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BRES2015-024754015 Avenida Martinez BRES2015-0247 ,.arw 4 atP VOICE (760) 777-7125 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 8/13/2015 Application Number: BRE52015-0247 Owner: Property Address: 54015 AVENIDA MARTINEZ JAMES BUCKLEY APN: 774221014 54015 AVENIDA MARTINEZ Application Description: BUCKLEY / ROOM ADDITION - DETACHED CASITA LA QUINTA, CA 92253 Property Zoning: Application Valuation: $15,098.00 Applicant: CARMEN BUCKLEY 54015 AVENIDA MARTINEZ LA QUINTA, CA 92253 AUG 13 2015 CITYOFLAQUINTA — COMMUNITY DEVELOPMENT DEPARTMENT . LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 70001 of Division 3 of the Business and Professions Code, and my License is in full force and effect. License Class: License No.: Date: Contractor: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Divisio 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for permit subjects the applicant to a civil penalty of not more than five hundred dollars ($_ 5Q0).: ( ( 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.). (_) 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 I am exempt under Sec. . B.&P.C. for this reason ate: 13 — I S Owner: (IAw Z " 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 N Lender's Contractor: Llc. No.: 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: _ Polity 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 3L-ZAZI abor Code, I shall forthwith comply with those provisions. Date: D ' 3'/ S Applicant: v 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 Building Official 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 city to er upon the above- mentioned property for inspection purposes. nate: ?-13-6- Signature (Applicant or Agent): DESCRIPTION FINANCIAL INFORMATION ACCOUNT QTY AMOUNT PAID PAID DATE ADDITION, EA ADDITIONAL 500 SF 101-0000-42400 0 $62.36 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY :DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE ADDITION, EA ADDITIONAL 500 SF PC 101-0000-42600 0 $17.40 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT AMOUNT PAID PAID DATE ADDITION, FIRST 100 SF 101-0000-42400 EO $120.83 $0.00 PAID BY METHOD ' RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE ADDITION, FIRST 100 SF PC 101-0000-42600 0 $171.14 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid forADDITION: $371.73 $0.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.60 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid forBUILDING STANDARDS ADMINISTRATION BSA $1.00 $0.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RESIDENTIAL, FIRST 1,000SF 101-0000-42403 0 $145.03 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RESIDENTIAL, FIRST 1,000SF, PC 101-0000-42600 0 $47.86 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid forELECTRICAL - NEW CONSTRUCTION: $192.89 $0.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE CONDENSER/COMPRESSOR 101-0000-42402 0 $36.26 $0.00 . PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE CONDENSER/COMPRESSOR PC 101-0000-42600 0 $24.17 • $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE 'FURNACE 101-0000-42402 0 $36.26 $0.00 PAID BY ':" METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID . PAID DATE FURNACE PC 101-0000-42600 0 $24.17 $0.00 PAID BY METHOD RECEIPT # ' . CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE VENT FAN 101-0000-42402 0 $12.09 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE VENT FAN PC 101-0000-42600 0 $4.83 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE WALL HEATER 101-0000-42402 0 $24.71 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT'QTY AMOUNT PAID PAID DATE WALL HEATER PC 101-0000-42600 0 $12.09 $0.00 PAID BY METHOD RECEIPT # . CHECK # CLTD BY Total Paid forMECHANICAL: $174.58 $0.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE FIXTURE/TRAP 101-0000-42401 0 $36.27 $0.00 PAID BY. METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE FIXTURE/TRAP PC 101-0000-42600 0 $36.27 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY ' DESCRIPTION ACCOUNTQTY AMOUNT PAID PAID DATE GAS SYSTEM, 1-4 OUTLETS 101-0000-42401 0 $12.09 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE GAS SYSTEM, 1-4 OUTLETS PC 101-0000-42600 0 $24.17 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE WATER HEATER/VENT 101-0000-42401 0 $12.09 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE WATER HEATER/VENT PC 101-0000-42600 0 $7.25 $0.00 PAID BY METHOD •RECEIPT# - CHECK #- CLTD BY DESCRIPTION `' ° ACCOUNT CITY ° AMOUNT PAID PAID DATE WATER SYSTEM INST/ALT/REP 101-0000-42401 0 $12.09 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD-BY DESCRIPTION ACCOUNT; QTY AMOUNT -` PAID PAID DATE WATER SYSTEM INST/ALT/REP PC 101-0000-42600 0 $12.09 $0.00 PAID BY METHOD.. RECEIPT #< CHECK # CLTD BY Total Paid for PLUMBING FEES: $152.32 $0.00 DESCRIPTION-. ACCOUNT - QTY AMOUNT . PAID PAID.DATE' SMI - RESIDENTIAL 101-0000-20308 0 $1.96 $0.00 PAID BY METHOD RECEIPT # ' CHECK # CLTD BY Total Paid forSTRONG MOTION INSTRUMENTATION SMI: $1:96 $0.00 „• $0.00 Description: BUCKLEY / ROOM ADDITION - DETACHED CASITA Type: BUILDING, RESIDENTIAL Subtype: ADDITION Status: APPROVED Applied: 6/25/2015 SKH Approved: 8/13/2015 JJO Parcel No: 774221614 Site Address: 54015 AVENIDA MARTINEZ LA QUINTA,CA 92253 Subdivision: SANTA CARMELITA AT VALE LA QUINTA Block: 297 Lot: 2 Issued: UNIT 27 7/13/2015 7/13/2015 Lot Scl Ft: 0 Building Scl Ft: 0 Zoning: Finaled: Valuation: $15;098.00 Occupancy Type: Construction Type: Expired: No. Buildings: 6 No. Stories: 0 No. Unites: 0 Details: 250 SQ. FT. ADDITION PER CONVENTIONAL LIGHT FRAMED CONSTRUCTION. ATTACHED CASITA ADDITIONAL CHRONOLOGY CHRONOLOGY TYPE STAFF NAME ACTION DATE COMPLETION DATE NOTES PLAN CHECK PICKED UP JIM JOHNSON 7/13/2015 7/13/2015 PPICKED UP BY OWNER PLAN CHECK SUBMITTAL STEPHANIE KHATAMI 6/25/2015 6/25/2015 RECEIVED RESUBMITTAL PHILIP JUAREZ 7/29/2015 7/29/2015 PLANS RESUBMITTED MR. BUCKLEY CALLED MR BUCKLEY @ NUMBER PROVIDED AND GOT TELEPHONE CALL JIM JOHNSON 7/13/2015 7/13/2015 ANSWER MACHINE NUMBER ON APPLICTION WAS 562 243 8848 PLANS READY FOR CORRECTIONS TELEPHONE CALL JIM JOHNSON 8/13/2015 8/13/2015 called owner to inform him plans are ready to issue need to fill out owner builder info and pay school fees. • • Printed: Thursday, August 13, 2015 4:54:54 PM 1 of 4 . SYSTEMS Printed: Thursday, August 13, 2015 4:54:54 PM 2 of 4 SYSTEMS PHONE FAX EMAIL NAME TYPE NAME ADDRESSI CONTACTS CITY STATE ZIP APPLICANT CARMEN BUCKLEY 54015 AVENIDA MARTINEZ LA QUINTA CA 92253 OWNER JAMES BUCKLEY 54015 AVENIDA MARTINEZ LA QUINTA CA 92253 ACCOUNT QTY AMOUNT Printed: Thursday, August 13, 2015 4:54:54 PM 2 of 4 SYSTEMS FINANCIAL INFORMATION _ CLTD DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY ' BY ADDITION, EA 101-0000-42400 0 $62.36 $0.00 ADDITIONAL 500 SF ADDITION, EA 101-0000-42600 0 $17.40 $0.00 ADDITIONAL 500 SF PC ADDITION, FIRST 100 SF 101-0000-42400 0 $120.83 $0.00 ADDITION, FIRST 100 SF 101-0000-42600 0 $171.14 $0.00 PC Total Paid forADDITION:. $371.73 $0.00 BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00 - Total Paid forBUILDING STANDARDS ADMINISTRATION $1.00 $0.00 BSA: RESIDENTIAL, FIRST ^101-0000-42403 0 $145.03 $0.00 1,OOOSF RESIDENTIAL, FIRST 101-0000-42600 0 $47.86 $0.00 1,000SF, PC Total Paid forELECTRICAL - NEW CONSTRUCTION: $192.89 $0.00 CONDENSER/COMPRES 101-0000-42402 0 $36.26 $0.00 SOR CONDENSER/COMPRES 101-0000-42600 0 $24.17 $0.00 SOR PC FURNACE 101-0000-42402 0 $36.26 $0.00 Printed: Thursday, August 13, 2015 4:54:54 PM 2 of 4 SYSTEMS Permit Details PERMIT DUMBER City of La Quints BREs2015:02, Printed: Thursday, August 13, 2015 4:54:54 PM 3 of 4 SYSTEMS CLTD DESCRIPTION ACCOUNT QTY AMOUNT PAID ' . PAID DATE RECEIPT # CHECK # . METHOD ' ., PAID BY BY FURNACE PC 101-0000-42600 0 $24.17 $0.00 VENT FAN 101-0000-42402 0 $12.09 $0.00 VENT FAN PC 101-0000-42600 0 $4.83 $0.00 WALL HEATER 101-0000-42402 0 $24.71 $0.00 WALL HEATER PC 101-0000-42600 0 $12.09 $0.00 Total Paid forMECHANICAL: $174.58 $0.00 FIXTURE/TRAP 101-0000-42401 0 $36.27 $0.00 FIXTURE/TRAP PC 101-0000-42600 0 $36.27 $0.00 GAS SYSTEM, 1-4 101-0000-42401 0 $12.09 $0.00 OUTLETS GAS SYSTEM, 1-4 101-0000-42600 0 $24.17 $0.00 OUTLETS PC WATER HEATER/VENT 101-0000-42401 0 $12.09 $0.00 WATER HEATER/VENT 101-0000-42600 0 $7.25 $0.00 PC WATER SYSTEM 101-0000-42401 0 $12.09 $0.00 INST/ALT/REP WATER SYSTEM 101-0000-42600 0 $12.09 $0.00 INST/ALT/REP PC Total Paid for PLUMBING FEES: $152.32 $0.00 SMI - RESIDENTIAL 101-0000-20308 1 0 $1.96 $0.00 Total Paid forSTRONG MOTION INSTRUMENTATION SMI $1.96 $0.00 TOTALS:00 Printed: Thursday, August 13, 2015 4:54:54 PM 3 of 4 SYSTEMS Printed: Thursday, August 13, 2015 4:54:54 PM 4 of 4 SYSTEMS ATTACHMENTS REMARKS NOTES REVIEW TYPE REVIEWER SENT DATE DUE DATE RETURNED DATE REVIEWS STATUS NON-STRUCTURAL - 2WK JIM JOHNSON 6/25/2015 7/10/2015 7/13/2015 REVISIONS REQUIRED 0 PLANNING - 2WK WALLY NESBIT 6/25/2015 7/2/2015 7/6/2015 READY FOR APPROVAL DOC 8/13/2015 NON-STRUCTURAL - I 2WK JIM JOHNSON 7/29/2015 8/12/2015 8/13/2015 F APPROVED Printed: Thursday, August 13, 2015 4:54:54 PM 4 of 4 SYSTEMS ATTACHMENTS Attachment Type CREATED OWNER DESCRIPTION PATHNAME SUBDIR ETRAKIT ENABLED DOC 7/13/2015 JIM JOHNSON 54-015 AVENIDA 54-015 AVENIDA 0 MARTINEZ.docx MARTINEZ.docx DOC 8/13/2015 JIM JOHNSON SCHOOL FEESBRES2015- SCHOOL FEESBRES2015- 0 0247.pdf 0247.pdf DOC 7/29/2015 PHILIP JUAREZ 2922_OOl.pdf 2922_001.pdf 0 Printed: Thursday, August 13, 2015 4:54:54 PM 4 of 4 SYSTEMS Bin # Qty ®f La Quinta Building &r Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # Isll"o Project Address: di 74 Owner's Name: 7A PS 60 M A. P. Number: 7 744 a a 0 Address: 5 -V -01r 4dV-1VF4C, W4 - Legal Description: r GJ 3-C17A n-4 Roh City, ST, Zip:15 9 Contractor:-- a(13 W -PT Address: Project Description: (Skl) City, ST, Zip: Telephone: . ....... ......... ...... State Lic. # City Lic. #:. Arch., Engr., Designer: Address: City, ST, Zip: Telephone: ........... XX.. ........ . struction Type: Occup cy: State Lic. 4: ect ty rce one Proj I -A99*-h--7A1fe-r-- Repair Demo Name of Contact Person OL Sq. Ft.: )SO # Stories: Units: Telephone # of Contact Person: Estimated Value of Project? fa -1,-1040 0.0 APPLICANT: DO NOT WRITE BELOW THIS LINE 4 Submittal Reqld —Rcc1d TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural CaIcs. Reviewed" ready for.corrections Plan Check Deposit Truss CaIcs. Called Contact Person Plan Check Balance Title 24 Calcs. 02 S Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2" Revic'w,ready for corrections/issue1 ig 3 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 -A- Total Permit Fees 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 250 S.F. or $0.00 have been paid for the property listed above and that building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued. Fees Paid By Exempt - Carmen Buckley Check No. Bank Name/Recipient of Certificate Telephone 562-243-8848 Funding Exempt By Dr. Gary Rutherford Superintendent tea. - ` = -2•...A Fee collected /exem to b Shar c it rey Payment Recd Zi-$o.00 ;,ewer/U der>j Signature P NOTICE: Pursuant to Government Code Section 66020(d)(1), thk will erve 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 61hwMich 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 without embossed seal Embossed Original - Building Department Applicant Copy - Applicant/Receipt Copy - Accounting CERTIFICATE OF COMPLIANCE Desert Sands Unified School District itits 47950 Dune Palms Rog ad ¢ BERMUDA DUNES r Date 8/13/15 La Quinta, CA 92253 RAN CJ INDIAN AN WELLSPALM No. 31897 (760) 771-8515 DESERT Zj ` QIN INDA 1y Q IOs Owner Buckley APN # 774-221-014 Address 54015 Avenida Martinez Jurisdiction La Quinta City La Quinta Zip Permit # Tract # No. of Units 1 Type Residential Addition Lot # No. Street S.F. Lot # No. Street S.F. Unit 1 54015 Avenida Martinez 250 Unit 6 Unit 2 Unit 7 Unit 3 Unit 8 Unit 4 Unit 9 Unit 5 Unit 10 Comments Attached Casita 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 250 S.F. or $0.00 have been paid for the property listed above and that building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued. Fees Paid By Exempt - Carmen Buckley Check No. Bank Name/Recipient of Certificate Telephone 562-243-8848 Funding Exempt By Dr. Gary Rutherford Superintendent tea. - ` = -2•...A Fee collected /exem to b Shar c it rey Payment Recd Zi-$o.00 ;,ewer/U der>j Signature P NOTICE: Pursuant to Government Code Section 66020(d)(1), thk will erve 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 61hwMich 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 without embossed seal Embossed Original - Building Department Applicant Copy - Applicant/Receipt Copy - Accounting Tw9p 4 4 a" P.O. BOX 1504 LA QUINTA, CALIFORNIA 92247-1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT PROPERTY OWNER'S PACKAGE (760)777-7012 FAX (760) 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 beens (ubmitted`Ain your name listing yo if s the builder of 'the property improvements specified at ,$^ O/ A o 2 z Y ` ,VP y 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 signs you understand or verify this information. 42L-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. 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. ot 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. 5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value fl -My construction is at least five hundred dollars.($500), including labor and materials, I maybe considered an "employer" under state and federal law. A-6. I understand if I am considered an "employer" under state and federal law, I must register with the state and federal r govement, 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. 7'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. A0 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. 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 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 , party legally , and financially responsible for proposed construction activity at the following address: 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. 9L__1 2. 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 Contractois 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 p t. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the cy is required to be resented when the permit is 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, 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 owners signature. Property Owner's Signature: Date: 0 sOFFWC-rcopy CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHOD CF1R-PRF-01 Project Name: Private Guest House Calculation Date/Time: 15:16, Wed, Jun 24, 2015 Page 1 of 7 Calculation Description: Title 24 Analysis Input File Name: Billings guest House T24.xml GENERAL INFORMATION 01 Project Name Private Guest House 02 This building incorporates features -that require fieliiRtesting°and/or catiori;by ai• certrfiedHERS rater under the supervision of a CEC-approved HERS provider. 02 Calculation Description Title 24 Analysis V 11 03 Project Location 54015 Avenida Martinez ENERGY USE SUMMARY 04 City La Quinta 05 Standards Version Compliance 2015 06 Zip Code 92253 07 Compliance Manager Version BEMCmpMgr 2013-3c (710) 08 Climate Zone CZ15 09 Software Version EnergyPro 6.5 10 Building Type Single Family 11 Front Orientation (deg/Cardinal) 0 12 Project Scope Newly Constructed 13 Number of Dwelling Units 1 14 Total Cond. Floor Area (FT Z) 250 15 Number of Zones 1 16 Slab Area (FT Z) 250 17 Number of Stories 1 18 Addition Cond. Floor Area N/A 19 Natural Gas Available Yes 20 Addition Slab Area (F.TZ)' N/A 21 Glazing Percentage (%) 18.4% COMPLIANCE RESULTS 01 Building Complies with Computer Performance ^A- ' 10-4 02 This building incorporates features -that require fieliiRtesting°and/or catiori;by ai• certrfiedHERS rater under the supervision of a CEC-approved HERS provider. 03 This building incorporates one or,'more Special,Fea u' res shown, kbelow V 11 L.V. i t ENERGY USE SUMMARY 04 05 06 07 08 Energy Use Standard Proposed (kTDV/ft2-yr) Design Design Compliance Margin Percent Improvement Space Heating 1.93 1.79 0.14 7.3% Space Cooling 230.57 237.31 -6.74 -2.9% IAQ Ventilation 5.81 5.81 0.0 P Water Heating 66.24 57.18 9.0 % .. AI I Photovoltaic Offset -- 0.00 0.00 CET I -Y DEPT Compliance Energy Total 304.55 302.09 2.46APPROVU . % . —.. --. ice, i I wv r rvi GATE BY Registration Number: 215-N0170758A-000000000-0000 Registration Date/Time: 2015-06-24 15:39:39 HERS Provider: CaICERTS inc. CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CF1R-02272015-710 Report Generated at: 2015-06-24 15:16:58 (37-- CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHOD CF1 R -PRF -01 Project Name: Private Guest House Calculation Date/Time: 15:16, Wed, Jun 24, 2015 Page 2 of 7 Calculation Description: Title 24 Analysis Input File Name: Billings guest House T24.xml REQUIRED SPECIAL FEATURES The following are features that must be installed as condition for meeting the modeled energy performance for this computer analysis. • Window overhangs and/or fins HERS FEATURE SUMMARY The following is a summary of the features that must be field -verified by a certified HERS Rater as a condition for meeting the modeled energy performance for this computer analysis. Additional detail is provided in the building components tables below. Building -level Verifications: • IAQ mechanical ventilation Cooling System Verifications: • Minimum Airflow • Verified SEER HVAC Distribution System Verifications: • -- None — Domestic Hot Water System Verifications: • -- None -- ENERGY DESIGN RATING This is the sum of the annual TDV energy consumption for energy use eccomponents iincluded in the performance _ce compl_ iance approach for the Standard Design Building (Energy Budget) and the annual TDV energy consumption for lighting and components.not regulated by'Title 24, Part 6 (siacn as'domestic appliances,and consumer electronics) and accounting for the annual TDV energy offset by an on-site renewable energy system. fl. 1nn Refer@nce1Energy U'se Energy Design Rating Margin Percent Improvement Total Energy (kTDV/f2-yr)'1,474.38 , P q It 471.92 2.46 0.5% 'includes calculated Appliances and Miscellaneous Energy Use (AMEU) BUILDING - FEATURES INFORMATION 01 02 03 04 05 06 07 Project Name Conditioned Floor Area (ft2) Number of Dwelling Units Number of Bedrooms Number of Zones Number of Ventilation Cooling Systems Number of Water Heating Systems Private Guest House 250 1 3 1 0 1 ZONE INFORMATION I CITYR H' 01 02 03 04 05:itriN&& SAFE DEPT. 07 Zone Name Zone Type HVAC System Name Zone Floor Area (ft2) Avg. Ceilin Height e/ D W to ea in j' eatin System 2 QGuest Quarters Conditioned HVAC Systeml 250 8 r H y11s I DA i E___BY Registration Number: 215-N0170758A-000000000-0000 Registration Date/Time: 2015-06-24 15:39:39 . HERS Provider: CaICERTS inc. CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CF1R-02272015-710 Report Generated at: 2015-06-24 15:16:58 CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHOD Project Name: Private Guest House Calculation Date/Time: 15:16, Wed, Jun 24, 2015 Calculation Description: Title 24 Analysis Input File Name: Billings guest House T24.xm1 CFI R -PRF -01 Page 3 of 7 OPAQUE SURFACES 01 02 Y: 034=-, 11 ff i W 3 04 M 05 X07 01 02 03 04 05 06 07 08 Name Zone Construction Azimuth Orientation Gross Area (ft2) Window & Door Area (ft2) Tilt (deg) North Exterior Wall Guest Quarters R-21 Wall 0 Front 200 20 90 South Exterior Wall Guest Quarters - R-21 Wall 180 Back, 200 1 0.29 90 East Exterior Wall Guest Quarters. R-21 Wall 90 Left 125 16 90 Exterior Wall Guest Quarters R-21 Wall 0 Front 125 30 90 Roof Guest Quarters R-38 Roof Attic 250 ATTIC 01 02 03 04 05 06 07 08 Name Construction Type Roof Rise Roof Reflectance Roof Emittance Radiant Barrier Cool Roof Attic Guest Quarters Attic RoofGuest Quarters Ventilated 2 0.1 0.85 Yes No WINDOWS p, 01 02 Y: 034=-, 11 ff i W 3 04 M 05 X07 08 09 10 Name Type Surface (Orientation-Azimuth)- Width (ft)- " I Height (f4) Multi i er �?�rZa (ft) U -factor SHGC Exterior Shading Window#4 Window 'East Exterio�jWall (Left"90) ;�, f-11 K 4'!0„f i- <o of ”' 16.0 0.29 0.22 Insect Screen (default) Window Window Exterior Wall (Front -0) 3.0 10.0 1 30.0 1 0.29 10.22 1 Insect Screen (default) DOORS 01 02 03 04 Name Side of Building Area (ft) U -factor Door North Exterior Wall 20.0 0.50 OVERHANGS AND FINS 11 01 02 03 04 05 06 07 08 09 0CITY2 DUMA Overhang Left FinOmniDEPT Window Depth Dist Up Left Extent Right Extent Flap Ht. Depth Top Up DistL I o Boj Up o Bot Up Window #4 2 0.1 2 2 0 0 0 0 4 0 Window 2 0.1 2 2 0 0 0 0 0 0 0 0 Registration Number: 215-N0170758A-000000000-0000 Registration Date/Time: 2015-06-24 15:39:39 CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CF1R-02272015-710 DATE HERS Provider: CaICERTS inc. Report Generated at: 2015-06-2415:16:58 CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHOD Project Name: Private Guest House Calculation Date/Time: 15:16, We Jun 24, 2015 Calculation Description: Title 24 Analysis Input File Name: Billings guest House T24.xml CFI R -PRF -01 Page 4 of 7 OPAQUE SURFACE CONSTRUCTIONS 01 02 03 04 05 06 07 Total Cavity Winter Design Construction Name Surface Type Construction Type Framing R -value U -value Assembly Layers (gal) Efficiency Input Ratinv action) DHW Heater 1 Natural Gas Small Storage • Cavity / Frame: no insul. 12x4 Top Chrd 0.65 320 j0-Btu/h Collpf RU 0 2x4 Top Chord of Roof Truss @ 24 Roof Deck: Wood Siding/sheathing/decking Attic RoofGuest Quarters Attic Roofs Wood Framed Ceiling in. O.C. none 0.644 Roofing: Light Roof (Asphalt Shingle) • Inside Finish: Gypsum Board • Cavity / Frame: R-21 / 2x6 • Exterior Finish: Wood R-21 Wall Exterior Walls Wood Framed Wall 2x6 @ 16 in. O.C. R 21 0.066 Siding/sheathing/decking • Inside Finish: Gypsum Board Ceilings (below Cavity/Frame: R -9.1/2x4 R-38 Roof Attic attic) Wood Framed Ceiling 2x4 @ 24 in. O.C. R 38 0.025 Over Floor Joists: R-28.9 insul. SLAB FLOORS 01 02 03 04 05 06 07 Name Zone Area (ft2) Perimeter (ft) Edge Insul. R -value & Depth Carpeted Fraction Heated Slab -on -Grade Guest Quarters ,,., 11 1250'"" 1 " (65 . ..—., None 1 No I F ...rd' 4 1 4 1 E 1 f"""" 1. — w 9 F "'1n. i t 9 F 3 1 f t BUILDING ENVELOPE -HERS VERIFICATION`'*- 01 01 04 Quality Insulation Installation (QII) Quality Installation of Spray Foam Insulation Building Envelope Air Leakage ACH @ 50 Pa Not Required Not Required Not Required -- WATER HEATING SYSTEMS 01 02 03 04 05 06 Name System Type Distribution Type Water Heater Number of Heaters Solar Fraction (%) DHW Sys 1 - 1/1 DHW Standard DHW Heater 1 1 .0% . WATER HEATERS I IIKITA 01 02 03 04 05 0 Y° 8 BUILD N o ' Tank Volume Energy Factor ort dby Lo s R Name Heater Element Type Tank Type (gal) Efficiency Input Ratinv action) DHW Heater 1 Natural Gas Small Storage 30 0.65 320 j0-Btu/h Collpf RU 0 Registration Number: 215-N0170758A-000000000-0000 Registration Date/Time: 2015-06-24 15:39:39 CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CF1R-02272015-710 I,_r - R" rovider: CaICERTS inc. Report Generated at: 2015-06-24 15:16:58 CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHOD Project Name: Private Guest House Calculation Date/Time: 15:16, Wed, Jun 24, 2015 Calculation Description: Title 24 Analysis Input File Name: Billings guest House T24.xml CFI R -PRF -01 Page 5 of 7 WATER HEATING - HERS VERIFICATION 01 02 03 04 05 06 07 Name Pipe Insulation Parallel Piping Compact Distribution Point -of Use Recirculation Control Central DHW Distribution DHW Sys 1 - 1/1 -- — — — – -- SPACE CONDITIONING SYSTEMS 01 02 03 04 05 06 SC Sys Name System Type Heating Unit Name Cooling Unit Name Fan Name Distribution Name :Heat Pump System 1:::2 Heat Pump Heating and Cooling System Heat Pump System 1 Heat Pump System 1 None None HVAC - HEAT PUMPS 01 02 03 04 05 06 07 08 09 10 System Type _; -- Heating Cooling Zonally Multispeed HERS Name Type HSPFICOP Cap 47 Cap 177 SEER EER Controlled Compressor Verification Heat Pump System 1 DuctlessHeatPump t P 10.5 I' 12000-- ` 1 t % 10600 23 13 No No Heat Pump System 1 -hers -cool HVAC - COOLING UNIT TYPES HFRS PROVI.DFR 01 02 03 04 05 06 07 Name System Type Efficiency EER SEER Zonally Controlled Multi -speed Compressor HERS Verification Ductless HeatPump 13 23 Not Zonal Single Speed HVAC COOLING - HERS VERIFICATION 01 02 03 04 05 06 Name Verified Airflow Airflow Target Verified Refrigerant Verified EER Verified SEER C.narg" Heat Pump System 1 -hers -cool Required 350 Not Required ,Te,_4,red Registration Number: 215-N0170758A-000000000-0000 Registration Date/Time: 2015-06-24 15:39:39 CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CF1R-02272015-710 `+ • - - -- - — BUILDING & SAFETY DEPT APPROVED FOR CONSTRUCTION DATE BY Report Generated at: 2015-06-24 15:16:58 inc. CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHOD Project Name: Private Guest House Calculation Date/Time: 15:16, Wed, Jun 24, 2015 Calculation Description: Title 24 Analysis Input File Name: Billings guest House T24.xml CF1 R -PRF -01 Page 6 of 7 IAQ (Indoor Air Quality) FANS 01 02 03 04 05 06 Dwelling Unit IAQ CFM IAQ Watts/CFM IAQ Fan Type IAQ Recovery Effectiveness(%) HERS Verification SFam IAQVentRpt 32.5 0.25 Default 1 0 Required Registration Number: 215-N0170758A-000000000-0000 Registration Date/Time: 2015-06-24 15:39:39 CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CF1R-02272015-710 CITY 4F LA QUINTA BUILDING & SAFE ®PT. AP CONSTRUCTION FOR DATE__ —BY HERS Provider: CaICERTS inc. Report Generated at: 2015-06-24 15:16:58 • • , M CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHOD CF1R-PRF-01 Project Name: Private Guest House Calculation Date/Time: 15:16, Wed, Jun 24, 2015 Page 7 of 7 Calculation Description: Title 24 Analysis Input File Name: Billings guest House T24.xm1 DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Compliance documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: f a c/v2i//ic Butch White Company: Signature Date: BREEZE AIR CONDITIONING INC 2015-06-24 15:39:39 Address: CEA/HERS Certification Identification (If applicable): 75-145 ST CHARLES PLACE City/State/Zip: Phone: PALM DESERT, CA 92211 (760) 346-0855 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am eligible under Division 3 of the Business and Professions Code to accept responsibility for the building design identified on this Certificate of Compliance. 2. 1 certify that the energy features and performance specifications identified on this Certificate of Compliance conform to the requirements of Title 24, Part 1 and Part 6 of the California Code of Regulations. 3. The building design features o[system design features identified:on this'Certificate of Compliance are consistent with the information provided on other applicable compliance documents, worksheets, calculations, plans and specifications submitted tto..the enforcemenntagency for approval with this building permit application. Responsible Designer Name:R^e 'sponsi LI L Designer Signatu 0, / Butch White y ,f • .1 Company: - Date Signed: .. 2015-06-24 151919 BREEZE AIR CONDITIONING INC Address: License: 75-145 ST CHARLES PLACE 416394 City/State/Zip: Phone: PALM DESERT, CA 92211 .(760) 346-0855 Digitally signed by Ca10ERTS. This digital signature is provided in order to secure the content of this registered document, and in noway implies Registration information. CITY OF LA QUID PA BUILDING (& SAFE respons pfo tr thheeNS rydf lD FOR tiJ DATE Registration Number: 215-N0170758A-000000000-0000 Registration Date/Time: 2015-06-24 15:39:39 HERS Provider: CaICERTS inc. CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CF1R-02272015-710 Report Generated at: 2015-06-24 15:16:58