RR (05-1890)77113 Calle Mazatlan
05-1890
P.O. BOX 1504 VOICE (760) 777-7012
78-495 CALLE TAMPICO L FAX (760) 777-7011 .
LA QUINTA, CALIFORNIA 92253. BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 5/19/05
Application Number 05-0_0_00189b' Owner: ,
Property Address: 77113 CALLE MAZATLAN RENYI ELIZABETH MARIE
APN: 658-230-012- - 818 CHARNWOOD DR
Application description: RE -ROOF - WYCKOFFI NJ 7841
Property Zoning: LOW-DENSITY RESIDENT n
Application valuation: 10189 D nn e
qq Ap 2 Q SUS Contractor:
Applicant: Architect E gineLi`i WESTERN PACIFIC ROOFING CORP
Of QUI 3462 LA CAMPANA WAY
C9 ` cEpEPT• PALM SPRINGS, CA 92262
\ (760) 000-0000
f Lic. No.: 235717
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - --- - - - - - - - - - - - - - - - - - --- - - - - - - I - - - - - - - - - - - - - - - - - - - - - - - - - - - - —
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION ,
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. _ I have and will maintain a certificate'of consent to self -insure for workers' compensation, as provided
License Class: B C39 License No.: 235717 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued.
l 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
OWNER -BUILDER DECLARATION insurance carrier and policy number are: '
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier STATE FUND Policy Number 0457624-2005
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to — I certify that, in the performance of the work for which this permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair anystructure, prior to its issuance, also requires the applicant for the person in any manner so as to become subject to the workers' compensation laws of California,
permit to file a signed statement that he or she is licensedpursuant to the provisions of the Contractor's State and agree that, if I should become subject to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or - 3700 of the Labor Code, I shall forthwith'comply with those provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by r - %
any applicant for a permit subjects the applicant to a civil penalty - of not more than five hundred dollars ($5001.: Date: J -Z ' Z pplicant:
(_ 1 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 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon, - SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND _
and who does the work himself or herself through his or her own employees, provided that the DOLLARS ($100,0001. IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
_ one 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.). APPLICANT ACKNOWLEDGEMENT
(_ 1 I, as owner of the, property, am exclusively contracting with licensed contractors to.construct the project (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of ' conditions and restrictions set forth on this application.
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed 1 . Each person upon whose behalf this application is made, each person at whose request and for '
pursuant to the Contractors "State License Law.). whose benefit work is performed under or pursuant to any permit issued as a result of this application,
I—) I am exempt under Sec. , B.&P.C, for this reason the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La Quinta, its officers, agents and employees for any act or omission related to the work being
performed under or following issuance of this permit. -
Date: Owner: 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
CONSTRUCTION LENDING AGENCY permit to cancellation.
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the I certify that I have read this application and state that the above information is correct. I agree to comply with all
work for which this permit is issued (Sec. 3097, Civ. C.). - - city and county ordinances and state laws relating to building construction, and hereby authorize resentatives
of this county to enter upon the ove-mentioned property for inspection purposes.
Lender's Name:- o'f 17)A
/1 ate: S Z ` Signature (Applicant or Agent):171A
Lender's Address: n -
LQPERMIT - r
Application Number 05-00001890,
Permit RE -ROOF
Additional desc .
Permit Fee . . 30.00_
Plan Check
Fee
.00
Issue DateValuation
0 _
Expiration Date 11/15/05
Qty Unit Charge Per
Extension
'BASE FEE
30.00
Special Notes and Comments
RE -ROOF WITH POLYURETHANE FOAM COATING
"
SYSTEM
Fee summary Charged Paid
Credited
Due
Permit Fee Total' 30.00
.00.
00
30.00
Plan Check Total .00
.00
.00.
.00
Grand Total 30.00
.00
.00
30.00
LQPERMIT
. \ _
of * (A"aC4V
P.o. Box 1504 APPLICATION ONLY
Building 78-105 CALLE ESTADO
Address l AM ZOQf-L14AJ LA OUINTA, CALIFORNIA 92253
ner
Mailing
Addresspp
City I Zi Tel.
L., Q 0. f 3 SG <1- /_'? s
Add)ss • '
City Zj Tel.
'. 373
3 -1
State Lic.*-City
City
& Classif. Lic. ff
Arch., Engr.,
Designer
Address
City (Zip( State I
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
t.
7000) of Division 3 of the Business and Professions Code, and my license is In full force and
effec
0RATURE DATE --
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Susiness and Professions Code: Any city or county which requires a
permit to construct, after, 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, Chapter9 (commencing with Section 7000) of
OMslon 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 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, 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.)
❑ 1 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. Company
❑ Copy is filed with the city. 0 Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE
(This section need not be completed if 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, 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
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 it work thereunder is suspended for 180 days.
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 enter the above-
mentioned property for Inspection purposes.
Signature of applicant Date
.Mailing Address
City, Slate, Zip
BUILDING DIVISION I
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number
Legal Description
Project Description C ^ 3 L io e2a, r,4
Sq. Ft.d 1 No. No. Dw.
Size > Stories Units
New Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
O O
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
/ Q
Const.
. p p
Mech.
p p
Electrical
SS
Plumbing
)WV.9 d
S.M.I.
-73
Grading
Driveway Enc.
Infrastructure
3 7 7 9.
TOTAL
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 Permit
Validated by:
Validation:
Building.
Address 77-113 14azatlan
Owner
.Mailing
Address Pa Vii. Box 780
Cit Zi
P.O.BOX 1504 No. 003135
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING:- TYPE CONST: OCC: GRP.,
Santa Rosa .Cove
A: P. Number .-_
Tel
Y
. poi . g-3 3 '
P
g
Legal Description
Project Description 7Zt33.
* . ..•. ......... .... ..
Contractor
Flarr .le C4n tr; w6.3.on
Address .. _ _
P. 0- B03Z 1540
• y.
CitEi3
3.a2
Zip
i9
I
Tel.'
i'"62
o
State Lic.
City -
& Classif. -378318 •'
Lic. #
Sq. Ft..' 236,
Size- .. ., y_
No. ` - No. Dw.
: Stories_. : , .. ....Units
• .... .... ..... .. _
Arch.; Eng.,•
New ❑ Add ❑
'' Alter ❑ '::Repair O. ' Demolition ❑
ii'.! Designer
Address
Tel.
City
.:... _
Zip
State
Lia'#
-
t • . LICENSED CONTRACTOR'S DECLARATION
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. .. lIFY: Y..✓ ltrl.
_ ..
"`
.. .. _.. .. _ - :.
`'
SIGNATURES •. s -•,....- _. pi ` _._" .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 -idconstruct, alter, improve, demolish, or repair any -structure,' prior to its, issuance also
-requires the applicant Yor 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) of
Division 301 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 o/ not more than five hundred dollars ($500): ' ^ ... • -
O" I, as ownerof 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 /or the purpose o/ sale.)- -• -
Estimated' Vall uation
-
-
- • - . fs z ' -
•A f •. O _
-•c.x .-
-PERMIT. -
-•
- .7.
•- - 'AMOUNT
.ar• - "
Pfan. Chk... Dep..
• - - .
- -
Plan Chk.. Bal....
- -
46.4
C011S1.'
` 603A0
-
- -
Mech.
- ;fp - -
Y Sid
-•
`•.EI@CtrlCal
pgqq T
:d Ga c ti 5
"Plumbing " ..
- .. s - "
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con.
- struct -the project. (Sec. • 7044, Business and.Pro/essions Code: The Contractor's License Law • •
I does not apply,. to an owner of property who builds or improves thereon, and who contracts for
such projects projects with a contractors) licensed pursuant to the Contractor's License Law.) - -
_ 0 l am exempt under Sec.•" B: &.P.C. for -this reason -
S,M,I,'..
44 f .
' • ,i s't
Grading
-
Driveway Enc.
Date Owner
Infrastructure
3,779*64
WORKERS' COMPENSATION DECLARATION
' I hereby affirm'that'I'have a certificate of consent'to self•ifisuie, or:a certificate'oi
- Worker's Compensation Insurance, or a certified copy thereof. (Sec *3800, Labor Code.)
,
' 'Policy No.Company
Ci Copy is filed with the city.. ❑ Certified copy is hereby furnished.
TOTAL
fir] A Ca
S CERTIFICATE OF EXEMPTION FROM
-WORKERS, COMPENSATION INSURANCE'
REMARKS-
• (This section need not be completed if the permit' is for one hundred dollars ($100)' valuation
or less.) _
I certify that in the performance of the work for which this permit0051132 is issued, I shall not
• employ any person in,any, manner so as to become subject to the Workers' Compensation
Laws of California
.r• #`.t
- Ltr'65 Li2a.
"
r +s, yv
%(};if„ta f1al: f 3.7.7Ci
- Date-:- , . ' Owner. .. ,
- NOTICE TO APPLICANT. If, after making this Certificate - of Exemption
9you "should become
subject' to.'the Workers' Compensation provisions o/ the Labor code; you must forthwith
comply with such provisions or this permit shall be deemed revoked:
- = •
ZONE: BY'.' -
Minimum Setback '
.' - • -
Front,Se.tback from Center.Line -
:
Rear Setback from. Rear Prop..Line
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.) - •
Side Street Setback from Center Line
Side Setback from Pfoperty Line
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 state thatdhe above information is correct.
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.
FINAL DATE
ISSUed.,by: '
'"' • '
Validated by:
INSPECTOR''-
Date PerfTllt'=
- Signature of applicant "' Date
Mailing Address
Validation:
-
City, State, Zip
r HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT. ®
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. I SQ. FT.
WALL SO. FT. ®
S0, 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
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
(ROUGH)/2
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP./EQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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.
SQ. FT. p c
BATH TUB
SQ. FT. ®c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/a c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
VENTILATION
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.
(ROUGH)/2
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
REINF. STEEL
FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FR G
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
NSPECTIONJZ
CERT. OCC.
FENCE FINAL
IMJYCI.I UM'A W U MR 1 UMr W1M111NLA,
GARDEN WALL FINAL
— -
s . i °+rte-
05;;:10 ! 3/:3/ •i /il/ar
PREPARED FOR:
Att.nchment 0
Glenn Bradley Enger, A.I.A. Four, 2
73-960 El Paseo, Suite 5 (Revised 3/34)
Climate Zones 2, , G, and 6-15
Palm Desert, California 92260 •
COMPLIANCE CHECKLIST G-3 LAQUINTA by LaQuinta Joint Venture
For Low -Ride Residential Buildings
(except hotels and motels)
Step 1: Enter on the form the values for each measure from your building -plan
and specifications sheet.
Step 2: Enter points on this page while working through the point system
Building She!! Measure Points
'Total Floor. Area !50 -
1. Slab -on -Ground'; Perimeter ft., Depth in. • , , • . . R- O
2, Raised Floor R -Value, R- n
3. Ceiling Insulation or Construction Assembly , , • , ,R- , O
Attic, Percent of Roof Over Conditioned Space loo e 21 oft- o
4. Wall Insulation or Construction Assembly. ., R- -
Glazing; Total 9 Floor Area Single Double Triple
5. ilorth- Facing. . . ft2 la ). ft2 ft2 -lp
o. East -Facing ,; fi .4 ft- 2 7Z5-
7. South -Facing, . ftp f t 2 ft
8. West -Facing i ft2ft2 ft2 t
9. Skylight. _ O q ft 0 ft ft
2 oQ
10. Shading Coefficient.
(excluding overhang)
a. East Vee-T,iealr GL,ND) 0,? 0' SC _I.
b. South. va.R lz r !_ QL N ,
c. West tvl- p-TIc;A4- . $L µo 3p.SC Q
d. North. . .(VERTt ti: . 4t o . O..a'sc . . —5 -
e. Skylight -
11. Horizontal South 0'verhan9 Length.' 2 ft . . • p
12. Movable Insulation, q Floor Area, N q o
13. 'Infiltration (indicate Standard, Medium o7i Ignt) M F Olu rn : I
14, Thermal Mass
Exterior 'Wall Thernial Mass
Area, Heat Capacity, R -Value . .ft2, HC, R -
Interior Thermal Mass '
Area, Heat Capacity, R -Value.. `` ' ,
.HVAC System+* 5lol 7.3
15. Gas Furnace without Refrigeration.Cooling
C 21 50
(Seasonal Efficiency) . . ,.. . , . ,N SE p
16, Heat Pump (Energy Efficiency Re.tio) . , . , . , , . . N p Er.R O
11. Gas Furnace with Refrigeration Cooling
Seasonal Efficiency and Seasonal
Energy Efficiency Ratio . . SE q•5 ;E=R +12,
18. Active Solar (11 et Solar Fraction, ,) -
19. Zonally Controlled Electric • • . . .. .
Resistance Space Heating , , , , , , (yes/11o; K)p
0
Domestic Water iieatinq**
20. Solar With Gas Backup (;iet Solar Fraction, ;) . , • , , , , , , "NSF
21. Other Water Heating (Describe type) G A S p _
Point System Cemoliance Tota), . . , , , , , . . . _d
`.Lneci tst tte-, not a point system measure.
**Attach documentation for effiCiencies and NS=,
PREPARED BY:
Joseph N. Cicchini; Civil Engineer, Inc.
44267 Monterey Aventie;'Suite B
Palm Desert, California 92260 (.619)-341-2273