RER (11-0748)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
`Application Number: 11-00000748
Property Address: 52680 AVENIDA MENDOZA
APN: 773-303-009-15 -000000-
Application description: REMODEL - RESIDENTIAL
Property Zoning: COVE RESIDENTIAL
Application valuation: 2000
Applicant: Architect or Engineer:
-
--------=------------------- - - - - -.
LICENSED CONTRACTOR'S DECLARATION
4
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
1 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: 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 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
K��yy applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
(W 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, 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 am exempt under Sec. , B.&P.9/Vr this reason
I hereby affirm under penalty of perjury that there is
work for which this permit is issued (Sec. 3097, Cis
Lender's Name:
Lender's Address:
LQPERN11T
LENDING AGENCY
,n lending agency for the performance of the
VOICE (760)-777-7012
FAX (760) 777-7011
INSPECTIONS (760)777-7153
Date: 7/08/11
Owner: 1_
RW REAL ESTATJ5, INC.
52680 AVENIDA MENDOZA
LA QUINTA, CA 92253
Other struct info rU. C U j
Contractor:
Owner
DITION 2010 CODES
------------------
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 =------ -- - - - - -- - - - - - - Policy 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 me subject to the workers' compensation laws of California,
and agree that, if 1 should be me ubject to the workers' compensation provisions of Section
3790 of the Labor Code, I all fo hwith comply with those provisions.
,U—/ cant:
WARNING: FAILURE TO SECURE WORKERS' PENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENA S AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000)• IN ADDITION TO THE OST 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 t a e information is correct. I agree to comply with all
city and county ordinances and state laws relating to b dding c struction, and hereby authorize representatives
of this county to enter upon the above-mentioned prorty for in pection purposes.
O r
e: L /1 7dr. (Applicant or Agent-
Application Number . . . . 11-00000748
.Permit . . .
BUILDING PERMIT
Additional desc . .
Permit Fee . . . .
45.00 Plan Check
Fee
29.25
Issue Date . . . .
Valuation
. . .
. 2000
Expiration Date
1/04/12
Qty Unit Charge
Per
Extension
BASE FEE
15.00
15.00 2.0000
HND. BLDG 501-2,000
30.00
----------------------------------------------------------------------------
Special Notes and Comments
INSTALL 6 NEW WINDOWS
& 1 FRENCH DOOR
(EXISTING FRAMEWORK).
2010 CODES.
--------
-------------------_-----------
Other Fees . . .
-------------------------
. . . . BLDG STDS ADMIN (SB1473)
1.00
ENERGY REVIEW FEE
2.93
Fee summary Charged Paid Credited
--------------------
----------
Due
---------------------------
Permit Fee Total
45.00 .00
.00
45.00
Plan Check Total
29.25 .00
.00
29.25
Other Fee Total
3.93 .00
.00
3.93
Grand Total
78.18 .00
.00
78.18
LQPERMIT
Bin #
City -of La Quinta
Building U Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
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Project Address:
Owner's Name:
A. P. Number:
Address: J J
'
Legal Description:
Contractor:Telephone:
City, ST, Zip:
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Address:
Project Description:
City, ST, Zip:
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Telephone:
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State Lic. # :
City Lic. #;
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
}y�it
Construction Type: Occupancy:
(,1
State Lic.
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: J J U�
Sq. Ft.: �3
# Stories:
#Units: I
Telephone # of Contact Person: — — b
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
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Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cities.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2*' Review, ready for corrections/issue
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
Total Permit Fees
a
P.O. BOX 1504
LA QUINTA, CALIFORNIA 92247-1504 BUILDING & SAFETY DEPARTMENT
78-495 CALLS TAMPICO (760) 777-7012
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011
PROPERTY OWNER'S PACKAGE
Disclosures & Forms for Owner -Builders Applying for Construction Permits
I�►IPORTI"T! NOTICE TO MMERTY OWNER
Dear Property Owner.
An. application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified at
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
Ownes-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.
OV R'S AQMWLE1)(;MNT AND VERWWATION OF INFO AlWN
�
D RECTTONS. Read and initial each statement below to signify you understand or verify tkis information.
\` \A 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
injures. 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 -
WN 2 -
roperty.
WN2. 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.
�. 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.
I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on
permits and contracts.
M. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value
of my construction is at least five hundred dollars ($500), including labor. and materials, I may be considered an "employer'
under state and federal law.
6. I understand if I am considered an "employer' under state and federal law, I must register with the state and federal
government, 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. ,
1 ri" � k. ' . I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residentia
structures cannot .legally build them with the intent to offer them for sale, unless all work is performed by license4
subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performe
under contract with a licensed general building Contractor.
�8. 1 understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liabk for any
financial or personal. jgj.aries 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 "employee' 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 (CS, LB) at 1-
800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors.
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:
l L I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all
aplicable laws and requirements that govern Owner -Builders as well as employers.
2. 1 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 maybe unable to assist you with any financial loss
you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors 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 is
the agency responsible for issaing;
other verification acceptable to th�
owner's signature.
Signature of property owner
this form must be completed and signed by the property owner and returned to
Note: �4 copy of the property owner's driver-'sRcense form notarkaden; or
n required to be presented when the permit is issued to verify the property
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 OWNEWS BEHAL
Excluding the Notice to Property Owner, the execution of which I understandis 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 owner's signature..
Property Owner's Signature: Date:
Prescriptive Certificate of Compliance: Residential CF -IR -ALT
Residential Alterations Page 1 of 5
Project Name: F7177
Zone # # of Stories
uh' a �
General Information
Site Address:
Enforcement Agency: Date:
Building Type Single Family ❑ Multi Family
Circle the Front Orientation: N, E, S, r degrees
Conditioned Floor Area (CFA):
Project Type: N.,Alterations ❑ Envelope ❑ Fenestration ❑ Roof ❑ HVAC
Table
Replacement or Change Out ❑ Duct Replacement ❑ Water Heater
NOTE: This form is not to be used for Newly Constructed Buildings or Additions
Insulation Values For Opaque Surfaces (for Furring use the Mass and Furring Strips Construction table below)
Assembly Alteration
❑ Opening of framed cavity alone— Alterations that involve the opening of the framed cavity ofa wall, ceiling, or floor must install the
mandatory minimum insulation value per §150 for the altered assembly. Fill in Columns A —C and enter mandatory insulation value in Column H.
❑ Replacement of entire assembly— Replacement of an entire wall, ceiling, or floor assembly requires the installation of Component
Package- D insulation values in Table 151-C. Fill in Columns A —J.
Opaque Surface DetailS For the furred portioned of Mass Walls see Furring Strips Construction Table below.
A B I C D
E
F G I H I I J
Proposed See Note
Standard
Values From JA4
Table
Walls From Reference
Framing Thickness,
Framed Continuous
JA4 Proposed
Tag/
IDS
Assembly Name
or Type]
Material Spacing,
and Size or Other
U-
factor
JA4 Table
Numbers
Cavity Insulation
R-value6 R -Value?
Assembly Assembly
Cell Value U-factor9
C N
Assemblyc
e
o .2 E c Von
Final
Mass
Name or JA4 Table75
;, y E c e A >
Assembl
Thickness'
T e2 Number' ¢ >
c " ❑ ' ¢ >
U -factor
Comment
Note: For furred assemblies, accounting for Continuous Insulation R -value, see Page JA4-3 and Equation 4-1. For calculating furred walls use the Mass and
Furring Constniction table below.
1. For Tag/ID indicate the identification name that matches the building plans.
2. Indicate the Assembly Name or type: Roof/Ceiling, Walls, Floors, Slabs, Crawl Space, Doors and etc... Indicate the Frame type and Size: For
Wood, Metal, Metal Buildings, Mass, enter 2x4, 2x6, or etc... see JA4 for other possible frame type assemblies.
3. Enter the thickness for mass in inches or Spacing between framing members enter; 16 "or 24 "OC; or Other for all other assembly description
such as Concrete Sandwich Panel, Spandrel Panel, Logs, Straw Bale Panel and etc....
4. Based on the Climate Zone; enter the Standard U factor from Table 151-B, C or D for each different assembly Name or type.
5. Enter the Table number that closely resembles the proposed assembly.
6. Enter the R -value that is being installed in the wall cavity or between the framing; otherwise, enter "0 ".
7. Enter the Continuous Insulation R -value for the proposed assembly; otherwise, enter "0 ".
8. Enter the row and column of the U factor value based on Column F Table Number and enter the Assembly U factor in Column J
9. The Proposed Assembly U factor, Column J, must be equal to or less than the Standard U factor in Column E to comply.
Furring Strips Construction Table for Mass Walls Onl
A I B I C I D I E
F G H I J I K
L
M
Proposed Properties of Masonry and Concrete
Added Interior or Exterior Insulation
Walls From Reference
in Furring Space from Reference
Joint Appendix Table 4.3.5 4.3.6 4.3.7
Joint Appendix Table 4.3.13
N
3) O
ce
C N
Assemblyc
e
o .2 E c Von
Final
Mass
Name or JA4 Table75
;, y E c e A >
Assembl
Thickness'
T e2 Number' ¢ >
c " ❑ ' ¢ >
U -factor
Comment
Registration Number:
2008 Residential Compliance Forms
Registration Date/Time: HERS Provider:
August 2009
Prescriptive Certificate of Compliance: Residential CF -IR -ALT
Residential Alterations Page 2 of 5
Project Name: Climate Zone # # of Stories
Mass and Furring Strips Construction(footnotes)
1. Indicate the type of assembly to include; Hollow Unit Masonry Walls, Solid Unit Masonry, Solid Concrete Walls, Etc. Additional assemblies can
be found Reference Joint Appendix J44.
2. This is the U -Factor based on the thickness of the assembly in inches.
3. The R -value of the insulation to be added on the interior or exterior of the assembly.
4. The Calculated 9-Valueis the R -value of the furred out section of the assembly.
4 The Final Assembly is calculated using Equation 4-2 or Equation 4-4of the Reference Joint Appendix J44. The equation is the inverse of Column
added to Column I. Column K is the inverse from column J.
7. Insert the calculated U- actor value on to the Opaque Sur ace Details in Column J
FENESTRATION PROPOSED AREAS
eplacing window alone — Replacement windows shall meet the U -Factor and SHGC Value requirements of Component Package D in
Table 151-C. The Total Fenestration and West facing Area requirements are not applicable.
❑ Adding 50ft2 or less of window area — Newly installed windows shall meet the U -Factor and SHGC Value requirements of Component
Package D in Table 151-C.
❑ Adding more than 50ft2 of window area — Newly installed windows shall meet the U -Factor and SHGC Value and the Fenestration
Area requirements of Component Package D in Table 151-C. Complete the Altered Fenestration Allowed Area Table on Page 2 of the CF -IR -ALT
Orientation
Fenestration Type and Frame (North, East, PropsedAreal Maximum Maximum NFRC or Default
Window, Glass Door or Skylight) South, West ft U-factorz-' SHGC', 1,4 Values
J �
1. Fenestration area is the area of total glazed product (i.e. glass plus frame). Exception: When a door is less than 50% glass, the fenestration
area may be the glass area plus a "2 inch frame" around the glass.
2. Enter value from Component Package D Requirements in Table 151-C.
3. Actual fenestration products installed and as indicated in CF -6R -ENV Form shall be equivalent to or have a lower U factor and/or a lower
SHGC value than that specified on the CF -1 R ALT Form.
4. Submit a completed WS -31? Form if a reduced SHGC is calculated with exterior shading.
5.1fopplicable 61 this stage enter "NFRC" or NFRC Certified windows or are CEC "Default " valuesfound in Table 116-A or B.
ALTERED FENESTRATION ALLOWED AREAS
(Complete if more than 50f12
of fenestration is added)
A
B
C
D
E
F
G
Allowed
Existing
Fenestration
Total Area
CFA of Entire
% of
Fenestration
Area
Fenestration
Allowed
Proposed Areae
Dwelling
CFA
Area
Removed
Area Added
A x B)
(E -D + C
Total Fenestration Area
ft'
.20
>
West Fenestration Area
(Required In
.05
>
CZ's 2,4&7-15
1. West Fenestration Area includes west -sloping skylights and any skylights with a pitch less than 1:12.
2. West facing glazing area removed cannot be "counted" twice. " In order to distribute the west glazing area removed to the other orientations,
input the west glazing area removed in the Total Fenestration Area row, column D.
3. Include the Proposed Area of the West facing fenestration in both Area columns below.
4. To meet compliance, the Proposed Area must be less than orequal to the Total Allowed Area or BOTH the Total and West Fenestration Areas.
Registration Number: Registration Date/Time: HERS Provider:
2008 Residential Compliance Forms
August 2009
Prescriptive Certificate of Compliance: Residential CF-IR-ALT
Residential Alterations Pa e 5 of5)
Project Name: Climate Zone # # of Stories
HERS VERIFICATION SUMMARY The enforcement agency should pay special attention to the HERS Measures specified in this
checklist below. A completed and signed CF -41? Form for all the measures specified shall be submitted to the building inspector before final
inspection.
Duct Sealing & Testing HERS verification is required for this measure.
❑ YES ❑ NO YES: In Climate Zones 2 and 9-16, if more than 40 linear feet of new or replacement ducts are installed in unconditioned
space, the ducts are to be sealed per §I52(b)IDii and the newly in ducts are to be insulated per §151010.
❑ EXCEPTION: Existing duct systems that are extended, which are constructed, insulated or sealed with asbestos.
❑ YES ❑ NO YES: In Climate Zones 2 and 9-16, if the existing space -conditioning system (HVAC equipment and ducting) is replaced, the
ducts are to be sealed per § 152(b)1 Di.
❑ YES ❑ NO YES: In Climate Zones 2 and 9-16, if the existing HVAC equipment is replaced (including the replacement of the air handler,
outdoor condensing unit of a split system, cooling or heating coil, or the furnace heat exchanger) the ducts are to be
sealed per §152(b)IE.
❑ EXCEPTION: Duct systems that are documented to have been previously sealed confirmed through HERS
verification in accordance with procedures in the Reference Residential Appendix RA3.
❑ EXCEPTION: Duct systems with less than 40 linear feet in unconditioned space.
❑ EXCEPTION: Existing ducts stems constructed, insulated or sealed with asbestos.
Refrigerant Charge - Split System HERS verification is required for this measure.
❑ YES ❑ NO YES: In Climate Zones 2 and 8-15, when the existing HVAC equipment is replaced (including the replacement of the air
handler, outdoor condensing unit of a split system A/C or heat pump, cooling or heating coil, or the furnace heat
exchanger) a refrigerant charge measurement shall be verified per § 152(b)l F.
Central Fan Integrated (CFI) Ventilation System and Fan Watt Draw
The ventilation requirements of § 150 o do not apply to existing residential homes.
Ducted Split Systems - Air Conditioners and Heat Pumps: Airflow HERS verification is required for this measure.
❑ YES ❑ NO YES: In Climate Zones 10 through 15, when the existing space -conditioning. system (HVAC equipment and ducting) is
replaced, the airflow and fan watt draw shall be verified per 152(b)1Ci to meet therequirements of §151(f)7B.
Documentation Author's Declaration Statement
• I certify that this Certificate of Compliance documentation is accurate a d co plete.
Name: Yom\ J � � S � �\ ;
J vJ
Signatu e:
Company:
Date: \
Address:
If Applicable ❑ CEA or ❑ CEPE
(Certification #):
City/State/Zip:
Phone:.
Responsible Building Designer's Declaration Statement
• I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the building design identified on
this Certificate of Compliance.
• I certify that the energy features and performance specifications for the building design identified on this Certificate of Compliance conform
to the requirements of Title 24, Parts I and 6 of the California Code of Regulations.
• The building design features identified on this Certificate of Compliance are consistent with the information provided to document this
building design on the other applicable compliance forms, worksheets, calculations, plans and specifications submitted to the enforcement
agency for approval with this building permit application.
Name: T
Name:
Signature:
Company:
Date:
Address:
License:
City/State/Zip:
Phone:
For assistance or questions regarding the Energy Standards, contact the Energy Hotline. at. 1-800-772-3300.
Registration Number:
2008 Residential Compliance Forms
Registration Date/Time: HERS Provider:
August 2009
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