0307-386 (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
Vpate�fe/ Signature of Contractor -
�o
/// OWN ER-BUILDER'DECLARATION
f
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 1, 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 Coder-
( ) 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.
�.7 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 ST.4T g'• F111gT3 . Policy No. 229.0023566-71003
(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
workers' compensation laws of California, and agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I sh �I forthwi h comply wI those provisions.''-
d/Date�/,I �' APPlicant�� e''C� J 7✓�/IV, r
Warning: Failure to secure Workers'�t4A -4ation'eoverage4is 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 pu saan .to
any permit issued as a result of this applicaton agrees to, & shall, iinc�e'r�nlfy
hold, harmless the City of La Quinta, its officers, agents and enfp�l��o,YYees:
•°2. Any permit issued as a result of this application becomes null aT void if
work. is not commenced within 180 days from date of issuancLbuildin
h nj
permit, or cessation of work for 180 days will subject permit to ca.
I certify that I have read this application and state that the above infos
correct. I agree to comply with all City, and State laws relating to th�Fll
construction, and herebyauthorize �resentativesfof this City to enter upon
the.above-mentioned property for -inspection purposes.
Signature (Owner/Agent)' J 9 / _ Date��;/rr✓
BUILDING PERMIT .. PERMIT#
DATE ` VALUATION LOT TRACT
TRACT
r ' 1 %? '° 7,T 30 x'349
JOB SITt ' li
APN
ADDRESS 81..420 M-NOSTf3MMA
767-490-",�
OWNER
CONTRACTOR / DESIGNER / EN INEER
AUX & 34ADM CHAi9F.7,`
n7�RdySgcw DFW,.4QPM TT
IND.W11 WMLS CA 92210
(760)'173-.4487 CMWf 6645
USE OF PERMIT
ISIDE,bi 17AL AD73TA'F N
$00 SF ADDITION .tPI.,It. APPrZOVED PJANS,
FT{JDIVO.iV. SF
JES17wpC.ltG9.C-10S OF CQJ,'i6,.S:C4C/irTIOAY
PIUMUFFY S'CpMMe1RY
PLAN cmcr, FE
CONSTRi7CTION M, $271.50
MUCIIANIM4 FEE. 101.000.42 JL -000 323.E
.
PLttM6IN0 FZF ' lolrOf0419-000 $22,00
STR.0140 MOTION A ZX7 R _''VD 101-000-7,41-060 $2,172
93 PM.PAW1'.0.I0,t3t3
WEAL O47
L.i •T1I
J 1�4 2003
OF LA 61UINTA
LANCE DEPT
RECEIPT
DATEf
BN y
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
. BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air.
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
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
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVAL
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
OX for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
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)
COMMENTS:
Coaeheh' -Valley Unified School District
P.O. Box 847, Thermal, CA 92274
(760) 398-5909 — Fax (760) 39,14-1224
Project Name:
Owner's Name: . ALEX
Project Address: 81-1
Project Description:
' This Box For District Use Only
j DEVELOPER FEES PAID T`
AREA' AMOUNT �..UN
LEVEL ONE AMOUNT : LEVEL TWO AMOUNT: MITIGATION AMOUNT: COMM/IND
DATE: I RECEE'T: I CHECK #:
'i I
CERTIFICATE OF COMPLIANCE
(California Education Code 17620)
•i
I
Date:
1 NADINE CHAVE;
KINGSTON HEA'
I l uri
rNITIALS:
OCTOBER 13, 2003.
Phone No.
92253
APN: 767-490-030 {E Tract #: 29349-1 Lot #'s: 30
i
Type of Development: Residential —XXxxxCommercial Industrial
t
Total Square Feet of Building Area: 500 sq. ft.
I I
Certification of Applicant/Owners: The person signing certifies that the above information is correct and makes this statement
under penalty of perjury and further represents that he/sheis aul orized to 'gn on behalf of the owner/developer.
i
Dated: Signature: +
SCHOOL DISTRICT'S REQUIREMENTS FOR THE ABOVE PROJECT HAVE BEEN OR WILL BE SATISFIED IN
ACCORDANCE WITH ONE OF THE FOLLOWING: (CIRCLE ONE)
Education Code Gov. Code Project
17620 65995 Approval
Number of Sq.Ft. .500
Amount per Sq.Ft. $ 0
Amount Collected $
Building Permit Application Completed: Yes/No
By: Carey M. Carlson
Asst. Supt., Business Serv.
Certificate issued by:
Elvira-Mattson
ice lec
Agreement Existing Not Subject to Fee
Prior to 1/1/87 Requirement
Note: Any addition of 500 sq. ft. or less is
( exempt rom I. eve oper ees
Signature:
an
- NOTICE OF 90 DAY PEP'IOD FOR PROTEST OF FEES AND STATEMENT OF FEES
Section 66020 of the Government Code asserted by Assembly Bill 3081, effective January 1, 1997, requires that this District provide (1) a written notice to
the project appellant, at the time of payment of school tees, mitigation payment or other exactions ("Fees"), of the 90 -day period to protest the imposition of
these Fees and (2) the amount of the fees. Therefore, in accordance with section 66020 of the Government code and other applicable law, this Notice shall
serve to advise you that the 90 -day protest period in regard to such Fees or the validity thereof, commences with the payment of the fees or performance of
any other requirements as described in section 66020 of the Government code. Additionally, the amount of the fees imposed is as herein set forth, whether
payable at this time or in whole or in part prior to issuance of a Certificate of Occupancy. As in the latter, the 90 days starts on the date hereof. This
Certificate of Compliance is valid for thirty (30) days from the date of issuance. Extension will be granted only for good cause, as determined by the School
District, and up to three (3) such extensions may be granted. At such time as this Certificate expires, if a building permit has not been issued for the project
that is the subject of this Certificate, the owner will be reimbursed all fees that were paid to obtain this Certificate of Compliance.
MV:c/mydocs/devfees/certificate of compliance 09/30/02
,r
'CERTIFICATE OF COMPLIANCE: RESIDENTIAL
/11 111. a r-- — - _ nr• 1 i _ . A.,— — .. ••
Project: Title T.-
81-120 Pmgd s 1 LN
Project Address
Documentation Author
or Ccnnputer)
1 —.
Zone
e 1 of 3) , CF -IR
ja- off . '2003
ate
Building Permit o
Plan Check / Date
Field Check/ Date
GENERAL-INFORMATI N
Total Conditioned Floor Area Average Ceiling Height: _� ft
Conditioned Slab Floor Area fit
Building Type: Single family —4- Addition
(check one or more) Mull:i-Family Existing -Plus -Addition
Front Orientation: _�� //�/ South ! East / West / All Orientations
(input Ront orientation in degrees from True North and circle one)
Number of Stories
Number of Dwelling Units: i —
Floor Construction Type: Slab/Raised Floor (circle one or both)
RADIANT BARRIER (required in climate zones 2.4.8-15) Required for this submittal yes —no
BUILDING ENVELOPE INSULATION
Component Frame Type Cavity Sheathing Total R- Assembly Location/Comments
Type wd = wood Insulation Insulation Valuel U-Pactorl (attic, garage, typical, etc.)
stl = steel R Value R --Value
Wall
Wall
Roof -
AIN 94tr—
Roof
Floor
Floor
Slab Ed c
1r
--• •- -•• ---•-- •�•.... - .•u,na�cluuiv u-�cacluraFClK1LMQUI eO.rOTa WO0tr-tMMe0wait that meets cayit]/R Vfl1uC
insolation requirements for the Frescriintive Packnee-
FENESTRATION
Fenestration
#T - e/Pos.
Front
Orien- Area
tation�
s,
vv.a
Fenestration Fenestration Exterior Overhangs/
U -Factor SHGC ShadingAtt, Fins
...
front
Left
b�,®
--
Left
Rear
'� ,�
D • ,,_
r .-
Rear
�
�
Right
Ri ht
Sk li ht
Sk li ht
CITY OF LA QUINTA
7`RRROVED
FOR CONSTRUCTION
DATE - 0' 03BY
t � f
CERTIFICATE OF COA IPLIANCk: RESIDENTIAL
(Page 2 of 3)
CF-
SEER,
Heating
Project Title
'
Date
04,C)
HVAC SYSTEMS .i
M��1
Note: Input hydropic or combined hydropic data under Water H6ting Systems, except Design Heating Load.
Distribuion
Heating Equipment Minimum Type and Duct or
WATER HEATING SYSTEMS
Heat Pump
Type (furnace, heat Efficiency Location Piping Thermostat
Configuration
munn. etc.) (AFUE orHSM (ducts. attic: etc.1 R Value
Tvne
(gnlit nr nneknoel
Cooling Equipment Minimum 4 Heat Pump
Type (air conditioner, ` Efficiency Location Duct Thermostat Configuration
DXF-1.-.. T__....
SEALED DUCTS and TXVs Lor Alternative Measures
U Sealed Ducts (nit climate zones)
(installer testing and certification and HERS rider field verification acquired)
I
U TXVs, readily accessible (climate zones 2 and 8-15 only)
(Installer testing and certification and HERS Rater or field verification required)
U Refrigerant Charge/Air Flow (climate cones 2 and 8-15 only)
(Installer testing and certification and HERS Rater or field verification required)
OR
Alternative to Sealed Ducts and TX`fs (see Package C or D Alternative Package Features for Project Climate Zone)
Climate .Zone
Window SHGC
Window U -Factor
SEER,
Heating
04,C)
13-0
M��1
f
WATER HEATING SYSTEMS
Energy'
External
Rated'
Tank
Factor or
Tank
Water Heater
Distribution i
Number Input (kW
Capacity
Recovery
Standby' Insulation
Type
Tvpe
in Svstem orBttAr)
(stations)
Efficienev
Loss (a/o) R -Value
1. For small gas storage water heaters (rated inputs of less than or cgdal to 75,000 Btulhr), electric resistance, and heat pump water heaters, list Energy
Factor. For large gas storage water heaters (rated input of greater than 75,000 Btu/hr), list Rated Input, Recovery Efficiency and Standby Loss.
For instantaneous gns water heaters, list rated input and recovery cificicneics. R
SYEGIAAL FEATURES (add extrasheets if necessary). Pacltage C and D: TXVs, Sealed Ducts, Radiant
Harriers (see installation requirements for radiant barriers in Section 8.13 of the 200IResidential Manual).
Package Ce thermal )mass (thermal mass type, covering, thickness, and description).
�'�•�.�� MSF'- (�. :ASO g�b1D��71,R� Wl�i�y L-
�'i
Compliance Forms ^t 4ugust 2001 A-3
CERTIFICATE OF COMPLIAN
Project Title q
CMLIANCE STATEMYNTIf'
: RESIDENTIAL (Page 3 of 3
Date
CF -IR
This certificate of compliance lists the building featyres and performance specifications needed to comply with
Title 24, Parts'1 and 6 of the Califomia Code of Regulations, and the administrative regulations to implement
them. This certificate hag been signed by the individual with overall design responsibility. When this certificate
of compliance is submitted for a single building plat to be built in multiple orientations, any shading feature that
is varied is indicated in the Special Features/Remarks section. The undersigned recognize that compliance using
duct sealing and TXVs requires installer testing and ;certification and field verification by an approved HERS
rater.
Designer or Owner (per Business
u�siin(e�s�s�and Professions Cbde) Documentation Author
Name: __I)ua Name: jwbz % g ff
Titleffim: SM. �tyt40 r ,
Address: 44M Address;
Fkw
Telephone:�10U-•yo-I V. t-10 � .' Telephone: 10 • ! .V
Lic: M 56(
1
(signature)
Enforcement Agency
Name:
T:�1...
Agency:
Telephone:
(date) (signature)
(signature / stamp) (date)
(date)
ii
4
Compliance Forms Awgust 2001 A-4
i •
assessing how a proposed design compares to this package of features. More detail on
each of the requirements follows later in this chapter.
Table 3-1- Summary of Package D Requirements
1
2
3
4
5
16
7
8
9
10
11
12
13
14
15
16
BUILDING ENVELOPE
insulAtion minimums
Ceiling
R38
R30
R30
R30
R30
R30
R30
R30
R30
R30
R38
R38
R38
R38
R38
R38
Walls
R21
R13
R13
R13
R13
R13
R13
R13
R13
R13
R19
R19
R19
R21
R21
R21
"Heavy mass" walls
R4.76
R2.44 R2.44
R2.44
R2,44
R2.44
R2.44
R2.44
R2.44
R2.44
R4.76
R4.76
R4.76
R4.76
R4.76
R4.76
Below -grade walls
RD
RO 'i
RD
RD
RQ
RO
RD
RD
RD
RD
RD
RD
RD
RD
R0
R13
Slab floor perimeter
NR
NR
NR
NR
NR+
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
R7
Raised floors
R192
R192
R192
8192
R1t1,2
R192
8192
R192
R102
R102
R192
R192
R192
R192
R192
R192
Concrete raised Floors
R8
R8:
RD
RD
R01
i
RD
i
RD
R0
RD
RD
R8
R4
R8
•118
R4
R8
Radiant Barrier
NR
REQ
NR
REQ
NRi
NR
NR
REQ
REQ
REQ
REQ
REQ
REQ
REQ
REQ
NR
GLAZING
�i
!
Maximum U -factor'
0,65
0.65
0.75
0.75
0.7ii
0175
0.75
0.75
0.75
0.65
0.65
0.65
0.65
0,65
0,65
0,60
Maximum total area
16%
16%
20%
20%
16°
20%
20%
20%
20%
2D%
16%
16%
16%
16%
16%
16%
Solar Heat Gain Coefficient`
t
South -facing glazing
NR
0.40
NR
0.40
NRI
NR
0.40
0.40
0.40
0.40
0.40
0.40
0.40
0.40
0.40
NR
West -facing glazing
NR
0.40
NR
0.40
NR
NR
i
0.40
0.40
0.40
0.40
0.40
0.40
0.40
0.40
0.40
NR
East -facing glazing
NR
0.40
NR
0.40
NA
NR
0.40
0.40
0.40
0.40
0.40
0.40
0,40
0.40
0.40
NR
North -facing glazing
NR
0.40
NR
0.40
NR
NR
0.40
0.40
0.40
0.40
0.40
0.40
0.40
0.40
0,40
NR
THERMALMASSs
NR
NR
NR
NR
N�l
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
SPACE -HEATING SYSTEM°
Electric -resistant allowed
No
No
No
No
Noi
No
No
No
No
No
No
No
No
No
No
No
Ifgas, AFUE =
MIN
MIN
MIN
MiN
MIN
M'IN
MIN
MIN
MiN
MIN
MIN
MIN
MIN
MIN
MIN
MIN
If heat pump, split system HSPF° =
MIN
MIN
MIN
MIN
MIN
MIN
MIN
MIN
MIN
MIN
MIN
MIN
MIN
MIN
MIN
MIN
Single package system HSPF =
MIN
MIN'
MIN
MIN
Ml1
MIN
MIN
MIN
MiN
MIN
MIN
MIN
MIN
MIN
MIN
MIN
SPACE -COOLING SYSTEM
If split system AIC, SEER = MIN MIN MIN MIN MIN MIN MIN MiN MIN MIN MiN MiN MIN MIN MIN MiN
Refrigerant charge and alrflow NR RI3Q-„ NR NR NRI . NI NR REQ" REQ' kEQ- REQ" REQ" REQ' REQ' REQ- NR
testing or TXV
If single package A1C, SEER = MiN MIN ' MIN MIN MIN MIN MIN MIN MIN MIN MIN MIN MIN MIN MIN MiN
SPACE CONDITIONING DUCTS
Duct Sealing REQ` REQ- REQ'REQ" REG- REQ` REQ- REQ- REQ- REQ- REQ- REQ- REQ- REQ- REQ- REQ -
DOMESTIC WATER -HEATING
TYPE (System must meet budget,
see §151 (4) 1 and (08 and Any. Any- Any Any Any Any Any Any Any Any Any Any Any Any Any Any
Tables 3-14 to 3-17) {' 1
HERS rater field verification and diagnostic testing are required f sr thlsifeature. As an alternative under Package D, better glazing and higher
efficiency equipment can be used Instead of the diagnostic testing of air distribution ducts, split system air conditioners and heat pumps, See
Table 3-2 for the Increased values, which vary by climate.
NR = Not Required REQ = Required " MIN = Minimum ^
I
I,
I
3-2 Augu�t 2Q01 Residential Manual
I
'I '
Alternative to The base Package D requires that a HERS rater come to the building house (at least for
Package D a sample of the homes) and perform diagnostic testing to verify that the air distribution
ducts are properly sealed and that split system air conditioners or heat pumps either have
the proper refrigerant charge and the proper airflow across the evaporator coil or have a
thermostatic expansion valve. If the builder does not want to do the field verification and
diagnostic testing, then an alternative set of requirements are available that require more
energy efficient fenestration and space conditioning equipment (see Table 3-2).
Table 3-2 - Summary ofA/ternative to Package D Requirements
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
Window U 0.55 0.40 0.55 0.40 0.55 0.55 0.40 0.40 0.40 0.40 0.40 0.40 0.40 0.40 0.40
0.55
Window SHOC NR 0.35 NR 0.35 NR NR 0.35 0.35 0.35 0.35 0.35 0.35 0.35 0.30 0.30
NR
SEER MIN MIN MIN MIN MIN MIN MIN MIN 11.0 11.0 11.0 11.0 12.0 12.0 13.0
MIN
AFUE or 90 MIN MIN MIN MIN MIN MIN MIN MIN MIN MIN MIN MIN MIN MIN
90
HSPF 7.6 MIN MIN MIN MIN MIN MIN MIN MIN MIN MIN MIN MIN MIN MIN
7.6
Note: These are alternative Package D prescriptive requirements. If these performance levels are provided, the requirements shown in Table
3-1 with an asterisk are not required. These include diagnostic testing of air distribution ducts, refrigerant charge and airflow and field
vertFlcatlon of a thermostatic expansion valve.
Figure 3 -1 -
California Climate
Zones
Residential Manual August 2001 3-3