RR (11-0718)54075 Avenida Madero
11-0718
4
P.O. BOX 1504 VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 6/30/11
CApplication Number: 11-00000718 Owner:
Property Address: 54075 AVENIDA MADERO PINSCORP, INC 1
APN: 774-192-015-4 -000000- 54075 AVENIDA MADERO
Application description: RE -ROOF LA QUINTA, CA 92253
Property Zoning: COVE RESIDENTIAL (760) 578-1790 7+
Application valuation: 8000 JUN 0 20qq i
Contractor: ` II 11
A licant: Architect or En ineer: Owner Gff1''-t.(i°417 1
PP 9 :....r e•.,r,-
----------------------.-------------------------------------------------------------------7--------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 70001 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. 7031.5, Business and Professions Code: Any city or county that requires a permit to
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
pplicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
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 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 for the purpose of sale.).
(_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the 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 contractor(s) licensed
pursuant to the Contractors' State License Law.).
(_) I am exempt under Sec. , B.&P.C.. for this reason
Date: Itt Owner:
IF
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there 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
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 and policy number are:
Carrier -- --- ------------- ---- - Policy Number
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: / / Applicant: ,
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($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.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director 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 inspection purposes.
I
Date1 /V• 7 /Gf,.
: v -7# `'gnature (Applicant or Agent):
Application Number . . . 11-00000718
Permit RE -ROOF
Additional desc .
Permit Fee 30.00
Plan Check Fee
.00
Issue Date . . . .
Valuation . . .
. 0
Expiration Date 12/27/11
Qty Unit Charge Per
Extension
BASE FEE
30.00
----------------------------------------------------------------------------
Special Notes and Comments
REROOF LIGHT WEIGHT CONCRETE TILE ON
4:12 SLOPE ROOF. PRODUCT EAGLE MALIBU
414 CRRC 0918-0043 R:30 INSULATION
2010 CRC.
----------------------------------------------------------------------------
Other Fees . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid
-------------------------------------
Credited
--------------------
Due
Permit Fee Total 30.00
.00 .00
30.00
Plan Check Total .00
.00 .00
.00
Other Fee Total 1.00
.00 .00
1.00
Grand Total 31.00
.00 :00
31.00
LQPERMIT
06/30/2011 11:56 7603229308.
Malibu
-
88 Tiles per 100 sq ft
with 3- headlap
550 APrOx Installed weight
field file per 100 sq ft
000"
HO SUrW MW WWW AbWlVr COPWIT170)
RWC PALM SPRINGS
17'
W
\\.tl
12
vk#sw
Na:433 No:455
Name: cavenne, Name: Alhambra
Ref Eft SRI ARef A.SFU
Ref FM SRI A.Ref A.SRI
Lt
.30 .91 32 .27 28 .22 .89 21 .21 20
No: 426
Name:Valencia
Ref Eml SAI A.Ref A.SAI
.19 .89 17 .19 17
NO: 497
Name: slate Range
FW Eml SRI A.Aef A.SRI
.13 .94 12 .15 is
No: 04
Name: INalran Brown
Ref EMI SRI A -Ref k5RI
.13 .94 12 .15 is
F
No: 418 No: 445
Narm: Twrac= Goir Ngme:Sunrtse Blend
,-O
Ref Eml SM AROf ASRI R9f Eml SFU A.P.9f A.SRI
X .76 32 .31 27 LEED1 .15 93 14 .17 17
0
Prescriptive Certificate of Co fiance: Residential Reroof CF-IR-ALT-ReRoof
Pro ect Address: Climate Zone Permit
camROOFIN RODUCTS (COO ROOFS) §151(012
When the area of exterior roof surface to be replaced exceeds 50% of the existing roof area, or 1,000 fe, whichever is less, the new
roofing area must most the rooting product "Cool Roof' requirements of §152(b)1Hi, 152(b)l Hii, or 152(b)1Hili.
Check applicable alternative or exception below if the roof alteration is exempt from the roofing product "Cool Roof requirements::
❑ Cool roofs not required in Climates Zones 1-12,14, and 16 with a low sloped roof pitch (less or 2:12 pitch).
❑ ' Cool roofs W required in Climates Zones 1-9, and 16 with a steep -sloped roofs (greater pitch than 2:12) and product weight less than 5Abtfe.
Alternatives to §152(b)1 HI and §152(b)HII, Steep -slope roof (pitch > 2:12)
❑ Insulation with a thermal resistance of at least 0.85 hr-fl?•°F/Btu or at least a 3/4 inch air -space is added to the roof deck over an attic; or
Existing ducts in the attic are insulated and sealed according to §151(()10; or
In climate zones 10, 12 and 13, with 1 112 of free ventilation area of attic ventilation for every 150 ft2 of attic floor area, and
where at least 30 percent of the free ventilation area is within 2 feet vertical distance of the roof ridge; or
Building has at least R-30 ceiling insulation; or
Building has radiant barrier in the attic meeting the requirements of.§151(02; or
❑ Building has no ducts in the attic; or
❑ In climate zones 10, 11, 13 and 14,.R-3 or greater roof deck insulation above vented attic.
Exception to §152(b)l Hill, Low-siope roof ( pitch S 2:12)
❑ Building has no ducts in the attic.
Other Exceptions
❑ Roofing area is covered by building integrated; photovoltaic panels and solar thermal
panels are exempt from the Cool Roof criteria.
❑ Roof constructions that have thermal mass over the roof membrane with at least 25 IbMa are exempt from the Cool Roof criteria.
NOTE. If any one of the alternatives or exception is checked the Aged Solar Reflectance and Thermal Emittance requirements for roofing
products in §118(1) are not applicable. Do not rill table below.
eat It PI a r i
O 9 tfr-O
Note: If no CRRC-
Roof Slope
S 2:12 > 2:1
❑ ❑
13❑
1 label is available; this compliance method cannot be used, use the Performance
i. The CRRC Product ID Number can be obtalned from the Coo/ Roof Rating Council's Rated Product Directory at wwwp co Inoofs onsh+rodMY mctsseamh OhD
2. Indicate the type of product is being used for the roof top, l.e. single -ply roof, esphatt roof, metal roof, etc.
?. if the Aged Reflectance is not available in the Cool Roof Rating Council's Rated Product Directory then use the Initial Reflectance value from the same
directory and use the equation (0.2+0.7(pbw _ 0, 2) to obtain a calculated aged value. Where p is the Initial Solar Reflectance.
4. Check box if the Aged Reflectance is a calculated value using the equation above.
5. Calculate the SRI value by using the SRI- Worksheet at htfn;//avww.enervv ca 24/
ecopy of the SRI- Worksheet to the CF -IR. and enter the resulting value in the SRI Column above and attach
Product Weight
5lb/flz t 5lb/f?
Product
T
Aged Solar
Reflectance 3,4
Thermal
Emittance
SRIS
❑
E
X
4
❑
❑
❑
❑4
To apply Liquid Field Applied Coatings, the coating must be applied across the entire roof surface and meet the dry mil thickness or coverag
recommended by the coatings manufacturer and meet minimum performance requirements listed in §118(1)4. Select the applicable coating:
❑ Aluminum -Pigmented Asphalt. Roof Coating ement-Based Roof Coating ❑ Other
NOTE When a Cool Roof ....................................red, installing ^„tasty, shall complete and submit the CF 6R -ENV -01 Mr final immartinn
Statement
I oertify under penalty of perjury, under the laws of the State of California, the information provided on this form is accurate and complete.
I certify that the energy features and performance specifications identified on this Certificate of Compli
ed r i t f '
1 and 6 of the Cali(omia Code f R ance conform to the
Name:
Company
Foi
o emulations. equ ismer s o Tdle 24, Parts
C—
Signature:
c
:ss:
License:
aJJJaVC Ur quesuons regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300.
i
P.O. BOx 1504
LA QUINTA, CALIFORNIA 92247-1504
7$-495 CALLE TAM_PIC_O
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
PROPERTY OWNER'S PACKAGE
(7 60) 777-7012
FAX (76.0) 777-7011
Disclosures & Forms for Owner -Builders Applying for Construction Permits
IMPORTANT! NOTICE TO PROPERTY OWNER
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourse.lf as the builder of the property
improvements specified at j 4 — 0 '1 S VA P, 1Z a , L ek- &.4 , .- 'f't- & A- A 'LZ fI
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 permit issued in your 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.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
DIRECTIONS: Read and initial each statement below to signify you understand or verify this information.
V 1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder"
building 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. I understand building permits are not required to be signed by property owners unless they are responsible for the
construction and are not hiring a licensed Contractor to assume this responsibility.
\kQ * 3. I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect
myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my
own.
4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on
permits and contracts.
t,A Q_5. 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.
4 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.
A -R -D. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential
structures 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.
f
8. I understand as an Ownei-Builder if I sell the property for which this permit is issued, I maybe held. liable for any
financial or personal injuries sustained by any subsequent owner(s) that'result from any latent construction defects .in the
workmanship or materials.:
JQ 9. I understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue
Service, 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 (CSLB) at 1-
$60-321-CrSLB (2752) or www.cslb.ca.gov for more information about licensed contractors.
Q' 10. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the
party legally and financially responsible for propo_seconstruction activity at the following address:
\Q '11. I agree that, as the party legally and furancially responsible for this proposed construction activity, I 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
have 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 civil 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 owner Date: 6 -5d/ 11
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, I hereby authorize
the following person(s) to act as my 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 owner's signature.
Property Owner's Signature: Date:
N . 8. I understand as an Owner -Builder if I sell the property for which this permit is issued,. I may 'be held liable for any
financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the
workmanship or materials.
JQ 9. I understand I may obtain more information regarding my obligations as an `employer" from the Internal Revenue
Service, 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 (CSLB) at 1-
800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractor's.
"Af * 10. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that 1 am the
party legally and financially responsible for ropos construction activity at the following address:
' Di S MA. d - 'e G t + i v- . e -id-- of L- -L-
\Q \1 1Z -
•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.
\( p* 12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I
have 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 ratable 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 civil 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 owner V Date: 4 .0 1,
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, 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 Location or Ar PLIF
Aso
Name of Authorized i
Address of Authorize(
I declare under penal
information and certi
acceptable to the dg
Property Owner's S
• •,o,N97 •s78 B' rp/p
id I personally filled out the above
ization, or other verification
roperty owner's signature.
06/30/201.1 11:49 7603229308 RWC PALM SPRINGS PAGE 02/04
Cool Roof Rating Council Page 1 of 3
Rated Products Directory: Search Results I new search )
(last updatod 24 Jun 2011 12:50 CDT)
Showing Search Results for:
Company: EAGLE Roofing Products
Color Category: Brown
Product Type: Tile or Slate, Shingles, Shakes, Tile or Slate
select' from products where campany_name='EAGLE Roofing Products' and (color like '%Brown°%') and (type like'Tile or Slate%' or
type Ilke 'Shingiss, Shakes, Tile or Slate%) orderer company_name asc
Ma cturer Solar Reflect. Therm Emit. SRI IM
LCRRC
Coloroquct Slope- I (sorted +) Brarid Model Cater ory Type irttt 3 r Ihtt 3 h -•'
0918-0043 AGILE
ooftng
Products
Annette
Slnder
(800-400-
3245)
091
091
EAGLE
Roofing
Products
Annette
Sindar
(860-400-
32,15)
EAGLE
Roofing
Products
Annette
Sin! dar
(8610-400•
3245)
0918-0063 EAGLE
Roofing
Products
Annette
Sindar
(800-400•
Bel Air Brown Tile or 0.13 pending 0.91 pending 11 pending Steep
4687, State
Capistrano
3687;
Double
Eagle Bel
Air 4087,
Golden
Eagle 1687,
Malibu
2687, It -wt
Bel Air 287,
It -wt Golden
Eagle 167,
Ponderosa
5687, Itlwt
Ponderosa
387, It/wt
Double
Eagle
Ponderosa
987, Rustic
Malibu 787,
Double
Ponderosa
no Orange, Tile or 10.18 pending 0.98 pending 15 pending Steep
Yellow, Slate
Brown
httt)://www.coolroof,s.org/t)roductcJresult.-nhn?nrintview=l&maxT.i.qt=2.5RrnavP_Stnrt-l%r... 6/30/9.011
—
- -
Y ApDllr
Arcadia. Bel Air
Brown, Tile or 0.13
pending
0.94 pending 12 pending Steep
Walnut 4502,
Multicolor Slate
Brown, Capistrano
Canyon 3581,
Brown Malibu
Malibu 414,
PoWferosa
5502, lVM .
Pnderosa
ir
Brown Tile or 0.15
pending
0.92 pending 14 pending Steep
,
q
Slate
strano
,
u 2689
Bel Air Brown Tile or 0.13 pending 0.91 pending 11 pending Steep
4687, State
Capistrano
3687;
Double
Eagle Bel
Air 4087,
Golden
Eagle 1687,
Malibu
2687, It -wt
Bel Air 287,
It -wt Golden
Eagle 167,
Ponderosa
5687, Itlwt
Ponderosa
387, It/wt
Double
Eagle
Ponderosa
987, Rustic
Malibu 787,
Double
Ponderosa
no Orange, Tile or 10.18 pending 0.98 pending 15 pending Steep
Yellow, Slate
Brown
httt)://www.coolroof,s.org/t)roductcJresult.-nhn?nrintview=l&maxT.i.qt=2.5RrnavP_Stnrt-l%r... 6/30/9.011
Bin #' ....
•
City O ,La Quetta
Building 8i Safety.Division
P.O. Box 1504, 78-495 Calle Tampico
La Quints, CA 92253 (760) 777-70 1' ,2
Building Permit Applicatiodand Tracking Sheet
Permit #
Project Address: S 4 .• 0 -Is- ✓ , Ot Ls r o
-1017-5
Owner's Name: Co I N Ci
A. P. Number:
Address: 5 LA- o S MaL4,yu
Legal Description:
City, ST, Zip: (A–
Contractor::<:•
Tele hone: :<: ..:.::» s:;> • s
Address:
Project Description: •Zp
City, ST, Zip:
Ram. G
i.0 v:it:;:;+}••'. r n} ;. ..i}j.>.,>.:::C 4}i';
Telephone: :s' •%• •}:-
State Lic. # : Ci Lia #:
ty
Arch., Engr., Designer:
• C..
r cicf
R• 3t f • _ • / •
Address:l
w►a l i b y J y
City, ST, Zip:
t? ( C—
Telephone:
State Lic. #:
:r :;:: <. «:;.:
,:t'M;•::};:.:....-. 3>M>
0.
3'2 : +:w`;r:_%c; :•.» :::; . kms':
% ` s <''.'°`"'....'
Construction Type: - Occupancy:
Project type (circle one . New Add'n Alter Repair Demo
Sq. Ft.: # Stories: t #Units:
Name of Contact Person: J L O e I r1 So r
Telephone # of Contact Person: 1610— -7 141'
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
N
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Cales.
Plans picked up
Construction
Flood plain pian
Plans resubmitted
Mechanical
Grading plan
2°" Review, ready for correctionsliissue
Electrical
Subcontactor 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 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
72)
V
Tity 4 4.Qumm
Building 54-075 ASilrlii& Madem
Art r1 rPcc
Owner
Mailing
Address cam
City Zip Tel.
Contractor
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Address . .. I
Zip" I Tel.
State Lic. City
& Classif. Lic. #
Arch., Engr.,
Designer
Address Tel.
City Zip State
Lic. #
_ LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: -,(Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to rile a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that. he is 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 a civil penally of not more than five hundred dollars ($500).
❑ 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, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon and who does such work himself or through his own employees,
provided that such 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 did not build or improve for the purpose of sale.)
O I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
O 1 amexempt under Sec. B. & P.C. for this reason
. I
Date Owner I
t Y !
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
O Copy is filed with the city. . .0 Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed i1 the permit is for one hundred dollars ($100) valuation
or less.) -
I certify that in the performance of the work for which this permit is issued, I shall not
employ anyperson in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT- If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
Ihereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct.
1 agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives -of this city to enter the above-
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address x
City, State, Zip C
No.. 002386
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number %
Legal Description
Project Description
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from. Property Line
FINAL DATE INSPECTOR
Issued by: Date 5~23'x'86 Permit
Validated by:
Validation:
A 5 6 5 2 5 23 20.00 U
HARD COPY
Sq. Ft. No. No. Dw.
Size Stories Units
New Ox Add ❑ Alter ❑ Repair ❑.
Demolition ❑
24 feet of 4 -foot high stucco ferum
64 felw of 6-fdot hich st K m fc s.
t
Estimated Valuation
70 q }} qq
. 7-92.
-PERMIT AMOUNT
Plan .Chk. Dep.
Plan .Chk. Bal.
Const.
20.00
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
20.00
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from. Property Line
FINAL DATE INSPECTOR
Issued by: Date 5~23'x'86 Permit
Validated by:
Validation:
A 5 6 5 2 5 23 20.00 U
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT. ®
POR. SQ. FT. ®
GAR. SO. FT. ®
CAR P. SQ. FT.
WALL SQ. FT. ®
SQ. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
ROUGH PLUMB.
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GAS (ROUGH)
LAUNDRY TRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE,TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
BOND BEAM
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/a c
SEWAGE DISPOSAL
LUMBER GR.
SQ.FT.GAR ® 3/ac
HOUSE SEWER
FRAMING
FINAL INSP.
GAS PIPING
PERMIT FEE
17
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
ILsETBACK O— -7-4Q
ROUND PLUMBING0 -
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
Qjj&-OUND. REINF. 20 -C6
v
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
CU. yd.
$ —Plus—X$—=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
DEC, /
17
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH.;
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
inarc iun a ammAi unconn111HLa.
GARDEN WALL FINAL