RR (10-0093)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA,' CALIFORNIA 92253
Application Number: 10-00000093
Property Address: 52840 AVENIDA NAVARRO
APN: 773-335-006-21 -000000-
Application description: RE -ROOF
Property Zoning: COVE RESIDENTIAL
Application valuation: 3500
Applicant: Architect or Engineer:
I
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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
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
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.).
I _ 1 I am exempt under Sec. I , B.&P.C. for this reason
Date:^ ID Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
LQPER 11T
Owner:
JIMENEZ EDGAR
52840 AVENIDA
LA QUINTA, CA
(760)564-5215
Contractor:
Owner
NA
92
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
2/09/10
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the fallowing 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 become subject to the workers' compensation provisions of Section
3700 of the Labor Code, I shall forthwith comply with those provisions.
Date:,. Applicant: Applicant: ��
WARNING: FAILURE TO SECURE W KERS' 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.
1 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 ycounty to enter upon the above-mentioned property
/for inspecti�onn� purposes.
L /
Date: 0/%O Signature (Applicant or Agent):
Application Number . . . . . 10-00000093
Permit . .
. RE -ROOF
Additional desc .
Permit Fee..
30.00
Plan Check Fee
.00
Issue Date . . .
.
Valuation . . .
. 0
Expiration Date
8/08/10
Qty Unit Charge Per
Extension
BASE FEE
30.00
----------------------------------------------------------------------------
Special Notes and
Comments
RE -ROOF PERMIT 2008 RESIDENTIAL
COMPLIANCE FORM /
AUGUST 2009 APPROVED
/
PER S.T.
_
----------------------------------------------------------------------------
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
31.00
LQPERMIT
Prescriptive Certificate of Compliance: Residential CF -IR -ALT
Residential Alterations a e 1 of 5
Project Name: , I A, -Climate Zone # I # of Stories
General Information
Site Address: �jdo r t RVGVV
Enforcement Agency: r Date:
J
Building Type Single Family ❑ Multi Family
Circle the Front Orientation: N, E, S, W, or degrees
Conditioned Floor Area (CFA):
Project Type: ❑ Alterations nvelope ❑ Fenestration IrRoof ❑ HVAC
JA4
Assembly
Cell Value'
Replacement or Change Out ❑ Duct Replacemen! ❑ Water Heater
NOTE: This form isnot to be used jar 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 of a 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 ofan entire wall, ceiling, or floor assembly requires the installation of Component
Package- D insulation values in Table 151-C. Fill in Columns A -J.
O a ue Surface Details For the furred =tioned of Mass Walls see Furring Strips Construction Table_ below.
A B C D E F G H I I J
ProPosed Nft Note Standard Values From JA4
Table
Framing Thickness,
Taq Assembly Name Material Spacing, U- JA4 Table
iD or Type' and Size' or Othe? factor' Numbers
Framed
Cavity
R -value°
Continuous
insulation
R -Value?
JA4
Assembly
Cell Value'
Proposed
Assembly
U-factor9
Walls From Reference
in Furring Space from Reference
Joint Aopendix Table 4.3.5 4.3.6 4.3.7
Joint Appendix Table 4.3.13
T
v
U
o
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 Construction table below.
1. For Tag/1D 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 Only
A I B I C I D I E
F I G I 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 Aopendix Table 4.3.5 4.3.6 4.3.7
Joint Appendix Table 4.3.13
T
v
U
o
Assembly
_
O
`o_-�
Final
Mass Name or JA4 Table
y
Assembly
Thickness' Type' Number' a>
a X e Q> LLI ad �
U -factor '�
Comment
Registration Number: Registration Date,Time:
2008 Residential Compliance Forms
HERS Provider:
August 2009
Prescriptive Certificate of Compliance: Residential CF -IR -ALT
Residential Alterations Page 3 of 5
Project Name: Climate Zone # # of Stories
ROOFING PRODUCTS (COOL ROOFS) §151(1)12
When the area of exterior roof surface to be replaced exceeds more than 50% of the existing roof area, or more than 1,000f?, whichever is
less, the new roofing area must meet the roofing product "Cool Roof 'requirements of§152(b)IHi, 152(b)IHii, or 152(b)IHiii.
Check applicable alternative or exception below if the roof alteration is exempt from the roofing product "Cool Roof ' requirements. Note: if any
one of the alternatives or exception below is checked, the Aged Solar Reflectance and Thermal Emittance requirements for roofing products in
§I18(i) are not applicable. Do not fill table below.
O Cool Roofs Not Required in Climate Zones 1-12, 14, and 16 with a Low Sloped. Ley or 2:12 pitch.
OCool Roofs Not Required in Climate Zones 1 through 9 and 16 with a Steep -Sloped Roofs (pitch greater than 2:12) and product unit weight less
than 51b/ft2.
Alternatives to §152(b)1Hi and §152(b)Hii, Steep -slope roof (pitch > 2:12)
❑ Insulation with a thermal resistance of at least 0.85 hrft2•°FBtu 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(f)10; or
O In climate zones 10, 12 and 13, with 1 W of free ventilation area of attic ventilation for every 150 ftZ of attic floor area, and
where at least 30 percent of the free ventilation area is within 2 feet vertical distance of the roof ridge; or
❑ 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)1Hiii, Low -slope roof (pitch:52:12)
❑ Building has no ducts in the attic.
Other Exceptions
❑ Roofing area covered by building integrated; photovoltaic panels and solar thermal panels are exempt from the below Cool Roof criteria.
❑ Roof constructions that have thermal mass over the roof membrane with at least 25 lb/112 is exempt from the below Cool Roof criteria.
Note: If no CRRC-I label is available, this compliance method cannot be used, use the Performance Approach to show compliance, otherwise,
Check the applicable box below if Exem t from the Roofing Products "Cool RoofRequirement:
Roof Slope
Product Weight
Product
Aged
Solar
Thermal
CRRC Product [D Number
< 2:12 > 2:12
< 5lb/ftz > 5lb/ft
Type'
Reflectance3'4
Emittance
SRIS
0
❑
❑
❑
04
❑
a
o
13
04
❑
❑
❑
❑
❑4
❑
❑
❑
❑
❑4
1. The CRRC Product ID Number can be obtained from the Cool Roof Rating Council's Rated Product Directory atwivw.coolroofs.oMIproducts/search.phg
2. Indicate the type of product is being used for the rooftop. i.e. single-plv roof, asphalt roof, metal roof, etc.
3. If the Aged Reflectance is not available in the Cool 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;,,;,;ot- 0.2) to obtain a calculated aged value. Where p is the Initial Solar Reflectance.
4. Check box if the Aged Reflectance is a calculated value using the equation above.
5. Calculate the SRI value by using the SRI- Worksheet at hitp://u•iilv.enerev.ca.pov/title24/and enter the resulting value in the SRI Column above and attach acopy of
the SRI- Worksheet to the CF -I R.
To apply Liquid Field Applied Coatings, the coating must be applied across the entire roof surface and meet the dry mil thickness or coverage
recommended by the coatings manufacturer and meet minimum performance requirements listed in §1 18(i)4. Select the applicable coating:
❑ Aluminum -Pigmented Asphalt Roof Coating
❑ Cement -Based Roof Coating
113 Other
Registration Number:
2008 Residential Compliance Forms
Registration Date/Time: HERS Provider:
August 2009
Prescriptive Certificate of Compliance: Residential CF -IR -ALT
Residential Alterations Page 5 of 5
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 -4R 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)1Dii and the newly installed ducts are to be insulated per §I51(f)10.
❑ 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)1 E.
❑ 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)IF.
Central Fan Integrated (CFI) Ventilation System and Fan Watt Draw
The ventilation requirements of § 15 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 13 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 the requirements of 151(f)7B.
Documentation Author's Declaration Statement
• I certify that this Certificate of Compliance documentation is accurate and complete.
Name:
Signatire:
P
^ ' 1 c L
Date:
Address:
If Applicable ❑ CEA or ❑ CEPE
o U t . . °eb S1
(Certification #):
City/State/Zip:
Phone:
I-
) -
, rResponsible
ResponsibleBuilding 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.
• 1 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 1 '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 fora roval with this building permit application.
Name:
Signat r
-\ l . me EZ
Company:
Date:
Address:
�2 U4 L
License:
City/State/ • ,,
:�
Phone:
/,
�S& S
For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300.
Registration Number: Registration Date/Time: HERS Provider:
2008 Residential Compliance Forms
August 2009
... y +�..'N A �tii
Rated Products Directory: Search Results [ new search j ( print friendly view ]
(last updated 26 Jan 201012:02 PST)
Showing Search Results for:
Product Type: Shingles or Shakes, Tile or Slate, Shingles, Shakes, Tile or Slate
select' from products where(type like 'Shingles or Shakes%' or type like 'Tile or Slate%' or type like 'Shingles, Shakes, Tile or Slate%') order by company_name asc
(showing records 1 - 360 of 360)
All Records
http://www.coolroofs.org/products/results.php?pageStart=1&maxList=all&type[0]=Shingles or Shakes&type[l]=Tile or Slate 1/27/2010
Manufacturer
Solar
Reflect
Therm Emit.
!RRC
Information
Product
Slope
Pr
Prod. ID
(sorted +)
Brand
Model
Color
Type
mit
❑
�
�❑�
mit �
Application
0916-0001
Armorlite
Armorlite
Patina
Green
Shingles,
0.44
pending
0.93 pending
Steep
Roofing
Shakes, Tile
Technology, LLC
or Slate
Amit Rao
(714-835-7575)
0916-0003
Armorlite
Armorlite
Golden Pond
Brown
Shingles,
0.37
pending
0.92
pending
Steep
Roofing
Shakes, Tile
Technology, LLC
Amit Rao
or Slate
0916-0002
(714-835-7575)
Armorlite
Armorlite
Satin Copper
Metallic
Shingles,
0.46
pending
0.93
pending
Steep
Roofing
Shakes, Tile
Technology, LLC
or Slate
Amit Rao
(714-835-7575)
http://www.coolroofs.org/products/results.php?pageStart=1&maxList=all&type[0]=Shingles or Shakes&type[l]=Tile or Slate 1/27/2010
ddi Ro Rating Council
Page 27 of 35
11 ' J
0850-0014
((503) 240-7842)
Malarkey
Roofing
Products
Bill Morgan
((503) 240-7842)
I
Highlander -CS
II
Dove White
!/� B
II
Bright White,
Grey
II
Shingles or
Shakes
II
0.27
II
pending
II
0.90
II
pen -ding'
II II
Steep -J
j
I
0942-0007
MonierLifetile
Kayla Swanson
(949-585-8214)
Apple Bark
Barcelona-1BCCS0431, Barcelona-1HBCS0431,
Villa-1VICSO431
Tan, Brown,
Multicolor
Tife or Slate
0.18
pending
0.90
pending
Steep
10942-0039
MonierLifetile
Apple Cider
Vanguard Roll-1VRCS0263Orange,
Black,
Tile or Slate
0.19
pending
0.90
pending
Steep
j
Kayla Swanson
Multicolor
(949-585-8214)
0942-0038
MonierLifetile
Arizona Clay
Vanguard Roll-1VRCS7049
Red, Orange,
Tile or Slate
0.20
pending
0.91
pending
Steep
Kayla Swanson
Multicolor
(949-585-8214)
0942-0042
MonierLifetile
Athenian Blend
Vanguard Roll-1VRMS6062
Red, Orange,
Tile or Slate
0.28
pending
0.95
pending
Steep
Kayla Swanson
Yellow,
(949-585-8214)
Multicolor
I
0942-0019
MonierLifetile
Autumn Blend
Barcelona -1 BCCS6160
Orange, Tan,
Tile or Slate
0.23
pending
0.90
pending
i
Steep j
Kayla Swanson
Multicolor
(949-585-8214)
j
i 0942-0041
MonierLifetile
Kayla Swanson
(949-585-8214)
Brandywine Blend
Spanish S 1SPCU7766
Red, Orange,
Browri,
Multicolor
Tile or Slate
0.26
pending
0.86
pending
Steep
10942-0045
MonierLifetile
Brookside
Slate -1 FACS0212
Tan
Tile or Slate
0.21
pending
0.91
pending
Steep
Kayla Swanson
Rosewood Blend
i
(949-585-8214)
i 0942-0003
MonierLifetile
Brown Blend
Barcelona -1 BCCS3233, Barcelona -1 HBCS3233,
Tan, Brown,
Tile or Slate
0.20
pending
0.91
pending
I
Steep
Kayla Swanson
Shake-1FBCF3233, Shake-1SRCF3233, Slate-
Multicolor
(949-585-8214)
1 LSCS3233R, Villa -1 VICS3233
0942-0009
MonierLifetile
Kayla Swanson
(949-585-8214)
Buckskin
Barcelona-1BCCS0141, Slate-11-SCS0141, Split
Old English Thatch -1 FOCZ01 41, Villa-IVICS0141
ran, Brown,
lticolor
Tile or Slate
0.22
pending
0.90
pending
Steep i
0942-0032
MonierLifetile
Kayla Swanson
Buff Flashed
Villa -1 MPSS0210
Orange,
Tile or Slate I0.33
pending
0.93
pending
I
Steep
Yellow,
(949-585-8214)
Multicolor
I
0942-0044
MonierLifetile
Kayla Swanson
(949-585-8214)
Burnt Mission
Barcelona -1 HBSS7117, Vanguard Roll-
1VRCS7117
Red, Brown,
Multicolor
Tile or Slate
0.17
pending
0.89
pending
Steep
0942-0040
MonierLifetile
Buttercup Blend
Spanish S-1SPCU6243
Orange, Tan,
Tile or Slate
9��ing0.92pending
Steepnn�1
/ I
s
P.O. Box 1504
LA QUINTA, CALIFORNIA 92247-1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
PROPERTY OWNER'S PACKAGE
(760) 777-7012
FAX (760) 777-7011
Disclosures & Forms for Owner -Builders Applying for Construction Permits
MWaRT'ANT! NQTICE 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 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.
OWWS AC"ONYLEDGMENT AND VERMCATION OF INFOR14t flN
DIRECTIONS: Read and initial each statement below to signify you understand or ver. ify this information.
C U 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-
2.
arty
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.
f3. 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.
�l
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.
U5. 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.
CL6. 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.
C,-7. 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 license<
subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performer
under contract with a licensed general building Contractor.
If
CJ 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 personat irituies 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 "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. l 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.
(-10. 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:
11. I agree that, as the party legally and financially responsible for this proposed construction activity, 1 will abide by all
applicable laws and requirements that govern Owner -Builders as well as employers.
12. 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 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 in civil court. It is also
important for you to: understand that if an unlicensed Contractor or employee of that individual or firth 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 arepply ro 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 property owner's drlver'sIkense, form notar;Uadon., or
Other verification acceptable to the agency is required to be presented when the permit is ifssued to verify the property
owner's signature.
Signature of property ownerDate:
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 asmy agents) 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 tAuthorized 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:
Bin #
Qty of La Quinta
Building 8t Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
"\I
Project Address: b vG '
Owner's Name: ,
A. P. Number:
Address:�� - V
Legal Description
City, ST, Zip: Lem ZZ53
Contractor.
•
Telephone:
W:vYia .ir v :{r,�?i'•r> : ri.: �i'%! J j�^v4
Address:
Project Description:
City, ST, Zip:
Telephone:
p
7��ia`ft:. FCS".C•:'^r;�:<'+.Yb;�;:.Y,.'ri�,c.,i: v<:;;3y
\ \ \\ (1 \ \ �.// .�
State Lic. # :
City Lie.
Arch.,. Engr., Designer.
Address:
City., ST, Zip:
Telephone: �. ...; .. 5 *•
n.
State Lie. #: :.�f:r.;a
Name of Contact Petson: ZJC1& V
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. FL:Iq M
I #Stories:
# Units:
Telephone # of Contact Person: z
Estimated Value of Project: QQ
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Reed
TRACKING
PERMIT FEES
Plan Sets
Pian Check submitted
Item Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Tide 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 correctionsrssue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees