RR (05-1892)77133 Calle Mazatlan
05-1892
P.O. BOX 1504
78-495 CALLE TAMPICO.
LA QUINTA, CALIFORNIA 92253
T4ht 4 e(PQ"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number:{05'-00001'892
Property Address: 77133 CALLE MAZATLAN
APN: 658-230-010- - -
Application description: RE -ROOF
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 10189
I(CIF114AMCF-DEPI Applicant: Architect or Engineer: MAY 2 0 `005TY OTA
F l A atiI
--------------------------------------------------
LICENSED CONTRACTOR'S 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{Class: B C39 LiLicJe%se No.: 35717
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
1 _ 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
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
and who does the work himself or herself through his or her own employees, provided that the
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
one year of completion, the owner -builder will have the burden of proving that he or she did not build or
improve for the purpose of sale.).
1 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
1 1 I am exempt under'Sec. , B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
LQPERMIT
Owner:
KIRCHNER THOMAS L
4 SORA CT
ALISO VIEJO, CA 92656
Contractor:
WESTERN PACIFIC ROOFING CORP
3462 LA CAMPANA WAY
PALM SPRINGS, CA 92262
(760)000-0000
Lic. No.: 235717
VOICE (760) 777-7012
FAX (760) 777-701 T
INSPECTIONS (760) 777-7153
Date: 5/19/05
-----------------------------------------------
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 STATE FUND Policy Number 0457624-2005
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
e 3700 of th or Code, I shall forthwith comply with t r s.
-Gr APPhcant:
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 1$100,0001. IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
conditions and restrictions set forth on this application.
1 . Each person upon whose behalf this application is made, each person at whose request and for
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La Quinta, its officers, agents and employees for any act or omission related to the work being
performed under or following issuance of this permit.
2. Any permit issued as a result of this application becomes null and void if work is not commenced
within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the above information is. correct. I agree to complypith all
city and county ordinances and state laws relating to building construction, and hereby authorize repres atives
of this county to enter upon th bove-mentioned property for inspection purposes. ,
'bate: - Z Signature (Applicant or Agent):
Application Number . . . . . 05-00001892
Permit RE-ROOF
Additional desc .
Permit Fee 30.00
"Plan Check
Fee
.00
Issue Date
Valuation
. . .
. 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
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 77-133 Mazatlan. LA•QUINTA, CALIFORNIA 92253
Owner
Mailing
Address F. 0. Box 780
City Zip Tel.
La Quinta' 1 92253 564-13.5
Contractor
Address
iota 1 32253 1 564 -
State Lic. I City
& Classif. 378328 Lic. #
Arch ; Engr., "
Designer
Address Tel.
City Zip State
Lic. #
J LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business-aan nd, Professions Code, and my license is in full force and
effect. A A;;
SIGNATURE`'— DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to -,construct, alter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to 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 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 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.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions. Code: The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
O 1 am exempt under Sea 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'. COMPENSATION INSURANCE
(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 or 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 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, State, Zip
HARD
No. .()03733
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number Santa Rosa Cove
,Legal Description "
Project Description G-3 3e Oninka
Sq. Ft. 23 No. No. Dw.
Size 6 Stories w Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
$167,984 -
PERMIT
AMOUNT
Plan Chk. Dep.
Distances:
Plan Chk.,Bal.
496*U4
Const.
603.UU
Mech.
57. 00
Electrical
58.55
Plumbing
104.00
S.M.I. =
11.73
Grading
Validated by:
Driveway Enc.
Infrastructure
3,779.64
TOTAL
tS;:
in Ji, E; 7•t Tht7-y LLJ;AA !z.
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:
Date3J21f 0.8 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SQ. FT. ®
CAR P. SQ. FT.
WALL SQ. FT. ®
SO, 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
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
BOND BEAM
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1+/a c
SEWAGE DISPOSAL
LUMBER GR.
SQ.FT.GAR ® 3/4c
HOUSE SEWER
FINAL INSP.
ROOFING
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)/
METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
REINF. STEEL
A (FINAL) Ll
TEMP. POLE
GROUT
WATER HEATER
ICE/2, v
27
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
NISH GRADING
ZE AL INSPECTION/
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS.
GARDEN WALL FINAL
053 :10 !,' )/;8/ i 'til/ar
PREPARED FOR:
Attdchaent D
Glenn Bradley Enger, A.I.A. Form 2
73-960 El Paseo, Suite 5 (Pevised 3/34)
Palm Desert, California 92260 Climate Zones 2, S, G, and G-15
COMPLIANCE CHECKLIST G-3 LAQUINTA by LaQuinta Joint Venture
For Low-Ri e.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 Shell
Meesure
Points
*Total Floor Area2
1.
Slab -on -Ground; Perimeter ft., Deoth* in.
0
2.
Raised Floor R -Value.
3.
Ceiling Insulation or Construction Assembly . . . ,
, , , R_ -_
O
4.
Attic, Percent of Roof Over Conditioned Space 100 i
Wall
21 soft-
Insulation or Construction Assembly. , . . , ,
, , R- _
o
Glazing;
Total S Floor Area Single Double
Triple
5,
3,;rth-Facing. b : ft 14 ( ft
ft
-(p
6.
East -Facing . . . S ft2 ft2
2
-
7.
8.
South -Facing, ft2 f;2
West -Facing 2
ft 2
2
9.
i ft ft
Skylight. p A ft
ft
0 - ft2
_
ft2
10.
Shading Coefficient
(excluding overhang)
a. East BL N
. fV,8 7 c,:4. SC .
b. South. g0.Q14-^, OL4*4
. . . . . . . . . . . .
_1
. O e_SC
.
e. No tn.
...
. .
C 6RT 414L. 4 !0 . o sC
e. Skylight ASC
. .. . . . . . .
. . . . . . .
.
.
O
11.
Horizontal South Overhang Length. 2 ft ..,
. . . . . . . .
. . . .
O
12.
Movable Insulation, ". Floor Area. N ;
13.
Infiltration (indicate Standard, Fadium or ignt)
M
O
14.
Thermal Mass
Exterior Wall Thermal Mass
Area, Heat Capacity, R -Value . . . . . .
2, HC, R -
-ft
Interior Thermal Mass
Area, Heat Capacity, R -Value . . . . . .. 5 61
ft 2, R- O
-r 12
HVAC
System**
_jjq_HC,
7.
Cbl
2150
15.
Gas Furnace without Refrigeration. Cooling
(Seasonal Efficiency).. . . . .
N SE
D
16.
Heat Pump (Energy Efficiency Ratio)N
p EER
O
17.
Gas Furnace with Refrigeration Cooling
Seasonal Efficiency and Seasonal
18.
Energy Efficiency Ratio
Active Solar (Net Solar Fraction, ;)
SEa• j SE:R
'=
t1Z
19.
Zonally Controlled Electric
. . . .-Q-
Resistance Space Heating . . , , , , , , , , . .
•(Yes/No) _ IO
-
Domestic Nater Heatin0••
20.
Solar With Gas Backup (;let Solar Fraction, 1,) . . •.
<ySF
21.
Other Water Heating (Describe type)
G A
p
Point System Ccmoliance Total. . . . . . . . .
_•
*Che
Ci 1st not a point system measure,
"Attach
docunentation for efficiencies and IIS=.
PREPARED BY:
Joseph N. Cicchini, Civil Engineer, Inc.
44267 Monterey Avenue, Suite B
Palm Desert, California 92260 (.619)-341-2273