RR (05-1898)77193 Calle Mazatlan
05-1898
P.O. BOX 1504
78-495. CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
T4440"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: 05-000018.98 Owner:
Property Address: 77193 CALLE MAZATLAN GROSS TERRY S
APN: 658-230-004- - - - 2170 LINDSAY COURT
Application description: RE -ROOF TUSTIN, CA 92782
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 8572
aContractor:
Applicant: Architect or Enginee D [ry WESTERN PACIFIC. ROOFING CORP
3462 LA CAMPANA WAY
MAY 20 2005. PALM SPRINGS, CA 92262
(760)000-0000
CiTY FLAG4UINTA Lic. 'No.: 235717
FINANCE DEPT -
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 LicenseNo.: 235717
.IC.nl,actor:
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, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
the structure is not intended or offered•for sale (Sec. 7044, Business and Professions Code: The
.Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
and who does the work himself or herself through his or her own employees, provided that the
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
one year of completion, the owner -builder will have the burden of proving that he or she did not build or
improve for the purpose of sale.). - - -
(_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.). '
( 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:
C
Lender's Address:.
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/19/05
WORKER'S COMPENSATION DECLARATION
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
-9issued.
1 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 subjecttothe workers' compensation provisions of Section
7qpO
or C fo 'ith o y with tho provisions.
11 ate: / i1
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES.UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION -TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
conditions and restrictions set forth on this application.
1 . Each person upon whose behalf this application is made, each person at whose request and for
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La Quinta, its officers, agents and employees for any act or omission related to the work being
performed under or following issuance of this permit.
2. Any permit issued as a result of this application becomes null and void if work is not commenced
within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the above information is correct. I agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of this c02ty tp enter upo move -mentioned property for ins pe on pur oses.
,Dgte: d Signature (Applicant or Agent):
Application Number 05-00001898'
Permit RE -ROOF
Additional desc .
Permit Fee . . . . 30.00
Plan-Check•Fee
00
Issue Date
Valuation . . .
. 0
Expiration Date 11/15/05'
Qty Unit ChargePer
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
Plan Check Total -.00
.00 ..00
.00
Grand Total 30.00
.00 .00
.30.00
LQPERMIT
. - -
Building
• Address
Owner
_ P.O. BOX 1504 ' N O . _ 0' 3
78-105 CALLE ESTADO
77-193 ,Mazat.lin, . Y • _ LA QUINTA, CALIFORNIA 92253
Ta O1: rota Joint Venture BUILDING: .TYPE=CONST.w « OCC: GRP:
Mailing
Address 0. Box, 7.80Sca.nta . ''.o , Cow.' • " A:P: Number ' -
City Zip Tel. a_
544-13T5 Legal. Description
.A44 V. Ua. 3f
Contractor .
Project, Description G-1 Seville
..Address..
y ...
'Cit
Zip
Tela
t L, 0AUnta
92253
564--6244
State Lic.
& Classif,,
7
City
Lic. # '-
Sq. Ft, No. No. Dw.
Size....:°y ' ..._.,Stories•. ...;w Units
Arch., Engr:, - _ , .... _. - ...... - _
• -
`:. Designer -: - '.
New ❑ Add ❑. Alter ❑' Repair ❑ Demolition
Address
Tel.
City
Zip
State
Lic.'# ... .
- j , '; •, 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
x•
.. - ..... .... . . .. -
.
SIGNATUREr ' . ..:- ..=... .. _ .,-. ... - - _. . A' r e- ""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:fs.ezeinptAt6eire/rom; and the:basis
for. the alleged exemption. Any violation
lation of Section. 7031.5 .by 'any( applicant for a permit '-
a civil penaltyof not m e than.five'hugndred dollars. $500. '
. sub'ects'the. licant toproperty,-
0 I, as, owner of the ro ert or m employees with wages as their sole compensation, will
do the work; and the structure is not intended or offered dor, sale. (Sec: 7044, Buisness and:
.- Professions Code: The Contractor's License Law does not apply, to an owner.of property who
builds or'improves thereon and who does such work himself or..through- his own employees,-
i provided that such. improvements are not intended -or offered for,sale.•If, however;, the building •.
or improvement is -sold within one year of completion, the owner -builder will have the burden'
of proving that he•did not build or improve for the purpose,of sale.) .,
Estimated V81UatlOrt y$M 012
'
'' .•. '
-PERMIT . AMOUNT - -
- -
.. '
D6p.. ,•
£'
FIBn.Chk: - - - h s ;a ,r A - -'•
ai 2T8 ta' .04
y rpp
.Const... •. " - - ' -
• - -«^
Mech.'
-' Electrical••
Plumbing'''"
O 1, 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 n t 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
_. - q
$,M,l• ^ - &•..
_
Grading
Driveway Enc.
Date Owner.
Infrastructure
' WORKERS' COMPENSATION DECLARATION
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.)'.
'Poll cyNo. Company,._
O. Copy is filed with the city. , ,O, Certified copy is hereby. furnished..
TOTAL
REMARKS € '
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.) .. - ... -. .. -
certify that in the performance of thg 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. -
r "` . ;. -
s', g r1 A W:,'t t,kyy' `l s .'I i'.4 AµUP754` , 541
-
' Date' Owner
- NOTICE TO APPLICANT: If, alter making this Certificate of Exemption -Jou should - become '
' subject to -the Workers" Competisation provisions' of the -Labor Code,' you must foithwitti-
• comply with such provisions or this permit shall be deemed revoked. -
ZONE: BY: - - -
- '
Minimum Setback Distances:
Front.Setback from.Center. Line
_ .Rear
Setback.from Rear,Prop.,Line
CONSTRUCTION LENDING•AGENCY'
"I hereby. affirm that thele is a construction lending agency Tor the performance of the '
work for which this permit is issued. (Sec. 3o9.7,.Civil Code.).• ' -.
Side Street SetbaCkfrOm Centel Line
- " Slde-Setback from•Pfoperty Line
Lender's Name
FINAL.DAT,E INSPECTOR
3/2,1/88
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:, : w - ' •. -
. I certify that I have read this application and state`that-the above informationis-correct.-
I agree to comply with all city and county ordinances and stat e"laws'telating,to building
construction, and hereby authorize representatives ofthis city toenterthe- above-: '.
mentioned property for inspection purposes. "
_ .
Permit
Issued by: r Date' •-
`. • -d
Validated by:
Signature of applicant Date
. Mailing Address
Validation:
... _ ..
City, State, Zip
-
--• ' - ._... - _ ' =. - - ' • «• 'Y+ - `'a-,
'HARDCOPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES'
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SQ. FT. ®
CAR P. SQ. FT.
WALL SQ. FT. ®
SQ. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
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,TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ®c
BATH TUB
BOND BEAM
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LUMBER GR.
SQ.FT.GAR Q 3/ac
HOUSE SEWER
FINAL INSP.
ROOFING
GAS PIPING
PERMIT FEE
PERMIT FEETOTAL
r.1
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.IEOUIP.
REINF. STEEL
) Zi
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FI H GRADING
&I'NAL INSPECTIONIZ- '5
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
:d
r.
05;;:.10 !: .1 31231,N# Vil/a r
AtUiclvnent V
PREPARED FOR:
Glenn Bradley Enger, A.I.A. Form 2
73-960 El Paseo, Suite 5 (Pevised 3/3-1)
'Palm Desert-, California 92260. Climate Zones 2, 4. G, and &-15
COMPLIANCE CHECKLIST G-3 LAQUINTA by LaQuinta Joint Venture
For Low-Rike 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
Buildino Shell Meesure Points
*Total Floor Area 2
. . . . . . . . . . . . . . . . . . . . . . f t
1. Slab -on -Ground; Perimeter, ft., De oth -4n . . . . . . R_ 0
2. Raised Floor. R -Value.
3. Ceiling Insulation or Cons tr'ti ou,,' *r. *As
Attic, Percent ofRoof Over Conditioned Space IoO
R-1 5
4. Wall Insul ation or Construction Assembly, . . . .. . . .
Glazing; Total % Floor Area Sinole Doutile
Triple
5.
;forth -Facing, 2 2 2
ft ft7 ft
6. East -Facing . . . f t 2 2
g.,4, f q ft
7. South -Facing, . . ft 2 — f 1 2 ft 2
8. West -Facing 2 15 2'
--ft 2 2095 ft2 —ft 2
9., Skylight. . . . . tt 2
0 ft —ft 0
10, Shading Coeffi'i
clent
(excluding overhang)
a East' . 'etme-Aar P4 o) Sc . ... . . . . . . . . . . -1
V
b: South b0.RzC:",, 0, - SC . . . . . . . . . . .
-gT
c West WA w- l$L4,j0_
e. Skylight 1 10 C
d: North. . .
4ZA05C .... . . . . . . . . . . .
A11A SC . . . . . . . . . . . . .
11. Horizontal South,Overhang Length. ft ... . . . . . . . . . . . 0
12.' Movable Insulation, '.Floor Area. 1 —
w JA 0
13. Infiltration (indicate Standard, Medium a T71 Fgn t MEDIUM
.4. I Thermil Pass
Exterior.Wall Thermal Mass
Area, Heat Capacity, R -Value . . . . . . . 'ft2
Interior Thermal Mass C R
Area, Heat Capacity, R -Value . . . . 561 ft2 0,Cj HC, R70 .3
.-
HVAC Svstem**
15, Gas Furnace without Refrigera tion. Cool ing
(Seasonal Efficiency).. . . . . ... . . . . . . .. . . . Vj
16, Heat Pump (Energy Efficiency Ratio) . . . . . . SE
17. Gas Furnace. with Pefr'49cratior. Cooling
. . ... . . . ER
Seasunal Efficiency and Seasonal
Energy'Efficiency Ratio . . ... . . . . . . . . . -
—SE SE:_R +12-
18. Active Solar (Net Solar Fraction, %)
19. Zonally Controlled Electric
Resistance Space Heating . . . . . . . . . . . . . .(Yes/No/ wo
DOMeStic Nater Heatinq**
20, Solar With Gas Bockup (.Net Solar Fraction; 1.) IISF
.21. Other Water Heating (Describe type)
Point System CcmDliance Total . ... . . . . .. . . . . . . •.
Che 71SE not a point -system, measure.
**Attj'dh documentation for efficiencies and NSF.
PREPARED BY:
Joseph N. Cicchini, Civil.Engineer, Inc.
44267
67 Monterey Avenue, Suite B
Palm Desert,. California 92260 (.619)-34172213