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10-0708 (RER)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 10-00000708 Property'Address: 52950 AVENIDA CARRANZA APN: 773-322-011-16 -000000- Application description: REMODEL - RESIDENTIAL Property Zoning: COVE RESIDENTIAL Application valuation: 5000 Applicant: T -4 -tit 4 4 Q" Architect or Engineer: 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).: (_) 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.). ( 1 I am exempt under Sec. , B.&P.C. for this reason / Date: �-S O CONSTRUCTIOWLENDING 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: JONASSON TIM c/o JONO INVESTMENTS, LLC 79755 DECLARATION CT LA QUINTA, CA 92253 AUG 23 2010 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 8/04/10 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 1 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: 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 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 property for inspectio urpo Lses. Date: 2; oAignature (Applicant or Agent)' w Application Number . . . . . 10-00000708 ------ Structure Information EXIST. 12.40 2 B 2 BA SFD ----- Construction Type . . . . . TYPE V, UNPROTECTED Occupancy Type . . . . . . DWELLG/LODGING/CONG <=10 Other struct info . . . . . CODE EDITION 2007/08 ENERGY # BEDROOMS .00 ---------------------------------------------------------------------------- Permit . Additional desc Permit Fee Issue Date Expiration Date BUILDING PERMIT 72.00 1/31/11 Plan Check Fee 46.80 Valuation 5000 Qty Unit Charge Per Extension BASE FEE 45.00 3.00 9.0000 THOU BLDG 2,001-25,000 ---------------------------------------------------------------------------- 27.00 Permit . . ELECT - ADD/ALT/REM Additional desc . Permit Fee . . . . 20.25 Plan Check Fee 5.06 Issue Date . . . . Valuation 0 Expiration Date .1/31/11 Qty Unit Charge Per Extension BASE FEE 15.00 7.00 .7500 PER ELEC DEVICE/FIXTURE 1ST 20 5.25 -------------------------------7-------------------------------------------- Special Notes and Comments ALTERATION OF EXISTING LIVING AREA TO OFFICE (112 SF). RELOCATE FRONT DOOR & REPLACE WITH 15 SF WDW. REVISE WDW IN LIVING ROOM TO ADD FRONT DOOR AND NEW 15 SF WINDOW. U -FACTOR = .40, SHGC = .35 2007 CODES, 2008 ENERGY. ---------------------------------------------------------------------------- Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 ENERGY REVIEW FEE 4.68 Fee summary ----------------- Permit Fee Total Plan Check Total Other Fee Total Grand Total LQPERDIIT Charged Paid 92.25 .00 51.86 .00 5.68 .00 149.79 .00 Credited Due .00 92.25 .00 51.86 .00 5.68 .00 149.79 529 5:0'Avenida C a irra nza Existing CITY,OF LA QUINTA BUILDING & SAFETY DEPT APPROVED FOR .CONSTRUCTION 2 Car Garage DATE /,4/20/0", 7A r�j 3r�, A " artA� nYA u . O. f 631JUNINlit A �903 1" �z Front Patio T'l 3 Li � 10 Guest Bed roams Guest Bath Master lRath AL AIC I!Pantry I Master Bedroom Kitchen Livinq Rgam 21'3'x Dining Area �Rear Patin --toter l.st - April 30 "AN ADEQUATELY SIZED DEBRIS CONTAINER Nionday - Friday: 7:00 i.�:rn: to 5:30 p.m. IS REQUIRED ON THE JOB SITE DURING ALL 8:00 a.m. to 5:00 p.m. PHASES OF CONSTRUCTION AND MUST BE Isuiidaay:..__ . None. C-overnmeni�Code,Holidays: --None i ` } EMPTIED AS NECESSARY FAILURE TO DO SO Rayl st `- Si'pternb`er, 3®th �.. 11 `� MAY CAUSE THE CITY TO HAVE THE CONTAINER Friday DUMPED AT THE EXPENSE OF THE OWNER/ l . P �at� day; 00Ma ma=to y 07:Mp.m. ,CONTRACTOR." S,U nday:'i „tNone_,,ic �, r - ;-) Government Code lfolydays: None "" ---- A RE -INSPECTION FEE OF $30 Construef4n-rs-•NOT°PERYi IfffD " on the following Code'Holidays '" WELL BE CHARGED IF THE APPROVED MANS AND JOB CARD ARE NOT ON New Year's Day THE SITE FOR INSPECTION. A SCHEDULED Dr. Martin Luther King Jr. Day NO EXCEPtONS1 President's Day Memorial Day . Independence Day Labor Day Veteran's Day Thanksgiving Day Christmas Day F A 52950 Avenida Carranza Proposed Office I a: CITY W- LA QUINTA BUILDING & SAFETY DEPT. APPROVED FOR C NSTRUCTION 2 [Gar Gairage: DATE 4 6Y=ML: Front iRablo Llf(W -- — a Guest, Bedroom 0 office Living Room i A/C T i Guest, Bath Pantry i I Master Bath lKlit6hen Dining Area I Aw -- - - i Master Bedroom Rear Patio Iw — Prescriptive Certificate of Compliance: Residential CF -IR -ALT Residential Alterations Page 1 of 5 Project Name: JONASSON ALTERATION T Climate Zone #1 5 11 #of Stories General Information Site Address:52950 AVE CARRANZA Enforcement Agency:LQ B&S Date:AUG 03, 2010 Building TypeE Single Family Multi Family Circle the Front Orientation: N, E, S, W, or degrees W Conditioned Floor Area (CFA): Alterations Project Type: x .._i Replacement or Change Out Envelope [@ Fenestration Roof HVAC Duct Replacement El Water Heater NOTE: This form is not to be used for Newly Constructed Buildings or Additions Insulation Values For Opaque Surfaces (for Furring use the Mass and Furring Strips Construction table below) Assembly Alteration or floor must install the E3 Opening of framed cavity alone— Alterations that involve the opening of the framed cavity of a wall, ceillat;ory mandatory minimum insulation value per §150 for the altered assembly. Fill in Columns A —C and enter in insulation value in Column H. Replacement of entire assembly— Replacement of an entire wall, ceiling, or floor assembly requires a installation of Component Package- D insulation values in Table 151-C. Fill in Columns A — J. FA Opaque Surface Details For the furred portioned of Mass Walls see Furring Stri sC struction Table below. A B C D E F G H I J Proposed ee oce Standard Values From JA4 Table Added Interior or Exterior Insulati Framing Thickness, in Furring Space from Reference Framed Continuous JA4 Proposed Tag/ IDS Assembly Name or Type Material and Size' Spacing, U- or Other factor° JA4 le N ber5 Cavity Insulation R-valueb R -Value' Assembly Row/Cols Assembly U-factor9 � y N U c a c U ��` Ass bl u' 7 FL- H `o m_0 �'� > Final Assembly Note: For furred assemblies, accounting for Continuous Clation R -value, a Page JA4-3 and Equation 4-1. For calculating furred walls use the Mass and FurringConstruction table below. 1. For Tag/ID indicate the identification nam tkfflvNtch,es the ilding plans. 2. Indicate the Assembly Name or type: Roo j/ ' g, Walls, F oors, Slabs, Crawl Space, Doors and etc... Indicate in column G the Frame material and Size: For Wood, Metal, Metal ildings, M ss, enter 2x4, 2x6, or etc... see JA4 for other possible frame type ass blies acing bet en framing members enter; 16 "or 24 "OC; or Other for all other• ass mbly criptlon such as Concrete Sandwich Panel, Spnel, ogs, Straw Bale Panel and etc.... �. 3. Enter the thickness for mass in inches or SIthwall 4. Based on the Climate Zone; enter the t factor found in JA4 Table based on the R -Value from Table 151-B, S. Enter the Table number that closely ree proposed assembly. Q 6. Enter the R -value that is being installall cavity or between theframing; otherwise, enter "07. Enter the Continuous Insulation R-vaproposed assembly; otherwise, enter "08. Enter the row and column ofthe Ufacbased on Column F Table Number and enter the Assembly U f tii 6wm9. The Proposed Assembly Ufactor, Colst be equal to or less than the Standard U factor in Column o 2 z i. — c A. v - 11� ri Furring Strips Construction Tabl for Mass Walls Onl \ 0 A I B D I E F G H I J Proposed Properties of Mas my and Concrete Added Interior or Exterior Insulati Walls From ference in Furring Space from Reference Joint A endix Tab 4.3.5, 4.3.6, 4.3.7 Joint Appendix Table 4.3.13 g � O � y N U c a c U ��` Ass bl u' 7 FL- H `o m_0 �'� > Final Assembly Mass Thickness' me or T e2 JA4 Table Number' ¢ > v e e c k ° ¢ > U-factor6'' Comment Registratton Vumber- �.. - Registration Date/Time HERS Provider 2008 Residential Compliance Forms 0 �� March 2010 Prescriptive Certificate of Compliance: Residential CF -IR -ALT Residential Alterations p /� age 2 of 5 Project Name: IONASSON ALTERATION Climate Zone TION 15 1#of Stories Mass and Furring Strips Construction(footnotes) 1. Indicate the type of assembly to include; Hollow Unit Masonry Walls, Solid Unit Masonry, Solid Concrete Walls, Etc. Additional assemblies can befound Reference Joint Appendix JA4. 2. This is the U -Factor based on the thickness of the assembly in inches. 3. The R -value of the insulation to be added on the interior or exterior of the assembly. 4. The Calculated R- Valu is the R -value of thefurred out section of the assembly. 4 The Final Assembly is calculated using Equation 4-2 or Equation 4-4of the Reference Joint Appendix JA 4. The equation is the inverse of Column added to Column I. Column K is the inverse from column J. 7. Insert the calculated U- actor value on to the Opaque Sur ace Details in Column J FENESTRATION PROPOSED AREAS 0 Replacing window alone _ Replacement windows shall meet the U -Factor and SHGC Value requirements of Component Package D in Table 151-C. The Total Fenestration and West facing Area requirements are not applicable. E] Adding 50fe or less ofwindow area — Newly installed windows shall meet the U -Factor and SHGC Value requirements of Component Package D in Table 151-C. Adding more than 50fe of window area — Newly installed windows shall meet the U -Factor and SHGC Value and the Fenestration Area requirements of Component Package D in Table 151-C. Complete the Altered Fenestration Allowed Area Table on Page 2 of the CF -IR -ALT C Orientation E F G Fenestration Type and Frame Window Glass Door or Skylight) (North, East, South, West(ft) PropsedArea' Maximum U-factorz' 7 Maximum SHGCZ' 3' ° NFRC or Default Value5 SH WDWS W 30 .40 .35 DEFAULT Area Fenestration Area Proposed Area ° Dwelling CFA2, 3 Area° Removed Area Added6 A x B) (E -D) + C Total Fenestration Areae -(W) I. Fenestration area is the area of total glazed product (i.e. glass plus frame). Exception: When a door is less than 50% glass, the fenestration area may be the glass area plus a "2 inch frame " around the glass. 2. Enter value from Component Package D Requirements in Table 151-C. 3. Actual fenestration products installed and as indicated in CF -6R -ENV Form shall be equivalent to or have a lower U factor and/or a lower SHGC value than that specified on the CF -IR ALT Form. 4. Submit a completed W5 -3R Form if a reduced SHGC is calculated with exterior shading. 51fapplicable at this stage enter "NFRC" or NFRC Certified windows or are CEC "Default " valuesound in Table 116-A or B. ALTERED FENESTRATION ALLOWED AREAS (Complete if more than 50jt= of fenestration is added) A B C D E F G CFA of Allowed Existing Allowed Entire •% of Fenestration Area Fenestration Area Proposed Area ° Dwelling CFA2, 3 Area° Removed Area Added6 A x B) (E -D) + C Total Fenestration Areae -(W) West Fenestration Area (Required In 1.240 5 24 9. 3 0 62' 45 CZ's 2,4&7-15 1, The Proposed West Fenestration Area includes West -sloping skylight area and any other skylight area with a pitch less than 1:12. 2, Enter 20% when no West orientation restriction or 15% when West fenestration is being installed in Climate Zones 2, 4, & 745. Note that the maximum allowed fenestration can only be 5% of the CFA as indicated in Column F Column G must be equal to or less than Column F. 3, In climate zones 2, 4, 7-15, no more than 5% of the CFA is allowed for west facing glazing. 4, Existing Fenestration area must be counted toward the maximum allowed 15% or 20% of the whole building and calculated in Column G. The Proposed Area must be less than or equal to Column F. S. Enter the fenestration removed as part of the alteration if any in column D. 6, Enter the Fenestration area that is being added as part of the alteration. 2008 Residential Compliance Forms W March 2010 Prescriptive Certificate of Compliance: Residential CF -IR -ALT Residential Alterations p /� Page 5 of 5 Project Name: IONASSON ALTERATION Climate Zone#� 5 #of Stories HERS VERIFICATION SUMMARY The enforcement agency should pay special attention to the HERS Measures specto.44 this checklist below. A completed and signed CF -4R Form for all the measures specified shall be submitted to the building ins or 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 replac nt ducts are installed in unconditioned space, the ducts are to be sealed per §152(b)1Dii and the newly inst ducts are to be insulated per §151(f)10. EXCEPTION: Existing duct systems that are extended, w ' are constructed, insulated or sealed with asbestos. OYES ONO YES: In Climate Zones 2 and 9-16, if the existin s ce-cond' ' ing system (HVAC equipment and ducting) is replaced, the ducts are to be sealed per §152(b)1Di. []YES ONO YES: In Climate Zones 2 and 9-16, if the exis ' C equipment is replaced (including the replacement of the air handler, outdoor condensing unit of a split syste ooling or heating coil, or the furnace heat exchanger) the ducts are to be sealed per 4152(b)IE. EXCEPTION: Duct systems at are documented to have been previously sealed confirmed through HERS verification in accorda with procedures in the Reference Residential Appendix RA3. EXCEPTION: Du ystems with less than 40 linear feet in unconditioned space. EXCEPTION• isting ducts stems constructed, insulated or sealed with asbestos. Refrigerant Charge - Split Stem HERS verification is required for this measure. D YES 0 NO YES: In mate Zones 2 and 8-15, when the existing HVAC equipment is replaced (including the replacement of the air dler, outdoor condensing unit of a split system A/C or heat pump, cooling or heating coil, or the furnace heat exchaner) a refrigerant charge measurement shall be verified per § 152(b) IF. Central Fan egrated (CFI) Ventilation System and Fan Watt Draw The ventilati requirements of § 150(o) do not apply to existing residential homes. Ducted lit Systems - Air Conditioners and Heat Pumps: Airflow HERS verification is required for this measure. NO YES: In Climate Zones 10 through 15, when the existing space -conditioning system (HVAC equipment and ducting) is 6>6 replaced, the airflow and fan watt draw shall be verified per § 152(b) 1Ci to meet the re uirements of § 151 7B. Documentation Author's Declaration Statement • I certify that this Certificate of Compliance documentation is accurate and complete. Name: TIM J O N AS S O N Signature: Company: ate: �) k I Address: AVEN I DA CARRANZA If Applicable -CEA or _.: CEPE If (Certification #): City/State/Zip:LA QUI NTA, CA 92253 Phone: Responsible Building Designer's Declaration Statement • I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the building design identified on this Certificate of Compliance. • I certify that the energy features and performance specifications for the building design identified on this Certificate of Compliance conform to the requirements of Title 24, Parts 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 for approval with this building permit application. Name: Signature: Company: Date: Address: License: City/State/Zip:. Phone: For assistance or questions regarding the Energy Standards, contact the Energy Hotline at. 1-800-772-3300. r_�.r �._ ..v Novi. -..- , - _..- Regrstrakon Number ;Registration Date%I ime: HERS Provider: 2008 Residential Compliance Forms _ March 2010 P.O. Box 1504 LA QUINTA, CALIFORNIA 92247-1504 78-495 CA[ LE TAMP[CO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT PROPERTY 0"U ER'S PACKAGE (760) 777-70.12 FAX (760) 777-7011 Disclosures & Forms for Owner -Builders Applying for Construction Permits RMOMTt NOTICE 10 R O1PMTY OWNIFR Dear Property Owner. Ari. 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 In%rmation Verification Form to make you aware of your responsibilities and possible risk you may incur by having thispermit•issued in your name as the Owner -Builder. We-wdLno#.issue_"uddmg-per--mit until-yo"ave-read;-initialed your--understanding_of-eaeh-pmvision, 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 ACIMW EVG�E ' AND YEWWATMN OF-INFO0 , MN_ MAEC170NS. head and initial eachstatement below to signify you understandor verify this information. 1. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder" buRding 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 Oil' my property. 2. 1 understand building permits are not required to be signed by property owners unless they are responsible for the c truction and are not hiring a licensed Contractor to assume this responsibility.. 3.1 understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect '166if 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 its and contracts. 5.1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value o y construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employe' under state and federal law. 4er6. 1 .understand if I am considered an "employee, under state and federal law, I_ must register with _the.state. and federal nment, 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. ,�fi_7 1 understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential s 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. . -#I.. r. 48. 1 understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held -liable for any cial or personal. Wj.uries sustained. by any subsequent owner(s) that- result from any latent construction defects in the workmanship or materials. 9. I understand 1 may obtain more information regarding my obligations as an "employee, from the Internal Revenue 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 (CSI,B) 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 Vty legally and finc-ally possible . for proposed. construction activityat the following address: 11. l agree that,, as the party legally and financially responsible for this proposer! construction activity, .1 will abide by all licable 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 Me provided on this form. Licensed contractors, are regulated by liws 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 am 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, Wu will be responsrbie for ve f n o�noi those-Cflntractors are propedy-licen�and-th�st;ttus of their workers' compensation insurance coverage. Before a building per 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 propertyownerr's driver-'s1'feerese; farm nrrta'*attxrn; or other verification acceptable+to the agency is.riiiiired 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 understand is my personal responsibility, I hereby authorize the following pemon(s)- to act as, my agents) to apply for, sign, and file the documents necessary to obtain an Owner=Builder Permit for my project. Scope of Construction Pro}ect (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 felled out the above information and certify its accuracy. Note: A copy of the owner's driver's license, joint notarization, or other verification acceptable to the agency is required'id be presented when the permit is issued to verify the property owner's signature.. Property Owner's Signature: Date: 4a8. I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held.liable for any tial or personal. i4jucies 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 IntOMA P-Dveno@ 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 130ard (CS' 0) at 1- 800-321-CSLB (2752) or www.cstb.ca.gov for more information about licensed contractors. (7--) � 10. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the legally Q and cially " b o . for proposed. construction activity at the following address: . 1. I agree that, as the party legally and Wmacially responsible for this proposed construction activity,.I will abide by all able laws and requirements that govern Oftel r -Builders as well at employers. 12.1 agree to notify the issuer of this form immediately of any additions; deletions, or Cham to any of the information l e 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, Bre Contractors' State License Board may be unable to assist you with any tinaneial. loss . . you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be inleivil court. It is also important for you to, understand that if an unlicensed Contractor or employee of that individual or f nn is injured while wwldng on your property; you may be held liable for damages. If you obtain a permit as Owner -Builder and wises to hire CoutaaEtors, you will be mWasrble for ymff3 nxydietim or not thyged and the SM= of their wcsrtce& . eompensation insurance coverage. Before a building per can be Issued, this form must'be completed and signed by the property owner and returned to the agency responsible for issuing. de.permtL Nate: A copy of the property owner's drlver'sllcsnse; form npta*01014 or other verification acceptable to the agency is required to be presented when. the permit is issued W 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 AGENTTO AOT ON PROPERTY OWNER'S B>IIALP Excluding the Notice to Property Owner, the exec3ntion of which I understand is my personal respomsibality, I hereby authorize the fOUDwing 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 per►nit is issued to verify the property owner's signature.. Property Owner's Signature: Date: Bin # City 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: C1tYrC-' Vk-Z-4" Owner's Name: A. P. Number: �j - 32 - O L 1-- 4 Address: ` rr Legal Description: -L O t -61.4c 1 V City, ST, Zip: Contractor: Address: Project Descriptiojn: tt tiLL `p Se dr 0 City, ST, Zip: C l �f, Y ©O VlA Tele phone:':z>%,. 001 ->.csr�R:ssf% �:�z� . '•r..•: ,�s:T{d�' � 'C -e u.�e Q t L Q, - �Q State Lic. # : City Lic. #; rs-<-'}- Arch., Engr., Designer: O,� Address: City., ST, Zip: Telephone: State Lic. #: ck Name of Contact Person: C . Construction Type: LJMq t-ftv&.RAccupancy: Project type (circle one): New Add'n =Tepair Demo Sq. Ft.: Stories: # Units: Telephone # of Contact Person: 2-5-0 — lc -I Z Z Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE tl Submittal Plan Sets Req'd Recd TRAC MG PERMIT FEES Plan Check submitted 700 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 tad Review, ready for correctio ssue //P 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 j Total Permit Fees CITY OF LA QUINTA SUB -CONTRACTOR LIST JOB ADDRESS �v Z4 �� t�J�— CGrc-uc�z.� PERMIT NUMBER OWNER ,� 0 10-1A BUILDER This form shall be posted on the job with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their employe are authorized to work on this job. Any changes to t�is 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. Trade / Classtf�cation........... ..:;:. .. ;.....DoitittactQr...:.... : :. aic it a::.:::.:.: :. ,.. :Stag Conb`act9r.s....... �..5............... 'n a �#kers G4ixlpensatr�stra»Su a �. ::: ..:::.:..: :..:,::..... Ci :8us7bS Lede ......... � ..... . 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) EARTHWORK (C=12) CONCRETE (:C=8).. FRAMING (C. 5)•�tie `` ,, La�S�'�uTi4� �p iG77 / 3.3t •11oZ3goo��67. Z. •11 pSlDo� �. STRUGT. S7:EEL'(C=51>j'' MASONRY 1G=29). PLUMBING: (:C-36.) LATH, PLASTER: ("S1-.:`., :DRYWALL. (G9) HVAC (C-20) :ELECTRICAL: e - ROOFING -SHEET METAL'(( 43) FLOORING :I:C-151' GLAZING 4017w. I. : I N S U I ATI O N;' (C= 21 ... '> SEWAGE Di P.:(G_d2);>z;<<::: PAINTING W-33): CERAMIC TILE; (0_64I* << CABIN.ETS.::(C=6) FENCING (:C=131 LANDSCAPING (.C-27)<'. POOL (C-53)