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15572 (AR). FhQum�' t; � P.O. BOX 1504 f Building 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Address 4S-.94�i . Ri:e�titiant3 Palms Owner h Mailing Address fame as above City Zip Tel. Le �Quinta 92253 Contractor owner/builder Address ' . City Zip Tel.: State Lic. & Classif.., City Lic. # Arch., Engr., Designer Address I Tel. Cityi (Zip ( State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) t.of Division 3 of the Business and Professions Code, and my license is in full force and effec SIGNATURE DATE OWNER -BUILDER DECLARATION. I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a permit to construct, after, improve, demoffsh, or repair any structure, 'prior to its issuance also requires the applicant for such permit to rile a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing with Section .7000) of Division 3 of the Business and Professions Code, or that. he 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 rive 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, Buisness and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or Improves thereon and who does such work himself or through his own employees, provided that such 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 did not build or improve for the purpose or sale.) ❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044, Business and •Professions Code: The Contractor's License Law does not apply to an, owner of property who builds or improves thereon,, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) ❑ 1 am exempt under Sec B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company ❑ Copy Is filed with the city, ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE - (This'sectlon need not be completed If the permit is for one hundred dollars ($1.00) valuation or less.) I certify that in the performance of thg work for which this permit is issued, I shall not employ any person in any manner so as to become subject to.lhe Workers' Compensation Laws of California. Date Owner NOTICE TO APPLICANT. t, after making this Certificate -of Exemption you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. 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. - This is a building permit when properly filled out, signed and validated, and Is subject to expiration If work thereunder is suspended for 180 days: 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 "the above- mentioned property for inspection purposes. - Signature of applicant Date' ,. Mailing Address City, State, 'ZIp No. 15572 JILDING: TYPE CONST. OCC. GRP." P. Number gal Description oject Description relocate renter heater and add 24 sq ft for pantry. ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line ---- " Side Setback-om Property Line FINAL�ATE U ���INSPECT0R Iuj Issued b :e''^ l 11 100 Dllt II Permit 11 t, y t,t...-- -- Lf Validated by: Validdt on Sq. Ft.2 4 Size No., Stories No. Dw. Units New ❑ Add= Alter ❑ Repair ❑ ' -Demolition ❑ Estimated Valuation, 1,303.00 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electricalq_ Oil Plumbing 111 S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS `�. ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line ---- " Side Setback-om Property Line FINAL�ATE U ���INSPECT0R Iuj Issued b :e''^ l 11 100 Dllt II Permit 11 t, y t,t...-- -- Lf Validated by: Validdt on CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES ` i 1ST FL. SO. FT. ® $ UNITS COLL. AREA 2ND FL. SQ. FT. p YARD SPKLR SYSTEM �. ) POR. SQ. FT. ® MOBILEHOME SVC. BAR SINK GAR. SO. FT. ® POWER OUTLET ROOF DRAINS CAR P. SO. FT. DUCT WORK DRAINAGE PIPING WALL SO. FT. ®' DRINKING FOUNTAIN, SO. FT. ® HEATING (FINAL) URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED GRADING cu. yd. $ plus x$ LAUNDRYTRAY AIR HANDLING UNIT CFM KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET' COMPRESSOR HP POLE, TEM/PERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SQ. FT. ® c BATH TUB FIRE ZONE ROOFING ' SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL SPARK ARRESTOR SO.FT.GAR ® 3/ac HOUSE SEWER GAR. FIREWALL GAS PIPING PERMIT FEE LATHING PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ =$ LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING ' FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION G 9✓ CERT. OCC. FENCE FINAL INSPECTOR'S SIONATURESIINITIALS GARDEN WALL FINAL --nivica:e c4 cmpliancs: Res' al (Pace i OT _') CF -1 R ot iltle lac Shading Devices Dale t 0l t Addnesa / �/ dtnq Pert a I 8udmi Plan ChecK / Date Front..... ( ) Left ....... ( ) - 1 Left ....... ( .) .' Rear ..... ( ) VI f-4 ocumentatlon Author Telephone Field Chock / Date Right..... ( . ) rntorooment Aqency use only jmplianee.AAethod.(Padkage. Point System or Computer) Climate Zone !ENERAL INFORMATION (! otal Conditioned Floor Area:/ 2r tt2 '-Wilding Type: V Single Family "/Addition Addition :heck one or more) Multi -Family Existing I P us =ront Orientation: North / East / South / West / All Orientations (Input onentaaon to degrees and ctrde one.1 Vumber of Dwelling Units. :Ioor Construction Type: Sla / Raised Floor (circle one or both) BUILDING SHELL INSULATION Construction .:omponent , 'Insulation Assemoly LocatiorvComments hype R Value U -Value (attic to garage typical. etc.) Wall .............. -13 Wall .............. Roof ............. Roof ............. Floor ............. Floor............. Slab Edge .... FENESTRATION Shading Devices Fenestration. Area. Fenestration Interior Exterior Overhang Framing Type Ives/not (metal/woodtvinyl) Orientation (sf) LI -Value (roller blind. etc.) (shadescreen. etc.1* Front..... ( ) Front..... ( ) Left ....... ( ) - 1 Left ....... ( .) .' Rear ..... ( ) VI f-4 Rear, ..... ( ) Right..... ( ) Right..... ( . ) Skylight....... Skylight ....... THERMAL MASS . Type/Covering Area Thickness (slab/exposed tele etc) (sf) (inches) Location/ Description(kitchen. batn. etc.) 2—i—A _t...,— 1022 Certificate of Compliance: Residential Input (kW Capacity Recovery Standby' Insulation or Btu/hr) (gallons) Efficiency Loss (%)' R -Value (Page 2 of 2) CF -1 R Prplect Title ` I Date HVAC SYSTEMS Note: Input hyaronic or comoined hydronic data under Water Heating Systems, except Design Heating Load. Heating Equipment Minimum Typebution Pe and Duct or Type (furnace, heat Efficiency Location Piping Thermostat umo. etc.) (AFUE/HSPF) (ducts/attic, etc.) R -Value Type Cooling Equipment Minimum Duct Type (air conditioner, Efficiency heat pumo. evao. cooiina) (SEER) Location Duct Thermostat Configuration (attic etc) R -Value Tvpe (soli( or package) WATER HEATING SYSTEMS Water Heater Distribution Number Type Type in Svstem Energy' Rated' Tank Factor or External Tank Input (kW Capacity Recovery Standby' Insulation or Btu/hr) (gallons) Efficiency Loss (%)' R -Value 1. For smsil gas storage (rated input!S 75.000 BIWhr), electric resistance and heat PUMP water hesters. list Energy Factor. For large gas storage water hooter* (rated input 2 75.000 BtWhr), list Rated Input. Recovery Efficiency and standby Loss. For instantaneous gas water heaters, list Rated Input and Recovery Efficiency. SPECIAL FEATURES/REMARKS (Add extra sheets if necessary) COMPLIANCE STATEMENT This certificate of compliance lists the building features and performance specifications needed to comply with Title 24, Parts 1 and 6, of the California Code of Regulations, and the administrative regulations to Implement them. This the certificate has been signed by individual with overall design responsibility. When this certificate of comptlarlce Is submitted far a single building plan to be built multiple Me orientations, any shading feature that Is varied is Indicated in the Special FeaturestRemarks section. Designer or Owner (per Business L Professions Code) Name: ride/Firm: Address: Documentation Author Name: ride/Firm: Address: Telephone: AJC. r• Telephone: (signature) (date) Enforcement Agency. Name: Title: Agency: , Telephone: (Signatureistamp) (date) tieviesd January 1992 (signature) (dam) V-.., r T C 4 K, - J ;7-', - (D of < ou V 9 rAl), �-! 6 - lsa E:l i CITY 0 F LA SAFETY BUILDING& C ) ACCEPTED FO'N-1eo,�k SUBJECT To AND ALL -A -p -p -L -:,CA -8—L By 5Z 'PS Al- 4CLOW -M cuff PPI&OtL ro RM t,V 5f, F -W- 66A)ugul (V �. �- � n r «..—.tr.+�w-y'+•--.w. +-+... �-� ,+fi"'ra^rr �.�-^-: v�.T t,'i`;.>. � . _ �r..3z-ww.+' BUILDING DEPARTMENT .:. 'CITY OF LA QUINTA OFFICE: (619) 777-7012 INSPECTION REQUESTS: (619) 777-7153 <± �5 TO: DATE: ADDRESS:�d9 CORRECTION NOTICE PERMIT NO. ,rzs n,r Inspector :�;