09-0816 (RER)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA,. CALIFORNIA 92253
Application Number: 09-00000816
Property Address: 52952 AVENIDA OBREGON
APN: 773-315-016-10 -000000-
Application description: REMODEL - RESIDENTIAL
Property Zoning: COVE RESIDENTIAL
Application valuation: 2000
Applicant: Architect or Engineer:
0-14
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING. PERMIT
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 Class: License No.: '
Date: Contractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from_:the Contractor's State License Law for the
following reason (Sec. 7631.5, Business and Professions Code: Any city or county that requires a permit to
construct, alter; improve, demolish, or repair any structure, prior to itsissuance, also requiresthe applicant for the
permit to.file a signed'. statement thabhe or she is licensed pursuant.to the provisions of the Contractor's State
License Law (Chapter 9 (cornmencing with Section 7000) of Division 3 of the Business and Professions Code) -or
that he or sheds 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 civil penalty of not more than five hundred dollars ($500).:
1 _✓) I, as owner of.theproperty, 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 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 far the purpose of sale.). -
(as owner of the property;'am:`ezclusively'"contracting with licensed contractors toconstructthe 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 contractorls) licensed
pursuant to the Contractors' State License Caw.).
() I am exempt under Sec. , B.&P.C. for this reason
CO RUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that-115ere 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:
LQPERMIT
Owner:
HUBBARD LEO
7548 OLD SANTA FE
SANTA FE, NM 87505
(760)238-2764
Contractor:
Owner'.
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
M
------------------
WORKER'S COMPENSATION DECLARATION
Date: 7/29/09
I hereby affirm under penalty of perjury one of the following declarations:
_ I have and will maintain a certificate of consent'toself-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. -
1 haveand.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 and. policy number are:. -
Carrier - - - - - - =- - - - - - -- -- ---r-Policy Number
certify that, in -the performance ofthework 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.
d
•WARNING`. FAILURE.TO SECURE S' COMPENSATION.COVERAGE'IS UNLAWFUL, AND SHALL
SUBJECT AWEMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100;000). IWADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR -IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.' -
APPLICANT ACKNOWLEDGEMENT
,IMPORTANT Application is hereby made to the Direct6i of -Building and Safety for a 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 applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La Quinta, its officers, agents and employees for any act or omission related to the work being
performed under or following issuance of this permit.
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 county ordinances and state laws relating to building construction, and hereby authorize representatives
of this county to enter upon the above-mentioned property for inspectio urposes.
Oati - e_ -Z-�?1%3 V,�Signature•fApplicant•or-Agent):
Application Number . . . . . 09-00000816
Permit . . . BUILDING PERMIT
Additional desc .
Permit Fee . . . . 45.00
Plan Check Fee
29.25
Issue.Date . . . .
Valuation . . .
. 2000
Expiration Date 1/25/10
Qty Unit Charge Per
Extension
BASE FEE
15.00
15.00 2.0000 HND BLDG 501-2,000
30.00
----------------------------------------------------------------------------
Special Notes and Comments
WINDOW AND DOOR CHANGE OUT (4) DOORS
6'
X 7'; (2)WINDOWS 6' X 3'; (1) 3'X 3!
PER
APPROVED PLANS & A.J.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG
STDS ADMIN (SB1473)
1.00
ENERGY
REVIEW FEE
2.93
Fee summary Charged Paid
---------------------------
Credited
Due
----------
Permit Fee Total 45.00
--------------------
.00 .00
45.00
Plan Check Total 29.25
.00 .00
29.25
Other Fee Total 3.93
.00 .00
3.93
Grand Total 78.18
.00 .00
78.18
LQPERMIT
Bin #
7777 M
City 6f La. Quetta
0 ..
-Building W SafOtYbtyfflon
P.O. Box I'504, 78-495:Calle Tampico
La Quinta, CA 92253. (760')2777-7012
Building. Permit Ap pl!ea tion an d'T.ra ckin Sheet
Permit #
Project Address:
Owner's :Naim :.
A. P. Number: 0 [G —7
Legal Description: -�Tjp\ 02-C)
6ty, ST,,Z' ip': S/� KIM F: E 7 5
Contractor:
Telephone:,-,-: 11.
Address:
Project Description: -6:ur W i,.il,
City, ST, Zip:US,
04)
Telephone:
.... . ...... . . . . . . . . . . . . . . .
State Lic. #
City Lic. #..
Arch., Engr., Designer:
Address -
City., ST, Zip:
Telephone:
. . . . . . . . . . . . .
.
�'.Constructic�nType: Occupancy:
.,P�dject type (cjile one):. New� Add'n Alter Repair Demo
State Lic.
Name of Contact Person:
t.;
Sq- Ft.:
# Stori ies:
#Units:
Telephone #,of Contact Person: 25 2 7
Estimated ValueofProject
APPLICANT: DO NOT. W.RIT.E.,13ELOW THIAIWNE
Submittal.
Req' d
Rec!d
TRACIONG,
PERMIfi FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
'truss Cales.
Called Contact Person
Plan Check Balance.
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan .
2". Review, ready for. corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up.
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
3rd
Reyiew,.ready'for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
`Total Permit Fees
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CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
DATE 1 By'
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CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 1 of 4) CF -1R
Project Title t Date
52
Project Address ,� _ Building Permit a
Documentation
Compliance Method (Prescriptive)
Telephone ' '." Plan Check/ Date
Field Check / Date
Climate Zone Enforcement Agency Use Only
✓ ❑ Alternative Component Package Method: (check one) C D D (Alternative)
Package C and Package D choices require HERS rater field verification and/or diagnostic testing (see CF -1R page 3)
For Package D Alternative see Appendix B Table 151-C Footnotes 7-14
GENERAL INFORMATION
Total Conditioned Floor Area (CFA) ftZ Average Ceiling Height: ft
Maximum Allowed West Facing Fenestration Products PerTable 151-B or 151-C ---- (5% X CFA) ft2
Maximum Allowed Total Fenestration Products Per Table 151-B or 151-C ---- (20% X CFA)
✓ ❑ Building Type: (check one or more) Single Family Multifamily Addition Alteration
(If adding fenestration fill out WS -411, Fenestration Maximum Allowed Area Worksheet and see Section 8.3.2
for Additions and 8.3.3 for Alterations.)
Number of Stories: Number of Dwelling Units:
Floor Construction Type: Slab/Raised Floor (circle one or both)
Front Orientation:_ North / South /.East /. West / All Orientations (input front orientation in degrees from True
North and circle one).
✓ ❑ RADIANT BARRIER (required in climate zones 2, 4, 8-15)
OPAQUE SURFACES INCLUDING OPAQUE DOORS
Component
Type (Wall,
Roof, Floor, .
Slab Edge,
Doors)
Frame
Type Cavity
(Wood Insulation
or Metal) R -Value
Assembly. U -
factor (for
Continuous wood, metal
Insulation frame and mass
R -Value assemblies)'
Joint
Appendix
IV
Reference
Roof Radiant
Barrier Location/Comments
Installed (attic, garage,
Yes or No typical, etc.
1) See Joint Appendix IV in Section IV.2, IV.3 and IVA, which is the basis for the U -tactor criterion. U -tactors can not
exceed prescriptive value to show equivalence to R -values.
Residential Compliance Forms
CITY OF LA QUINTA
BUILDING & SAFETY, DEPT.
APPROVED
FOR CONSTRUCT
I N
DATE 8Y
March 2005
FENESTRATION - MAXIMUM ALLOWED AREA WORKSHEET WS -4R
Project Title
Date
FENESTRATION PRODUCTS - NEW CONSTRUCTION- NEW.BUILDINGS
Use this table for new building construction to account for total building.% of,fenestration.
A
B
C
D
E F
G
#/Type/Pos.
(Front, Left,
Rear, Right,
Skylight)
Orientation
Total
Fenestration,
West Facing
Area(ft2)
Total Fenestration
for N, S, E
Orientations Area
(ftZ
Total Percent of
CFA West Facing.
Z @QFeti4 1k4eludifig
( K 0 0
Total % of
Fenestration
3A est
0°/ + F
North
North
Proposed
. Installed
Orientation
Proposed
Installed
New Area
(ft2).(C-E+G)
Total Net
Fenestration
(ft2)
BUILDING & SAFETY
PR'O
FC R CONSTRU
DEPT.
ED..
TION
North
I
South
East
East
164
Wet
West4
"j
South
South
'2: '
' zo
Totals
East
I I
East
— 12
1) If west facing area exceeds 5% of CFA in climate zones 2, 4' and 7-15, t
2) If total percent of fenestration exceeds 20% including West facing orientations then performance approach must be used. West
facing area includes skylights tilted to the west or tilted in any direction when the pitch is less than 1:12 for Package D only.
FENESTRATION PRODUCTS - NEW CONSTRUCTION- ADDITIONS
✓ [Less than 100 ft2, ❑ Less than or Equal to 1000 ftZ, ❑.Greater 1000 ft2
A B
C D
E
F
G
H
#/Type/Pos.
( Front, Left, Orientation
Rear, Right, N, S, E, W
Skylight)
Addition's'
Addition's New
i 2
CFA Fenestration
Area ftZ
Fenestration
Area Removed to
make way for(p
Addition ft
Total Area
Fenestration
+ E)
Total % of
West Facing
Fenestration
(F/C)x100%
Total % of
Fenestration
(F/C)x100%
North
Removed
Area
(ft2)
Proposed
. Installed
Orientation
Proposed
Installed
New Area
(ft2).(C-E+G)
Total Net
Fenestration
(ft2)
Total %of Z
Fenestration
H / A .
Max of 20%
South
North
I
North
East
' '
164
West4
"j
South
South
'2: '
' zo
East
East
I I
East
— 12
West
Total
`
West
1) Additions that add less than 50ft2 of fenestration area are exempt from the maximum total area limits. See Table 8-2 in RM.
2) If the addition has a floor area equal to or less than 1,000 ft', the maximum allowed fenestration % may be increased to by the,
amount of glazing removed in the wall that separates the addition from the existing'house. See Table 8-2 in RM.
3) If the addition has a floor area greater than to 1,000 ft', must meet Package D requirements. See Table 8-2 in RM.
4) West facing area includes skylights tilted to the west or tilted in any direction when the pitch is less than 1:12 for Package D.
FENESTRATION PRODUCTS: ALTERATIONS
Use this table for alterations to an existing building where fenestrations products (windows) are being removed and/or added.
A
B
C
D
E
F
- G.
H
I
CFA
Existing
Orientation
Existing
Area
Z
(ft)
Removed
Orientation
Removed
Area
(ft2)
Proposed
. Installed
Orientation
Proposed
Installed
New Area
(ft2).(C-E+G)
Total Net
Fenestration
(ft2)
Total %of Z
Fenestration
H / A .
Max of 20%
North
I
North
North
' '
164
South
"j
South
South
'2: '
' zo
East
East
I I
East
— 12
West
West
C5
West
0
2
Total
2r-7 Co
Total
'L 7j
Total
1) When 50 ft2 or more of fenestration area is added to an existing building; then the fenestration must meet the requirements of
Package D. The area requirement for the total fenestration. area for the whole building, including the added fenestration, must not
exceed 20% otherwise the Performance Approach must be used. Note: The 5% west facing limit is exempt. See Section 8.3.3 in
the RM for further details.
Residential Compliance Forms March 2005
P.O. BOX 1504
LA QOINTA, CALIFORNIA 92247-1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA "92253
BUILDING & SAFETY DEPARTMENT
PROPERTY OWNER'S PACKAGE
(760) 777-70.12
FAX (760) 777-7011
Disclosures & Forms for Owner -Builders Applying for Construction Permits
.04PMANT! NOTICE TO PROPERTY OWNER
Dear Property Owner.
:Ari. application--for--a building permit has been submitted in your natne listing yourself as the builder of the ,property
improvements specified at
We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to make you aware of your
responsibilities and possible risk you may incur by having this permitissued inyour name as the
Owner -Builder. We will not issue a building.permit until you -have read, initialed your understanding of each'provision,
signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice
unless you, the property owner, obtain the prior approval of the permitting authority.
OVMER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
DIRECTIONS: Read and initial each. statement below to signify you understand or verify this'information.
1,I understand a frequent practice of unlicensed persons is to have the property owner obtain an. "Owner -Builder''
b7ilding permit that erroneously implies that the property owner is providing his or her own labor'and material personally. I, as
an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person
and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those
injuries. I am willfully acting as.an Owner -Builder and am aware of the limits of my insurance_ coverage for injuries to workers
'on my property.
4�_2. 1 understand building permits are not required to be signed by property owners unless they are responsible for the
struction and are not hiring a licensed Contractor to assume this responsibility.
3. 1 understand as an "Owner -Builder" I am the responsible:party of record•on the permit..I understand that I may protect
If from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my
own.
C4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on
permits and contracts.
C5. I understand if I employ or otherwise engage any persons- other than California licensed Contractors, and the total value
of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer"
under state and federal law.
-6. I understand if I am considered an "employer" under state and federal law, I must register with the state and federal
government, withhold payroll taxes, provide workers' compensation disability insurance, and' contribute to unemployment
compensation for each "employee." I also understand 'my failure to abide by these laws may subject me to serious financial
risk.
Q7. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential
strucccttures cannot .legally build them with the .intent to offer them for sale, unless all work is performed by licensed
subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed
under contract with a licensed general building Contractor.
�8. I understand as an Owner -Builder if I.sell the property for which this perrrut is issued, I may be held liable for any
`fivaficial or personal. injuries sustained by any subsequent owner(s) that result from any latent construction defects in the
workmanship or material`s.
49. I understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue
er `ce, the United States Small Business Administration, the California Department of Benefit Payments, and the California
Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CS -1,B) at 1-
800-321-CSLB (2752) or www.csib.ca.gov for more information about licensed contractors.
10. I am aware of and consent to an. Owner- Builder building permit applied for in my name, and understand that I am the .
legally and financially responsible . for proposed construction activity at the following address:
1 LI agree that, as the party. legally and ftnaticialiy responsible for this proposed construction activity, l will abide by all
applicable laws and requirements that govern Owner -Builders as well as employers.
12. I agree to notify the issuer of this form immediately of any additions; deletions, or changes to any of the information I
ve provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with
someone who does not have a- license,. the Contractors' State License Board may be unable to assist you with any financial loss
you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in'civii court- It is also
important for you to. understand that if an unlicensed Contractor or employee of that individual or firm is injured while working
on your property; you may be held liable for damages. If you obtain a permit as Owner -Builder and wish to. hire Contractors,
you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers'
compensation insurance coverage.
Before a building permit can be issued, this form must be completed and signed by the property owner and returned to
the agency responsible for issuing; the. permit. Note: A copy of the property owner's driver's.license, form notarization, or
other verification acceptable to the agency is required to be presented when the permit is issued to verify the property
owner's signature.
Signature of property ownDate:
Note: The following Authorization Form is required to be completed by the property owner only when designating
an agent of the property owner to apply for a construction permit for the Owner -Builder.
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the Notice to Property Owner, the execution of which I understandis my personal responsibility, I hereby authorize
the following person(s) to act as. my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner -Builder
Permit for my project.
Scope of Construction Project (or Description of Work):
Project Location or Address:
Name of Authorized Agent:
Address of Authorized Agent:
Tel No
I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above
information and certify its accuracy. Note: A copy of the owner's driver's license, form notarization, or other verification
acceptable to the agency is required to be presented when the permit is issued to verify the property owner's signature..
Property Owner's Signature: Date: