RER (10-0040)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA,. CALIFORNIA 92253
Application Number: X10:00000040
Property Address: 52450 AVENIDA NAVARRO
APN: 773-275-010-13 -000000-
Application description: REMODEL - RESIDENTIAL
Property Zoning: COVE RESIDENTIAL
Application valuation: 3000
'T4'yl 4 4 Q"
Applicant: Architect or Engin r:
-----------------
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
. BUILDING PERMIT
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 70001 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 �•) I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
�j— 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.).
(_ I 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
CDate:-- I , I U- ^ 'Owner:
CONSTRUCTION LENDING AOEWY
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:
VELASQUEZ GERARDO
52450 AVENIDA NAVARRO
LA QUINTA, CA 92253
(760)777-9405
Contractor:
Owner
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 1/15/10
-----------------------------------------------
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
A 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
3700 of the Labor ode, I shall forthwith comply with those provisions.
Date:. ^ 1 .Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE 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
4 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 county to enter upon the above-mentioned prope . f r inspectio purpose, .
Date: ( _ s = L Signature (Applicant or Agent):
LQPERA•IIT
Application Number . . . . . 10-00000040
Permit BUILDING PERMIT
Additional desc .
Permit Fee54.00
Plan Check Fee
35.10
Issue Date
Valuation
3000
Expiration Date 7/14/10
Qty Unit Charge 'Per
Extension
BASE FEE
45.00
1.00 9.0000 THOU BLDG 2,001-25,000
9.00
-----------------------------------=---------
Special Not and Comments
-------------------------------
REPLACE (4)NEW WINDOWS SAME FOR SAME &
_....... - (1)SLIDING DOOR SAME FOR SAME.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
ENERGY
REVIEW FEE
3.51
Fee summary Charged Paid
Credited
Due
Permit Fee Total 54.00
.00 .00
54.00
Plan Check Total 35.10
.00 .00
35.10
Other Fee Total 4.51
.00 .00
4.51
Grand Total 93.61
.00 .00
93.61
LQPERA•IIT
P.O. Box 1504
LA QUINTA; CALIFORNIA 9224711504
7$-495 CALLE TAMPICo
LA QUINTA, CALIFORNIA'92253
BUILDING & SAFETY, DEPARTMENT
PROPERTY OWNER'S PACKAGE
(760) 777-7012
FAX (760) 777-7011
Disclosures & Forms for Owner -Bu. 11ders Applying for Construction Permits
M-POSTANT! 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
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
Owner -Builder. We will not issue a building_ permit until yon>have read, initialed your understanding of eacheprovision,
signed, and returned this form to us at our official address indicated.'An agent of the owner cannot execute this'Motice
unless you, the property owner, obtain the prior approval of the permitting authority.
OVIID'S ACKN0-WLEDGWNT AND VERIFICATION OF iA GIIMATIflN
DIRECTIONS: Read and initial each statement below to signify you understand or den:fy this information.
r,.V I. 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 tabor 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.
(,\L_2. 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.
C._Ik3. 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.
r,2V 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.
C.�, V 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.
G7. 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.
Gds. 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. i»juries sustained. by any subsequent owner(s) that result from any latent construction defects in the
�'
workmanship or materials.
v'V 9. I understand I may obtain more information regarding my obligations as an "employes" from the Internal Re*enue
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 1-
800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors.
GA10. I 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:
4V 11. 1 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 L
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 may be 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 iwcivil court. It is also
important for you to: understand thattif an urtlicensed.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.permit Note. A copy of the properV owner's driver's.l?eemse; form notaruado,,6 or
other verification acceptable to the agency is required to be presented when the permit is issued to verify the property
owner's signature.
Signature of property owner 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 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: Tel No
Address of Authorized Agent:
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:
READ CAREFULLY -
DO NOT REMOVE THIS
LABEL UNTIL AFTER
FINAL INSPECTION
A JELD-WEN® manufactured product
STORAGE AND HANDLING:
'Care must be exercised in storage and handling. Store and secure under
cover at a slight slant against a wall with the full width of the window
head and sill supported. The storage space must be adequately
ventilated. Allow sufficient space between products for ventilation.
CLEANING AND CARE:
1. Do not clean with gasoline, diesel fuel, solvent based, petroleum-
based products or abrasive materials. Use water and mild soap only.
2. Keep weep holes and sill clean and free of debris, lubricate moving
parts on a regular basis.
3. Applied glass films are not recommended and may void
warranty claims
NOTE: IT IS THE RESPONSIBILITY OF THE OWNER,
ARCHITECT OR GENERAL CONTRACTOR TO SELECT
PRODUCTS IN COMPLIANCE WITH APPLICABLE
LAWS AND BUILDING CODES.
For Installation Instructions, Warranty, Care and Maintenance and
additional information about JELD•WENO products visit our website
at: www.jeid•wen.com
For customer service call 1-800-JELD-WEN
MANUFACTURING LOCATIONS
EL CAJON, CA - STOCKTON, CA - VISTA. CA - VENICE, FL
GAINESVILLE, GA - GRINNELL, IA - RAWOUL, IL - MT. VERNON. ON
BEND, OR - STAYTON, OR - RINGTOWN, PA - CORSIC ANA, TX
YAKIMA, WA - HAWKINS, WI -• CHEYENNE, WY
NOGALES, SONORA MEXICO
The attached are JELD-WEN'S recommended installation instructions .
for vinyl windows and patio doors which incorporate an integral
nailing fin. While the use of these installation instructions is
recommended, installation in strict compliance with AAMA
specifications (2400-02) is an alternate method of window
installation. Use of the AAMA specifications (2400-02) will not affect
application of the JELD•WEN Window and Doors. jimited warranty.
For wood, clad -wood and aluminum windows, please use the
attached installation instructions or visit the JELD-WEN website for
complete details.
CANADIAN MANUFACTURING LOCATIONS
WINNIPEG, MB - TORONTO, ON - SAINT APOLLINAIRE, QC'.
PRODUCTS MANUFACTURED AND/OR SOLD IN CANADA MUST COMPLY
WITH INSTALLATION REQUIREMENTS CAN/CSA•A440.4.98. THIS WINDOW
OR SLIDING PATIO DOOR SYSTEM MEETS OR EXCEEDS THE MINIMUM
CRITERIA SET FORTH IN CAN/CSA•A440.4.98'WINDOWS" OR
CAN/CGSB-82.1 'SLIDING DOORS' FOR Al, B1, C1.
m 2005 JELD>WEN, inc. JELD-WEN is a registered trademark of
IELD-WEN, inc., Oregon USA
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I 600 Series SNdar
DP= 725/-25 HS-LC25 Size tested: 72" x 60"
Gkiting: 0.09375" outer / 0.00375" inner
Tested to: AAMAJWDMA/CSA 101/i.S.2/A440-05
J
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Canada
1 800 387-2000
energystar.gc.ca
.U.S. / E.U.
1 888 782-7937
energystar.gov
'p gg = Qualified/Admissible
JEL"EN.
WINDOW
JEL-A-609 610 314" OA 1"
Wide Contour Grid
National Fenestration
Rating Council®
�-- 367e644-1
ENERGY PERFORMANCE RATINGS
EVALUAGON DE RENDIMIENTO ENERGETICO
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meet the air infiltration
requirements of Section 116(a)
American Architectural
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Manufacturer of Certified Products-
Manufacturor stipulatos conformanco to tho applicahlo standards
JELOMEN Windows & Doors
600 Sorlos Slidor
DP= +25125 HS-LC26 slzo tostod: 72" x 60"
Glazinge, 0.09375" outor 10,09375" Innor
I Tested to: AAMAIWIDMAICSA 1011I,S,21A44045
REMOVE ONLY AFTER FYNAL INSPECTION. RETAIN LABEL FOR YOUR RECORDSDate
Seq Build
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that particular zone or
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National Fenestration
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ENERGY PERFORMANCE RATINGS
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nufactured. product
Canada
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1 888 782-7937
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WINDOWS & DOORS'
Vinyl Frame
Builders Sliding Patio
Door
National Fenestration CU -D Spacer CLR TMP + LowE
Rating Council® TMP Nrw Flat Grid (518")
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® American Architectural
Manufacturers Association.
Manufacturer of Certified Products
ler
sill Manufacturer stipulates conformance to the applicable standards
Rt ` JELD-WEN Windows 8 Doors
Builders Patio Door
DP- +201-20 SD -R20 Size tested: 95 112" x 95112"
Tested to: AAMAIWDMAICSA 10111-S.21A440-05
REMOVE ONLY AFTER FINAL INSPECTION - RETAIN LABEL FOR YOUR RECORDS
Seq Build Date
Order Line Batch gD0046 11124109
C4 4 11240009
Din #.
City of La Quinta
Building Sr Safety Division
P.O. Box 1504, 78-495 Calfe Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
b�
_ProjectAddress:'Ja'
a.
Owner's Name:
A. P. Number:
Address:
Legal Description:
City, ST, Zip: 0%,\
Contractor:. 0.6
Telephone76O -777' qy
Address:
Project Description:
City, ST, Zip:
VjV— vv (o6w -
Tel hone:
�. � .' .- ��''• �'�.:
5 v i N C0 ongR.
State Lic. # :
City Lic.
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
Construction Type: Occupancy:
State Lic. #:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person: Estimated Value of Project: ' 3 (w
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Plan Seb
Req'd
Rec'd
'[RACKING PERMIT FEES
Plan Check, submitted Item Amount .
Structural Calcs.
Reviewed, ready for corrections
Pian Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balauce
Title 24 Cales.
Pians picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2'' Review, ready for corrections/issue
Electrical
Subcootector List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Pians resubmitted
Grading
IN HOUSE:-
''' Review, ready for correctionsPissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees