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09-1200 (AR)r rte+ - Ci P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 09-00001200J Property Address: 50036 CALLE ROSARITA APN: 658-250-007- - - Application description: ADDITION - RESIDENTIAL Property Zoniny: LOW DENSITY RESIDENTIAL Application valuation: 12000 Applicant: AI"+.- T4'(t 4 4 " BUILDING & SAFETY DEPARTMENT BUILDING PERMIT �chitecPZ Eng'I�tee: C-Oar/a✓k✓ 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, 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: i 's• .- /a _ I hereby affirm under penalty of work for which this permit is issued (Sec. 3097, Civ. G.). Lender's Name: _ Lender's Address: LQPERMIT Owner: JAMES & LAUREN DWULET 50036 CALLE ROSARITA LA QUINTA, CA 92253 Contractor: if / iJ. .Owner VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 1/27/10 -- - - - - ------ - - - - -- --- ---- 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 _ 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 the workers, compensation provisions of Section 3700 of the Labor Cad I shall forthwith comply with tl bse provisi ns Date: % Applicant: �\! I WARNING: FAILURE TO SECURE WORKERS' C MPENSATION COV AGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENA IES 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 I city and county ordinances and state laws relating to building construction, andjheby,,,authorirepresentatives of this countyy ttoenter on the above-mentioned property r ins ction pure Dat:/✓ignature (Applicant or Agent): Application Number . . 09-90001200- 9-00001200------ ------Structure Information 25 SF ADDTN TO KITCHEN ----- Construction Type . . . . TYPE V, UNPROTECTED Occupancy Type . . . DWELLG/LODGING/CONG <=10 Other struct info.. . . . CODE EDITION 2007 # BEDROOMS .00 FLOOD ZONE NO GARAGE SQ FTG .00 PATIO SQ FTG .00 1ST FLOOR SQUARE FOOTAGE 25.00 2ND FLOOR SQUARE FOOTAGE .00 Permit . . . BUILDINGPERMIT-• Additional desc . Permit Fee 135.00 Plan Check Fee 87.75 Issue Date Valuation . . . . 12000 Expiration Date 7/26/10 Qty Unit Charge Per - Extension BASE FEE 45.00 10.00 9.0000 ----------------------------------------------------------------------------- THOU BLDG 2,001-25,000 90.00 Permit . . . ELECT -,ADD/ALT/REM Additional desc : Permit Fee . . . . . 34.03 Plan Check Fee 8.51 Issue Date . . Valuation 0 Expiration Date 7/26/10 Oty Unit Charge Per Extension BASE FEE 15.00 25.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY .88 20.00 .7500 PER ELEC DEVICE/FIXTURE 1ST 20 15.00 7.00 .4500 ----------------------------------------------------------------------------- EA ELEC DEVICE/FIXTURE >20 3.15 Permit . . . PLUMBING' Additional desc . Permit Fee 33.00 Plan Check Fee 8.25 Issue Date Valuation . . . . 0 Expiration Date 7/26/10 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 6.0000 EA PLB FIXTURE 6.00 1.00 3.0000 EA PLB WATER INST/ALT/REP 3.00 1.00 3.0000 EA' PLB FIXTURE DRAIN/VENT REP/ALT 3.00 in LQPERIIIIT Application Number . .. . . 09-00001200 Permit . . . . . PLUMBING Qty Unit Charge Per Extension 2.00 3.0000 EA PLB GAS PIPE 1-4 OUTLETS 6.00 Special Notes and Comments 25 SF KITCHEN ADDITION AND WINDOW ALTERATIONS. 2007 CODES. NOTE: TERRY SMITH IS AUTHORIZED AGENT OF OWNER. Other Fees . ... . BLDG OTDO.ADMIN (EB1473,) 1 n ENERGY REVIEW FEE 8.78 STRONG MOTION (SMI) - RES 1.20 Fee summary Charged --------------------------- Paid -------------------- Credited ---------- Due Permit Fee Total 202.03 .00 .00 202.03 Plan Check'Total 104.51 .00 .00 104-.51 Other Fee Total 10.98 .00 .00 10.98 Grand Total 317.52 .00 00 317.52 LQPERMIT Bin # I City of La Quinta Building & Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sf:eet Permit # -u� ' Project Address: Owner's Name: A. P. Number: Address: Legal Description: kn 1 A T City, ST, Zip: Contractor:Telephone: `s,r:M;:}::�:...::.::.::.<.,.,:.;k::::�:z_, deo::.;>;:::".:>,:;: •°i:,.u:,;::;:;:;;:?>. Address: Project Description: City, ST, Zip: Telephone:>::: State Lic. # : City Lic. #, (` Arch., Engr., Designer: Address: Gfj City., ST, Zip: 2 hone: h 5 State Lic. #: % `' "`'' "'`""''"'""' onructionTele Type: 4P Y: Project type (circle one): New Repair Demo Name of Contact Person: 5 j Sq. Ft.: # Stories: ` # Units: Telephone # of Contact Person: Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING ?ERMIT FEES Plan Sets 3 Plan Check submitted % Item Amount Structural Calcs. Reviewed, ready for corrections 'iJ Plan Check Deposit Truss Calcs. Called Contact PersoniA, Plan Check Balance, Tide 24 Calcs. L/ M1 -Plans picked up Construction Flood plain plan Plans resubmitted ( 211,6Mechanical VIY Grading plan 2°"Review, ready for correction /issue �. Electrical Subcontactor List Called Contact Person Z, Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- ''d Review, ready for corrections/issue Developer Impact Fee O Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Ll Total Permit.Fees � & t - r��y Ns ,4PP, ` CERTIFICATE'OF COMPLIANCE w Desert Sands Unified School District z4� 0 47950 Dune Palms Road ¢BERMUDA DUNES r' U) RANCHO MIRAGE 0 + Date .1/29/10 ' - La Quinta, CA 92253 INDIAN WELLS •� di PALM DESERT ,y No. 30594 (760) 771-8515 LA QUINTA INDIO y� `•k Owner • M/M Leon Dwulet APN # 658-250-007 Address 500356 Calle Rosarita Jurisdiction La Quinta City La Quinta . Zip Permit # Tract # No. of Units 1 Type Residential Addition Lot # No. Street S.F. Lot # No. 4 Street S.F. Unit 1 50036 Calle Rosarita 25 Unit 6' Unit 2 Unit 7 ' Unit 3 Unit 8 Unit 4 Unit 9 Unit 5 Unit 10 Comments At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions under5 00 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile ho mes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason: Residential Addition 500 Sq Feet or Less EXEMPT This certifies, that school facility fees imposed pursuant to Education Code Section 17620 and Government Code 65995 Et Seq. in the amount of .$0.00 X 25 S.F. or $0.00 have been paid for the property listed above and that - building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued. Fees Paid By Exempt - Terry Smith Check No. . Name on the check 'Telephone 760-836-6860 Funding Exempt By Dr. Sharon P. McGehee Superintendent Fee collected /exemp y S Mc V e Payment Recd - : X0:00 '-;- y .� ,MvedUnde'r Signature ; t 1Y t NOTICE: Pursuant to Government Code Section 66020(d)(1), t ' will s rve to notify you that the 90 -day approval period in which you may protest the fees o r other payment identified above will begin to run from the date whit the building or installation permit for this project is issued, or from the date on which those amounts are paid to the District(s) or to another public ent' orized to collect them on the District('s) behalf, whidhever is earlier. NOTICE: This Document NOT VALID without embossed seal Embossed Original - Building Department Applicant Copy - Applicant/Receipt Copy - 4ccounting TITLE 24 REPORT Title 24 Report for: DWULET RESIDENCE'S ADDITION 50036 CALLE A —Q TA, CAKE Project Designer: GLS ARCHITECTURE GROUP 74 491 Joni dr. suite #9 Palm Desert, CA 92211 760 340-3528 Report Prepared By: GLS Architecture Group 74991 Joni Dr. #9 Palm Desert,'CA 92211 JAN 1'2 2010 BY: Job Number: Date: 1.2/17/2009 The EnergyPro computer program has been used to perform the calculations summarized in this compliance report. This program has approval and is authorized by the California Energy Commission for use with both the Residential and Nonresidential 2005 Building Erergy Efficiency Standards. This program developed by EnergySoft, LLC - www.energysoft.com. EnergyPro 4.4 by EnergySoft Job Number: �j User Number: 5553 TABLE OF CONTENTS Cover Page Table of Contents Form CF -1 R Certificate of Compliance Form MF -1 R Mandatory Measures Summary Form WS -5R Residential Kitchen Lighting ..HVAC System Heating and Cooling Loads Summary 1 2 3 7 9 10 Certificate Of Compliance: Residential ❑ Multi Family Existing + Add/Alt Existing Floor Area: (Part 1 of 4) CF -1 R DWI)I FT RESIDENCER ADDITION Fuel Type: Natural Gas Slab on Grade Area: 1,616 ft2 12/17/2009 Project Title Area: 262 ft2 Avg. U: 0.69 Number of Dwelling Units: 1.00 Ratio: 16.2% Avg. SHGC: 0.48 Number of Stories: Date _5D_ W- AI LE ROSARITA__I AQUINTA Zone Name Floor Area Volume Units Zone Type Type Hgt. Area HAVC EXIS 161 1613 5 --tOO- Conditioned Project Address OPAQUE SURFACES Insulation Act. Gains Condition Type Frame Area U -Fac. Cay. Cont. AZm. Tilt Y / N Status JA IV Reference Building Permit # SLS Arc , rtilri- Grniln EXST-1591 Roof- Wood 1,591 0.049 R_19 R;0.0 _p_ 0 X ❑Existing 01-A4 (760) 340-3528 .Wall_ Wood 460 0.110 R_11 R-0 0 315 9.0 ❑Existing_ 09-A2 Documentation Author rXv Wall Wood 911 n 110 R_11 Rio 0 5to 4 90 ❑Existing- 09-A2 FV -ST -1 -AM Telephone plan Check/Date Fner vPro .EXzSL1591 A IlmateZone 15 Field Check/Date Compli rrifce Method Mall_ Wood 56 _0-102 R-13 RR -0.0 315 _g.0 - ❑New 09-A3 EXIST -1591 Climate Zone EXIST -1591 TDV Standard Proposed Compliance (kBtu/sf-yr) Design Design Margin Space Heating 4.99 3.91 1.08 Space Cooling 126.06 110.87 15.18 ❑ ❑ Fans 18.19 15.90 2.28 Domestic Hot Water 13.28 13.28 0.00 ❑ ❑ Pumps 0.00 0.00 0.00 Totals 162.52 143.97 18.54 Perce 11.4% Building Type: Single Family ❑ Addition Total Conditioned Floor Area: 1,616 ft2 ❑ Multi Family Existing + Add/Alt Existing Floor Area: 1,591 ft2 Building Front Orientation: (SE)135 deg Raised Floor Area: 0 ft2 Fuel Type: Natural Gas Slab on Grade Area: 1,616 ft2 Fenestration: Average Ceiling Height: 10.0 ft Area: 262 ft2 Avg. U: 0.69 Number of Dwelling Units: 1.00 Ratio: 16.2% Avg. SHGC: 0.48 Number of Stories: 1 BUILDING ZONE INFORMATION # of Thermostat Vent Zone Name Floor Area Volume Units Zone Type Type Hgt. Area HAVC EXIS 161 1613 5 --tOO- Conditioned Setback 2 _n/a OPAQUE SURFACES Insulation Act. Gains Condition Type Frame Area U -Fac. Cay. Cont. AZm. Tilt Y / N Status JA IV Reference Location / Comments Mall_ Wood 97 0 110 R_11 R-0 0 _ 315- 90 X ❑Rp.[ri0.med- 09-A2 EXST-1591 Roof- Wood 1,591 0.049 R_19 R;0.0 _p_ 0 X ❑Existing 01-A4 EXST-1591 .Wall_ Wood 460 0.110 R_11 R-0 0 315 9.0 ❑Existing_ 09-A2 ST -1591 � rXv Wall Wood 911 n 110 R_11 Rio 0 5to 4 90 ❑Existing- 09-A2 FV -ST -1 -AM Wall Wood 457 0.110 R_11 R-0 0 X3.5__ 40 -Existing- 09-A2 EXIST -1591 r DooNone 48 0.500 None RR -0 0 ---135_ gn - ❑Exis n 28-A4 .EXzSL1591 Wall Wood 287 0 110 R-11 R_n n _29s gn IN ❑Fxisting 09-A2 EXIST -1591 -all Wood 18 0_102 R_13 R-0 0 45_-g0 X ❑New 09-A3 FXIST-1591 Mall_ Wood 56 _0-102 R-13 RR -0.0 315 _g.0 - ❑New 09-A3 EXIST -1591 Root_ Wood 25 _0025_ R-38 RR -0.0 _0 ❑Altered 01-A1.8 (E=01 -A111 EXIST -1591 Q ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ EnergyPro 4.4 by EnergySoft User Number: 5553 Job Number. Page: 3 of 10 Certificate Of Compliance : Residential (Part 2 of 4) CF -1 R DWULET RESIDENCE'S ADDITION 12/17/2069 Project Title Date FENESTRATION SURFACES True Cond. Location/ # Type Area U -Factor' SHGC2 Azm. Tilt Stat. Glazing Type Comments A- 2 Window Window Rear Rear (NW) (NW, 16.0 0.870 NFRC _0.59 NFRC 315 -9.0_ Bemoved2K1 Build F Std M -tal - D flints (IST -1591 20.0 0.570 NFRC 0_40 NFRC 315 90 New PRESCRIPTIVE WDW Z-14 EXIST -1591 3 Window Rear (NW) 20.0 0.870 NFRC 0_59 NFRC 315 90 Removed2K1 Build.E.Std Metal - Def rinte EXIST -1591 4 Window Rear (NW) 20.0 0.870 NFRC 0_59 NFRC 315 90 Removed2K1 Build.E.Std Metal - Def rinte EXIST -1591 5 Window Right (NE) 40.0 0.570 NFRC 0_40 NFRC 45 90 New PRESCRIPTIVE WDW Z-14 EXIST -1591 6 Window Right (NE) 14.0 0.570 NFRC 0_40 NFRC 45 90 New PRESCRIPTIVE WDW Z-14 EXIST -1591 3 Window Right (NE) 12.0 0.870 NFRC 0.59 NFRC -45 90 Removed2K1 Build E Std Metal - DefTinte EXIST -1591 8 Window Right (NE) 12.0 0.870 NFRC 0_59 NFRC 45 90 Removed2K1 Build.E.Std Metal - DefTinte EXIST -1591 6 Window Right (NE) 25.0 0.870 NFRC 0.59 NFRC 45 90 Removed2K1 Build E Std Metal - DefTinte _EXIST -1591 AQ Window Right (NE) 24.0 0.570 NFRC 0.40 NFRC 45 90 Existing PRESCRIPTIVE WDW Z-14 EXIST -1591 Z Window Right (NE) 42.0 0.870 NFRC 0_59 NFRC 45 90 Removed2K1 Build.E.Std Metal - DefTinte EXIST -1591 12 Window Front (SE) 6.0 0.870 NFRC 0_59 NFRC 135 90 Removed21<1 Build.E.Std Metal - DefTinte EXIST -1591 13 Window Front _(SE) 20.0 0.870 NFRC _U9 NFRC 135 _90- Existing 2K1-uiId.E.Std Metal - DefTinte_EXIST-1591 3.0 14 Window Front (SE) 20.0 0.870 NFRC 0_59 NFRC 135 90 Existing 2K1 Build.E.Std Metal - DefTinte EXIST -1591 15 Window Front (SE) 20.0 0.870 NFRC 0_59 NFRC 135 90 Existing 2K1 Build.E.Std Metal - Def rinte EXIST -1591 16 Window Front (SE) 8.0 0.870 NFRC 0_59 NFRC 135 90 Existing 21<1 Build.E.Std Metal - DefTinte EXIST -1591 17 Window Front (SE) 20.0 0.870 NFRC 0_59 NFRC 135 90 Existing 21<1 Build.E.Std Metal - DefTinte EXIST -1591 18 Window Left (SW) 20.0 0.870 NFRC 0_59 NFRC 225 90 Existing 2K1 Build.E.Std Metal - Def rinte EXIST -1591 -IQ Window Rear (WW) 56.0 0.570 NFRC 0.40 NFRC 315 90 New PRESCRIPTIVE WDW Z-14 EXIST -1591 1. Indicate source either from NFRC or Table 116A. 2. Indicate source either from NFRC or Table 116B INTERIOR AND EXTERIOR SHADING Window Overhang Left Fin Right Fin # Exterior Shade Type SHGC Hgt. Wd. Len. Hgt. LEA RExt. Dist. Len Hgt Dist Len Hgt 1 Bug Screen 0.76 3.5 3.5 1.0 0.1 2.0 2.0 2 Bug Screen 0.76 4.5 3.5 1.0 0.1 2.0 2.0 0.1 4.0 0 0.1 4.0 0 3 Bug Screen 0.76 4.5 3.5 1.0 0.1 2.0 2.0 4 Bug Screen 0.76 4.5 3.5 1.0 0.1 2.0 2 Q 5 Bug Screen 0.76 4.5 7.5 6.0 0.1 6.0 6.0 0.1 2.0 0 0.0 0.0 0 6 Bug Screen 0.76 3.0 3.5 2.0 0.1 2.0 2.0 0.1 2.0 _ 0 0.1 2.0 0 7 Bug Screen 0.76 4.5 2.5 1.0 0.1 2.0 2.0 8 Bug Screen 0.76 4.5 2.5 1.0 0.1 2.0 2.0 9 Bug Screen 0.76 4.5 2.5 10.0 0.1 10.0 10.0 10 Bug Screen 0.76 3.5 5.5 1.0 0.1 2.0 2.0 11 Bug Screen 0.76 6.5 5.5 10.0 0.1 10.0 10.0 12 Bug Screen 0.76 4.5 3.5 1.0 0.1 2.0 2.0 13 Bug Screen 0.76 4.5 3.5 1.0 0.1 2.0 2.0 14 Bug Screen 0.76 4.5 3.5 1.0 0.1 2.0 2.0 15 Bug Screen 0.76 4.5 3.5 1.0 0.1 2.0 2.0 16 Bug Screen 0.76 1.5 3.5 1.0 0.1 2.0 2.0 17 Bug Screen 0.76 4.5 3.5 1.0 0.1 2.0 2.0 18 Bug Screen 0.76 4.5 3.5 1.0 0.1 2.0 2.0 19 Bug Screen 0.76 6.5 7.5 1.0 0.1 0.0 0.0 THERMAL MASS FOR HIGH MASS DESIGN Area Thick. Heat Inside Condition Location/ Type (so (in.) Cap. Cond. R -Val. JA IV Reference Status Comments PERIMETER LOSSES Type L Insulation R -Val. Location JA IV Reference Condition Location/ Status Comments Run Initiation Time: 12117/0914:28:59 Run Code: 1261088939 EnergyPro 4.4 by EnergySoft User Number: 5553 Job Number: Page: 4 of 10 Certificate Of Compliance : Residential (Part 3 of 4) CF -1 R DWULET RESIDENCE'S ADDITION 12/17/2009 Project Title Date HVAC SYSTEMS Heating Minimum Cooling Minimum Condition Thermostat Location Type Eff Type Eff Status Type HAVC EXIS Central Furnace 80% AFUE Split Air Conditioner 14.0 SEER Existing Setback HVAC DISTRIBUTION Duct Duct Condition Ducts Location Heating Cooling Location R -Value Status Tested? HAVC EXIS Ducted Ducted Attic 8.0 Existing No Hydronic Piping Pipe Pipe Insul. System Name Length Diameter Thick. WATER HEATING SYSTEMS Rated Tank Energy Tank Insul. Water Heater # in Input Cap. Condition Factor Standby R -Value System Name Type Distribution Syst. (Btu/hr) (gal) Status or RE Loss (%) Ext Standard Gas 50 gal or Less Small Gas No Pipe Insulation 1 40,000 50 Existing 0.57 n/a n/a Multi -Family Central Water Heating Details Hot Water Pump Hot Water Piping Length (ft) Add 1/2" Control # HP Type In Plenum Outside Buried Insulation REMARKS COMPLIANCE STATEMENT This certificate of compliance lists the building features and 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 certificate has been signed by the individual with overall design responsibility. The undersigned recognizes that compliance using duct design, duct sealing, verification of refrigerant charge and TXVs, insulation installation quality, and building envelope sealing require installer testing and certification and field verification by an approved HERS rater. Designer or Owner (per Business & Professions Code) Name: Title/Firm: GLS ARCHITECTURE GROUP Address: 74 491 Joni dr. suite #9 Palm Desert Telephone_7'3��8,�� +_-- (sigaef f•e) (date) Enforcement Agency Name: Title/Firm: Address: Telephone: (signature) (date) Documentation Author Name: Title/Firm: GLS Architecture Group Address: 74991 Joni Dr. #9 Pal Teleot,rt (7 . nergyPro 4.4 by EnergySoft User Number: 5553 AM Ki—h— _ (date) Certificate Of Compliance: Residential (Part 4 of 4) CF -1 R DWULET RESIDENCE'S ADDITION 12/17/2009 Project Title Date Special Features and Modeling Assumptions The local enforcement agency should pay special attention to the items specified in this checklist. These items require special written justification and documentation, and special verification to be used with the performance approach. The local enforcement agency determines the adequacy of the justification, and may reject a building or design that otherwise complies uaseu on the adequacy or the special justification and documentation submitted.Plan----I Field The Existing Roof "Roof -25" has a U -Factor greater than the Table R3-11 CEC Default Vintage Values. HERS Required Verification Items in this section require field testing and/or verification by a certified home energy rater under the supervision of a HERS nrnvidar ucinn annrnvarl tactinn nnrirnr uarifi—fin...r. fh^A� Plan EnergyPro 4.4 by EnergySoft User Number: 5553 Job Number. Pape:6 of 10 Mandatory Measures Summary: Residential (Page 1 of 2) MF -1 R NOTE: Lowrise residential, buildings subject to the Standards must contain these measures regardless of the compliance approach used. More stringent compliance requirements from the Certificate of Compliance supercede the items marked with an asterisk (•) below. When this checklist is incorporated into the permit documents, the features noted shall be considered by all parties as minimum component performance specifications for the mandatory measures whether they are shown elsewhere in the documents or on this checklist only. DESCRIPTION Check or initial applicable boxes or check NA if not applicable and included with the permit application documentation. N/A DESIGNER ENFORCE - MENT Building Envelope Measures ❑ ❑ a § 150(a): Minimum R-19 in wood ceiling insulation or equivalent U -factor in metal frame ceiling. ❑ ❑X ❑ § 150(b): Loose fill insulation manufacturer's labeled R -Value: ❑ ❑ ❑ *§ 150(c): Minimum R-13 wall insulation in wood framed walls or equivalent U -factor in metal frame walls (does not ❑ a ❑ apply to exterior mass walls). ❑ a ❑ § 150(d): Minimum R-13 raised floor insulation in framed Floors or equivalent U -factor. § 150(e): Installation of Fireplaces, Decorative Gas Appliances and Gas Logs. 1. Masonry and factory -built fireplaces have: a. closable metal or glass door covering the entire opening of the firebox b. outside air intake with damper and control, flue damper and control 2. No continuous burning gas pilot lights allowed. § 150(f): Air retarding wrap installed to comply with §151 meets requirements specified in the ACM Residential Manual. § 150(g): Vapor barriers mandatory in Climate Zones 14 and 16 only. § 150(1): Slab edge insulation - water absorption rate for the insulation alone without facings no greater than 0.3%, water vapor permeance rate no greater than 2.0 perm/inch. § 118: Insulation specified or installed meets insulation installation quality standards. Indicate type and include CF -6R Form: § 116-17: Fenestration Products, Exterior Doors, and Infiltration/Exfiltration Controls. ` 1. Doors and windows between conditioned and unconditioned spaces designed to limit air leakage. 2. Fenestration products (except field fabricated) have label with certified U -Factor, certified Solar Heat Gain Coefficient (SHGC), and infiltration certification. 3. Exterior doors and windows weatherstripped; all joints and penetrations caulked and sealed. ISpace Conditioning, Water Heating and Plumbing System Measures § 110-13: HVAC equipment, water heaters, showerheads and faucets certified by the Energy Commission. § 150(h): Heating and/or cooling loads calculated in accordance with ASHRAE, SMACNA or RCCA. § 150(i): Setback thermostat on all applicable heating and/or cooling systems. § 1500): Water system pipe and tank insulation and cooling systems line insulation. 1. Storage gas water heaters rated with an Energy Factor less than 0.58 must be externally wrapped with insulation having an installed thermal resistance of R-12 or greater. 2. Back-up tanks for solar systems, unfired storage tanks, or other indirect hot water tanks have R-12 external insulation or R-16 internal insulation and indicated on the exterior of the tank showing the R -value. 3. The following piping is insulated according to Table 150-A/B or Equation 150-A Insulation Thickness: 1. First 5 feet of hot and cold water pipes closest to water heater tank, non -recirculating systems, and entire length of recirculating sections of hot water pipes shall be insulated to Table 1508. 2. Cooling system piping (suction, chilled water, or brine lines), piping insulated between heating source and indirect hot water tank shall be insulated to Table 150-B and Equation 150-A. 4. Steam hydronic heating systems or hot water systems > 15 psi, meet requirements of Table 123-A. 5. Insulation must be protected from damage, including that due to sunlight, moisture, equipment maintenance, and wind. 6. Insulation for chilled water piping and refrigerant suction piping includes a vapor retardant or is enclosed entirely in conditioned space. 7. Solar water -heating systems/collectors are certified by the Solar Rating and Certification Corporation. ❑ ❑ ❑ ❑ a ❑ ❑ a ❑ ❑ a ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ a ❑ ❑ a ❑ ❑ a ❑ ❑ ❑ ❑ ❑ a ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ a ❑ ❑ a ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ IEnergyPro 4.4 by EnergySoft User Number: 5553 Job Number: Page 7 of 10 Mandatory Measures Summary: Residential (Page 2 of 2) MF -1 R NOTE: Lowrise residential buildings subject to the Standards must contain these measures regardless of the compliance approach used. More stringent compliance requirements from the Certificate of Compliance supercede the items marked with an asterisk (') below. When this checklist is incorporated into the permit documents, the features noted shall be considered by all parties as minimum component performance specifications for the mandatory measures whether they are shown elsewhere in the documents or on this checklist only. DESCRIPTION Instructions: Check or initial applicable boxes when completed or check N/A if not ENFORCE - applicable. N/A DESIGNER MENT Space Conditioning, Water Heating and Plumbing System Measures: (continued) § 150(m): Ducts and Fans 1. All ducts and plenums installed, sealed and insulated to meet the requirements of the CMC Sections 601, 602, 603, 6C4, ❑ Fx] ❑ 605, and Standard 6-5; supply -air and return -air ducts and plenums are insulated to a minumum installed level of R-4.2 or enclosed entirely in conditioned space. Openings shall be sealed with mastic, tape or other duct -closure systen- that meets the applicable requirements of UL 181, UL 181A, or UL 1818 or aerosol sealant that meets the requirements of UL 723. If mastic or tape is used to seal openings greater than 1/4 inch, the combination of mastic and either mesh or tape shall be used. 2. Building cavities, support platforms for air handlers, and plenums defined or constructed with materials other than seabd ❑ ❑ ❑ sheet metal, duct board or flexible duct shall not be used for conveying conditioned air. Building cavities and support ❑ Q ❑ 150-C, and do not contain a medium screw base socket (E24/E26). Ballasts for lamps 13 Wafts or greater are electric platforms may contain ducts. Ducts installed in cavities and support platforms shall not be compressed to cause reductions § 150(k)1: HIGH EFFICACY LUMINAIRES - OUTDOOR HID: contain only high efficacy lamps as outlined in Table 150-C, ❑ Q ❑ in the cross-sectional area of the ducts. § 150(k)2: Permanently installed luminaires in kitchens shall be high efficacy luminaires. Up to 50% of the Wattage, as determined ❑ ❑ ❑ 3. Joints and seams of duct systems and their components shall not be sealed with cloth back rubber adhesive ❑ ❑X ❑ duct tapes unless such tape is used in combination with mastic and draw bands. ❑ ❑ ❑ OR are controlled by an occupant sensor(s) certfied to comply with Section 119(d). 4. Exhaust fan systems have back draft or automatic dampers. ❑ ❑ ❑ 5' Gravity ventilating systems serving conditioned space have either automatic or readily accessible, manually operating ❑ ❑ ❑ dampers. ❑ ❑X ❑ same lot shall be high efficacy luminaires (not including lighting around swimming poolstwater features or other Article 68[ 6. Protection of Insulation. Insulation shall be protected from damage, including that due to sunlight, moisture, equipment ❑ ❑ ❑ maintenance, and wind. Cellular foam insulation shall be protected as above or painted with a coating that is water § 150(k)8: Permanently installed lighting in the enclosed, non -dwelling spaces of low-rise residential buildings with four or more ❑ ❑ ❑ retardant and provides shielding from solar radiation that can cause degradation of the material. EnergyPro 4.4 by EnergySoft User Number: 5553 Job Number: Page:8 of 10 7. Flexible ducts cannot have porous inner cores. ❑ ❑ ❑ § 114: Pool and Spa Heating Systems and Equipment 1. A thermal efficiency that complies with the Appliance Efficiency Regulations, on-off switch mounted outside of the ❑ ❑ ❑ heater, weatherproof operating instructions, no electric resistance heating and no pilot light. 2. System is installed with: a. At least 36" of pipe between filter and heater for future solar heating. ❑ ❑ ❑ b. Cover for outdoor pools or outdoor spas. ❑ ❑ ❑ 3. Pool system has directional inlets and a circulation pump time switch. ❑ ❑ ❑ § 115: Gas fired fan -type central furnaces, pool heaters, spa heaters or household cooking appliances have no continuously ❑ ❑ ❑ burning pilot light. (Exception: Non -electrical cooking appliances with pilot < 150 Btu/hr) § 118 (i): Cool Roof material meets specified criteria ❑ ❑ ❑ Lighting Measures § 150(k)1: HIGH EFFICACY LUMINAIRES OTHER THAN OUTDOOR HID: contain only high efficacy lamps as outlined in Table ❑ Q ❑ 150-C, and do not contain a medium screw base socket (E24/E26). Ballasts for lamps 13 Wafts or greater are electric and have an output frequency no less than 20 kHz. § 150(k)1: HIGH EFFICACY LUMINAIRES - OUTDOOR HID: contain only high efficacy lamps as outlined in Table 150-C, ❑ Q ❑ luminaire has factory installed HID ballast. § 150(k)2: Permanently installed luminaires in kitchens shall be high efficacy luminaires. Up to 50% of the Wattage, as determined ❑ ❑ ❑ in Section 130(c), of permanently installed luminaires in kitchens may be in luminaires that are not high efficacy luminaires, provided that these luminaires are controlled by switches separate from those controlling the high efficacy luminaires. § 150(k)3: Permanently installed luminaires in bathrooms, garages, laundry rooms, utility rooms shall be high efficacy luminaires. ❑ ❑ ❑ OR are controlled by an occupant sensor(s) certfied to comply with Section 119(d). § 150(k)4: Permanently installed luminaires located other than in kitchens, bathrooms, garages, laundry rooms, and utility rooms shall be high efficacy luminaires (except closets less than 70 ft) OR are controlled by a dimmer switch OR are controlled ❑ ❑ ❑ by an occupant sensor that complies with Section 119(d) that does not turn on automatically or have an always on option - 150(k)5: Luminaires that are recessed into insulated ceilings are approved for zero clearance insulation cover (IC) and are ❑ 0 ❑ certified to ASTM E283 and labeled as air tight (AT) to less than 2.0 CFM at 75 Pascals. § 150(k)6: Luminaires providing outdoor lighting and permanently mounted to a residential building or to other buildings on the ❑ ❑X ❑ same lot shall be high efficacy luminaires (not including lighting around swimming poolstwater features or other Article 68[ locations) OR are controlled by occupant sensors with integral photo control certified to comply with Section 119(d). § 150(k)7: Lighting for parking lots for 8 or more vehicles shall have lighting that complies with Sections 130, 132, and 147. ❑ ❑ ❑ Lighting for parking garages for 8 or more vehicles shall have lighting that complies with Section 130, 131, and 146. § 150(k)8: Permanently installed lighting in the enclosed, non -dwelling spaces of low-rise residential buildings with four or more ❑ ❑ ❑ dwelling units shall be high efficacy luminaires OR are controlled by occupant sensor(s) certified to comply with Section 1 L9(d). EnergyPro 4.4 by EnergySoft User Number: 5553 Job Number: Page:8 of 10 i Residential Kitchen Lighting Worksheet WS -5R DWULET RESIDENCE'S ADDITION 12/17/2009 Project Title Date At least 50% of the total rated wattage of permanently Installed luminaires in kitchens must be in luminaires that are high efficacy luminaires as defined in Table 150-C. Luminaires that are not high efficacy must be switched separately. Kitchen Lighting Schedule. Provide the following Information for all luminaires to be installed in kitchens. High Efficacy Luminaire Type High Efficacy? Watts Quantity Watts Other Watts (1) 2 ft Fluorescent T8 Rapid Start ElecD Yes X No 20.0 x 4 = 80 or 1) 26w Compact Fluorescent Triple 4 Pin Yes X1 No 1 28.0 x 7 = 196 or MW Recessed Incandescent Yes No X 60.0 x 3 = or 180 Yes No x = or Yes No x = or Yes No x = or Yes No x = or Yes No x = or Yes No x = or Yes No x = or Yes No x = or Yes No x = or Yes No x = or Yes No x = or Yes No x = or Yes No x = or Yes No x = or Yes No x = or Yes No x = or Yes No x = or Total A: 276 8: 180 COMPLIES IF A z E YES ® NO ❑ Energypro 4.4 by Energysoft User Number: 5553 Job Number: Paae:9 of 10 1HVAC SYSTEM HEATING AND COOLING LOADS SUMMARY PROJECT NAME DATE DWULET RESIDENCE'S ADDITION 12/17/2009 SYSTEM NAME FLOOR AREA HAVC EXIS 1 616 Number of Systems 1 Heating System Output per System 68,000 Total Output (Btuh) 68,000 Output (Btuh/sqft) 42.1 Cooling System Output per System 47,500 Total Output (Btuh) 47,500 Total Output (Tons) 4.0 Total Output (Btuh/sgft) 29.4 Total Output (sgft/Ton) 408.3 Air System CFM per System 2,000 Airflow (cfm) 2,000 Airflow (cfm/sgft) 1.24 Airflow (cfm/Ton) 505.3 Outside Air (%) 0.0 Outside Air (cfm/sgft) 0.00 Note: values above given at ARI conditions 26.0 of Outside Air 0 cfm 68.5 of 11.0 177.6 of Outside Air 0 cfm 80.5/66.2 of Total Room Loads Return Vented Lighting Return Air Ducts Return Fan Ventilation Supply Fan Supply Air Ducts TOTAL SYSTEM LOAD COIL COOLING PEMC COIL HTG. PEAK CFM I Sensible Latent I CFM I Sensible 1,962 29,698 2,640 772 24,773 0 5,341 3,104 0 0 0 0 0 0 0 2,375 -2,375 5,341 3,104 42,7551 2.6401 28 605 PAYNE PA14NA0480OGBMA 43,330 0 Total Adjusted System Outputa3,33o 0 (Adjusted for Peak Design conditions) TIME OF SYSTEM PEAK Aug 2 pm RIGS (Airstream Temperatures at Til 68.5 of 100.50F 0 Heating Coil 80.5 / 66.3 of Supply Fan 2000 cfm 68,000 68,000 Jan 12 am 101.6 of —).h Supply Air Ducts 100.1 of ROOMS 70.0 of h Return Air Ducts `i 60.2/59.0 OF 61.3/59.4 OF Supply Air Ducts Cooling Coil Supply Fan 2000 cfm h Return Air Ducts 4 63.8 / 60.3 of 51.7% R.H. ROOMS 78.0 / 65.5 of EnergyPro 4.4 by EnergySoft User Number: 5553 Job Number: Page: 10 of 10 t ACKNOWLEDGMENT State of California " Countyof f2�¢ 4P S?A ) On Aue 2� .oa before me, 0o�P!•1->9 (insert name and title of the officer) personally appeared .1I77ES UGC who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the' person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. - --- pE10RAMAY '" IMI Comm, # 1581310 N + .� Contra Cotla county Signature (Seal) M LCanonhDIM2 sono?e siro9� City of La Quinta June 25, 2009 hereby authorize terry Smith to act on my behalf regarding construction at my home located at 50036 Calle Rosarita ,Santa Rosa Cove,La Quinta ,California. Thanks for your help in this matter J es 'Dwulet , --I October 2, 2009 Jim Dwulety - utr .4 a+... _ 1343 Locust- Street, #206 Walnut ,Creek,,.,CA!;,945961! ;c- ..... _ : s u; r 3 �:., . • . ., ;:'.. i �,.: ;.. �c:, ,� [[ �4..�w.��1l�r Lf.J.. .�)/�i �' :. 1.1.'��- ,f ', � , � •. �. ...��. .. /h i4 f:. .i ��.. Re:,50Q36. Calle:Rosiarita. 1. � ;" .. �, Dear Mr. Dwulet: � • • •. � :� �i�'�'• As I mentioned to Terry Smith today, your architectural request for the new windows, front doors, and for. moving out the wall of your kitchen approximately 18" toward your -patio has been approved with the following stipulations: Actual modification .must conform to the plans and specifications submitted and approved, including furnishing.us a copy of City of La Quinta building permits. • The color of the front doors and windows must be approved in advance • -Competent, licensed professionals shall do all of the work. • All work is to be in compliance with local building codes and ordinances. •,:;Any damage .to,the common area resulting from this modification and its construction shall be repaired at the owner's expense. ;; °•. �df-a.iconstruction bin is rented through Burrtec, it should be beige in color, if r.= ; possible. •�The;bin: must be kept locked. All construction debris are to be removed from the site by the close of each day to maintain the aesthetics of the Santa Rosa Cove. Please contact'us prior to delivery of the bin. • Prior to the commencement of any work the contractor and their sub- contractors) must provide the Association proof of workers comp, liability and auto insurance; naming the Association as additionally insured. • Prior to the commencement of any work you or your contractor must provide the names of the scheduled workmen to the security guards at the Mazatlan gate, (760-564-5414). Your contractor must review and sign the Association's Contractor Rules. Please contact the Association office once your modifications are complete for a final inspection. A copy of the approved variance will be mailed to you after the inspection. If you have any questions, please call us. Thank you. Best regards, aee Dave Scott Community Association Manager On Behalf of the Board of Directors The Santa Rosa Cove Association SRC SANTA ROSA COVE ASSOCIATION 00.D3w, Ik 49-991 Eisenhower La Quinta, California (760)777-7621 Fax: (760) 564-8418 Mailing Address: P.O. Box 12920 Palm Desert, CA 92255 #/IV,"0017« tI 06/25/2009 10.44 RIE:( 7607777011 P.O. BOX 1504 l.A RUINTA 15LM DEPT LA QUINTA, CALIFORNIA 92247.1504 78.495 CALLS TAMPICO LA QUINTA, CALIFORNIA 92253 PAuE 03/04 BUILDING & S!1FrzTX DI$PARTMENT JAN 12 2010 - PROPERTY OWNS .'S PACKAGE (760) 777.7012 VAX (760) 777-7011 Disdosam & Forlr>I>Es for Owner -Builders Applying for Construction Permits BY: ;a MOR AATI—NO- ECE_TO PROP.ERMOUNMR Dear Property Owner: Ari epplieafion fbr a buildin petp4 ban bm submitted ' your name lash if as the builder of the property impriovmmita speeded at s ,- C/IL We aro providing you with, an weer -Builder A,cleoowie Whew rmd Inforhotion'Verificatiod Form to malts you aware of your mesponsibiilties and possible ride you mayi=' =' by having this permit imed in jrour name as file Owner'%Buiidez. We will not issue a building permit until. you have read, i ttitialed your uederstamAng of each provioWn, sigtted, and rdlarned this form to us at out ofFiadal adult m indienteed. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting a dun it'y and initial each �datement below to sfgnoyou understmrd or vertu '" y 1. I understand a ftequent practice of unlicensed persons is to lova the pruperty owner obtain an - "Owner-Bur'Idet" bids ft permit that erroneously implies that the property owner is providing his or her own labor and material personally. 1, as an ovmer-Bizac r' may be held liable and subject to serious financial risk for any injuries su3W=d by an unlicenw person and bis or her employees while working on ray property, My homeowner's kmirance may not provide coverage for those injuries. I am willfblly acting as an Owner-Bullft and ain aware of the limits of my insurance coverage for injuries to world Oft my prov"ty- I understand Building penrdts am trot required to be signed by Property owners unless they are responsible for the canstrttct on Fad are not hiring a licensed C ntmctor to asmvae this rMonsibility. 3.1 notterstmd as an "Owner-13WIder" I am rite res�onsible patty of record on the permit I understand that 1 may proted myself toth potential financial risk by hir'in a liceowd conftetor and having the permit filed In his or her name instead of my own. Ell derststud C.outtraetors are required by law to be licensed and beaded in California and to their license nutribera on contracts. derstand if I ra v)oy or otherwise engage airy persons, other titan, C Wiforaia licensed Contractors, and the total value o rntzuation is at leant five bnmdred dollars ($500), Including labor and materials, I may be considered an "employer" under state and federai.law. Tunderstand if 1 dun eoxWdemd an "bm¢tloyer" under state and federal law, I trust registerwith the state and federal go7mtnt, withhold payroll taxes, provide workers' compensation disaEbiiity insurance, and a =ibuw to unemploy+fttet+t compensation for snot "cgaployee." I also understand may failvm to abide by those lawn may mlbject me to .sAnours financial' Halt I understand under Califbrnia Contractors' State License Law, an bwmer-Builder wbo builds single-family residential structure's cannot legally build them with the stem to offer tlrerrr for Dale, unless all vsotic is performed by licensed subeantractots ffird the mmfber of str tures docs not exceed four within any calendar year, or all of, the work is performed under eontract with a licensed S"eral building Contractor. 06/25/2009 10:44 7507777011 LA WINdTA BLDG DEPT PAQE .04/04 E-fy"I undarstand as an Owner -Builder If I aeon tot pmpeily for wbicb. this permit Is imued, I posy be bold UAW £err any f rmnoial or personal Injuries gMtW nod by ,any subsequent owrrer(s) that result from any latent construction de%ct�; in. the worlcttmusitip or reatzrials_ /undenta d I may obtann more inftnation regarding my obligations as an "CIMloy0r" &'oro the Imo• RW;ftt1e Service, the United Sues Small Miners AdminWmtioa, the California Depament of Benefit Payments, and the California Division of Industrial Accidents. t ala understand I may contact the Califbrmia Contractors' State License Board (CSLB) at 1- 800-32 LD (2752) or wwwxdb.oa,gov for more information about licensed contractors. 0, I erre aware of and eoinsent to an Owner-Duilder buiidufp permit applied for in my name, and unda stand that -I am the party legally and fbi= revs le fur imposed coosteuction a%V" at the fbtlowits address: 1. I agree burr, as the VaM legally and financially responsible for thus proposed commotion activity, I will abide by all applicOe laws acrdnquircmcnts than governOwner-Builders as well as ctapt*yen. 12. X awe to nom the issuer o£this form immediately of any RdCMon.9, dcladow% or4anges to any of'the' i aatlott x have provided on tide form,. Licensed em"etol;s are regulated by laws desiped to protcrt the public. ff you co ntbmt with someone woo doesnot have a licmie, the Contractors' State License Boars; may be unable -to assist you with any fhumcid loss you may =Wn as a result of a complaiaL Yaw only remedy against uMcmeed Coftatvts uM be in civil com#- It is also important fbr you to understand that iif'an unlicensed'CenU74or or employee sof that indivi or firm is injured. addle wodmtg on your property, you may be hold liable for damages. If yarn obtain a permit as Owner Buflder and wish to lire Contractom, yon. will ' be rMobsible for'verf(ft wb,c&cr or not those Contractors aro proper licensed and the status of " wddters' compWovion itm mme coverage. Were n building persalt can be issued, tuts foram taunt its oompleted auto deed by the prW rty owner and retmaed to W AMCY raapmnMe for ism the pertsdL Note: A copy e the property vweer1V furan nomr4g o?h or other ve#Tiim ion acceptable tv tW agency Ca required to bepresented whom rite p laic is, ilPvW m u,'ify &L- pnvperrly owner's signature. V16 tv Signature of ptt+perty �rer "�/ ,,;,. Date; � J r Note; ne foll g Authorization ,Form is required to be compleW by the property owner only when designating an Wnt of the property owner to apply for a construction permit for the Owner Builder. AM- SORIZA17ON OF AGENT TO ACT_ ON- PROPERTY GVMR'S MULF Excluding the Notice to Property Owner, the executionof wMelt I understand is my personal respomibility, I benby author w the following pereon(s) to act as my Wnt(s) to apply fbr, sign, and file rite documents maccesdry to *brain an d® nmguildet Permit for mypff+aject. Scope of Constracdo»•Pto}ect (or Description of Work): Project Location or Address; Name of Autho A Add=q t►k'AuthorhW Agent: I declare under penalty of pedu y that I -am the property owner for the addtm listed above =41 - molly Mod cru the above Information and ecreil3r its .accuracy. Note: A copy of the owner's drivers license, fnrm notw*aiion; or other verifuation accaptahle to ilea ograney Is required to hapreaented whm dw pemit isWwed to ve r#y the Property owner's signature. Pr'opeTty Owner's signature; Dome, "� � �