0104-064 (AR)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
:5::-87n•2 1?' I G'�y,!•7 WPB
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&RC. 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 Policy No.
,. die:'3.1.;ws'sl R`rA 4'1i'AV MIY J."B.i.Fla
(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
,porkers' compensation laws of California,.wand 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: a 9 -"t C \ APPlicantiti. -.. ; .:._Jr .,. �r� •z
, Warnin§,-Tailure 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 >� 1,. s..-Y� ._ "�` `' "Date'A
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0104 -WA TRACT
JOB SITE
APN
ADDRESS 4744M. 1. 11000
643-120-•0-31
OWNER
CONTRACTOR / DESIGNER / EN (NEER
JAW"33 A ORKaLAHAVAS.
919cINu.M, II.M11rLaN&IN
4q.4,557IAVONtEGO
52- 405 p EalAVyLLA
L& CU.�TEA CA 92253
L�� Q1WRTA CA 92253
`
X0),56 99 C✓R7O 37"�1
,
USE OF PERMIT
I qd.-S SA' IZ00,V .A,ODJT!0N PZR .A1yPI'.tJVEN.) ;PLANS
ADEWTION 19710 2F
; �'.Q";3 i�41:0 C09T Off" CONS: RUC: "�'IOtV
s S; `,='..�: •
¢> �,�y � p g.y. Y t y A �-s a
.1G .1Cf..i�ll.AA 8 A.S LY,r S V-40AA RY
.
k?LA CH10'CK FTI.F, 101-000-439-318 WAD
iw;t i5°"i'RIlf:'i'I+ON it'n:}?. 101.,.v0 0-4,n8-000 SIX00
1lsl!a"..'il;d�`�►t,FER 1I314MA20.0 0 5301to
HTPC�Y 0 MOT30N ME. - RES10 1131 -WO -241-000 f1 A7
21 2001 Iia Paras::PATOFIEFS
,v�+
APR
CITU FTA QUINTA
RECEIPT
DATE. p
BY v
DATE FINALED
INSPECTOR
INSPECTION RECORD
z' OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms& Footings — �� ./
Underground Ducts
Ducts
Slab Grade
ReturnAir
steel
"
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap_d�
_ _
F.A.U.
Framing
Insulation]
-
/ /� _
Compressor
Vents
Fireplace P.L.
_
Grills
Fireplace T.O.
Fans & Controls
Party Wail Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
//Q�
2/77
Drywall -Int. Lath
//`%
Final8/Zd/
c�
Final
POOLS - SPAS
BLOC KW"' At I p PROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. 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
COMMENTS:
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)
Desert Sands Unified School District
477950 Dune Palms Road
Notice: La Quinta, CA 92253. -
Document Cannot Be Duplicated 760-77178515
CERTIFICATE OF COMPLIANCE
APN# 643-120-031
La Quinta
Permit # 0104-064
Date 4/12/01
No. 21876 Jurisdiction
Owner NameJames & Sheela Havas
No. 47-655 Street' Via Montigo
City La Quinta Zip 92253
Tract # Lot # Square Footage
Type of Development, Residential Addition
Comments
Log #.
Study Area
197
No. of Units 1
I
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 197 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 exempt Telephone .760 X71-4186
Name on the check -
-04 t
By Dr. Doris Wilson �
Superintendent
Fee collected /exempted by Arlene Garcia Exempt $0.00
11AnAA Check No. N/A
Signature
NOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notity 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 sssued or on which they are paid to the Districts) or to another public entity authorized to
collect them on the District('s)(s') behalf, whichever is earlier.
Collector: Attach a copy of count or city plan check application form to district copy for all waivers.-
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting,
JON TANDY
37630 Medjool Ave.
Palm Desert,. CA 92211
Office (760) 772-7192
RE C I AL I N S • • Fax (760) 772-7193
REGISTERED INSPECTOR'S WEEKLY REPORT Pager (760) 776-3338
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE
❑,POST TENSIONED CONCRETE
❑ REINFORCED MASONRY
O STRUCT. STEEL ASSEMBLY rO��jOpXl/
❑ ASPHALT ❑ OTHER J
O FIRE PROOFING
JOB LOCATION
NV
REPORT SEOUENCE NO.
TYPE OF STRUCTURE
r
��`` _ // f •
tl l �OY J h = L U//fid/
PERMIT NO.
DATE
DATE
0/
DAY OF WEEK
MXTERIAL DESCRIPTION
ARCH
T
INSPECTOR
HRS. CHARGED
ENGINEER
ASSISTANTS
HRS. CHARGED -
INSPECTION
DATE
- =
GENERAL
CONTRACTOR S� ... _�
SUB
�_- CONTRACTOR
,/ I
I/
f.
COPY SENT TO CLIENT O
CONTINUED ON NEXT PAGE O
PAGE
OF
r
-CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE•INSPECTED -TO THE BEST OF MV SIGNA URE OF REGISTERED INSPECTOR
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE
NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED /Q sQ 3 ��,�� �7
PLANS. SPECIFICATIONS.* AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS. ' DAT OF REPORT REGISTER NUMBFR
CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 1 of 2) CF -1R
Proj Kej , , y _ Date
uthor 1,
Building Permit b
Pian Check / Date
Field Check / Date
Compliante Method (Package or Computer) Climate Zone
Enforcement Agency Use Only
GENERAL INFORMATION
Total Conditioned Floor Area ft' Average Ceiling Height: R
Conditioned Slab Floor Area ft
Building Type: Single Family Addition
(check one or more) Multi -Family . Existing -Plus -Addition
Front Orientation: North / South / East / West / All Orientations
(input front orientation in degrees from True North and circle one)
Number of Stories
Number of Dwelling Units:
Floor Construction Type: Slab/Raised Floor (circle one or both)
BUILDING SHELL INSULATION
Component
Type
Frame Type. Cavity Sheathing
wd = wood Insulation Insulation
stl = steel R -Value R -Value
Total R-
Value'
Assembly
U -Value'
Location/Comments
(attic, garage, typical, etc.)
Wall
Left
Standard
Left
Q
'Wall
Standard
Rear'
Standard
Right
Roof
Right
Standard
Skvlight
Standard
Roof
Standard
Floor
Floor
Slab Edge
FENESTRATION
4hndinv ni-mirPe
Fenestration Orien-
#/ Type/Pos. tation
Area Fenestration Fenestration Interior Exterior Overhangs
(ft') U -Value. SHGC Shading Shading Att. /Fins
Att2
Front
Standard
Front
Standard
Left
Standard
Left
Standard
Rear
Standard
Rear'
Standard
Right
Standard ,
Right
Standard
Skvlight
Standard
Skylight
Standard
1
' For prescriptive compliance, Total R -Value and Assembly U -Value are not required for a wood -framed wall that meets
cavity R -value insulation requirement for the Prescriptive Package.
' For prescriptive compliance, there are no credits for any interior shading except the default or"Standard" drapery. These
default interior shading devices (draperies) need not be installed for compliance purposes.
July 1, 1999 '
W
CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 2 of 21 CF-1R
Prolcct l Isle Date
HVAC Sl'S77 NIS
Note: Input Indnati: c^:n! r_! hv,rt• d t cd V. .. t II:??i �ccr •,, 'e• J>:. ;
• - - _ . 11t:^tit:_ Lead
Heating Equipment Minimum l y pe and Duct or Heat Pump
Type (fomite. heat Efiicienc�' l.ncatinn „Piping Thermostat Configuration
pump, ct..) (AFUL or I I51,F) 40actc. attic. vic.t TYpe (split or packaec)
Cooling Equipment h•linimurn -- Duct , Heat Pump
Type (air conditione,. EfficieUc\ Location Duct, Thermostat Configuration
heat pump, ecap. coolinci (SEFR) (auir, etc.) R-Vale ' " Type )'p (split or.paekage)
WATER HEATING SYSTEMS
Energy' External
- Rated' Tank • Factor or. Tank
'Water Heater Distribution Nun)ber' Input (I:%t' r Capacity Recovery Standby' Insulation
Type Tcpe. ii'S� stem or Mu'hr) (ga!lonc) Efficiencv Loss (°a) R-Value
1. For small gas slora_e %\aier heaters gmcd inputs o!'Ics: tL•aa of equal to 5Ati
NO ro/hr).'cicctric rc�istance, and heat pump seater healers, list Energy
Factor. For large eat stntage w:•ucr h_•alcts (rated input of erc:!tcr than 75.1111t thu%hr).list Rated Input: Reco%-cry Etrteiencv and Standby Loss.
For instantaneous gas water heaters. list rated input and recn%in efficiencies.,
SPECIAL FEATURES nntl AIOD LING ASSUINITITIONS (Add extra sheets if necessary)
Including Thermal Mass (thermal mass tdl!:-, coxering• thickness. and description)
COMPLIANCL'STATEAIENT
This certificate of eomaliame list, ill; buildiue Ica!otc= and �L:doinia;•.c specificatiims needed to comply with Title 24• Parts 1 and 6 of
the California Code of Rcgulntion.. and the admini:r, ti%c regulalions In implement them. This certificate has been signed by the
individual with o\ crall d:signtcsrnn<ibililN Illic certi)icate el crinpliancc is subniiiied for a single building plan to be built in
multiple oriemaiions. am',shadill'. fcallite 111.11 is Natio! i> indi.•ated ill t.lt: SlIccial l ciuures /,Remarks section.
Designer or usine. and Professinnc Code) ` I)ocullientation A 11 or
Name:qTitle"Finn: _ l ulc%Firm:
Address: rlh+ &( /(r / J ,-address.2
&262r
Telephone: 1 clephim -
Lic. z:
(signature)� vl/ V
k (d:r.1 i ta)urr) (date)
Enforcement Ane"e
Name:
Title:
Agency.
�. Telephone:
(signature / stamp)
1997
/