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09-0414 (RER)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Tiht 4 4 Q" BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Application Number: 09-00000414 (f Owner: Property Address: 51370 AVENIDA CARRANZA " U MANCHESTER BUILDERS LLC APN: 773-082-006-19 -000000- Q 82519 AIRPORT BLVD Application description: REMODEL - RESIDENTIAL lq/ y �1 HERMAL, CA 92274 Property Zoning: COVE RESIDENTIAL 0,5 Application valuation: 3000 C 2009 F�►zrr,�, � Contractor: Applicant: Architect or Engineer:fiPp Owner Do 001e -S; LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that 1 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 fcommencing 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).: (_) 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.). (_) 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 am exempt under Sec. , B.&P.C. for tom' Wcn Date: Owner: CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name: Lender's Address: LQPERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 5/04/09 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 become subject to the workers' compensation laws of California, and agree that, if I should become sub' to the workers' compensation provisions of Section 37 ��0pp}Iof the Labor Code, I shall f th comply with those provis' Date: yApplicant: WARNING: AILURE 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 1 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 constr , and hereby authorize entatwes of this count t o e er upon the above-mentioned property for i e n purposes. -Date: J t� Signature (Applicant or Agent): Application Number . . 09-00000414 ------ Structure Information MEP UPGRADES - RESIDENTIAL REMODEL ---=- Other struct info . . ---------------------------------------------------------°------------------- . . . CODE EDITION 2007MEP-CODES Permit . . . BUILDING PERMIT - Additional desc . . Permit Fee 54.00 Plan Check Fee 35.10 Issue Date . . . . Valuation . . . . 3000 Expiration Date . . 10/31/09 Qty Unit Charge Per Extension BASE FEE 45.00 1.00 .9.0000 -----------------------7--------------------------------------- THOU BLDG 2,001-25,.000 ------------ 9.00 Permit . . . ELECT - ADD/ALT/REM Additional desc . Permit Fee . . . . 40.95 Plan Check Fee 10.24 Issue Date . . . . Valuation 0 Expiration Date 10/31/09 Qty Unit Charge Per Extension BASE FEE 15.00 20.00 .7500 PER ELEC DEVICE/FIXTURE 1ST 20 15.00 2.00 3.0000 EA ELEC APPLIANCES 6.00 11.00 .4500 ---------------------------------------------------------------------------- EA ELEC DEVICE/FIXTURE >20 4.95 Permit . . MECHANICAL Additional desc . Permit Fee 51.00 Plan Check Fee 12.75 Issue Date . . . . Valuation . . . . 0 Expiration Date 10/31/09 Qty Unit Charge Per Extension BASE FEE 15.00 1:00 16.5000 EA MECH B/C >3-15HP/>100K-500KBTU 16.50 1.00 6.5000 EA MECH AH <=10K CFM 6.50 2.00 6.5000 ---------------------------------------------------------------------------- EA MECH VENT FAN 13.00 Permit . . . PLUMBING Additional desc . Permit Fee . . . . 22.50 Plan Check Fee 5.63 .Issue Date . . . Valuation 0 Expiration Date 10/31/09 Qty Unit Charge Per Extension LQPERMIT Application Number . . . . . 09-00000414 Permit . . . . . . PLUMBING Qty Unit Charge Per Extension BASE FEE 15.00 1.00 7.5000 EA PLB WATER HEATER/VENT 7.50 ---------------------------------------------------------------------------- Special Notes and Comments MECHANICAL/ELECTRICAL/PLUMBING UPGRADES - HVAC AND WATER HEATER CHANGE OUT WITH ALTERATIONS TO RESIDENTIAL ELECTRICAL WIRING FOR PLACEMENT OF LIGHTING FIXTURES AND RECEPTACLE OUTLETS. 2007 CALIFORNIA MECH/ELEC/PLUMB AND -ENERGY. May 4, 2009 12:11:02 PM AORTEGA ---------------------------------------------------------------------------- Other Fees .. . . . . . . BLDG STDS ADMIN (SB1473) 1.00 ENERGY REVIEW FEE 3.51 Fee summary Charged Paid Credited --------------------------------------------------------- Due Permit Fee Total 168.45 .00 .00 168.45 Plan Check Total 63.72 .00 .00 63.72 Other Fee Total 4.51 .00 .00 4.51 Grand Total 236.68 .00 .00 236.68 LQPERMIT CITY, OF LA QUINTAISUB-CONTRACTORLIST JOB ADDRESS_'f/ .170 amPERMIT NUMBER 09 - 1q/4 OWNER >� - -BUILDER . This form shall be posted on the job with the B ding Insaection Card at all times in a conspicuous place. Only persons appearing on this list or their employees are authorized to work on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance of building permit. For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response. rade !Cla777. ssification actor ::; :::::.:.::: Contr. ....:.....:.. . ::;:::>:'>::::::::S a :. o :: :: `:.:..:>: t Ie.0 ntractor Lacense.. ;..:.: _;: :.W9rkeis.Corrl erlsation:Irisuran�e:..: ;:' .:>::.. ;:::.:: City Business License:;::. [EARTHWORK Company Name Classification (e.g. A. B, C-8) License Number (xxxxxx) Exp. Date (xx/xx/xx) Carrier Name (e.g. State Fund, CalComp) Policy Number (Format Varies) Exp. Date (xx/xx/xx) License Number (xxxx) Exp. Date (xx/xx/xx) (C-121 .:, �* Q�0-7 �Q CONCRETE (C-8)'.. FRAMING :(C-5) STRUCT::STEEL IC-5a) ' MASONRY (C•291 ; - PLUMBING (C-36) LATH, PLASTER (C-35) DRYWALL (C-9)..... YAC (C-tot .:: " >'-:`:.:. Alate ? 3 91D E OW917 77 1-•31 l ELECTRICAL. (C40), R00FING'10=39) .:SHEET-METAL (C 43) FLO.RRING (t±=:15):. GLAZING (C-)7). :. ': `.i 7 '9344P ?o '31.1 0040 7X4 INSULATIOW(C-2) SEWAGE DISP (C-42)' . PAINTING (C=33) : CERAMIC TILE (C-54) CABINETS IG-6) FENCING (C-13) LANDSCAPING POOL (C-53) A. CICiRTIFXCA TE OF C0MPL1ANCB:. i SIDENTM L (Pa geI of 4 CF4 -XZZ rs►c.146L 6 cut7.9 Pro ect Tido ./� Data 1'rojeot Addre ogwkg PCrMR t AA DocxnmcntaG Author .Telephone PIm+Ct►octc/I)acc c ocnplianoo Method (Pic Ptive) C�i-#W0 Zone Eafaocmatt Agaxy Vsa Only KAiiemativo CompakntPadcage Method: (cl ccic onc)� C _T D _D (Alternative) Package C and Package D dwicts.regUirc HERS rater .field wifiealion and/or 4raViostictesting (sec CF -IR R page 3)- For Paclmgo D AkanaWe see Appcdix.B 7,4ble-151-C FooG►otcs 7-14 ' . - G`EI�TERAL Il�OR11'XAi�ON . , r Total Cbnditionod iiooc Am (CFA)- l - f ' _!'fi a Ckr"Iing Ncigbt: - �_ ti Maxirngrn Allowed Wart Facing Fu � hvduar Pei Table 15I4ioc 151-C.— (S%X CFA) Maximum AUowed'Total Fenc 6tion Products Pa Tabk ISI$or 151-C _(10./ X Cl Aj ft JrBtu ding Tyj= (cbecic erre or wore))_ Single Panu'ly Maldfanu'1y Addition . Alteration (if adding famtradioa fill.out WS4R,-Fa= ation Maximum Allowed Area Wabbe d and sce Section 83.2 . ' for Additions k1 .3.3 Altaaxious.3 Number of Sterns: 1 Number of Dwelling units: lMc C'cuction= Floor Aorboth) PMnt orientation: jam' North 1 SOU& / 66CG ations. (Uput &vni oiieatatson in d,.V= from Thip 2409111 and circle-oac)- ; ✓ 0. RADxANT BARPJMR (rewired in diaiate zones 2.4 &15) OPAQUE SURFACES )HCLUDjNG OPAQUE DOORS Componatt . Cwt,' Frame Rooi; Floor, Type- SIab.Edgq (Mood Doors Or Metal) Cavity Iiuulation R -Value Assembly U- filar (for [Jontinuotts. mod, moral- LQsulation frame and mass -Valuer assembiies.1 7oiat Appaxlix- IV Refecam . Roof Ram Barrier Installed -Yes or No Locationr-omaMts (attic,; -garage, typical, ctc,• .. - 3) Sea )oint.Appendixd V in Section IV.2„' lV3 and iV.4; rhich is the bas's for the U -factor criterion. U -factors can not exccGd presaiptin.. ver oc to show equivalence t0 R -values:. CITY OF to QUINI�°A' B(jILDING & SAFETY DEPT. -APPROVED : l FOR. ONSTRUCTaO.. Residential ComplianceFonns Mara2005 I " CERTIFICATE- OF COMPLYA.NCI Ci: RESIDENTIAL (Page z of 4) CF -IR . Project Title Date' FENESTRATION PRODUCTS-U-FACMR AND SHGC FENFS`iRATION MAXIMUM ALLOWED AREA WORKSHEET WS4R -must be included for New Construction, ' Additions and Alterations. Fenestration .if YOUPos. (Front, Left, Orion- Rear, Right,tation, Area S light) N, S E, Wmft U-faot0l? . U -factor Source' SH(jd SHGC Sources Exterior. Sha4ing/Overhangs6. . r box if WS -3R is included 1. all .1000:❑ ❑ 13 1) NK)rlignts are noW urciuded m West -lacing lenestratibn area if the skylights are tilted to the West or lifted rn any (hrecaon wren the pitch is less than 1:12. See-§151(f)3C and in Section 3223 of die Resideatial.Manual 411wer values in oris column are either NFRC Rated value or from, Standards default Table 116A. .3) Indicate source either from 1,FRC or Table 116A, 4) . Enter values in this columna from NFRC or from Standards Default Table 116B oradusted SHOC from WS-3P- ..-5) S3P- .-5) Indicate source eitherfirom NFRC or Table 116B. 6) Shading Devices are defined in Table 3-3 in the Residential Manual and see WS -3R to calculate Exterior Shading devices. 7) See Section 32X in the Residential Manual HVAC SYSTEMS Heating Equipment 'type and Opacity Lcat my, bo0a eta Minimum Efficiency, AFOE or MPF) Distribution:. Type and. Location Duct or Piping T'heamostat Configuration dudsmstti etc R Value it or 1. CoolingE Tyne and Residential Compliance Forms Duct.Locafson Duct Thermostat Configuration Flo 10IT01U�?.a00. F101 March ?W5 CERTIFICATE OYCOMPLU NCE: RESIDENTIAL (Page 3 Of 4) CF -1R• Project Title Date SEALED)bUM and TXVs (or Alternative Measuires) A signed CF -4R Form must be provided to the building department for each home•for which the following. are rrnnimA OR b Alternative to Sealed Duds and Refrigerant Charge /TXVs.(Soc Package D Alternative Padcsge Features for Project ClkWe Zone in the RM Appendix B Table 1511, Footnotes 7-14. -- OR -� For additions and alterations, duct a'ystents that are not docxtmented to•have been previously' ❑ sealed as confirmed through field verification and diagnostic testing in accordance with procedures in the Residential ACM Manual and dud systems with more than 40 linear feet in -unconditioned Races shall meet the recldirements of Section 150(m) and dud insulation irements of Package D. WATER HEATING SYS'T'EMS Distribution Type. Rated EneY Check box if system meds criteria ofa. "Standard" system.. Standard system is one -gas-fired water heater per Sealed Duds all climate zones installer testing and certification and'I`lERSmterfi d verification aired: e. TXVs, readily accessible (climate. zones 2 and 8-15 only) . (Installer testing and certification and HERS Rater Meld verification iced:... . not allowed. Oe Refrigerant Charge (climate zones Z and 8-15 only)•(Installer testing and certification and HERS Rater field verification iced. OR b Alternative to Sealed Duds and Refrigerant Charge /TXVs.(Soc Package D Alternative Padcsge Features for Project ClkWe Zone in the RM Appendix B Table 1511, Footnotes 7-14. -- OR -� For additions and alterations, duct a'ystents that are not docxtmented to•have been previously' ❑ sealed as confirmed through field verification and diagnostic testing in accordance with procedures in the Residential ACM Manual and dud systems with more than 40 linear feet in -unconditioned Races shall meet the recldirements of Section 150(m) and dud insulation irements of Package D. WATER HEATING SYS'T'EMS Rvstems serving single dwelling. units Distribution Type. Rated EneY Check box if system meds criteria ofa. "Standard" system.. Standard system is one -gas-fired water heater per CI - dwelling unit If the water heater is a storage type, 50•gallons is the maximum'.capacity and. recirculation system is Distribution not allowed. Standby Check box when using Preapproved Alternative Water Heating table, Table 54 in -Chapter 5 in the. Residential. uel Manual. No water heating calculations are required, and the sjstem com lies automaticaff . in. stem Bwllsr . �wts Efficiem Check box if system does not meet criteria of "Standard" system, and does not comply with the Preapproved ❑ Alternative Water Heating table. In this case, the Performance Method must be used and must be included in the .submittal: .10 Check box to verify that•a time control is required for a recirculating system pump for a system serving multiple . LA units Rvstems serving single dwelling. units C�..n4— -A- r vvlhinin Auwallvr er w,nate - - - Water Heater ype Distribution Type. Rated EneY Rated ( or stuJjir Tank. Water Heater Distribution mP,cti Tank Factor orr Number. Nor Qapaeq Thermal . Standby External Insulation uel in. stem Bwllsr . �wts Efficiem Loss °t° R -Value . LA ` 000 1 Aq_�_d I ... C�..n4— -A- r vvlhinin Auwallvr er w,nate - - - Water Heater ype Distribution Type. Number in .stem Rated ( or stuJjir Tank Capacity ides Factoror Thermal ' Efficien Standby" 'Loss V 'Tank External Insulation .R -Value 1. ror smau gas storage water neatens tracea inputs or cess than or equal to io,uw rstwtlr/,, vlc uiv s pLa uul—, --- -- pump water heaters, Iist Energy Factor, For large gas storage water -heaters (rated input of greater than 75,000, Btu/hr), 5,000- Btu/hr), list Rated Input, Rwoovery Efficiency, Thermal Efficiency and Standby Loss. For instantaneous gas water 'heaters, list Rated Input and Theimal Efficiencies. PiR6Insulation (kitchen lines >_ 3/4 inches) All hot water pipes from the heating source to the kitchen fixtures that ate'/+ inches or greater in diameter shall be thermally.insulated as specified by Section 150 G) 2 A or 150 G) 2 B. Residential Compliance Forms Man* 2005 jl� r CERTIFICATE Off' COYIPLL4NCE RESIDENTIAL. (Page 4 of 4) CF -112 Project Title Date SPECIAL FEATURES NOT REM IIUNG HERS VERIFICATION (add extra sheets ifnecessary) Indicate which special feattures are part of this project. The list below onlyyepresents special features relevant to the prescriptive method. +r Feature. R uired Forms rf a licable Description [7 Metal Framed -Walls CF4R- CF=61i part 6 of 12 0 Radiant Barriers CF -1R 7. O Exterior Shades WS -4R ❑ : Cool Roof. N/A; Attach CRRC Label to Forms. Q Dedicated Hydronic Heating Performance Calculation em ' Attach Rua to Forms. Req E3 Combined Hydronic System . Performance Calculation ired•Attach Run to Foams. . ❑ Gas Cooling r Performance Calculation R ufied. ❑ Butied Ducts -N% • Indicate on building plans. ❑ Kit&.en'Pipe Insulation Sec Section 5.62 Distn'bution ems in.Residential.Manual. Multiple Water Heaters Per Sea Table x-13 or use ❑ Dwelling ilnit Performance Calculation and .attach Run to Forms. ❑ Central Water Heating System Performance Calculation and Sw4ng Multiple Dwellings. attach Ruin to Forms. ❑ Non NAECA Large Water 'Heater. See Table 5-13 or use- D Indirect Waw Heater Performance. C tIculaiion and attach Rim to Forms See Tables -I3 or use E3 Instantaneous Gas Water Heater. Paformatrce Calculation and attach Run to Forms See Table 543 or use Solar Water Heating System Pexfotmanc Calcirlatioa and attach.R, toForms FO Wood Wye Boiler orinanee Calculation and .1-kaf attach Run to Forms SPECIAL FEATURES REOUIRINO HERS RATER- VERMCATION _(add extra sheets if pecessar d Indicate to the HERS Rater which credits are part of this project and need verification. +� Feature Reqaired Forms ff applicable) Description Duct sealin CF -611 vart4of 12 Refrigerant Charge ' CF -6R art '5 of 12 Thermostatic Ex anion Valve ... CF=61i part 6 of 12 March 2005 d. fartio")a A cc. cmc R E iW4 �xT F)20 Mok W �,�; of - R t -/x -!46a /A/ WA(,c s . ri r - op nno�t a 22 Y �dx6� �6xdo 36 3-F^r 36X36 lowo p&�y' w , ( - 0�6 z I � lie i` 0 N >L/) 'J ALLY lJ 1 I C�� 4p, r ' ( e µ � I 0 'IV olo sG x 60 36x3 36 . . y� x�a Cl T6AJA Al S Fr�K Rlz MODS P _i � a?0 AO)EIV1PSA Ci4R2.4VZ-A 1W- &Z2!Z wiz z�s 3Q t�,@C-7o PAS / Tuf 4 44�rw P.O. Box 1504 LA QUINTA, CALIFORNIA 92247-1504 78-495 CALLS TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT PROPERTY OWNER'S PACKAGE (7 60) 777-7012 FAX (760) 777-7011 Disclosures & Forms for Owner -Builders Applying for Construction Permits IMPORTANT! NOTICE TO PROPERTY OWNER Dear Property Owner: An application fora building permit has been submitted in your name listing yourself as the builder of the property imrovements 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. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION DI, �CHONS: Read and initial each. statement below to signify you understand or verify this information. 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 injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers on,�/Y property. ��,"//y 2. I understand building permits are not required to be signed by property owners unless they are responsible for the ��tion and are not hiring a licensed Contractor to assume this responsibility. 3. 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, 4/1 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),' includinglabor and materials, I may be considered an "employer" Y u der s to 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 k7. I understand under California. Contractors' State License Law, an Owner -Builder who builds single-family residential tures 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. • `r 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 wor nship 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. I also understand I may contact the California Contractors' State License Board (CSLB) at 1- 800 1-CSLB (2752) or www.csib.ca.gov for more information about licensed contractors. 01 0. lam 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 aappli ble 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 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 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 property 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. Signature of property owner Date: 90/)�, 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 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: Bin# Qty Of La Quinta Building &r Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # Project Address: t^ ( ("GL . Z Owner's Name. --Vb V,. d A. P. Number: Address:�o (j-� Legal Description: City, ST, Zip: Contractor: OW`n S2� ` \�� Telephone: �� ; %.. :r •a ;:::>>,:>::s•:<;: ;s :,;>:;>; Address: O Project Description:5 L !� cv ^Vo City, ST, Zip: L jj�v(qN)^ A0 L Telephone: h ne: State Lic. # : 3qqo City Lic. #•: — Arch., Engr., Designer:. NINE - . K l MOO Address: —lVfeV 5(.0 L%CL A—;;' S' City., ST, Zip: Telephone: > -'>' »'<><"<,'<:^:: •>'`<'N<?: 'inSii i�i:i :•i.•ti.•....fiiJ::L<::`v:�i :z;::::::s:><:<:•:f •;.a>:::<,.: Construction Type: t G' Occupancy: State Lic. Project type (circle one): New Add'n Alter Repair Demo Name of Contact Person: f0 iC\ Q Sq. Ft.: (a0d t ne's: Telephone # of Contact Person: S�%Lv`jCt q c) Estimated Value o roject: 17 .0. APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rec'd 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 resubmittedMechanical 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:- '"' Repiew,.ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees