0303-179 (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
Date 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:
(d) 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 �r • ? rn., 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:
Cartier Policy No.
(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 shall forthwith comply with those.provisions.
',Date: r Applicant
�Warning: Failure 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) Date
BUILDING PERMIT
DATE VALUATION LOT
JOB SITE
ADDRESS 51-48011 E14TQ, A 01M( 01\
OWNER
PERMIT # " ' .
J) 55 '4 .303--.1' 19 TRACT PA��yy L �e
APN
CONTRACTOR/DESIGNER/ENGINEER
51 X1.80 AlY`lO:C 1A lMRIi:GON
L.A QtWfA CA 125:a
7
USE OF PERMIT
F:I�. �3)WTLA1.. ADDITION
83 '3F AT)INTION PER APPROVED P -ANIS,
.ADDIT)OPd
83.00 8F
PLAN CHECK FEE 101-000-439.318 $46.80
CONSTR.11CTION ME 101-000-A 18-000 $72.00
ED.WITRIC al, Fa 101.000.420-000 $18.00
PLUMI S O40 JTK9 101-000-419--000$1€',. Do
STRONG MOTION PEE - RESID3 t - -' 09
[:MAR �1:4
2003
CITY OF LA QUiNTA
CBLf$
7.' ,
SIJB-TOTALCO�fUrPUCq-IOAT.At±f-)'PLAly C°;BFPK $155.30
IMS PFR -PAD IWSn
e
TOTAL R)?`.IZXIUTFETS . .9 NOW
RECEIPT DATE / BY DAT )r FINALD INSP O
/iAZ 7G
i
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
/
Ducts
Slab Grade
l
Return Air
Steel
Combustion Air
Roof Deck
3
Exhaust Fans
O.K. to Wrap i
F.A.U.
Framing
��
Compressor
Insulation
- Q
Vents '
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali 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 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
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit i
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
_G.F.I.
Smoke Detectors
Temp. Use of Power ;
Final i
UtilityNo ice (Perm)
COMMENTS:
OWNER/ BUILDER INFORMATION
Dear Property Owner:
An application for a building permit has been submitted in your name listing -yourself as the builder of the property
improvements specified.
For your protection you should be aware that as "Owner/BIuilder" you are. the responsible party of record on such a
permit. Building permits are not -required to be signed.by property owners.,unless they are personally performing their
own work. If your work is being''performed-by someone other than yourself, youmay protect yourself from possible
liability if that.perse6appliesfor the proper permit in. his or her name.
Contractors are required bylaw, to be licensed`and'bonded by the State of California and to have a business license
from the.'City or'County. °They are also required by law to, put .their license number` on all permits for which they
Apply.
If you plan to, do your own work, with'the exception of various trades that you plan to`subcontract, you should be
aware of the following information for your benefit and protection:
If you employ or otherwise engage anypersons otherthan: your. immediate family, and the work (including materials
and other costs) is $200.00"or. more' -for the entire project, andsuchpersons are not licensed as contractors or
subcontractors, then you may be an employer.'
w
If you are an employer, you must register with the State.and Federal Government as. an employer and you are subject
to several obligations: including State `and Federal. income taxwithholding,' federal social security taxes, worker's
compensation insurance, disability insurance costs and unemployment'ompensation,,contributions.
There may. be financial risks fo"r you if you,do not carryout these obligations; `and These risks are especially serious with
respect to worker's compensation insurance. -
For more specific information about your, obligations under Federal Law, contact the Internal Revenue Service (and, if
you wish, the U.S. Small Business Adminstration)-For more specific itiformation about your obligations under State
Law, contact the Department of Benefit`Payments grid the Division of Industrial Accidents.
If the structure is intended for sale, property owners ;who are' not licensed contractors are allowed to perform their
work personally or through their own employees, -without a;licensed contractor or subcontractor, only under limited
conditions.
A frequent practice of unlicensed persons professing to be contractors,is to'seeure an• "Owner/Builder" building
permit, erroneously implying that the property owner is providing hi- .or her, own labor and material personally.
Building permits are ,not required to be` signed by "property owners.uriless they are:,performing their own work
personally.
Information about licensed contractors•may be obtained by contacting the Contractors",,State'License Board in your
community or at 1020 N. Street, Sacramento, California 95814.
Please complete and return the enclosed owner -builder verification form so that we can confirm that you are aware of
these matters. The building permit will not be issued.until.the verification is returned.
Very truly yours,
CITY OF LA QUINTA
DEPT. OF BUILDING AND SAFETY
78-495 Calle Tampico
La Quinta, CA 92253
(760)777-7012
FAX (760) 777-7011
OWNE ' SIGNATURE/ DATE'
PROPERTY ADDRESS
PERMIT NUMBER(s)
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Notes: 0
I. Additions for any si: P Or size twinge COMM can also use prewiptive requi a ments listed in any column to
the d 9M as tong as 80 rek;ubemerts In the chosen column are met.
2- Meas shown in gray a a the Package D regertremwft teat apply o additions M the same manner as they
apply to now constructlon. Far if MPAMMOMS. either the Standard Package 0 6 the Alternative to
Patdmge D may be used (see Table 3-M.
3. 'Heavy Mase• and Uhl Mass• wells may meet the Package O requirements for mass wall Insulation
Instead of R-13 (see Table 3-1).
4. The rade» t barrier requirement only applies to the addition roof area. it is not neoessary to mb otlt a radiant
barrier in.the existing atttc.
5. Dual -glazed greenhouse windows and duftlazed skylights are assumed to meet the applicable U-fektor
regeriranerds.
6. This approach does not allow credit for glass removed. As described in Note 1, compliance with all the
requirements fbr the column for addimons of fess than 500 square feet is allowed, In which case credit for
glazing removed is allowed.
T. Glazing area Is limited to the Package O faneshaffon was plus the area of any glazing removed because of
the addition.
e. When heath andW coollng will be etiended to an addition from the exkstng system(sl the exisfmg
egedpmwd reed not comply w8h Ti>e 24. Part S. The healing systan capacity must be adequate to most
the mlhtlmean requirements of t18C Section 3110.111. foto electric restsfanos space heaft may be Installed.
9 The requhemams 1br testing reWg charge and aM ww (or brsW ft a 0mmosta8c eepaestah waive
OXV)) apply only ff e new split system air cbrsdittaner or heat pump la his as part of the addition. if a
sepaeafa efi dlsbtbution system Is histgged for the addillm been tidy new sysiam must be tested and sealed
to have a fess than cf equal to fk% of the fain aaVan existing airdishibutlen system is
edertded to serve ft addition, fhls too must be tes;04 but ilia tested target duct leakage depends on the
stae of the addWOn and other 0 - I r q domed. in Section 7,2.3. Detern*" the Target Percent Leakage.
In Rau of tesling duct leakage and n twd dnatge and ai raw (or insta1ing and v efflyt eg a TXV). the
buildercan douse Hearer ilia Aft"udwe tot D r nervtr SwTalde 3 2.
10. When the Alternative to Package D is used for addrdore of 500 fp or less, the fenestration U -factor and
SHGC afteda of the Alternative tc. Package O must be met See Table 3-2 for a summary of the
requfremenls.
11. When replacing a central air conditirneer that serves both the addition and existing building, the replacement
Is an alteraiims and must meet the reWk8 rents described in 7.52, New Space Conditioning Eclub menL
Resfdentfal Manual August 2001 7-7
10TI
Table 7-2 —
sae Of AdcOmr
Prescrlpfhre
Less then 600 iF
Less then 1,000
Requirements for
Component
Ion Iwo (1)
(1)
w (1)
All Additions (1)
Additions
Ceiling insulation
R-19
Package D (2)
Package D (2)
Package D (2)
Wall Insulators (3)
R-13
R-13
R-13
Package D (2)
Floor Insulation
R-13
Package D (2)
Package D (2)
Package D (2)
Fenestration U- factor (5)
0.75(1())
0-75(10)
Package D (2)
Package D (2)
Glaring
< 50 (8)
Package + Glass
Package + Glass
Package D (2)
Area
Removed(7)
Removed (l)
Solar Heat Gain
Package D (2)
Package D (2)
Package D (2)
Package D (2)
Coefficient (SHGC)
Radiant Barriers (4)
WA�
Package D (2)
Package D (2)
Package D (2)
Space Heating 6 Cooling (8)
Man
PadkagoO (2)
Package D (2) .
Packaga D (2)
Refrigerant Charge and,
N/Ajj
Package D (2)
Package D (2)
Package D (2)
Airflow (or TXV) (9)
Duct Sealing (9)
WA�
Package D (2)
Package D (2)
Package D (2)
Water Heater Replacement
WAX
WA
WA
NiA
Add Water Heater
Sealable 7-5
See Table M
See Table 7-5
See Table 7-5
Notes: 0
I. Additions for any si: P Or size twinge COMM can also use prewiptive requi a ments listed in any column to
the d 9M as tong as 80 rek;ubemerts In the chosen column are met.
2- Meas shown in gray a a the Package D regertremwft teat apply o additions M the same manner as they
apply to now constructlon. Far if MPAMMOMS. either the Standard Package 0 6 the Alternative to
Patdmge D may be used (see Table 3-M.
3. 'Heavy Mase• and Uhl Mass• wells may meet the Package O requirements for mass wall Insulation
Instead of R-13 (see Table 3-1).
4. The rade» t barrier requirement only applies to the addition roof area. it is not neoessary to mb otlt a radiant
barrier in.the existing atttc.
5. Dual -glazed greenhouse windows and duftlazed skylights are assumed to meet the applicable U-fektor
regeriranerds.
6. This approach does not allow credit for glass removed. As described in Note 1, compliance with all the
requirements fbr the column for addimons of fess than 500 square feet is allowed, In which case credit for
glazing removed is allowed.
T. Glazing area Is limited to the Package O faneshaffon was plus the area of any glazing removed because of
the addition.
e. When heath andW coollng will be etiended to an addition from the exkstng system(sl the exisfmg
egedpmwd reed not comply w8h Ti>e 24. Part S. The healing systan capacity must be adequate to most
the mlhtlmean requirements of t18C Section 3110.111. foto electric restsfanos space heaft may be Installed.
9 The requhemams 1br testing reWg charge and aM ww (or brsW ft a 0mmosta8c eepaestah waive
OXV)) apply only ff e new split system air cbrsdittaner or heat pump la his as part of the addition. if a
sepaeafa efi dlsbtbution system Is histgged for the addillm been tidy new sysiam must be tested and sealed
to have a fess than cf equal to fk% of the fain aaVan existing airdishibutlen system is
edertded to serve ft addition, fhls too must be tes;04 but ilia tested target duct leakage depends on the
stae of the addWOn and other 0 - I r q domed. in Section 7,2.3. Detern*" the Target Percent Leakage.
In Rau of tesling duct leakage and n twd dnatge and ai raw (or insta1ing and v efflyt eg a TXV). the
buildercan douse Hearer ilia Aft"udwe tot D r nervtr SwTalde 3 2.
10. When the Alternative to Package D is used for addrdore of 500 fp or less, the fenestration U -factor and
SHGC afteda of the Alternative tc. Package O must be met See Table 3-2 for a summary of the
requfremenls.
11. When replacing a central air conditirneer that serves both the addition and existing building, the replacement
Is an alteraiims and must meet the reWk8 rents described in 7.52, New Space Conditioning Eclub menL
Resfdentfal Manual August 2001 7-7