AR (0403-174)53745 Avenida Martinez
0403-174
12599
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:
(> ) 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 con r.acting with licensed
contractors to construct the project (Sec. 7044, Business & .Professionals
Code).
O I am exempt. rider Section B&P.C.,for this reason 1'
Date V 7 l Signature of Owned `
r
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:
Carrier Policy No.
(This section need not be completed if the permit valuation is for $100.00 or less).
( )-Ir 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, antl agree that if I should become
subject to the workers' compensation provisions of, Section 3700 of the Labor
Code, I • halljforthwith comply with those provision's. ' `
Date: — ' `J Applicant _ t •
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. ,f
Signature (Owner/Agent) r Date f
BUILDING PERMIT PERMIT#
0403-174
DATE VALUATION LOT TRACT
JOB SITE
ADDRESS 52S-745 AVF&IrOAWARMEZ
APN
7?4-131-( X.4
OWNER
CONTRACTOR / DESIGNER / EN (NEER
9MV:IE W!w
OWN IR BUU Z F_
33-745 .AWNTDA NfARM4TZ
7..A QZ}NTA CA. 92253
) e BLA
USE OF PERMIT
ili?.81DW11AL AD5311 014
94 SIP PATIO CONV'I'. -SION.
PATIO i:OWE,RSION 34,00 8E
EIMM.A17d) COS'r CrIt CONYMilMOAT
3,444.00
PLAN CHECK WE 1011-000-439-318 $40,95
CONSTRUC`f'IO1.1ILEI?; 101-000-418-000 $63.00
I:'LE0,TPdCr I, FEE - 101-000-420.000 $22.50
STRONG FEE,-RMID 1fit-000-U1-0 $.S9
.: ,
D Q
i LJ
MAR 19 2004
CITY OF LA QU;NTA
FINANCE DEPT.
dM-TY01'A1'1 C;OMMUii ON AINM RLL CT3 ILK
:t 26.95
IMS PrP$II7 FUS
"$0.00
'1'O`lAL FTWI I' M, ES MIFF ROW
I'
$12695
RECEIPT
DATE -?BY"
l
DAT FIN L
G
INSPECTOR
,_—__
SOC
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings 1� ��
Ducts
Slab Grade
Return Air
Steel�
Combustion Air
_
Roof Deck ' `�
Exhaust Fans
O.K. to Wrap
Framing ` (
F.A.U.
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 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
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F.1.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
At the.present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions under
500 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile
homes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason:
Residential Addition 500 Sq Feet or Less
EXEMPT
This certifies that school facility fees imposed pursuant to
Education Code Section 17620 and Government Code 65995 Et Seq.
in the amount of $0.00 X 84 S.F. or $0.00 have been paid for the property listed above and that
building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued.
Fees Paid By N/A -Steven Nieto Jr. Check No. N/A
Name on the check Telephone, 760-564-4707
Funding Exempt
By ' Dr. Doris Wilson
Superintendent
Fee collected /exempted by Yolanda Garcia Payment Recd $0.00
Over/Under
Signature
NOTICE: Pursuant to Government Code Section 66020(d)(1), this will serve to notify you that the 90 -day approval period in which you may protest the fees or
other payment identified above will begin to run from the date on which the building or installation permit for this project is issued, or from the date on which
those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
-%3) FiEDsc.
0
47950 Dune Palms Road
Q BERMUDA DUNES
Date
3/11/04
La Quinta 7 CA 92253
RAN ANWELLS LSMIRAGQ
INDIAN HO WE
No.
25638
(760) 771-8515
dd PALM LA QUINTA y
QINDIO L
O
Owner
Steve Nieto
APN #
774-131-024
Address
53-745 Avenida Martinez
Jurisdiction
La Quinta
City
La Quinta Zip 92253
Permit #
0403-174
Tract #
Study Area
Type
Residential Addition
No. of Units
Lot # No. Street
S.F. Lot # No.
Street S.F.
Unit 1
53745 Avenida Martinez
84 Unit 6
Unit 2
Unit 7
Unit 3
Unit 8
Unit 4
Unit 9
Unit 5
Unit 10
Comments Patio conversion
At the.present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions under
500 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile
homes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason:
Residential Addition 500 Sq Feet or Less
EXEMPT
This certifies that school facility fees imposed pursuant to
Education Code Section 17620 and Government Code 65995 Et Seq.
in the amount of $0.00 X 84 S.F. or $0.00 have been paid for the property listed above and that
building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued.
Fees Paid By N/A -Steven Nieto Jr. Check No. N/A
Name on the check Telephone, 760-564-4707
Funding Exempt
By ' Dr. Doris Wilson
Superintendent
Fee collected /exempted by Yolanda Garcia Payment Recd $0.00
Over/Under
Signature
NOTICE: Pursuant to Government Code Section 66020(d)(1), this will serve to notify you that the 90 -day approval period in which you may protest the fees or
other payment identified above will begin to run from the date on which the building or installation permit for this project is issued, or from the date on which
those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting
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/ Builder" 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, you may protect yourself from possible
liability if that person applies for the proper permit in his or her name.
Contractors are required by law 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 any persons other than your immediate family, and the work (including materials
and other costs) is $200.00 or more for the entire project, and such persons are not licensed as contractors or
subcontractors, then you may be an employer.
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 tax withholding, federal social security taxes, worker's
compensation insurance, disability insurance costs and unemployment compensation contributions.
There may be financial risks for you if you do not carry out 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 information about your obligations under State
Law, contact the Department of Benefit Payments and 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 secure an "Owner/ Builder" building
permit, erroneously implying that the property owner is providing his or her own labor and material personally.
Building permits are not required to be signed by property owners unless 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 mattersr'gbe 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
i
inta, 2253777-
7 77-701ER SI ATURE/DATE
PROPERTY ADDRESS
PERMIT NUMBER(s)
TITLE 24 REPORT
Title -24 Report for:
Margaret Nieto
53-745 Ave. Martinez
La Quinta, CA
Report Prepared By:
Steve Nieto
South West Concepts
78 -120 -Calle Estado, Suite 206
La Quinta, CA 92253
(760) 564-4707
Date:
3/05/04
C:iTY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVE®
FOR CONSTRUCTION
DATE J BY
CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 1 of 3) CF -1R
NIETO ADDITION
Project Title
53-745 AVENIDA MARTINEZ LA QUINTA CA, 92253
Project Address
SOUTH WEST CONCEPTS (760)564-4707
Documentation Author Telephone
PACKAGE D 15
Compliance Method (Package or Computer)
GENERAL INFORMATION
Climate Zone
)3/ 05/ 2004
ate
Building Permit #
Plan Check / Date
Field Check / Date
Enforcement Agency Use
Total Conditioned Floor Area 84 ftZ Average Ceiling Height: 8' ft
Conditioned Slab Floor Area 84 ft
Building Type: Single Family V Addition
(check one or more) Multi -Family Existing -Plus -Addition
'Front Orientation: 180° NorthSouth / East / West / All Orientations
(input fro tation in degrees from True North and circle one)
Number of Stories 1
Number of Dwelling Units: 1
Floor Construction Type: Slab aised Floor (circle one or both)
RADIANT BARRIER (required in climate zones 2,4,8-15) Required for this submittal ✓yes
BUILDING ENVELOPE INSULATION
no
Component
Type
Frame Type
wd = wood
stl = steel
Cavity Sheathing
Insulation Insulation
R -Value R -Value
Total R-
Value'
Assembly
U -Factor'
Location/Comments
(attic, garage, typical, etc.)
Wall
2 X 4
R-19
16.75
0.060
HOUSE EXT. FRAMED WALLS
Wall
Roof
2 X 4
R-38
41.667
0.024
2 X 4 TRUSSES
Roof
Floor
Floor
Slab Edge
For prescriptive compliance, total tc-value an(I Assembly U -tactor are not required for a wood -framed wall that meets cavity R -value
insulation requirements for the Prescriptive Package.
FENESTRATION
Shading Devices
Fenestration Orien- Area Fenestration Fenestration Exterior Overhangs/
#/T e/Pos. tation U -Factor SHGC Shadina Att. Fins
Front
Front
Left
Left
Rear NORTH 5 SQ.FT. 0.65 0.40 STANDARD 2 FT.
Rear
Right
Right
Skylight
Skylight
Compliance Forms August 2001
CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 2 of 3) CF -IR
NIETO ADDITION (03/05/2004
Project Title Date
HVAC SYSTEMS
Note: Input hydronic or combined hydronic data under Water Heating Systems, except Design Heating Load.
Distribution
Heating Equipment Minimum
Type and Duct or Heat Pump
Type (furnace, heat Efficiency
Location Piping Thermostat Configuration
pump, etc.) (AFUE or HSPF)
(ducts, attic, etc.) R -Value Type (split or package)
NONE
Cooling Equipment Minimum Duct Heat Pump
Type (air conditioner, Efficiency Location Duct Thermostat Configuration
heat pump, evap. cooling) (SEER) (attic, etc.) R -Value Type (split or package)
NONE
SEALED DUCTS and TXVs (or Alternative Measures)
❑ Sealed Ducts (all climate zones)
(Installer testing and certification and HERS rater field verification required)
❑ TXVs, readily accessible (climate zones 2 and 8-15 only)
(Installer testing and certification and HERS Rater or field verification required)
❑ Refrigerant Charge/Air Flow (climate zones 2 and 8-15 only)
(Installer testing and certification and HERS Rater or field verification required)
OR
❑ Alternative to Sealed Ducts and TXVs (see Package C or D Alternative Package Features for Project Climate Zone)
Climate Zone Window SHGC Window U -Factor SEER Heating
NONE
WATER HEATING SYSTEMS
Energy' External
Rated, Tank Factor or Tank
Water Heater Distribution Number Input (kw Capacity Recovery Standby' Insulation
Type Type in System or Btu/hr) (gallons) Efficiency Loss (%) R -Value
NONE
1. For small gas storage water heaters (rated inputs of less than or equal to 75,000 Btu/hr), 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 gas water heaters, list rated input and recovery efficiencies.
SPECIAL FEATURES (add extra sheets if necessary). Package C and D: TXVs, Sealed Ducts, Radiant
Barriers (see installation requirements for radiant barriers in Section 8.13 of the 2001 Residential Manual).
Package C: thermal mass (thermal mass type, covering, thickness and description).
NONE
Compliance Forms August 2001
CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 3 of 3) CF -IR
NIETO ADDITION (03/05/2004
Project Title Date
COMPLIANCE STATEMENT
This certificate of compliance lists the building features and performance specifications needed to comply with
Title 24, Parts 1 and 6 of the California Code of Regulations, and the administrative regulations to implement
them. This certificate has been signed by the individual with overall design responsibility. When this certificate
of compliance is submitted for a single building plan 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 and Professions Code)
Name:
Title/Firm: _
Address:
STEPHEN R. NIETO
SOUTH WEST CONCEPTS
78-120 CALLE ESTADO, STE#206
LA QUINTA CA, 92253
Telephone: (760)564-4707
Lic. #: 523837
(signature) (date)
Enforcement Agency
Name:
Title:
Agency:
Telephone:
(signature / stamp) (date)
Compliance Forms
Documentation Author
Name:
Title/Firm:
Address:
Telephone:
Lic. M
(signature) (date)
August 2001
MANDATORY MEASURES CHECKLIST: RESIDENTIAL (Page 1 of 2) MF -1R
Note: Lowrise residential buildings subject to the Standards must contain these measures regardless of the compliance approach used.
Items marked with an asterisk (') may be superseded by more stringent compliance requirements listed on the Certificate of
Compliance. When this checklist is incorporated into the permit documents, the features noted shall be considered by all parties as
minimum component performance specifications for the mandatory measures whether they are shown elsewhere in the documents
or on this checklist only.
Instructions: Check or initial applicable boxes when completed or enter N/A if not applicable.
DESCRIPTION
DESIGNER
ENFORCEMENT
Building Envelope Measures:
• § 150(a): Minimum R-19 ceiling insulation.
✓
§ 150(b): Loose fill insulation manufacturers labeled R -Value.
• § 150(c): Miniumum R-13 wall insulation in wood framed walls or equivalent U -Factor in metal frame walls
✓
does not aDDIY to exterior mass walls).
§ 150(d): Minimum R-13 raised floor insulation in framed floors.
§ 150(1) : Slab edge insulation - water absorption rate no greater than 0.3%, water vapor transmission rate no
greater than 2.0perm/inch.
§118: Insulation specified or installed meets insulation quality standards. Indicate type and form.
✓
§ 116-17: Fenestration Products, Exterior Doors, and Infiltration/Exfiltration Controls
1. Doors and windows between conditioned and unconditioned spaces designed to limit air leakage.
2. Fenestration products (except field -fabricated) have label with certified U -Factor, certified Solar Heat
✓
Gain Coefficient (SHGC), and infiltration certification.
3. Exterior doors and windows weatherstripped; all joints and penetrations caulked and sealed.
§ 150(g): Vapor barriers mandatory in Climate Zones 14 and 16 only.
§ 150(f): Special infiltration barrier installed to comply with § 151 meets Commission quality standards.
✓.
§150(e): Installation of Fireplaces, Decorative Gas Appliances and Gas Logs.
1. Masonry and factory -built fireplaces have:
a. Closeable metal or glass door
b. Outside air intake with damper and control
c. Flue damper and control
2. No continuous burning gas pilot lights allowed.
Space Conditioning, Water Heating and Plumbing System Measures:
§ 110- 113: HVAC equipment, water heaters, showerheads and faucets certified by the Commission.
✓
§ 150(h): Heating and/or cooling loads calculated in accordance with ASHRAE, SMACNA OR ACCA.
✓
§ 150(i): Setback thermostat on all applicable heating and/or cooling systems.
✓
§ 1500): Pipe and tank insulation
1. Storage gas water heaters rated with an Energy Factor less than 0.58 must be externally wrapped with
insulation having an installed thermal resistance of R-12 or greater.
2. First 5 feet of pipes closest to water heater tank, non -recirculating systems, insulated (R-4 or greater)
3. Back-up tanks for solar system, unfired storage tanks, or other indirect hot water tanks have R-12
✓
external insulation or R-16 combined intemal/external insulation.
4. All buried or exposed piping insulated in recirculating sections of hot water systems.
5. Cooling system piping below 55°F insulated. ,
6. Piping insulated between heating source and indirect hot water tank.
Compliance Forms August 2001
MANDATORY MEASURES CHECKLIST: RESIDENTIAL (Page 2 of 2) MF -1R
Note: Lowrise residential buildings subject to the Standards must contain these measures regardless of the compliance approach used.
Items marked with an asterisk (') may be superseded by more stringent compliance requirements listed on the Certificate of
Compliance. When this checklist is incorporated into the permit documents, the features noted shall be considered by all parties as
minimum component performance specifications for the mandatory measures whether they are shown elsewhere in the documents
or on this checklist only.
Instructions: Check or initial applicable .boxes when completed or enter N/A if not applicable.
DESCRIPTION
DESIGNER
ENFORCEMENT
Space Conditioning, Water Heating and Plumbing System Measures: (continued)
• § 150(m): Ducts and Fans
1. All ducts and plenums installed, sealed and insulated to meet the requirement of the 1998 CMC Sections 601,
603, 604, and Standard 6-3; ducts insulated to a minimum installed level of R-4.2 or enclosed entirely in
conditioned space. Openings shall be sealed with mastic, tape, aerosol sealant, or other duct -closure system
that meets the applicable requirements of UL 181, UL 181A, or UL 181B. If mastic or tape is used to seal
openings greater than 1/4 inch, the combination of mastic and either mesh or tape shall be used. Building
cavities shall not be used for conveying conditioned air. Joints and seams of duct systems and their
components shall not be sealed with cloth back rubber adhesive duct tapes unless such tape is used in
combination with mastic and drawbands.
2. Building cavities, support platforms for air handlers, and plenums defined or constructed with materials
other than sealed sheet metal, duct board or flexible duct shall not be used for conveying conditioned
air. Building cavities and support platforms may contain ducts. Ducts installed in cavities and suport
platforms shall not be compressed to cause reductions in the cross-sectional area of the ducts.
3. Joints and seams of duct systems and their compnents shall not be sealed with cloth back rubber
adhesive duct tapes unless such tape is used in combination with mastic and drawbands.
4. Exhaust fan systems have back draft or automatic dampers.
5. Gravity ventilating systems serving conditioned space have either automatic or readily accessible,
manually operated dampers.
6. Protection of Insulation. Insulation shall be protected from damage, including that due to sunlight,
moisture, equipment maintenance, and wind but not limited to the following: Insulation exposed to
weather shall be suitable for outdoor service e.g., protected by aluminum, sheet metal, painted canvas,
or plastic cover. Cellular foam insulation shall be protected as above or painted with a coating that is
water retardant and provides shielding from solar radiation that can cause degradation of the material.
§114: Pool and Spa Heating Systems and Equipment.
1. System is certified with 78% thermal efficiency, on-off switch, weatherproof operating instructions, no
electric resistance heating and no pilot light.
2. System is installed with:
a. At least 36 of pipe between filter and heater for future solar heating.
b. Cover for outdoor pools or outdoor spas.
3. Pool system has directional inlets and a circulation pump time switch.
§115: Gas fired central furnaces, pool heaters, spa heaters or household cooking appliances have no
continuously burning pilot light. (Exception: Non -electrical cooking appliances with pilot<l50 Btu/hr)
§118(f): Cool Roof material meet specified criteria
Lighting Measures:
§150 (k)l.: Luminaires forgeneral lighting in kitchens shall have lamps with an efficacy of40 lumeris/watt
or greater for general lighting in kitchens. This general lighting shall be controlled by a switch on a readily
accessible lighting control panel at an entrance to the kitchen.
§ 150 (k)2.: Rooms with a shower or bathtub must have either at least one luminaire with lamps with an
efficacy of 40 lumens/watt or greater switched at the entrance to the room or one of the alternatives to this
requirement allowed in § 150(k)2.; and incandescent recessed ceiling fixtures are IC (insulation cover)
✓
approved.
Compliance Forms August 2001
P.O. BOX 1504 No. 1299
Building 53--745 Martinez 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner . Al Debbas Construction
RUILDING- TYPE CONST. nCC' GRP_
Mailing
Address 54-994 Inverness
City
Zip
Tel.
La Quinta, CA
92253.
564-2856
Contractor
Hamilton Masonry .
Address
P.O. Box 1772
Ctd Quanta, CA
Zip 92253
Tela 564-4844.
State Lic. 591684
City 85
& Classif.
Lic. #
Arch., Engr.,
Designer
Address
Tel.
CityI Zip I State
Lic. #
LIC ENSED/CONTRACTOR'S DECLARATION
I hereb aft rm that I am icensed/under piovisios of Chapter 9 (commenci
000) 0,1 iron tot tre Busi ess and ProfejsiVss Code, and my license is,
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 file a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) or
Division 3 or 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 penalty of not more than rive hundred dollars ($500).
O 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 or 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 I am exempt under Sec. B. & P.C. for this reason
Date Owner
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. ompany
O&try is filed with the citfiled with the city. O 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 any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: If, alter making this Certificate or 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
I hereby 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 if work thereunder is suspended for 180 days.
I certify that I have read this application and stale 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 city to enter the above-.
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
P. Number
Legal Description
Project Description 38' of 3' high retaZn1ci; q wa11
44' of 6' high block wall
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑`' ` -•'Add ❑'° ' Alter
Repair ❑ Demolition ❑
stimated Valuation
$1,100.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
45.00
Mech.
Electrical
Plumbing
.S. M. 1.
Grading
Driveway Enc.
Infrastructure
TOTAL
45.001
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line -
Side Street`Setback from Center Line hy-
it.
Side Setback from P. ee
FINAL DATE INJFIBCTO .t
Issued by:.
Validated t
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SETBACK
GROUND PLUMBING
UNDERGROUND
YARD SPKLR SYSTEM
2ND FL. SO. FT.
SLAB GRADE
ROUGH PLUMB.
BONDING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
SEWER OR SEPTIC TANK
ROUGH WIRING
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (ROUGH)
METER LOOP
DRAINAGE PIPING
CAR P. SO. FT.
REINF. STEEL
GAS (FINAL)
WALL SO. FT. ®
DRINKING FOUNTAIN,
SO FT ®
WATER HEATER
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
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WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
ROOFING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
MESH
GAS PIPING
PERMIT FEE
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
SETBACK
GROUND PLUMBING
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
FOUND. REINF.
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$
_$
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FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
^
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTIONI—ti—lqo
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL