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BRES2016-0220a 78-495CALLE TAMPICO D LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT BUILDING PERMIT Application Number: BRES2016-0220 Property Address: 54677 AVENIDA DIAZ APN: 774263028 Application Description: ELLENZ RESIDENCE / INTERIOR REMODEL Property Zoning: Application Valuation: $30,000.00 Applicant: TIM ELLENZ 41650 YUCCA LN BERMUDA DUNES, CA 12203 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 Professions 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 ) 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 this reason Date: - — G / 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 (See. 3097, Civ. C.). Lender's Name: Lender's RECEI'VED60) 777-7125 FAX '(760) 777-7011 SEP 19#EHIMNS (760) 777-7153 CITY OF L.A QUINIAte: 9/30/2016 OwneCOMMUNITY D ELOPMENT TIM ELLENZ o o 2Q 15 OWNER / BUILDER ,9Ti19F,✓T Llc. No.: WORKER'S COMPENSATION DECLARATION I hereb ffirm 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 th work for which this permit is issued. 1 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. y workers' compensation insurance carrier and policy number are: Carrier Polity Number: _ I certify that in the performance of the work for which this permit is issued, I shad 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: —� /7/�•--Applica Zgr__Z�� WARNING: FAILURE TO SECURE WORKERS' COMPENSATION OVERAGE 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 Building Official 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 city to enter upon the above-mentioned property for inspection purposes. Date.- —��! (signature (Applicant or Agent: Date: 9/30/2016 Application Number:• BRES2016-0220 Owner: Property Address: 54677 AVENIDA DIAZ TIM ELLENZ APN: 774263028 Property Zoning: Application Valuation: $30,000.00 Applicant: Contractor: TIM ELLENZ OWNER / BUILDER 41650 YUCCA LN BERMUDA DUNES, CA 92203 Llc. No.: --------------------1�---------------------- Detail '.REPLACE (14)• WINDOWS, REPLACE (5) ODORS, ADDS (3) DOORS, ELECTRIC WATER HEA1 �R: (NSfALLNEW RVAC'PLUMBING, ELECTRICAL AND INSULATION. WALLS AND CEILING. NEW DRYWALL. PER 2013 CALIFORNIA BUILDING CODE. ALL PERMITS DOUBLED, STARTED WITHOUT PERMITS. CODE CASE* k FINANCIAL INFORMATION DESCRIPTION ACCOUNT QTY AMOUNT BSAS SB1473 FEE 101-0000-20306 0 $2.00 Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $2.00 DESCRIPTION ACCOUNT QTY AMOUNT RESIDENTIAL, EA ADDITION 1,060SF. 101-0000-42403 0 $24.66 DESCRIPTION ACCOUNT QTY AMOUNT RESIDENTIAL, EA ADDITION 1,000SF, PC 101-0000-42600 0 $5.08 DESCRIPTION ACCOUNT QTY AMOUNT RESIDENTIAL, FIRST 1,000SF 101-0000-42403 0 $290.06 DESCRIPTION ACCOUNT QTY AMOUNT RESIDENTIAL, FIRST 1,000SF, PC' 101-0000-42600 '0 ' ' ' $47.86 Total Paid for ELECTRICAL - NEW CONSTRUCTION: $367.66 DESCRIPTION ACCOUNT QTY AMOUNT CONDENSER/COMPRESSOR 101-0000-42402 0 $72.52 DESCRIPTION ACCOUNT • QTY AMOUNT CONDENSER/COMPRESSOR PC 101-0000-42600 0 $24.17 — DESCRIPTION---- ACCOUNT QTY AMOUNT EXHAUST HOOD 101-0000-42402 0 $24.18 DESCRIPTION ACCOUNT QTY AMOUNT EXHAUST HOOD PC 101-0000-42600 0 $4.83 DESCRIPTION ACCOUNT QTY AMOUNT FURNACE 101-0000-42402 0 $72.52 DESCRIPTION ACCOUNT QTY AMOUNT FURNACE PC 101-0000-42600 0 $24.17 DESCRIPTION ACCOUNT QTY AMOUNT VENT FAN 101-0000-42402 0 $48.34 DESCRIPTION ACCOUNT QTY AMOUNT VENT FAN PC 101-0000-42600 0 $9.66 Total Paid for MECHANICAL: $280.39 DESCRIPTION ACCOUNT QTY AMOUNT FIXTURE/TRAP 101-0000-42401 0 $193.44 DESCRIPTION ACCOUNT QTY AMOUNT FIXTURE/TRAP PC 101-0000-42600 0 $96.72 DESCRIPTION ACCOUNT QTY AMOUNT WATER HEATER/VENT 101-0000-42401 0 $24.18 DESCRIPTION ACCOUNT QTY AMOUNT WATER HEATER/VENT PC 101-0000-42600 0 $7.25 DESCRIPTION ACCOUNT QTY AMOUNT WATER SYSTEM INST/ALT/REP 101-0000-42401 0 $24.1$ DESCRIPTION ACCOUNT QTY AMOUNT WATER SYSTEM INST/ALT/REP PC 101-0000-42600 0 $12.09 - Total Paid for PLUMBING FEES: $357.86 DESCRIPTION ACCOUNT QTY AMOUNT REMODEL, EA ADDITIONAL 500 SF 101-0000-42400 0 $130.50 DESCRIPTION ACCOUNT QTY AMOUNT REMODEL, EA ADDITIONAL 500 SF PC 101-0000-42600 0 $52.20 DESCRIPTION - ACCOUNT QTY AMOUNT REMODEL, FIRST 100 SF 101-0000-42400 0 $98.62 DESCRIPTION ACCOUNT QTY AMOUNT REMODEL, FIRST 500 SF PC 101-0000-42600 0 $134.88 Total Paid for REMODEL: $416.20 yI DESCRIPTION ACCOUNT QTY AMOUNT SMI -RESIDENTIAL 101-0000-20308 0 •$3.90 Total Paid for STRONG MOTION INSTRUMENTATION SMI: $3.90 DESCRIPTION ACCOUNT QTY AMOUNT DOOR/WINDOW, NEW, EA ADDITION 1 101-0000-42400 0 $40.60 DESCRIPTION ACCOUNT QTY AMOUNT DOOR/WINDOW,-NEW, FIRST 1 _ _ 101-0000-42400 0 _ $121.82 DESCRIPTION ACCOUNT QTY AMOUNT DOOR/WINDOW, NEW, FIRST 1 PC 101-0000-42600 0 $59.46 DESCRIPTION ACCOUNT QTY AMOUNT DOOR/WINDOW, REPLACE FIRST 7 101-0000-42400 0 $121.82 DESCRIPTION ACCOUNT QTY AMOUNT DOOR/WINDOW, REPLACE, EA ADDITION 5 101-0000-42400 0 $60.90 DESCRIPTION ACCOUNT QTY AMOUNT DOOR/WINDOW, REPLACE, EA ADDITION 5 PC 101-0000-42600 0 $34.80 DESCRIPTION ACCOUNT QTY AMOUNT DOOR/WINDOW, REPLACE, FIRST 7 PC 101-0000-42600 0 $110.22 Total Paid for WINDOW/SLIDING GLASS DOOR/FENESTRATION: $549.62 4.) eme,V't.(LoiffCt/ � SCO r�Atk_ (��1�Z� bW cc��cP c�6o✓.�i�T uinta Building a Safety Division P.O. Box 1504,78-495 Calle Tampico La.Quinta, CA 92253 -:(760) 777-7012 Building Application' A lication a d Ti-rCkm Sheet , g Permit # Project Address: '7 Z Awe, -P; Z Owner's Name:! A. P. Number. O Address: \ — — Legal Description: City, ST, Zip: Contractor. T elephone: Address: Project Description: City, ST, Zip: Telephone: �{�!" at �':G`•' State Lic. # : City Lie'. #•: Lli (� b Ott) tCk W_5 �l (�� CIL Arch., Engr., Designer. Address: (� W a ct- lU 1. City., ST, Zip: Telephone: v ' P •�" � State Lic. #: "'' Name of Contact Person: T Construction Type:. Occupancy: . Project type (circle one): New Add'n Alter Repair Demo Sq. Ft.:' 2 (o(, p # Stories: , # Univ: Telephone # of Contact Person: $. -1 Estimated Value of Project: u . 00 0 APPLICANT: DO NOT WRITE BELOW'THIS UNE # Submittal Req'd Recd TRACKING PERMITFEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit. . Truss Calcs. Called Contact Person Plan Check Balance" Title 24 Cake. Plans picked up Construction Flood plain plan Plans resubmitted.. Mechanical Grading plan 2sd Review, heady for correctionsPissue Electrical Subcontactor List Called Contact Person Plumbing " Grant Deed Plans picked up SALL H.O.A. Approval Plans resubmitted Grading IN HOUSE:- '"' Review; ready for correcdonsfissae Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr " Date of permit issue School Fees Total Permit Fees 4.) eme,V't.(LoiffCt/ � SCO r�Atk_ (��1�Z� bW cc��cP c�6o✓.�i�T M P.O. Box 1504 LA QUINTA, CALIFORNIA 92247-1504 7$-495 CALLS 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 IMPORTANT! NOTICE TO PROPERTY OWNER Dear Property Owner: ,An application for a building permit his been submitted in your name listing yourself as the builder of the property improvements specified at °.S �i loll ,n L We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you inay 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 DIRECTIONS: Read and initial each statement below to signs you understand or verify this information. 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 my property. . I understand building permits are not required to be signed by property owners unless they are responsible for th construction and are not hiring a licensed Contractor to assume this responsibility. P e �. 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. �. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. K�S/ I understand 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. �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, risk. to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to.serious financial . 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. 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 workmanship or materials. . 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- 800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. 4pa 0. I am aware of and consent to an Owner -Builder building permit applied for.in my name, and understand that I am the legally, and financially responsible for proposed construction activity at the following address: -111. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all app icable laws and requirements that govern Owner -Builders as.well as employers. Av 2. Iagree to notify theissuer of this form immediately of any additions, deletions, or changes to any of the information I 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: 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 fora 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 bepresented when thepermit is issued to verify theproperty owner's signature. Property Owner's Signature: Date: e ' CITY OF LA QUI -NTA SUB -CONTRACTOR. LIST JOB ADDRESS 10-11r� 'S�ic'Z PERMIT NUMBER OWNER'C0"t- - „BUILDER`r, <V\.This form 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 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. ..::...:::::::::::::::................. Trade /Class �ficat�on :.:.................................. Contractor ................................... -...............::::.:....:. ........State Contractor s.License..:..::..:::::::.::::.::.::::::::::::::::.::... ion Workecs..Com:ensa.t.......:...................................... .. P.......... `mess Lice . Company Name Classification License Number Ex Date • Carrier Name Policy Number Exp. Date Licen se Number ber - Exp.. Date ) xxxxxx) (xx/xx/xx1 e.9.State Fund CalComP) (Format Varies) x/xxxx x x xx) xx x x xx ) :Eli .THIN.ORW 0< . -.12.' <> > . F:RA NI .I. N;G::(:::::.::1.:: { STRU;GT..ST�EL IC 51j SOIVFiY>s>:C-29 L'ATH''PLAS:TER> C. ELE::CT;RI,CAL (:C1:.:.;:..:..... { i. SHEETM i NSU 2 z> 3 :SEWAG...;DISQ;'(G` 4;;::: X. . 4`'>> CERAMIC(C.S 1 .,. :C �1'.B..INET.S>: I:::.:..1 LAN Q. CA'.:ING P .::::..:::.:.............::.:::.: r . r MECHANICAL EQUIPMENT FOR: Timothy Ellenz Residence 54671 Avenida Diaz — Alteration La Quinta, CA 92253 HVAC EQUIPMENT RECEIVED SEP,2 02016 CITY OF LA QUINTA COMMUNITY DEVELOPMENT • Outdoor Unit: York or Equal --- York Model YZH030 Split System Heat Pump (2.5 ton nominal) R410 Refrigerant • Indoor Unit: York or Equal --- York Model AHV36C+TXV Split System Air Handler/Coil Cabinet (3 ton) a. All Ductwork to be R-8 Insulation. b. All register cans to be air sealed to drywall. c. Indoor Air Handler to be located on 18" raised insulated platform with two return air filter grills. Provide blocking wings under platform to reduce RA blower noise. d. Provide throw down outdoor condenser pad. e. Provide 3/8" liquid line & 7/8" suction line for aprox. 40' of line set. f. Provide Heat Pump thermostat with night setback feature. g. HERS Verification is required on this project. Installing Contractor must register project with The California State Registry known as: Ca10ERTS. h. HERS Testing Verifications REQUIRED per Title 24 Report: 1. Verified Cooling Coil Airflow 2. Verified EER (13.0) 3. Verified SEER (15.75) 4. Fan Efficacy Watts 5. Duct Sealing 6% CITY OF LA QUip PA BUILDING &�SAFVED �� FOR CONS RUCTION T N