0008-098 (SFD)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
674074
Date�'' r,!•�- �7 Signature of Contracto
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 Signature of Owner -
WORKER'S COMPENSATION DECLARATION
x I hereby affirm under penalty of perjury one of the following declarations:
() I have and will maintairi a certificate of consent to self -insure for workers'
compensation, as provided for by Section 3700.6f 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 h"d D Policy No. 046.00073311
(This section need not be completed if the permit valuation is for $100.00'or less).
(;) I certify that in the performance of the.wort 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�l.shotild become
'subject to the workers' compensation provisions of Section 37601of the Labor
Code, I shall forthwith comply with those provisions.. of /
Date:. J . �af'a ;' `1 Applicant 1 111 t
Warning: Failure to secure Work'ers�-Compensation coverage#is.unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit, subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or, pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this' application becomes null and void if
work is not commenced within 180 days from date of issuance of'such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building:
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned propertyfor-inspection purposes: ?
At r
Signature (Owner/Agent) �� rr' r Date
BUILDING PERMIT PERMIT#
{liP$
DATE Jj VALUATION p.g6'I� Gln LOT TRACT
Dbvw6e�:t .uoi 65
Z a 1 r'? l f f1
JOB SITEf
ADDRESS -7110 VEM F, >t X1 ,A
APN
649-IMIC10,'D
OWNER
CONTRACTOR / DESIGNER / EN (NEER
10 5.:. MT DI.VE.ORNOW
SPAS CONI UC"i' 014.
PO BOX 1716
79-295 RANCHO LhQUTN':CAYJ'R
LA.Qf.1`�[fA CA 92253
z...A QUIN'1A CA 922.33
(760)771.1441 r—SI.6 V96
USE OF PERMIT
SYD.- LOTAS PL.A;N:MI IZ 4 PERMIT DOES NOT INCLUDE 8LOC1 W.P.L 1' OR ..
POOL, 75% PLAN CHF.R:WK PEI( REDUCTIOX MR MULTIPLE NUANCE OF
SAME PLAN TYPK '
C'U00 i'ON C014STRUCTION �VJ1$,00 Sr,
PORCH/PATIO 580.00 SF
6ARAGEICARPQR,T (SY)
NS': T."TTE D COST dig C7t NST€ TfC17()n
222,206.00
MOW FKC Si►LVf.MARY
CONSTRU•CTJON .SEE 101-000418.000 $1,230.00
PI,.e?N CHECK FEE 101-000.139.31 d . $2 4.23
IU1LCiI,'�Ai1GAI.1E 141.000.21-000
LLEC'TRICAL. MEE 101-1100-420-00071
'Pi,UMBD4 # FEE ' 101.000.419.004
STROr>!O MOT1014 iXE 111,13#» 101-000-241-000
CIRAD114 i FEE 101.000-4,i2.3.000 $20.00
DVi/-ELOP)M IMPACT FEE " $1,90'1.00
ART IN PUBLIC PEA&3 - fiE51C 7112 n000 -235-4U(3 $205.2 r
r. 0
Sti1:?,-T (Yr.A „ COWIR:UMOX AND PIAN CIMCM
$4,211.10
LE;aS 1R&PATD:1+ S
$0.00
'AOTAL MUM FUN DUE NOW
RECEIPT
DATE,
BY
(�
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
,
Underground Ducts
Forms & Footings
v� Com!
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
t.�
Exhaust Fans
O.K to Wrap
dj
F.A.U.
Framing
_
?Q�
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
_
POOLS/SFAS
BLOCKWA�L 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
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
_ (/
�Z
Pool Cover
Sewer Connection
/
Encapsulation
Gas Piping
��E
F/—�
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas) ?/T1 +450 -f -
ELECTRIC
AF PROVAL.,
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)
Title 24 'Report, for:
The'Stade Residence Addition (Package D)
48-7,45 Vista Estrella
La Quinta, CA 92253
+ o4 34 gZ
Project Designer: ,
CITY OF LA QUINTA.
BUILDING & SAFETY DEPT.
}APPROVED
FOR CONST UCTION
DATE. B
Report Prepar
Micah Combs t
CM ENERGY,CONSULTING
72 -925 -FRED WARING, SUITE #204
PALM DESERT, CA 92211
(760) 346-0855
Job -Number:
Date:
4/1/2004
The EnergyPro Computer program has been used to perform the calculations summarized in this Compliance report. This program has approval and is
authorized by the California Energy Commission for use with both the Residential and Nonresidential 2001 Buliding Energy Efficiency Standards.
This program developed by Energy3oft, LLC (415) 8835900.
EnergyPro 3.1 By Energy3oft Job Number: User Number:
' z
,
f Certificate of Compliance:• .Residential (part 1 of 2) CF -9 R
The Stade Residence Addition (Package D) 4/1 /2004 .
Project Title Date
48-745 Vita Estrella La Quinta
Project Address Building Permit #
MICAH COMBS (760) 346-0855 Plan Check! Date
Documentation Author Telephone
Package D 15 Field Check / Date
Compliance Method (Package or Computer) Climate Zone Enforcement Agency Use Only
GENERAL INFORMATION
Total Conditioned Floor Area: 190 f? Average Ceiling Height ID O ft `
Total Conditioned Slab Area: 190 ft2 ;
Building Type: a -
(check one or more)
hCG Single Family Detached ® Addition
❑ Single Family Attached ❑ Existing Building
❑ Multi -Family ❑ E xistirig Plus Addition
Front Orientation- (East) 90 deg Floor Construction Type: R Slab Floor
Number of Dwelling Units: 1.00
Number of Stories: 1 ❑ Raised Floor
BUILDING SHELL INSULATION
_
FENESTRATION.
Const.
Shading
Devices
Component ;
Frame
Assembly
Location/Comments
Overhang Side Fins
Yes / No Yes / No
Type
Type
U -Value
(attic, garage, typical, etc.)
E [,
R=�.8_6 of (R.38.N14.16)
Wood
0.028
Exterior Roof
0.37 Bun Screen
R-13 wall (W.13.20.16)
Wood
0.088
Exterior Wall -
_........... .—
Slab On Grade
i
_nLa.
0.756
•
.C_. v red Slab w/R-0.0 Perimeter Insulation
13
FENESTRATION.
Shading
Devices
'
Type Orientation
Area
SF
Fenestration Exterior •
'Shading
Overhang Side Fins
Yes / No Yes / No
Right(North)
___ZQS_4_ Q.d8__„
0.43eeq
E [,
❑
9.3 0.41
0.37 Bun Screen
❑ X❑
❑ x❑
_........... .—
..
❑ ❑
❑ D
11, El
❑❑
❑❑
n❑
--
- .- - --- --.._
- _ ❑ ❑
n ❑
---
' ❑ ❑
❑ ❑
Ll F-1
I ❑
_
❑ ❑
D ❑
❑ Q
❑
❑ ❑
El -11
El El
71 E-1
EnergyPro3.1 Bv_EnergySoR user Number. Job Number:,, . -
Pa e3 of 15
13
Hance: Residential
rt 2 2 2) CF -1 R
The Stade Residence Addition
EXISTING
(Package Q)
4!112004 _
"Onplect Trine
Date
HVAC SYSTEMS Note: Input Hydronic or Combined Hydronic data under Water Heating Systems, except Design Heating Load.
Distribution
Heatin Equipment Minimum
g q
Type (furnace., heat Efficiency
Type and'
Location
Duct or
Piping
Thermostat Location /
pump, etc.) (AFUE/HSPFXducts,
attic, etc.)
R - Varve
Type Comments
EXISTING TO BE USED
Cooling Equipment Minimum
Duct
Type (air conditioner, Efl7ciency
Location
Duct
Thermostat Location /
heat pump, evap. cooling) (SEER) '
(attic, etc.)
R -Value
Type Comments
EXISTING TO BE USED
WATER. HEATING SYSTEMSRated
1
Tank ,Energy Facts 1 Exterrial
Water Heater Water Heater.
Distribution # in
Input
Cap. or Recovery Standby Tank Insul.
Svstem Name Tvpe
Type . Svst. Btu/hr
-Value
(gal) Efficiency Loss (%) __R-Value-
EXISTING TO BE USED
1 For small gas storage (rated inputs of less than or equal to 75,000 stuthr), electric resistance and heat pump water heaters, list energy factor.
For large gas storage water heaters (rated input of greater than 75,000 Btulhr), list Rated Input, Recovery Efficiency and Standby Loss.
For instantaneous gas water heaters, list Rated Input and. Recovery Efficiency.
REMARKS __..._
.. ter ..
COMPLIANCE STATEMENT
This certificate of compliance I"ists the building features and performance specifications needed to comply with Title 24, Parts 1 and 6 of the
California Code of Regulations, and the administrative regulations to implement them. This certificate has been signed by the individual with
overall design responsibility. The undersigned recognize that compliance using duct sealing and TXV's requires installer testing and certifica
and fold verifica ' n by an approved HERS rater.
Designer or erBusines & P e n Code) Documentation.Author,'
Name: Name: Micah Combs _._...:..—_
Title/Firm: Title/Firm: ckEL4 YQNSULTING
Address: _.__.,,___.....,._...Y..- Address: .72;,925 FRED WARING, SUITE #2o4
r
PALM DESEft, CA 92260
Telephone: _; _.._ Telephone:.(7so_ 4s s9�
Lie. #: Fft
f - -, ,
(signature) (date)
Enforcement Agency ,
Name:
Title/Firm:....
Address:
Telephone: _
r ..
iEnergyPro3.1 . By EnergySoft User Number _
Job Number
i
data
Page.4 of 15
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