERIOR wALLS: BATTS
MANUFACTURER: KNAUF . THICKNESS: 6 314" R- VALUE: R-19,
CEILINGS: BA77S
MANUFACTURER: JOHNS MANVILLE THICKNESS: 11" R-VALUE: R-30,
GENERAL CONTRAgTQR: WESTERN PACIFIC HOUSING
BY.
TITLE:
DATE:
IN ILLATION Ci RACTOR: WESTERN INSULATION, L.P.
LICENSE NUMBER: 7 48
BY:
TITLE: PRODUCTIO MA G R
PATE: NOVEMBER , 20
TOTAL P.02
OCT -30-2002 03:32 AM
CER
CA
TO
r I
Rater
r •� IS _
Builder Name
Plan Number
Sample Group Number
P.02
CF -4R
en�fying signature Date Sample House Number
HERS Provider; 95aJ6
Firm. -
Street Address: 701 V G 1, City/Stete/zip: dl C f
poples to- Budder. HERS Provider
dERS RAT R CgMPLIAMCE STATEMENT
The house was; Tested 10 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.
j� 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 Pe) ffvalues
Test Leakage Flow in CFM 7 7
If fan now is calculated as 400cfm/ton x number of tons enter g
calculated value here
if fan flow Is measured enter measured value here
Leakage Percentage (100 x Test Wakage/Fan Flow) =,
Check Box for Pass or Fell (Pass -16% or less)
4as Fail
LPITHERMOSTATIC EXPANSION VALVE (TXV) or Commission approved equivalent
P 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
1 3 Yes ❑ 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,
C Yes 0 No
OCT -29-2002 TUE 12:13PM ID:
TXV is installed or Fan flow has been verified, If no TXV,
verified fan flow matches design from CF -1R.
Measured Fan Flow =
Yes for both 1 and 2 is a Pass
Li
Pass F8;l
C1 El
Pass frail
PAGE:2
I
Certificate of Occupancy
City of La Quinta
Building and Safety Department
This Certificate issued pursuant to the requirements of Section 109' of the Uniform Building Code,
certifying that, at the time of issuance, this structure was in compliance with the various ordinances
of the City regulating building construction or use. For the following:
BUILDING ADDRESS: 81-230 LEGENDS WAY
Use Classification: SPD Bldg. Permit No.: 0206-205
Occupancy Group: R-3, U-1 Type of Construction: VN Land Use Zone: RL
Owner of Building: SRHI, LLC
Building
Address:
16940 VON KARMAN AVE. STE, 200
City:
IRVINE CA 92606
By:
BILL GORDON
Date:
11-13-2002
POST IN A CONSPICUOUS PLACE