04-7657 (SFD)P.O. BOX 1504
78-495 CALLS TAMPICO Y VOICE (760) 777-7012
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011
INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: 041- 7 65 -7
t Date:
ADDlicanl •SFOs
Hppiicant-s mailing Address:
chitect or Engineer: ,it a
chitect or Engineer's ddress: .
ic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby amino under penalty of perjury that I am licensed under provisions of Chapter commando
Code, and my Licenfull fo e and effect. 1ii11�r //�`��JJ\\
w`� ��ctipn 7000) of Division 3 -of the Business and Professionals
sed c
�icense Classy �nse No.
ate �/�• 7� nrra[Nnr / /� J� [ 1
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.).
(, 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 contractor(s) licensed pursuant to
the Contractors' State License Law.).
(_.) 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 forAhis permit is issued.
1 have and willaifPs ntain workers' compensation insurance, as required by Section 3700 of the Labor Code, folw jV rice of the work for which this permit is
issued �t vubdcecs compensation insurance Cartier and policy number are: y p y�j
Carrier. Policy Numb
_ I certify t, in the performance of the or which this permit is issue I shall no toy any person in any manner so as to beco ubject to the workers'
compensation laws of Calif- agree thatt, i hould beco ubject to the wo�s' compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comDly with tho nmvisinnc i
M10
ate
WARNING: FAILSECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($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.
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
IMPORTANT Application is hereby made to the Director of BuildingAPPLICANT Saor aCKNOWLEDGEMENT
y permit subject to the conditions and restrictions set forth on this 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 application, the owner, and the Tand
� nd shall, defend, indemnify and hold harmless the City of La Ouinta, its
officers, agents and employees for any act or o 'ework being pe ed under or following issuance of this permit.
2. Any permit issued as a result of this appli becomesd if work is not co mended within 180 days from date of issuance of such permit or
cessation of work for 180 days will sub' permit to cancI certify that I have read this application and state at the above irtect I ag o comply with all city and county ordinances and state laws relating to building
construction, and hereby presentatives ou to en r upon the alb ntioned property for inspection purposes.
/ate �� Signature (Appl' g
Page
2
Application.Number
-"04=00007657 Date
12/13/0.4
Qty , ' .Unit Charge,,
Per
Extension
1.00 9.000.0'EA=
MECH`FURNACE <=100K
9.00
1. Q0 9._0.000
EA MECH B/C <=3HP/100K BTU
9..00
6: 0 0 6.5000
EA MECH ,' VENT FAN
3 9 :'�0 0.
1.00 6 :,5'0 0 0
EA MECH - EXHAUST HOOD
6.-50
Permit, ELEC-NEW
RESIDENTIAL
Additional,desc
Permit Fee
- 80.90 Plan Check Fee
5.06
Issue.Date
,Valuation
0
Expiration Date
'6/13/05
Qty : Unit Charge
`Pe'r_
Extension
BASE FEE.
15.00
,. 1740.00 0350 -'
ELEC NEW' RES - 1 OR 2 FAMTLY
60.90
250.00 ..0200'°:'
ELEC GARAGE OR' NON-RESIDENTIAL'
5.00
Permit PLUMBING
Additional desc
Permit Fee
146.25 Plan Check Fee
9.1.4
.
Issue DateValuation
0
Expiration Date
- p ate .` ..,�... - .:•
6/13/05
Qty '. , Unit Charge
' .Per
Extension
ension
.BASE'FEE
15.00
13.00 6.0000,
EA PLB; FIXTURE'
78'.00
1_00 15'.0000
EA` PLB.BUILDING SEWER :
15.00
1..00 7.5000,
EA PLB WATER HEATER/VENT
7.50 ..
1.00.,' 3.-0000
EA PLB WATER INST/ALT/REP.
3.00
1.00 9..0000•EAPLB
LAWN'SPRINKLER.SYSTEM
91.00
5.00 7500 "EA,`:.
PLB" GAS PIPE >=5
3.75
1.00 15 . 0000.
EA: PLB GAS' METER .
15.00 .
Permit ,. GR
,DING' PERMIT
Additional..desc
Permit -Fee
15.00, Plan Check Fee
.00
Issue Date
Valuation.
0
Expiration Date
6/13/05
-Qty Unit Charge
Per
...Extension
BASE FEE
15.00
Special _Notes and Comments,
SFD - LOT68. PLAN 4RA', 1740 SF.. PERMIT
DOES NOT,IN.CLUDE•_BLOCK
WALLS, ,POOL, SPA"
r
16
Page 3
-Application Number,...
-,,',04-00007657
. Date 12/13/04-
t ;ra
.-G-------------------------.--
---------------_--------------------------------
-
Special Notes and'
Comments`,
r
- OR DRIVEWAY APPROACH.
75% -PLAN CHECK'FEE.'.
REDUCTION APPLIED
FOR.MULTIPLE'ISSUANCE
OF SAME PLAN TYPE
-------------- - - --- --
'Other Fees
- -- ----------------..-------
k
----- ---------------------
ART IN PUBLIC -PLACES -RES
2 .00,
DIF .COMMUNITY CENTERS -:RES
97'.00
`DIF CIVIC CENTER - RES
366.00.
-
ENERGY REVIEW FEE
11.13
,
DIF FI -RE PROTECTION -RES
97.00
zJ -
.•. GRADING PLAN CHECK -FEE
.00
DIF LIBRAR•IES',- RES
225.00
PARK ,MAINT FAC -',RES'
5.00
PARKS/REC = RES
502.00
STRONG MOTION (SMI) - RES
11.26,
DIF STREET MAINT FAC -RES
15.0.0
DIF TRANSPORTATION.- RES
1098.00 "
Fee. summary-.`-.
Charged.'
Paid . ` -, 'Credited.
Due
- -.- - - - - - -.-
- --
--- - - - - -
«
-- - - -
Permit FeeTotal
- -----
1005.65
- 7 --- - - - - ---
:`00< 00
--- - - - - --
1005.65'
-'Plan Check Total,
y -130:42
.. 00. .00
130.42
a Other: Fee 'Total
` 2427-39
.00 : 00-
2427.39
Grand To'tai;-'
' _
3563'.46
.00 - . '. :-00
3563.46
-
1 A
'r e
w„
CERTIFICATE OF FIELD VERIFICATION &-DLAGNOSTIC TESTING.(Page 1'of.i). CF -4R
Project Address [ Puerta Azul:]'
Builder / Installer,.
57430 Via Vista / La Quinti / CA / 92253
Puerta Azul Partners, c/o Pacific, Security Capital
Builder / Installer Contact t ' Telephone
Plan Number / Permit'Number.,
Mike Kwaske 7607027215:
` 1 -:
HERS Rater t Telephone
Sample Group Number .
Dave Bricker -` CIHIEIEIRIS®.ID #CCN99380828 _ `' 7607743676 , .
14 i
Compliance Method (Prescriptiv =`' ';
Climate Zone 15 ;
Certifying Sig"m : Date.
Sample House Number F
A
68 ;-
Firm a ( :HERS
Provider '
`
Energy Driven. Solutions
CIHIEIEIRIS®
Address, r
City/State/Zip,.
t.
48455Still.WaterStreit
Indio/CA'/92201 -
�z.
' "Copies ton BUILDER, HERS PROVIDER AND BUILDING DEPARTMENT ' F
y . f :HERS RATER•COMPLIANCE STATEMENT
This house was: V Tested _ �• '
As the HERS rater providing diagnostic testing and field verification, rti yythatthe houses identified on this.form comply with'the diagnostic
.tested "compliance requirements as checked on this:form: I
-. ✓ The installer has provided a'copy of CF-6R'(I6stallation Certificate):
✓ Distribution system is fully ducted (i e., does'not use building cavities ' plenums or platform retums� in lieu of ducts). k
✓Where cloth backed,:rubber adhesive duct tape is mstalled,,mast1c.and drawbands are<used�mS combination with cloth backed rubber. adhesive
duct -tape to seal leaks at duct connection
i,./ MINIMUM REQUIREMENTS FOR I UCTION Cf) MPLIANCE•CREDIT ,� { r
Duct Diaginost c Leakage Testing Results (Maximum,6% Duct Leakage)
System # 1 ;a , • �, ( ;..
-
..'Duct Pressurization Test Results.(CFM @ 25 Pa), Measured Values
Test Leakage Flow in 'CFM'. 118. ,
If.fan flow is.calculated�as 400cfm/ton x number of tons enter calculatedvalue here
Y If fan flow is measured eiter'meisuied value *h re. '
r ti►
1 ` Leakage Percentag 100 x Tested Leakage /-Fan.Flbw) 5.9 '
Check Box for Pass or Fail (Pass=6%,or less)' ✓Pass 0 Fail
..
' Residential Compliance Forms - Generated -by CIHJEJEIRIS® http_//www.CHEERS.org August 2001
s. r . .