The URL can be used to link to this page

04-7092 (SFD)P.O. Box 1504• �� VOICE (760) 777-7012 78-495 CALLE TAMPICO TFAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 f 444INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: - Q 91,22Date: �1 l �0 0 Applicant: Architect or E gineer: ��,�� Applicant's Mailing Address: chltect or Engineer's Address: ` Lic. No.: C�3 7�GI BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S 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 C9lSe, and my License iull force and effect. S-7 3LA�` icense Class_ License No. `A J Date 'I G V`iiGontractor �av vSC�\.11SUC T �v� �� OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): U 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 and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself or through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). U I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractors) licensed pursuant to the Contractors' State License Law.). U I am exempt under Sec. , BA P.C. for this reason Date Owner WORKERS' 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. _y4have and will maintain workers' compens ' insurance, as required by Sectio 700 of the Labor Code, for the.performance of the work for which this permit is rr¢¢su d. My workers' cgppensatio rice carrier and eeotic nurph��ar artier S'1'CX_! e! >c`olicy Number t�l> _ I certify that, in the performs of the work for h this permit sued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of gre ifomia, and aat, if I shoul come subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply wit ose provisions. / WARNING: FAILURE TO SECURE SrC(�MP N ON COVERAGE IS UN AWFUL; AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUND USAND D RS ($100,000), IN ADDITION TO THE COST OF -COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABO OD ,INTEREST, AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY ~ I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name Lender's Address APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit sub' estnctions set forth on this application. I. Each person upon whose behalf this application is made, each person se request and for whose benefit wo ' rfonmed under or pursuant to any permit issued as a result of this application, the owner, and the appli , each agrees to, and shall, defend, indemnify and hold less the City of La Quinta, its officers, agents and employees for any act or omission ed to the work being performed under or following issuance of this rmit. 2. Any permit issued as a result of this application b es null and void if work is not o menced within 180 days from date of iss ance of such permit, or cessation of work for 180 days will subject permi 'to cancellation. I certify that I have read this application and state that the above information is correct. a I with and county ordina s and state laws relating to building construction, jand hereby authorize representatives of this county to enter upon th ned pr mspectior pu ` 1 _ 1 C q nature (Applicant or Agent): ` Page 2 'Application Number 04.-000070,92 Date. 11/16/04 - Qty Unit ChargePe'r `Extension 7.00 6.5000. EA MECH'.VENT.FAN. 45.50 1.00 6.5000=EA MECH EXHAUST'HOOD 6.50 Permit `ELEC=NEW RESIDENTIAL` Additional desc Permit -Fee. 74.3.2 Plan Check Fee 4.65 Issue Date Valuation 0 - Qty Unit Charge' .:P'er- Extension 'BASE<;FEE 15 .•00 1549.00 0350 ,`, ELEC NEW RES - 1 .OR 2 FAMILY 54.22 255.00, .0200 -. ELEC-'GARAGE,;OR NON-RESIDENTIAL •5.10 ------------- Permit PLUMBING "Additional desc -.Permit Fee 151.50 'Plan -Check Fee, . 9.28 Issue Date . Valuation 0 Qty Unit Charge:: -Per, Extension BASE,.FEE 15.00 14.00 6.0000,,EA PLB FIXTURE-. 84.00 1.00 15.000.O EA', PLB BUILDING SEWER 15:00 1.00 7..5000 -'EA PLB WATER•HEATER/V.ENT 7.50 1..00 3.000:0'.EA PLB; WATER'INS'T/ALT/REP 3.00 1.0.0 9..0000 EA -' PLB'LAWN SPRINKLER SYSTEM 9.0.0 1.00 3.0000:EA `. PLB GAS PIPE 1'-4 OUTLETS 3.00 1.00 15.-000.0 'EA PLB'GAS.METER 15.00 Permit: GRADING PERMIT Additional desc-.' " Permit, Fee 15:00 Plan Check Fee .00 Issue. Date °Valuation 0 Qty. Unit Charge Per Extension BASE FEE,' 15.00 Special Notes and Comments SFD - LOT'26. PLAN -"2A, 1549 SF.; PERMIT DOES NOT INCLUDE BLOCK WALLS,. POOL, `SPA; OR DRIVEWAY APPROACH., 75%..,PLAN CHECK,FEE REDUCTION APPLIED FOR:MULTIPLE ISSUANCE OF SAME PLAN TYPE., Other Fees ART IN PUBLIC PLACES -RES 00 <.. Page 3 i Application Number :'" 04-00007-092 Date .. x 11/16/04 ----_----------------------------------------------------.----------- • • Other Fees' ' . :. y, DIF•'COMMUNITY CENTERS -RES --------- 97.00 DI,F CIVIC I CENTER, - RES. 366.00 ' ENERGY REVIEW FEE 10.39 ' DIFFIRE PROTECTION -RES 97.00 ' ',, _ . GRADING PLAN CHECK FEE -' .00 DI -F LIBRA$IES - RES .225:00. ' DIF PARK•MAINT FAC - RES 5.00' . •; 'rDIF] PARKS/REC - RES - 502.00 : >-: STRONG . MOTI:ON(SMI') . = RES 9.95 '.DIF - STREET MAINT FAC -RES 115.00 DIF. TRANSPORTATION - RES 109800 Fee summary ChargedPaid` Credited.; -------------- I Due - ------ Permit Permit Feed "Total` "'_965.32, .00 - _ Y . 00, 965.32 Plar Check ,'Total ,'123 .•16 00 . 00 123.16. . - Other Fee -Total. 242.5.34 .00 •00 2425.34 Grand Total -3513.82,' y. 00 00 ,3513.82 - ' l r ' . ,ate • r • Y • ^ ," �-tvw t 1. *- CERTIFICATE OF FIELD VERIFICATION &'DIAGNOSTIC TESTING (Page I'of 1)CF-4R' Project Address I Puerta Azu1:J Builder /Installer : 57-371 Via Vista I La Quinti / CA % 92253. Puerta Azul Partners, c/o Pacific SecurityiCapital Builder /Installer. Contact Telephone t' Plan Number / Permit Number ' Mike Kwaske• 7607027215 • 1 = Q HERS Rater, Telephone Sample Grou P Number Dave Bricker - CIHIEIEIRIS®.ID•#C 99380828 7607743676. 19 = Compliance Method (Prescr' iv. : Climate -Zone 1$ ; Certifying Signature i 7 Date: Sample House Number •26, , Firm HER Provider.,` jEnergy Driven Solutions •CIHIEIEIRISO Address City/State/Zip 48-755 Still.Water Street' Indio LCA'/92201 - 1' Copies to: BUILDER, HERS PROVIDER AND BUILDING DEPARTMENT -HERS RATERCOMPLIANCE.ST.ATEMENT { This house was: ✓ Tested . As the HERS rater providing diagnostic testing and field verification�I, ,that the houses identified on'tliis.fonn comply with the, diagnostici, tested compliance requirements as checked on this form.. r. "./-The installer has provided a copy of CF -6R (Installiation Certificate) . , jl: k i ✓ Dg stribution system is fully ducted (i.e., domes not use buildmg•cavities'as plenums or platform returns.in lieu of'ducts). /. %Where cloth backed; rubber adhesive duct tape is installed mastic. and`drawbands are _ted 'n combination with cloth backed, rubber adhesive • (ducbtape to seal leaks aYduct connections. f , * ` " y , • 1 ../MINIMUM REQUIREMENTS FOR DUCTTLEAKAGE-REDUCTION CO' AANC-66REDIT . �,'• - � Aja+. i .,. .. Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage) r , System # 1 Duct Pressurization Test ResultsCFM.Pa) ' ( @ 25 Measured.Values Test Leakage Flow in CFM' 99 If:fan flow is.calculated as 460efrn/ton x number;'of tons enteicalciilated�value here If fan flow is measuredlen�ter'measu red value here Leakage Percenta • e 1,00 Tested Leakage a /'Fan Flow :t Check Box for Pas' 'or Fail (Pass 6% or less) > ✓ Pass< ';'Q Pail > 7. i• Residential Compliance Forms :Generated by CIHIEIEIRIS® http://www.CHEERS org _� August•200F .. to '' a FEB -06-2006 04:37 PM „ P.03 CERTIVICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING CF -4R Prof ct Title, Date '� "� l t/�� (//s�"•i L... O LST v e`-r� xzd Pr=ess Builder NnMe Bulli3er Conte t - Telephone Plan Number �1tii Gar�n� d 7�OJ HER Rater Tel p na Sample Group Number• ti ifying Signature ate Sample House Number Firm: �. �' Aratfza7�S HERS Provider: 5 Street Address: ?gao ffI'4414" i C/�L �� City/state/zip: Coples to: -Builder, HERS Provider RS RATER I MENT The house was: ❑ Tested pproved as part of sample testing, but was not tested ` As the HERS rater providin® diagnostic testing and field veriflcatlon, I certify that the houses Identified on this form com with the dlegnostic.tested compliance requirements as checked on this form. PDistribution system.is fully ducted (i.e., does not use building cavities as plenums or platform returns in lieu ��Where ducts) cloth backed, rubber adhesive duct tape Is Installed, mastic and drewbands are used In combination with cloth backed, rubber adhesive duct tape to seal leaks at duct connections. f MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage) Measured Duct Pressurizatlon Test Results (CFM @ 25 Pa) values Test Leakage Flow In CFM If fan Flow is calculated as 400cfm/ton x number of tons enter o calculated value here If fan flow is measured enter measured value here Leakage Percentage (100 x Test Leakage/Fan, Flow) Check Box for Pass or Fail (Pass=13% or less) Jed ❑ ass Fail 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 ass Fail ❑ MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT M Yes D No ACCA Manual D Design requirements have been met (rater has verified that actual installation matches values in 1 CF -1 R and design on plan. 2. ❑ Yes M No TXV is installed or Fan flow has been Verified. Ifno 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