10-1283 (RER)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
c&t(t 4 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: 10-00001283 Owner:
Property Address: 54300 AVENIDA CARRANZA FOORD BOB
APN: 774-243=002-22 -000000- 54300 AVENIDA
Application description: REMODEL - RESIDENTIAL LA QUINTA, CA
Property Zoning: COVE RESIDENTIAL (
Application valuation: 1000
Contractor:
Applicant: Architect or.Engineer: Owner
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 pplicant 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
iYY"��� the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
and who does the work himself or herself through his or her own employees, provided that the
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
one year of completion, the owner -builder will have the burden of proving that he or she did not build or
improve for the purpose of sale.).
(_ 1 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions 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. , BAP.C. for this reason _
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: 11/30/10
CARRANZA
9
1
0 Zv i0
U -T S.t
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 2007-2008cbeblicyNumber --------- - - - - - -
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 wor�`Rrs' co pensation provisions of Section
3700 of the Labor Code, I shall;Z',
mply dth tho provisions.
ate: J 70f NA scant:
WARNING: F RE TO SECURE WORKERS' COMP NSATION 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.
certify that I have read this application and state that the above information is correct. I agreeto comply with all
city and county ordinances and state laws relating to building constructio/n and here Yauthorize representatives
of this cou�to er upon the above-mentioned property for inspec idfi urposSignat (Applicant or Ager
v
Application Number . . . . . 10-00001283•
Permit . . .
BUILDING'PERMIT
Additional desc .
Permit Fee . . . .
25.00 Plan Check Fee
16.25
Issue Date . . . .
Valuation
1000
Expiration Date
5/29/11
Qty Unit Charge .Per
Extension
BASE FEE
15.00
5.00 2.0000 HND BLDG 501-2,000
10.00
----------------------------------------------------------------------------
Special Notes and Comments
REPLACE BAY WINDOW
AT FRONT OF RESIDENCE
WITH DOUBLE GARDEN
DOOR, USING EXISTING
FRAMING AND HEADER.
2007 CODE
-------------------_------
Other Fees . .
---------------------------
. . . . . BLDG STDS ADMIN (SB1473)
1.00
ENERGY REVIEW FEE
1.63
STRONG MOTION (SMI) - RES
..50
Fee summary
Charged Paid Credited
Due
Permit Fee Total
25.00 .00 .00
25.00
Plan Check Total
16.25 .00 .00
16.25
Other Fee Total
3.13 .00 .00
3.13
Grand Total
44.38 .00 .00
44.38
LQPERMIT
°F�Ww
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 & Porins for Owner -Builders Applying for Construction Permits
LWOTA Tt NOTICE TO PWOPERTY (WNEg
Dear Property Owner
An. application for a building permit has been submitted in your name listing yourself as the builder of the .prnporty
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 yourunderstanding 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.
OVIW'S ACKN0-WLEIDGIi� AND YER
MWATION `®E »ORMiy
DfiWCTKINS: Read and initial eachstatement befow to signify you understandor verlf this information.
/�. I understand a frequent practice of unlicensed persons is to have the property. owner obtain an "Owner-Buildee,
building permit that erroneously implies that the property owner is providing his. or her own labor and material persofiaft- 1, as
an Owner -Builder, may be held liable and subject to serious. financial risk for any injuries sustained by an unlicensed person
and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those
injuries. I am willfully acting as.an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers
'on my. property-
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..
�. I understand as an "Owner -Builder" I am the responsible party of record on the permit I understand that 16
ay protect
myself potential financial risk by hiring a licensed Contractor and having the permit -filed in his or her time instead of my
own.
'%_4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on
permits and contracts.
��5. I understand if I employ or otherwise engage any persons; other than California licensed Contractors, and the total value
of my construction is at least five hundred dollars -($500), including labor and materials, I may be considered an "employee'
under state 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 disabilityinsurance, 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
--)_�7. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential
structures cannot .legally build them with the .intent to offer them for sale, unless all work is performed by licensed
subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed
under contract with a licensed general building Contractor.
A?t : 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. 4,uries 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 -employee, 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 (CSI.B) at 1-
800-321-CSLB (2752) or www.csib.ca.gov for more information about licensed contractors.
0. 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:
agree that, as the party legally and financially responsible for this proposed construction activity,.( will abide by all
applicable laws and requirements that govern Owner -Builders as well as employers.
/ 12. I agree to notify the issuer of this form immediately of any additions, del etiotns, 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 Boand may be unable to aasist 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 wonting
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 Coutractors areP�'Y ro licensed and the status of their wormers'
p
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 issues the..permiL (Mote: A copy of tfre property owner's d6ver'st 6i'mue, form gotadairdvn, or
other verification acceptable too the agency is required to be presented when the permit is issued to verify the Property
owner's signature. nn
Signature of property owner 1 Date. s oC iU
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.
r TO ACT ON
Excluding the Notice to Property, Owner, the execption 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 AuthorizedAgent:
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:
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BUILDING & SAFETY DEPT.
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FOR CONSTRUCTION
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HERS VERIFICATION SUMMARY The enforrement 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
inspectiorL
Duct Sealing & Testing HERS verification is required for this measure.
17 YES 17 NO YES: In Climate Zones 2 and 9-16, if more than 40 linear feet of new or replacement ducts arc installed in unconditioned
space, t ie ducts are to be scaled.per §t52(b)IDii and the newly installedducts are to be insulated -M §151(f)10.
13 EXCEPTION: Existing duct systems that are extended, which are constructed, insulated or seated with asbestos.
17 YES E3 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 §I52(b)IDi.
13 YES 17 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 arc to be
sealed per §152(b)l E.
17 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.
O EXCEPTION: Duct systems with less than 40 linear feet in unconditioned space.
O EXCEPTION: Existing duct systems constructed, insulated or sealed with asbestos.
Refrigerant Charge- Split System HERS verification is required for.this measure.
O YES ONO YES: In Climate Zones 2 and 9-15, 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 § l S 1 F.
Central Fan Integrated (CF1) Ventilation System and Fan Watt Draw
The ventilation requkernerits of § 1 o do not apply to existing residential homes.
Ducted Split Systems - Air Conditioners and Heat Pumps: Airflow HERS verification is required for this measure -
0 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)lCi to meet the requirements of 151, 7B.
Documentation Author's Declaration Statement
a I certify that this Certificate of Compliance documentation is accurate and complete.
Name:
Signature:
Company: Date:
Address: _ n If Applicable 13 CEA or 0 CEPE
(Certification s):
City/State2ip: Phone:
,9
BespnnsibleBuilding Designer's Declaration Statement_ - — -
• l 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 I 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
en ,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.
Registration Number: Registration Date:Time: HERS Provider:
2008 Residential Compliance Forms
August
Mass and Fumt Construction(footnotes)
1. Indicate the type of assembly to include: Hollow Unit Masonry Walls, Solid Unit Masonry, Solid Concrete Walls, Etc. Additional assemblies can
found Reference Joint Appendix J44.
This is the U -Factor based on the thickness of the assembly in inches.
3. The R -value ofthe•insulation to be added on the interior or exterior ofthe assembly.
**The Calculated R -Value is the R -value of the furred out section of the assembly.
.4 The Final Assembly is calculated using Equation 4-2 or Equation 4-4of the Reference Joint Appendix JA4. The equation is the inverse of Colum
-added to Column L Column K is the inrverse from• column J.
7. Insert the calculated U- actor value on to the Opaque Surface Details in Column J
FENESTRATION PROPOSED AREAS
❑ Replacing window alone — Replacement windows shall meet the U -Factor a?d SHGC Value requirements of Component Package D in
Table 151-C. The Total Fenestration and West facing Area requirements are not applicable.
P Adding Soft 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 50ft2 of window area — Newly installed windows shall meet the U -Factor and SHGC Value and the Fenestration
Area requirements of Component Package Din Table 151-0. Complete the Altered Fenestration Allowed Area Table on Page 2 of the CF -IR -ALT
Orientation
, Fenestration Type and Frame
(North, East,
Pmpsakrea' MaximumMaximum NFRC or Default
Window Glass Door or S I'
South, West)
o?) U-famr, '' SHGC" values
X37
1. 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
arta may be the glass area plus a -2 inch frame': around the glass.
2. Enter value from Component Package D Requirements in Table 151-0.
3. Actualfenestration 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 -1 R ALT Form.
4. Submit a completed WS -3R Form if a reduced SHGC is eakulated with exterior shading.
5.Yapplicable at this staxe enter "NFRC'for NFRC Certified windows or are CEC "Default" values found in Table 116-A or B.
ALTERED FENESTRATION ALLOWED AREAS (Co t If more tkaa S Is addeQ
A B .0 D E F G
— Allowed— Existims Fenestration Total Arca —
CFA of Entire % of Fenestration Area Fenestration Allowed Proposed Areae
Total Fenestration �AreaDwellin CFA Area Removed Area Added A x B E -D + C
Total Fenestration Area
r fie► 20
West Fenestration Area'
(Required In 05
CZ's 2, 4 & 7 -15)
1. West Fenestration Area includes west -sloping skylights and any skylights with a pitch less than 1:12.
2. West facing glazing area removed cannot be "counted - twice. - In order to distribute the west glazing area removed to the other orientations.
input the west glazing area removed in the Total Fenestration Area row, column D.
3. Include the Proposed Area of the West facing fenestration in both -Area columns below. -
4. To meet compliance, the Proposed Area must be less than or eaual to the Total Allowed Area for BOTH the Total and West Fenestration Area
Registration Number: Registration Date:'Time:
2008 Residential Compliance Forms
HERS Provider:
August 26
Prescriptive Certificate of Compliance: Residential CF -IR -ALT
Residential Alterations a e i of
Project Name: Climate Zone N N of Stories
Geoeral Information
Site Address:s L/3DB Enforcement Agency: Date: U -z-
16
Building Type *ingle Family O Multi Family Circle the Front Orientation: N, E, S or degrees
Project Type: herations O Envelope O Fenestration El Roof O HVAC
Conditioned Floor Area (CFA): Replacement or Change Out O Duct tnoement O Water Heater
: 77r>: arm is tat to Si used` or New CoristrutYtd Bu -- or Addldons
lnwkdon Values For Opaque Surf Ices (for Fvrrtng use the Mau 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, eeilft or floor ears( install the
mamubtory minimum i ndation vale per f 130 far the altered as sembly. Fill in Columns A -C and eater mm *tart' W uhst ion vWW lot Column H.
13 Replacement of entire assembly- Replacement ofan entire wall, celitng, or floor assembly requires the lrustalhrtion of Conrponerd
P - D insulation values in Table 131-C. Fill in Columns A - J.
Opaque Surface Details For the furred portioned of Man Walls we Furring Strips Coastrwedoa Table bekw.
F3
Pro ""` Standard Values room sn• a.u.c
Framing [hidmess, Framed Goss inuous JA4 Proposed
Ta$/ Assembly Name Material Spacing, U- JA4 Table Gvity lnsulat:on Assombiy� Assem
ID or Tyne, and Sizer or Odm-' factor' Numbers R -value° R -Valuer Cell Value U-fa
Mote: For fwmd asseen ws accowd* for Cawtimaw lmwlatwn R -volae, see Page JA4-3 awl tgaarion 4-1. For cwlcwkxireg fired waUs use tae mass mea
Fwrty Cmar uction table below.
1. For Tag/ID indicate the identification name that mattes the building plans.
2. Indicate the Assembly Name ar type: Rotrf7Ceiling, Walls, Floors, Slabs, Crawl Space, Doors and etc ... lndtarte the Frame type and Sae: For
Wood Metal. Metal Buildings, Mass, enter 2x4, 2x6, or etc... see JA4 for other passible frame type assemblies.
3. Enter the thiabeess for mass in inches or Spacing between framing members enter: 16 "or 24 VC: or Other)6r all other assembly description
such as Concrete Sandwich Panel. Vpan&vl Panel, Logs, Straw Bale Patel and etc....
4. Based on the Climate Zone; enter the SkvKkwrd U factor from Table 131-B. C or D for eachdi*reni auemUY Nemec or type•
3. Enter the Table member that closely resembles the proposed assembly.
6. Enter the R-wdue that is being installed in the wall cavity or between the fia ming: 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 fatoin Column J
9.77e Proposed Assembly Ufactor. Column J, must be equal to or less duan thr.Stareda'd U factor in Column E to.comply.
F Seri
Construction Table for Mass Walls Oral
A 1
B 1 C 1 D
E
F I G H T[ J K
L M
Proposed Properties of Masonry and Concrete
Added interior or Exterior insulation
Wails From Reference
in Furring Space from Reference
Joint Appendix
Table 43.5 43.6 4.3.7
Joint Appendix Table 4.3.13
V
_b
Y �
° t
o F F, � V .,
Final.
Asscmbl7
Mass
Thickness'
Name or JA4 Table
TYPCI Number' < >
$ a ,
e K < >
U -factor, ' Comment
Registration Number: Registration Date Time:
2008 Residential Compliance Forms
HERS Provider:
August 200
ern # .
Qty Of La Quint
Building 8L Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
lb `�'�
Project Address: s- ,
Owner's Name:
A. P. Number:
Address: L AA AX19 Al
Legal Description:
City, ST, Zip: i1
Contractor: �—
Address:
Telephone: f
Project Description:
City, ST, Zip:
Telephone:
..;...;.
State Lie. # :
City Lie.
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
.nuA,?+10GH,i'iX 'til •
Construction Type: Occupancy:
roj ect type (circle one): New Add'n Alter Repair Demo
State Lie. #:
Name of Contact Person:
4Estimated
Sq. Ft.:
#Stories:
# Units:
Telephone # of Contact Person:
Value of Project: e }
APPLICANT: DO NOT WRITE BELOW THIS LINE
4
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
�� Z2.
Item Amount
Structural Cales.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cates.
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 correctionsflssue
Electrical
Subcontoctor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmittedGrading
IN HOUSE:-
''d Review, ready for correctionslissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees