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10-0024 (RER)P.O. BOX 1504 VOICE (760) 777-70.12 78-495 CALLE TAMPICO `' FAX (760) .777-7011 LA QUINTA, CALIFORNIA. 92.253 BUILDING 8c SAFETY DEPARTMENTINSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 1/11/10 Application Number..r10=00000024 Owner: Property Address: 52`9'52 AVENIDA OBREGON LEO HUBBARD APN: 773-315.-.016-10 -;0000.00- 52952 AVENIDA OBREGON Application description: REMODEL - RESIDENTIAL LA QUINTA, CA .92253 Property Zoning: COVE RESIDENTIAL Other struct info . . . . . C O Application valuation: 350 Contractor: Applicant: Architect or Engineer: Owner t! ✓�.` O a) DITION 200:7 t�IdA'f.� O j --------------------- - - --- ------ -- -------------' ------------ LICENSED CONTRACTOR'S DECLARATION: _ - WORKER'S COMPENSATION DECLARATION 'I hereby affirm under- penalty of perjury that I:amiicensed under provisions.ofChapter.9 (commencing with:. ` -_.: I hereby.affirm under penalty of perjury one of�the follo`wing.declarations: `. .Section}7000) of Division 3 of,the Businessland P,rofessionalse66,:and my License is in'full force and effect. _ I have.and.will maintain a certificatebf consent to self -insure for workers' compensa o , s;provided License Class: - License No::- forby Section 3700 of the Labor Code; for the performance of the work for which.this permit is issued.`- - Date: Contractor:. _ 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 thispermit is issued. My, workers' compensation - OWNER -BUILDER DECLARATION insurance carrier and policy number are:' .I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier - - --------- - Policy Number - following reason (Sec. 7031:5, Businessand Professions Code`. Any city or county that requires a permit to 1 certify that, in the -performance of the work for which this permit is issued, I shall not employ any construct; -alter, improve, demolish; or repair any structure,, prior to its issuance, also requires the applicant for the person in any manner so as to become subject to the workers' compensation laws of California, permit to file a signed statement that he or. she is licensed.pursuant,to -the provisions of the, Contractor's State - and agree that, if I should become subject to the workers`. compensation provisions of Section License Caw (Chapter 9.(commencing.witfi.Section 7000) of Division 3 of the Business and Professioris.Code).or 3700 of the Labor Code, I shall forthwith comply with those provisions. that -he dor she is exempt therefrom; and the basis for the alleged exemption: Any violation•of Section 7031.5 by ! N ` �'�" a applicant for apermirsubjects the applicant to a civil penalty of not more tfian five hundred dollars.IS5001.: ate: - !"1N icant:- ( 1 1, as owner of the'property, or my employees with wages as their sole compensation,, will do the work, and . the'structure isnot intended'oroffered,for. sale (Sec.'.7044, Business,and Professions Code:- The WARNING:-FAI RE TO'SECUREEIWORKERS' COMPENSATION. COVERAGE IS UNLAWFUL, AND�SHALL Contractors' State'License Law does not apply to an owner of property who builds. or.iniproves.thereon, SUBJECT. AN EMPLOYER:TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE: HUNDRED THOUSAND land who does.the work himself'or herself,through his or her own'employees, provided: that: the DOLLARS ($100,000). IN ADDITION. -TO THE COST OF COfv1PENSATION, DAMAGES AS PROVIDED FOR IN. improvements are not intended: or offered:for sale. If, however, the building. or improvement is.sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. one'ye"ar of completion,:the owner -builder will have the fiurden of proving that he'.or she did not build or improve for the purpose. of;salea• - - APPLICANT ACKNOWLEDGEMENT (_ 1 I, as owner of.theproperty,,am:exclusively.contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety'for apermit subject to the 7044, Business and:Professions Code: The Contractors' State LicenseLaw does not apply to an owner of conditions and restrictions set forth on this application. _ property -who builds or improvesthereon, and who contracts forthepiojects with a contractor(s) licensed - 1,.. Each person upon. whose behalf. this application is made, each person. at whose request and for pursuant,to the Contractors' -State License. Law.). whose benefit work is performed under or pursuant to any permit issued as a result of this application, (—I I am exempt under Sec. B.&P.C. for this reason 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 I 1,� ]/�/ performed under or following issuance of this permit.' Date: t' _ l Q _ I v Jrt�' �"ner: --�v 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 CONST UCTION LENDING AGENCY permit to cancellation. I hereby affirm under penalty of perjury that the s a construction lending agency for the performance of the I certify that I. have read this application and state that the above. information is correct. I agree to comply with all work for which this permit is issued (Sec. 3097, Civ. C.)• city and county ordinances and state laws relating to building construction, an hereby authorize representatives of this county to enter upon the ab ve-mentioned property for inspection purp es. Lender's Name: _ � �� Date: A 0. Qgnalicant or Agent): Lender's Address: LQPERMIT • ;;4 LQPERMIT Application Number . . . . . 10-00000024 Permit . . . BUILDING PERMIT Additional desc . Permit Fee 15.00 Plan Check Fee 9.75 Issue Date Valuation . . . . 350 Expiration Date 7/10./10 Qty -Unit Charge Per Extension BASE FEE 15.00 Special Notes and Comments • REPLACE ONE WINDOW FOR LIKE,. USING _, .. ,. „LIKE , 'PELI,A""THERMOSf U� FACTOR .35.;: ,SHGC ,.34 - - --------,-----------.--------- - - - -- --- -.----------------- Other•Fees ... . . . . . . BLDG:STDS ADMIN-(SB1473) -------------- 1.00. ENERGY, REVIEW .FEE •98 Fee summary, charged Paid. Credited Due Permit ;Fee -;Total 15.00 00 .00' 15:,00: Plan":Check Total :9-.-75 :0'0_ .. 0'0: 9':75 i Other .:Fee; -Total 1 .•98,00 .. ..00 1.98 Grand Total- 26.73 .00' :00 26:73 • ;;4 LQPERMIT P.O..BOX 1'504 LA QUtNTq" CALIFORNIA. 92247-1504 78-495 CALLE TAMPICO LA QUINTA,-CALIFORNIA 92253 =_ ' BUILDING & SAFETY DEPARTMENT' (760) 777-7012 FAX (760) 777-7011 "A DiscloR�-KAGE sures & For' QH her-Binders°ApplylIIg for Construction QIP .. Percy o VTt . NO. tC>O Permits Dear Pro K'uer. r ROPE 1 S TY OVVNE An. appLption--fora .. _ . building: Pee!miI has improvements specified at been 'submitted ..in We are pr Y°ur name listing yourself as the builder of the pro responsibilities fou wtth an Owner -Builder '& Possible nsk .ou. Acknowled and Inf ` Property O�r-Builder. ,dye Y ma , gment � ormation Veiificafion Forth to make Y uicui by had ing this Permit issued signed; not issue a buiidtug peruit':unW You aware of your g ,and "returned Y°ur Qaine`as the unless you, the this form to us at our official,address.tndicarea ted P�°per[y owner, obta ' tnittaled your anderstanding of each' Provision, ut the prior approval:of the An :agent of the owner cannot execute p pertitittiiig authont ,. this notice O.IWI �:R S ACI{No?W><,EDG DfRECTIOIVS Read ur and: '' NT AND , ural.eacfi statement below t 1CATi NOF >RMA'iQly I . I antlers nrIYY:ou understand yr verify tkis infor nation. understand a frequent practice of unlicensed g Permit.^that a Toneousl ' ed persons is to,: ave the 5ro e_ Owirer-Builder; Yimplies.that the P P owner Tay be held liable Property owner is pcovidrng his or her b, labor and to an "Own and his or her emplo ees and subject to serious financial risk for' injuries. 1"a Y while workin o z: mateiial personally. I, as Vain willfully actin g n �X'Property }y hom.. anY injwtes'sustai' b Y Pro gas an Owner_Builder y towner s insurance. Y an unlicensed person on m perty once May and am aware of the limitss'of{my msuraneoverage for those : overage for injuries to workers 2- 1 understand buildin e truction and are g Permits are not req u not hiring a licensed fired. 'O'be signed b Contractor to' Y PiOpertY own finless they are responsible for the I understand as an « assume this respon"stbrli Owner=Buildee, I. am r h' . self Gom potential financiaPrisk b there otm. y �— - sponsrble party of recordontthe e g a licensed Contractor.and.having,the e p rmit I tuiderstand that I. in p rmit filed in Y Protect �",_.Its 4- 1 understand Contractors are required b his or her name instead of my and contracts. Y law to be h censed. and bonded in°California and to list their license numbers on _5. I understand if I -,em l y construction IS at 1 P °y Or otheuwise eR east five gaS ($50ge.any persons;,other than California licensed Contractors and untjer state and federal law- hundred dollars ($500 including labor and- materials, l ma b the total value Y e considered_ an "employer , 6 I understand if l dirt considered an " inment, withhold . emPloyee' tinder state an Payroll' taxes, , provide workers' co d federal law I coo?,pensation for -each " f must register with the state and federal Tisk. emliloY-" I also understand, y fa jure�o abaent deabt�ty t�Ce and contribute to, tme to taitd m .. > y these laws may subject me to serious man ial 7 • .I understand under ca California Contractors' cannot .legally build State License bcmntractbrs them: with the intent to mow' a°`Owner-Builder who, builds single =family residential su and the number -I'D s offer them for sale; unless all work is under contract with a licensed ctures does -not exceed. four, within aii general building y calendar ear, Performed by licensed g Contractor. Y or all of the work is performed r.:I ...,..r d8. 1 understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any nabcial or personal. injurries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. 9. I understand I may obtain more information regarding my obligations as an ,employee, from the Internal Revenue 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 -LB) at 1- 800-321-CSLB (2752) or www_csib.ca.gov for more information about licensed contractors. 10,1 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: 11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner -Builders as well as employers. 6av l2. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I 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 iWcivil 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 -Js issued to verify the property owner's signature. Signature of property owner Date: 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 understand. is my personal responsibility, l hereby authorize the following person(s) to act asmy agents) 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' 's signature. Property Owner's Signature: Date: 0 CERTIFICATE OF'COMPLIANCE RESIDENTIAL..(Page 2 of 4) . C&IR Probed Title Date' FENESTRATION PRODUCTS= U -FACTOR AND SHGC ❑' FENESTRATION MAXIMUM ALLOWED. AREA' WORKSHEET-WS-4R'—must be included for New Construction, Additions and Alterations. Fenestration #/Type/Pos. Exterior / \' ront: Lek Orien- . Shadlng/OYerhangs6, 7 Rear, Right, tati Area U -factor sl GC box if WS -3R is S li t N S WI (fiU-factor? Sourod . ;SHOO Sources included - Dt� 13 Lv�S' ❑ . i.:..El 1 / SSC 711Yr,�C�A� fAW 1MIItau.i .iw Q/e.:F '%"� � l _ ❑ orurwa m any airecuon when the pitch isless than 1.12. See: § Section 151(f)3C and in 32_3 of tiie Residentral Manual 2) Enter values ii this columa are'either NERC Rated value or from Standards _default Table 116A, 3) Indicate souroe. either from NFRC'` or Table 116A, 4) Fater values in this column fr 'NFRC or from Standards Defatilt;Table.116B or adjusted.;SHGC from WS -3R 5) Iii(Scate.source.either &oM NFRC or Table 116B.- '6) Shading Devices are defined id Table 3-3 in the Residential Manual and see WS -3R to maculate Exterior Shading devices. 7) See Section 324 in the Residential Manual HVAC SYSTEMS Heating Equ* Minimum Distri 'on,. 'Type and opacity , ffidiency Typt,and 1 ocdhon Duct or.'Pipmg. Thermostat Configurationbeat bo8er etc. HSP eir- R -Value' u or. Cooling Equipment Muiimum Type and -Capacity Efficiency Du Location Dud Thermostat Configuration A� beat coon - SEER or EER etc =Value it Residential Compliance Forms March 2005 Bin # City of la- Quinta , Bulging 8r Safety Division P.O. Box 1504, T&495 Calle Tampico La Quints, CA 92253;=•(760) 777-7012 Building Permit Applrcation and Tracking Sheet . Permit # Project Address: wner's Name: A. P. Number: 6dd�.5-cj 5`L jOCII���� CJ pGpIJ Legal Description: Ci ST; -i FCr�ntractor �.c� •�% Telcphone:.M. °� i �s X11 s. N vh?} Address: Project Description: City, ST, Zip: — - Telephone:' s .s 3 State Lic.#: City, Lie.#; `y 1 - - a'1SG- IJP I�XId�� .hl j��'W �Lt. O Tda1_ Arch., Engr., Designer o Address: H C, City, ST, Zip:. V lfp. Lio Telephone:~`` - Construction Type: Occupancy: State Lic. #: Project type (circle one): New Add'n Alter Repair Demo Name of Contact Person: Sq: FL: # Stories: # Units: Telephone # of Contact Person: 7 �1 Estimated Value offProject:� S V APPLICANT: DO NOT, WRITE BELOW THISaINE # Submittal Req'd RecdTRACKDVG PERMIT FEES Plan Sets, Plan Cheek submitted item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Cales. Called Contact Person Plan Cheek Balance Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2" Review, ready forcorrectionsfissue Electrical 3. Subeontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- ''' Review, ready for correctionstiissue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees