RR (11-0514)P.O. BOX 1504
78-495 CALLE TAMPICO .
LA QUINTA, CALIFORNIA 92253
Application Number: 11=00000514 -
Property Address: 53025 AVENIDA MENDOZA
APN: 774-062-028-2 -000000-
Application description: RE -ROOF
Property Zoning: COVE RESIDENTIAL
Application valuation: 7000
(� I 444Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Applicant: Architect or Engineer:
--------------------------------------------------
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: - 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
n 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, 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 Coder 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. , BAP.C. !9f this reason
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:
ATWOOD LEON
51863 CANYON ROAD
MORONGO VALLEY, CA
------------------
Contractor:
Owner
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Dater 5/17/11
------------------------------------------------
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
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 become subject to the workers' compensation laws of California,
and agree that, if I should be��99yy��e subject to the workers' compensation provisions of Section
3700 of the La por Cody,�yyFfaljrfortDwiLh comfy with those provisions.
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 i mation is correct. I agree to comply with all
city and county ordinances and state laws relating to buildiit s ction, and hereby authorize representatives
of this county to enter upon the above-mentio d prope i ct n S.
DaDate*,,q ure (Applicant or Agan
Application Number . . . . . 11-00000514
Permit . . . RE -ROOF
Additional desc .
Permit Fee . . . . 30.00 Plan Check Fee
.00
Issue Date . . . . Valuation . . .
. 0
Expiration Date 11/13/11.
Qty Unit Charge Per
Extension
BASE FEE
30.00
----------------------------------------------------------------------------
Special Notes and Comments
IF R-30 INSULATION IS NOT EXISTING,
INSTALL PRIOR TO RE -ROOF TO FULFILL
CF -1R EXEMPTION. RE -ROOF WITH WITH 5 TAB
DIMENSIONAL SHINGLES ON PITCHED ROOF AND
500 S.F. TAR & GRAVEL ON FLAT ROOF. 2010
CODES.
------------------------------------------------------------------------=---
Other Fees . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid Credited _
Due
Permit Fee Total 30.00 .00 .00
30.00
Plan Check Total 00 .00 .00
.00
Other Fee Total 1.00 .00 .00
1.00
Grand Total 31.00 .00 .00
3.1.00
LQPERMIT
T-Vf 4 4 Q"
P.O. Box 1504
LA QUINTA, CALIFORNIA 92247-1504
BUILDING & SAFETY DEPARTMENT
_78_-49_5 CALLS TAM_PICO (760) 777-7012
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011
PROPERTY OWNER'S PACKAGE
Disclosures & Forms for Owner -Builders Applying for Construction Permits
IMPORTANT! NOTICE TO PROPERTY 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 5�) od 5 i1 JCn%, AM M gnAc j otLai Qui r 4-e
We are providing you with an Owner -Builder Acknowledgment and Inrmation 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 signify you understand or verify this information.
'�I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder"
inermit that
g p 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.
T:52. 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.
T3. 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.
T3_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
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.
T�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 meto serious financial
risk.
T-f—?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.
`J 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.
-(39. 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 l-
—�b��2�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:
__11. 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.
12. 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 lice e, the Contractors' State License -Board rr�;be u abl� Co, �s� sjyou with any financial loss
you may sustain as a result of z A iW<Ikotf2Shly r� "Ilfrst u i{1 c�ii<sCA- totitratMors 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 perm"tote. A copy of the property owner's driver's license, form notarization, or
other verification acceptable to the aj& wired to be presented when the permit is issued to verify the property
owner's signature.—�
Signature of proper
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 necessaryto 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:
RECORDING REQUESTED BY b1
COPY
THEN RECORDED AIL TO
POWER OF ATTORNEY - GENERAL
[includes optional Durable.Power of Attorney]
KNOW ALL PERSONS BY THESE*PRESENTS:
That I, LEON A. ATWOOD, the undersigned, (jointly or severally,' if
more than one) hereby make, constitute and appoint'THYRZA SEGAL my
true and lawful Attorney for me and in my name, place and stead and
for my use and benefit;
.(a) To ask, demand, sue for, recover, collect and receive each
and every sum of money, debt, account, legacy, bequest, interest,
dividend, annuity and demand (.which now is or hereafter shall become
due, owing or payable) belonging to or claimed by me, and to use and
take any lawful means for the recovery thereof by legal process or
otherwise, and to execute and deliver a satisfaction of release
therefor, together with the right and power to compromise or -compound
any claim or demand;
(b) To exercise any or all of the following powers as to real
property, any interest therein and/or any building thereon:To
contract for, purchase, receive and take possession thereof and of
evidence of title thereto, to lease the same for any term or purpose,
including leases for business, residence, and oil and/or mineral
development; to sell, exchange, grant or convey the same with or
without warranty; and to mortgage, transfer in trust, or otherwise
.encumber or hypothecate the same to secure payment of a negotiable or
non-negotiable note or performance of any obligation or agreement;
(c) To exercise any or all of the following powers as to all
kinds of personal property and goods, wares and merchandise, choses
in action and other property in possession or in action: To contract
for, buy, sell, exchange, transfer and in any legal manner deal in
and with the same, and to mortgage, transfer in trust or otherwise
encumber. -or hypothecate the same to secure payment of a negotiable or
non-negotiable note or performance of any obligation or agreement;
(d) To borrow money and to execute and deliver negotiable or
non-negotiable notes therefor with or without security; and to loan
money and receive negotiable or non-negotiable notes therefor with
such security as he/she shall deem proper;
(e) To create, amend, supplement and terminate any trust and to
instruct and advise the trustee of any trust-wherein'I am or may be
trustor.or beneficiary; to.represent and vote'stock, exercise stock
rights, accept and deal with any dividend, distribution or bonus,
join in any corporate financing, reorganization, merger, liquidation,
consolidation or other action and the extension, compromise,
conversion, adjustment, enforcement or foreclosure, singly or 'in
conjunction with others of any corporate. stock, bond, note, debenture
or other security; to compound, compromise, adjust, settle and
satisfy any obligation, secured'or unsecured, owing by or tome and
to_give or accept any property and/or money whether or not equal to
or less in value than the amount owing in payment,- settlement or
satisfaction thereof;
r
(f). To transact business of any kind or class and as my act and
deed to sign, execute, acknowledge and deliver any deed, lease,
assignment of lease, covenant, indenture, indemnity, agreement,
mortgage, deed of trust,'assignment of mortgage or of the beneficial
interest under deed of trust, extension or renewal of any obligation,
subordination or waiver of priority, hypothecation, bottomry,
charter-party, bill of lading, bill of sale, bill, bond, note,
whether negotiable or non-negotiable, receipt, evidence.of debt, full
or partial release or satisfaction of mortgage, judgment and other
debt, request for partial or full reconveyance of deed of trust and
such other instruments in writing or any kind or class as -may be
necessary or proper in the premises.*
(g) [Strike if not applicable.] This Power of Attorney shall
not be affected by subsequent incapacity of the principal [and shall
remain effective for a period of ten years after the disability or
.incapacity occurs].
kil Lft-Lik-- if nyt applicable.j This Power of Attorney shall
effective fur a period uf A-.LvK-- years after the disarbility or
ncapacity occurs]
(i)' If (g) and/or (h) are not stricken, the following warning
applies- WARNING TO PERSON EXECUTING THIS DOCUMENT:
THIS IS AN IMPORTANT LEGAL DOCUMENT. IT CREATES A DURABLE
POWER OF ATTORNEY.' BEFORE EXECUTING THIS DOCUMENT, YOU SHOULD KNOW
THESE IMPORTANT FACTS:
1. THIS DOCUMENT MAY PROVIDE THE PERSON YOU DESIGNATE AS YOUR
ATTORNEY IN FACT WITH BROAD POWERS -TO MANAGE, DISPOSE, SELL, -AND
CONVEY YOUR REAL AND PERSONAL PROPERTY AND TO BORROW MONEY USING YOUR
.PROPERTY AS SECURITY FOR THE LOAN. -
2. THESE POWERS WILL EXIST FOR AN INDEFINITE PERIOD OF TIME
UNLESS YOU LIMIT THEIR DURATION IN THIS DOCUMENT. THESE POWERS WILL
CONTINUE TO EXIST NOTWITHSTANDING -YOUR SUBSEQUENT DISABILITY OR
INCAPACITY.
3. YOU HAVE THE RIGHT TO REVOKE OR TERMINATE THIS POWER OF
ATTORNEY.
4. IF THERE IS ANYTHING ABOUT THIS FORM THAT YOU DO NOT
UNDERSTAND, YOU SHOULD ASK A LAWYER TO EXPLAIN IT TO YOU.
GIVING AND GRANTING unto my said Attorney full power and authority to
do and perform all and. every act and thing whatsoever requisite,
necessary or appropriate to be done in and about the premises as
fully to all intents and purposes as I might or could do if
personally present, hereby ratifying all that my said Attorney shall
lawfully do or cause to be done by virtue of these presents. The
powers and authority hereby conferred upon my said Attorney shall be
applicable to all real and personal property or interests. therein now
owned or hereafter acquired by me and wherever situate. •.
My said Attorney is empowered hereby to determine in his/her sole
discretion the time when, purpose for and.manner in which any power
herein conferred upon him shall be exercised, and the conditions,
provisions and covenants of any instrument or document which may be
executed by him/her pursuant hereto; and in the acquisition or
disposition of real or personal property,. my said Attorney shall have
exclusive power to fix the terms thereof for cash, credit and/or
property, and if on credit with or without security. ,
My attorney-in-fact shall have the following powers with respect
to my assets:
(i) To establish any trust with my assets for my benefit or for
the benefit of any other person upon such terms as may be necessary
or proper, to transfer any asset in which I have an interest to any
trust, and to exercise (in whole or in part), to release, or to let
lapse any power that I may have under any trust, .whether or not
created .by me, including any power of appointment, revocation,
amendment, or withdrawal, specifically including without limitation,
The Leon A. Atwood Revocable Trust Dated pPc�` , 2010; and
(ii) To make gifts, grants, or other transfers without
consideration to or for the benefit of any person, or to charitable
institutions, either outright or in trust, including the forgiveness
of indebtedness and the completion of. any charitable pledges -I may
have made, to make payments for the college and postgraduate tuition
and medical care of any person, and to pay any gift tax that may
arise by reason of any gifts. My attorney-in-fact is authorized to
consent to "split" gifts made by my .spouse to third persons under
Internal Revenue Code Section.2513.
When the context so requires, the masculine gender includes the
feminine and/or neuter,. and the singular number includes the plural.
WITNESS my hand this ��_ day of e=` 2010
LE N A. ATWOOD
-STATE -OF CALIFORNIA )
COUNTY OF RIVERSIDE
On Pe(,Ift) CV_20101 before me,- I"I `Jc(i� ,
Notary Public, personally appeared Leon A..twood, who proved to me
on the basis of satisfactory evidence to be the person(s) whose
names) is/are subscribed to the within instrument and acknowledged
to.me•that he/she/they executed the same in his/her/their authorized
capacity(ies), and that by his/her/their, signature(s) on the
instrument the'.-person(s), or the entity upon behalf of which the
person(s) acted, executed the instrument..
I certify under PENALTY OF PERJURY under the laws of the State of
California that the foregoing paragraph is true and correct.
.WITNESS my %njJd and official seal'.
MARY PATRICIA JAMES
(SEAL)
Signature Commission * 1883914
140my
Notary Public - CaliforniaRiverside County
Comm. Expires Mar 22, 2014
e
Prescriptive Certificate of
Address:
�d ZS
: Residential Reroof
e— VII dam
ROOFING PRODUCTS (COOL ROOFS) §151(012
When the area of exterior roof surface to be ren/aces
V area must meet the rooting product ,Cool Roof"
applicable alternative or exception below if the roof,
CF -1 R-ALT-ReRoof
Climate. Zone I Permit #
reds 50% of the existing roof area, or 1,000 ff, whichever Is less, the new
aquirements of §152(b)1Hi, 152(b)1Hi1, or 152(b)1HI11.
leration is exempt from the roofing product "Cool Roof requirements::
❑ Cool roofs not required in Climates Zones 1-12,14, and 16 with a low sloped roof pitch (less or 2:12 pitch).
❑ Cool roofs W required in Climates Zones 1-9, and 16 with a steep -sloped roofs (greater pitch than 2:12) and product weight less than 511bffle.
Alternatives to §152(b)1 HI and §152(b)HII, Steep -slope roof (pitch > 2:12)
❑ Insulation with a thermal resistance of at least 0.85 hr•f?`F/Btu or at least a 3/4 inch air -space is added to the roof deck over an attic; or
❑ Existing ducts in the attic are insulated and sealed according to §151(1)10; or
❑ In climate zones 10, 12 and 13, with 1 f12 of free ventilation area of attic ventilation for every 150 ft2 of attic floor area, and
where at least 30 percent of the free ventilation area is within 2 Beet vertical distance of the roof ridge; or
J� Building has at least R-30 ceiling insulation; or
❑ Building has radiant barrier in the attic meeting the requirements of §151(f)2; or
❑ Building has no ducts in the attic, or
❑ In climate zones 10, 11, 13 and 14,.R-3 or greater roof deck insulation above vented attic.
Exception to §152(b)l Hill, LOW -slope roof ( pitch 5 2:12)
❑ Building has no duds in the attic.
Other Exceptions
❑ Roofing area is covered by building integrated; photovoltaic panels and solar thermal panels are exempt from the Cool Roof criteria.
O Roof constructions that have thermal mass over the roof membrane with at least 25 bV are exempt from the Cool Roof criteria.
NOTE: If any one of the alternatives or exception is checked the Aged Solar Reflectance and Thermal Emittance requirements for roofing
products in §118(i) are not applicable. Do not fill table below.
CRRC Product ID Number Roof Slope
5 2:12 > 2:'
❑ [—r-
Note:
C
12
Product Weight
< 5lblRZ i 51b/ft
Product
TypW
Aged SolarThermal
Reflectance'.4
Emittance
SRIS
I
❑
❑
(34
❑
❑
Da
Note: If no CRRC-1 label is available, this compliance method can11 not be used, use the Performance Approach to show compliance,
1. The CRRC Product M Number can be obtained from the Cool Roof Ratiirg Coundl's Rated product Directory at , coolroofs o►o/nroducts/sea►ch rho
2. Indicate the type of product is being used Me roof top, i.e. single -ply roof asphalt roof metal roof, etc.
1. If Ura Aged Reflectance q not avageble in the Coo/ Roof Rating Council's Rated Product Directory then use the Initial Reflectance value from the same
directory and use the equation (0.2+0.7(p+„a„ _ 0.2) to obtain a calculated
1. Check box if the Aged Reflectance Is a calculated value btthe �d value. Where p is the Initial Solar Reflectance.
5. Calculate the SRI value b using using equation above.
y sing tee SRI- Worksheet at:/hvww. rherom• oovi*1624/ and enter
aoopy of the SRI- Worksheet to the CF -IR. the resulting value in the SRI Column above and attach
ro apply Liquid Field Applied Coatings, the coating must be applied across the entire roof surface and meet the dry mil thickness or coverag
'ecommended by the coatings manufacturer and meet minimum
performance requirements listed in §11804. Select the applicable coating:
Aluminum -Pigmented Asphalt Roof Coating ❑ Cement -Based Roof Coating ❑ Other
'r When a " —
installing contractor shall complete and submit the CF•6R-ENV-01 for final inspection.
• 1 certify under penalty of perjury, under the laws of the State of California, the information provided on this form is accurate and complete.
• I certify that the energy features and Performance specifications identified on this
laCertificate of Compliance conform to the requirements of Title 24, Parts
�--�-;
1 and 6 of the California Code of Rulations. y jSignet re:
(J Date:
A. :ss: %
3 yo Qf rh ;C, Cs+✓ee L o � L�cen
CRY/State/Zip / 5
hva ee 225 2 Phone:
For assistance or questions regarding the Energy Standards, contact the Ener 7&0-q7 92�
Energy Hotline at: 1-800-772-330o.
Bin #
City 0f LQ Quinta
Building &Safety. Division
P.O. Boz 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building, Permit Application and Tracking Sheet
Permit #
Project Address: 3O 'Aje en DZct
Owner's Name:
A. P. Number:
Address:51163 C� D ,
Legal Description:
City, ST, Zip:
Contractor:Telehon
P e• % 2 z>?>,:: }::...�•:::;.>:
Address:
Project Description:
City, ST, Zip:
I
Telephone:
ioe s hQ e)C1 St ► tl� C1�� YL
State Lic. # :
City Lic. #: "
- Y �wav e. 25o0 Y-ocx ort
Arch., Engr., Designer:
�+ „Q �Q . n r�OO
[ xb dl y�el�
Address:
-V
- P�C-SEJ Q e Dt�('�
City, ST, Zip:
`�
TelephonerConstructionType:
State Lic. #:
, •.J.,. •.<; SS`•:..•r.'%tri}„>::fr:;ir;?<:
Name of Contact Person:
Project type (circle one): New Add'n Alter (epair 'Demo
Sq. Ft.: 2560 # Stories: # Units:
Telephone # of Contact Person:
Estimated Value of Project: �t�o
APPLICANT: DO NOT WRITE BELOW THIS LINE
# '.
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
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
god Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing '
Grant Deed
Pians picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
3d Review, ready for correctionsfissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
01p-
i
1GCIGVI° _
TA
P.O. BOX 1504r NO. 13922,..-,
Building 53-025 Ave.. Mendoza 78-105 CALLE ESTADO Vi
Address' LA QUINTA, CALIFORNIA 92253;;,+,'
Owner Leon A. Atwood
MailingBUILDING: TYPE CONSTr, OCC: GRP. j`
Address P. 0. ,0oX '11'61
A. -P. Number s ; ,
City Zip Tel:
La Qt1Z� fCA,- CA 92253 • 564-2223 Legal Description ti f
Project Description
Address •.5'•, and 301 �of-,61 high block'wall.
City Zip Tel.:
State Lic. City
& Classif. Lic. #
-:Arch: Engr:;y
Designer
Address Tel.
City Zip State
Lic:'#
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that lam 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. t ..
SIGN ATU RE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. • 703 1.5, 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
subj cis the applicant to a civil penalty of not more than five hundred dollars,(3500).
Oras owner of the property, or my employees with wages as their sole compensation, will
dpdt a 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 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.): -
❑ 1 am exempt under Sec. ' B. & P.C. for this reason ye
rNi�
net
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Co pensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Polic N - Company
py is filed with the city. ❑ 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 t work for which this permit is issuecNi shall not
employ any pgrson in any mann rsso as to becom sub- ctito the.Workers' Co- pensation
Laws of'California. y
..,pa%—c4- ��wner �
yN 'GIf, after ro•`aking 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, State, Zip
Footing built i6 support a 51 hi.gi'i waill
.1n xurure. •
Nor`' No. Dw. r
',Stories Units
Add ❑ Alter ❑ Repair ❑ -Demolition.❑
Sq. Ft.
.Size
New ❑
itimated Valuation, 3* 1
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const. i
Mech. t[ t
Electrical s`
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMAF
. 1.
4.00
AMOUNT
•t
633.00
i
4 ,
ra
ice\ i i 'FA
111 u 17i
ZONE:—
Minimum
ONE: Minimum Setback Distances:
Front Setback from Center Line — ;—
Rear Setback from Rear Prop. Line s
a
Side Street Setback from Center Line
Side Setback from Property -Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE aq
f ~
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. Q. FT.
GROUT
WATER HEATER
WALL SO. FT. ®
FINAL INSP.
DRINKING FOUNTAIN
SQ FT ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
VENTILATION
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FIRE ZONE ROOFING
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
LATHING
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1+/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
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 aq
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 APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
n—
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
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL