The URL can be used to link to this page

08-1505 (AR)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 08-00001505 Property Address: 48775 AVENIDA FERNANDO APN: 658-300-001- - - Application description: ADDITION - RESIDENTIAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 9152 Tihf . 44Q." Applicant: Architect or Engineer: LICENSED CONTRACTOR'S DECLARATION BUILDING & SAFETY DEPARTMENT BUILDING PERMIT 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 a ofessiona's Cod a my License is in full force and effect. Licenslle CI s: Q Licens No . 667719 Date! -0 Contractor: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contra tor's St a License Law for the following reason (Sec. 7031 .5, Business and Professions Code: Any city o y 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).: 1 _ 1 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.). ( 1 I am exempt under Sec. , B.&P.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: LQPER\1IT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 /O Date: 9/29/08 Owner: (/ NOVOTNY GERALD Q 48775 AVENIDA FERNAND LA QUINTA, CA 92253Contrac All HINEYtCONSTRUCTION NgHcFOFpTTq 2000 E. NICOLA ROAD PALM SPRINGS, CA 92262 (760)275-1151 Lic. No.: 667719 ----------------------------------------------- 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 EXEMPT. Policy Number EXEMPT 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 w rkQ s' compensation provisions of Section 7000 of the Labor Co all fo thwith comply itfi hose provisions. Date: O0 Applican . WARNING: FAILURE TO SECURE WORKER COMPENSATION COVERADWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PE ALTIES AND CIVIL FINES UPUN OR THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATIONS AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEE APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application. 1 . Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application, the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to buildinI uction, and hereby ayyy orize representatives of this cou tQQy enter upon the above-mentioned proper coon purposes, / '1 Date 7 O Signature (Applicant or AgeeI: / l Application Number . . . . . 08-00001505 Permit . . . . . BUILDING PERMIT Additional desc . Permit Fee . . . . 117.00 Plan Check Fee 76.05 Issue Date . . . . Valuation . . . . 9152 Expiration Date 3/28/09 Qty Unit Charge Per Extension BASE FEE 45.00 8.00 9.0000 ---------------------------------------------------------------------------- THOU BLDG 2,001-25,000 72.00 Permit ELECT - ADD/ALT/REM " Additional desc . Permit Fee . . . . 20.60 Plan Check Fee 5.15 Issue Date . . . . Valuation . . . . • 0 Expiration Date . . 3/28/09 Qty Unit Charge Per Extension BASE FEE 15.00 160.00 .0350 ---------------------------------------------------------------------------- ELEC NEW RES - 1 OR 2 FAMILY 5.60 Permit MECHANICAL Additional desc . . Permit Fee . . . . 19.50 Plan Check Fee 4.88 Issue Date Valuation . . . . 0 Expiration Date .. 3/28/09 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 4.5000 EA MECH VENT INST/ DUCT ALT 4.50 ---------------------------------------------------------------------------- Special Notes and Comments - CLOSET ADDITION 160 SQ. FT. ---------------------------------------------------------------------------- Other Fees . . . . . . . . . ENERGY REVIEW 'FEE 7.61 STRONG MOTION (SMI) - RES .91 Fee summary Charged Paid Credited Due --------------------------- Permit Fee Total ---------- 157.10 ---------- .00 ---------- .00 157.10 Plan Check Total 86.08 .00 .00 86.08 Other Fee Total 8.52 .00 .00 8.52 Grand Total 251.70 .00 .00 251.70 LQPEPN11T Bin # Permit # Project Address: 8 S City of La Quinta to oq Building U Safe Division Safety P.O. Box 1504, 78-495 Calle TampicorA �1 p La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet -p�0 c� Owner's Name: 2.5 O 1�t7T11 A. P. Number: Address: 7 -1 S v�S � 2i is � 90 `j Legal Description: 6, &,1 L �„ , �r�-/ Contractor. IAds �r(�-rL�ti a, / City, ST, Zip: L,4 Telephone: Address: 'Z��p , �fl Ld j Project Description: City, ST, Zip:/4 t.m 5p2 ,� C -S C.d I?- 2Cr [_ U—c7 i' -v�r r 12n 1T l O Telephone: State Lie. # : -7 19 City Lic. #: Arch., Engr., Designer: G T', 14, c�b S (�r� Address: ZgZ2 tl 0 (r 2.,J &P v te—T City, ST, Zip: F L,wv 50v-1 r./ 6-S OA % ZZ -L Z Telephone: 2) Z�j _ "� '� State Lic. #: Construction Type: 06 Occupancy: Project type (circle one): Ne Add'n Alter Repair Demo Name of Contact Person: 0 5 f f . AJ Sq. Ft.: ,IpO # Stories: # Units: Telephone # of Contact Person: Estimated Value of Project: 11, �Pv o APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted 9 Item Amount Structural Cates. Reviewed, ready or correctio Plan Check Deposit Truss Cates. Called Contact Person 8 Plan Check Balance Energy Cales. Plans bicked up ®4- Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2"Review, read or corrections! a Electrical Subcontactor List Called Contact rson Plumbing Grant Deed Plans picked upS.M.I. H.O.A. Approval QQ Plans resubmitted "6 Grading IN HOUSE:- ''" Review, ready for correction issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees ETf1R- 10 ��orlS IL ql�l g July 6, 2009 Jeanne Marie Therese 48-775 Avenida Fernando LaQuinta, CA 92253 760-564-6965 Greg Butler Building & Safety Dept City of LaQuinta, CA Dear Mr. Butler, Please accept this request for an extension of the permit number 08-1505. I am dealing with an attorney in regards to this small addition. I advanced monies to Mr. Martin Schultz in order to oversee this project in my absence. He did not pay the contractors. I now need time to hire new "Subs" to finish the project and I am waiting the results determined by my "Council' before I can proceed in doing so. Your attention and consideration of my request will be greatly appreciated. Respectfully Yours, 4. ?EM arie Therese 87/1!/2UWj 11:51 P.O. BOX 1504 LA QUINTA, CALIFORNIA 92247-1504 7$-495 CALLS TAMPICO LA QUINTA, CALIFORNIA 92253 Buil.-DING & SAFETY DEPARTMENT PROVERTY O'WNER'S PACKA.O� (760) 777-7012 FAX (760) 777-701I Disclosures & Forms for Owner -Builders Applying for Construction Permits IMPORTANT! NOTICE TO W=n OWNER Dear Property Owner: An application fora building,pernift has bean ser � your listing �ounelf as the builder of the property ir�trn+emenb specified at - We An Pmndmg You wit an Owner-Bm'Ma Acknowledguient and Infmwdoo verification Form to make you aware of your respaasibilittes and possuble risk you may incur by having this penult issued in your name as the Owner-Bmida. We will not Issue a baildtog permit until you have read, initialed your andauanding of each prorvision, signed, and returned thb form to us at out offmj$d address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of lite pem*ting authority. OWNER'S ACKNOWL- z -GM NT Aum V=MCAMN OF IIVFQRMATION DtRE�G77ONS Read and irides! each statement below to signify you understand or %Wnfy this information• 1. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder." building permit that enonemnly implies that the property owner is providing, his or her own labor and mateTW personally. I, as an Owner -Builder, may be held liable and subject to serious financial risk for any injtnics sustained by an mhccnsed person and his or her employees while working on Toy property. My homeowner's instuance may not provide coverage for those -iz 0mcs. I an, wrllfully acting as an Owner-Btulder and am aware of the limits of my insurance coverage for injuries to workers on my property. \X2. I understand building peanits 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 resportsibihty. ,-/3. I understand as an ~Owner -Builder" I mn the responsible party of record on the Permit. I tmderstand that I tray protect myself from potential di ancial risk by hiring a licensed Contractor and having the pemdt filed in his or her URTM instead of my ORRI ,.Z4. I understand Contractors are required by law to be licensed and bonded in California and to list their license nambers on permits and contracts. ,./ 5. I understand if I employ or otherwise engage any persons, oQ= than California licensed Contractors, and tate total value of my eonstmetion is at least five hundred dollars (5500), including labor and materials, I may be considered an "employer" under state and federal law. ,/6. 1 understand if I am considered an "employer" under state and federal law, I rrmst register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and conuibute to unemployment eourpensation for each "ernployee." I also understand my failure to abide by these laws may subject ins to smous financial risk ,/ 7. I understand under California Contractm, State License Law, an Owner -Budder who builds single-family residential stnrctxurs cannot kgalhy build them with the intew to offer them for sale, unless all work is performed by licensed subcontractors and the nnmbor of structnn:a does not exceed four within any calendar y m, or all of the work is performed under contract with a licensed general building Contractor. 07/17/2009 11:51 7607777011 LA QUINTA BLDG DEPT raUt UVU4 ✓ 8. 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 4urks sustained by airy subsequent owner(9) that result from any latent construction defects in the Wor"Wor rnattriais. 9. 1 understand I may obtain rnore information regarding .my obligations as an "employer" £tom the Internal Revenue Service, the United States Small Business Athe California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' Stns License Board (CSLB) at 1- 71,0. -CSLB (2752) of www.colb,ca.gov for more information about licensed contractors. I am aware of and consent to an Owner -Builder budding permit applied for in toy name, and understand that 1 am the Part}' ie propped oonshvet an activity at tore following address: y 8 -?��ye ler o LCA 9 53 ✓ 11. i agree ft; as the party legally and financially responsible for this proposed construction activity, I will abide by all Applicable laws and tequfrernentc that govern Owner-Burldene as well as employers. ZI2. I qpm to notify the isz m of this forst immediately of any additims, deletiions, or themes to any of the information I have provided on this form. Licensed contract= are regulants by laws designed to protect the public. If you contract with someone who does not have a lioetse, the Contractors' State License Board tnay be unable to assist you with any fmanciat lass You may matain as a result of a oomplamL Your only remedy against unlicensed Contractors may be to civil court. It is also irttportam for you to understand that dao unlicensed Contractor or employoe of that individual yr firm is f;q)umd while working .on your property, you may be held habk for damages. If you obtain a permit as Owner-Mder and wish to hire Contractors, you will be responsible tlrr verifying whether or not those Contractors are properly licensed and the status of their walkers' motion intisucrmoe coverage. Before a building Permit can be trilled, this Corot :nose be completed sad signed by the property owner ttnd returned to the etgatey responsible (Or lasting the permit. Nor-: A copy of the Property owner's driver's mise, forme nontr arim, or oder ver ion accepmW to the agency is Mir&Vd to be presented whan flee permit it is issued to t>�y t he proper+ owner's signature. Signature of property owner. Date. Note: the following Authorisation .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. A DAMAXION OF AGMST TO ACT ON MQrEM OWNER'S UHAU Excluding the Notice to Property hirer, the execution of which I understand is my personal respovwbilfty, I hereby authorize the following persons) to act as my agent(s) to apply for, sign, and file the docuroents necessary to obtain an Owner -Builder Permit for my project Scope of Construction Project (or Description of Work): Pmjcct 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 fMcd out the above information and cdtify its accuracy. Note: A copy of the owner's driver's license, forms nofariaatiaus, or other ver4ication acceptable to the agency is required to be presented when the permit is tasued to verify the property ow,rer's stgnature. Property Owner's Signature: Date: Date 10/3/08 No. 30225 Owner Marty Schultz Address 48775 Avenida Fernando City La Quinta Zip Tract # Type Residential Addition CERTIFICATE OF COMPLIANCE Desert Sands Unified School District 47950 Dune Palms Road La Quinta, CA 92253 (760) 771-8515 APN # Jurisdiction Permit # No. of Units 4�J�IFIEDsc�o .Zcs� 1�VU� o BERMUDA DUNES r RANCHO MIRAGE INDIAN WELLS PALM DESERT ,y LA QUINTA 11 IN1D0 O y� O 658-300-001 La Quinta 1 Lot # No. Street S.F. Lot # No. Street S.F. Unit 1 48775 AVenida Fernando 160 Unit 6 Unit 2 Unit 7 Unit 3 Unit 8 Unit 4 Unit 9 Unit 5 Unit 10 Comments Closet Addition At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions under 5 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 160 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 - Josh Hiney Check No. Name on the check Telephone Funding Exempt By Dr. Sharon P. McGehee Superintendent .t Fee collected /exemp by S r ey Payment Geer/Under'` Signature NOTICE: Pursuant to Government Code SectioY66020(d)(1), this will serve to notify you that the 90Aay approval period in which you may protest the fees o r other payment identified above Will begin to run from the date on which 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 entity authorized to collect them on the District('s) behalf, whichever is earlier. NOTICE: This Document NOT VALID without embossed seal Embossed Original - Building Department Applicant Copy - Applicant/Receipt Copy - Accounting P.O. Box 1504 LA QUINTA, CALIFORNIA 92247-1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 November 6, 2009 Ms. Jeanne Marie Therese 48775 Avenida Fernando La Quinta, CA 92253 FILE BUILDING & SAFETY DEPARTMENT (760)777-7012 FAX (760) 777-7011 (Mailed on 11/6/09 to 48775 Avenida Fernando, La Quinta, CA 92253 and PO Box 11.2, Zephyr Cove, NV 89448-01,12) Dear Ms. Therese: This .letter is in response to your October 27th visit to City Hall, when you followed-up on your request for a permit extension for the residential addition at 48775 Avenida Fernando. As you recall, you originally requested this extension via fax in July 2009. My investigation into the permit status led to some questions. I telephoned you, but you were out of town Once you returned, we had a telephone conversation during which I told you that the permit was eligible for extension, but that I had no information to indicate that you had an interest in the property. After sharing with me your personal situation, you indicated that you would locate paperwork demonstrating your connection to the property. I assured you that I would not declare the permit to be expired, and would grant you the maximum benefit allowed by the Building Code once you provided me with ownership documentation. I. intended there to be no pressure -to hurry you. That is.still the case. The best information available to me still indicates property ownership in the name of Gerald R. Novotny. Additionally, your.letter of July 6, 2009 suggests that Hiney Construction, the contractor of record listed on the permit, is no longer involved in the project. Without a contractor, building permit #08-1505 is "on hold." No work is authorized at this time, but the permit is not in imminent danger of expiring. To proceed, a comprehensive solution would include: 1. Change of ownership. Please provide documentation demonstrating that you are the current owner of the property. 2. Change of contractor. Once the change in ownership is substantiated, the owner -builder declaration that you have completed can be applied to the permit. We. require owner -builders to provide either (a) proof of workers compensation insurance that will cover any workers on the site (frequently, homeowner's insurance policies are used to accomplish this), or (b) a complete list of sub -contractors, properly licensed by both the State and the City. The list must be reviewed and approved by the Building & Safety Department prior to permit issuance. 3. Extend and re -issue the permit Our total charge to you for this process is $4.50 (for re -issuing the permit with a change of contractor). I have included a copy of our sub -contractor listing form for your use. Please read its instructions carefully, as incomplete forms cause unnecessary processing delays. Also, when you supply the above information to the Building & Safety Department, including a copy of this letter will help whoever assists you to do so more effectively. Your truly, Greg B ler Building & Safety Manager gbutier@la-quinta.org Enclosure July.6, 2009 Jeanne Marie Therese 48-775 Avenida Fernando LaQuinta, CA 92253 Greg Butler Building & Safety Dept City of LaQuinta, CA Dear Mr. Butler, Please accept this request for an extension of the permit number 08-1505. I am dealing with an attorney in regards to this small addition. I advanced monies to Mr. Martin Schultz in order to oversee this project in my absence. He did not pay the contractors. I now need time to hire. new "Subs" to finish the project and I am waiting the results determined by my "Council" before I canproceed in doing so: Your attention and consideration of my request will be greatly appreciated. Respectfully Yours, ' anne. Marie Therese p OCT 2 7 2009 n CITY OF LA QUINTA 'BUILDING & SAFETY DEPARTMENT (760) 777-7012 �P+Tlf.OC%'11'!CG`T O 1> �760)fi7,.7.7 7,1' s G - er iNTy C=lY CONSTRUCTION !JOB IN CONSPICUOUS PLACE MUST SIGN ALL APPLICABLE SPACES JOB ADDRESS CLOSET ADDITION 150 S�). FT. TYPE OF INSPECTION DATE TEMPORARY POWER. SETBACKS INSP. ��-W r �J �j1Lj'�C7 ROOF NAIL / PRE -ROOF p5 OKAY TO WRAP FRAMING COMBINATION • [ L .Lob ROUGH ELECTRIC ROUGH PLUMBING ROUGH MECHANICAL INSULATION, COVER NO WORK UNTIL ABOVE SIGNED INTERIOR GYP. BD:. DRYWALL EXTERIOR LATH l GAS TEST SEPTIC ABANDONMENT SEWER CONNECTION SEPTIC / GREASE INTERCEPTOR MASONRY INSPECTIONS FOOTINGS /STEEL BOND BEAM POOL / SPA / WATERIFEATURE INSPECTIONS PRE-GUNITE / SETBACKS U/G PLUMBING U/G GAS U/G ELECTRICAL ' PRE -PLASTER (ALARMS/ BARRIERS FINAL INSPECTIONS TEMP. USE OF PERMANENT POWE ELECTRICAL PLUMBING MECHANICAL PUBLIC WORKS DEPARTMENT COMMUNITY DEVELOPMENT DEPT. FINAL / JOB COMPLETED ABOVE APPROVALS DO NOT INCLUDE RIGHT TO TURN ON UTILITIES OR OCCUPY BUILDING 07/17/2009 11:51 7607777011 LA QUINTA BLDG DEPT PAGE 03/04 LA QUINTA, CALIFORNIA 92247-1504 78-495 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 IAfP_Ol UNTl NOTICE TO kItQ _EM OWNEit Dear Property owner: An application for a building rmit has been sub in your n listing urseif as the builder of the property imwovements specified at er o L ad_ We are providing you with an Owner -Builder Acknowledgment and Information Verification Foran 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 your understanding of each provision, signed, and returned this form to us at oar 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 RTQBMA°TIt)N DIRECTIONS.• Read and initial each statement below to signify you understand or verify this information. I'll 1. I understand a $equcnt practice of unlicensed persons is to have (be property owner obtain an "Owner -Builder" building pemtit that erroneously impkes 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 MYYproperty- \,,1"2' roperty. / �2. 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. ./ 3. 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 being a licensed Contractor and having the permit filed in his or her name instead of my owner ✓ 4. I understand Contractors are required -by law to be licensed and bonded in California and to list their license numbers on pemvts 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 "employer" under state and federal law. V/ 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 to unemployment compensation, for each "cinployee" 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, as 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 caceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. 07/17/2009 11:51 7607777011 LA QUINTA BLDG DEPT PAGE 04/04 1-1118. 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 w79,understand slup Or materials, I may obtain more information regarding my obligations as an "employer" from the Internal Revenue Service, the United States Small Business Administration, the California Depwirrtent 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- 800-32 CSI,B (2752) or www,esib.ca.gov for more information about licensed contractors. 10. I, am aware of and consent to an Owner�Builder building permit applied for in my name, and understand that I. am the party legally bpd financially MTOo—=�aible for proposed construction activity at the following address: `t8 -775 ffye l�erktro LQ 9a�53 __ ,,-,I - I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner -Builders as well as employers. I/ 12.1 agree to notify the issuer of this form irrunediately of any additions, deletions, or changes to any of the information I rave 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, tate 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 employoc of that individual of 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 tnutstt 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 nodtrlZation, or other verification acceptable to the agency is required to be presented when the permit is issued to very the progeny owner's signature. Signature of property owner. Date: Note: Ae 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. AUTHMIZATIMOT AGENT TO ACT _PROPEM OWNER'S BEHALF Excluding the Notice to Property Oww, 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 Pes'mit 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 ofperjuty 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 :e driver's license, form notarization, or other verification acceptable to the agency is required to be presented when the permit is Lpsued to verb the property owner's signature. Property Owner's Signature: Date: TANDY'S INSPECTION SERVICES, INC. PO BOX 13766 - PALM DESERT, CA 92255-3766 a OFFICE / FAX - 951 .769.9717 PAGER 760.776.3339 SPECIAL- INSPECTION DAILY l WEEKLY REPORT TYOF f f l� k TION PERFORMED PERMIT NU� BE$p� RES DENTOI L TCOMM RCIAL DATE/ O ` O PHYSICAL ADDRnS (INCLUDE STREET NAME AND CITY) L e r r►a� c�c� 7tAvENDR Q--0 l J08IVBF/ NVEf�VYBUSIN�CORPORATE CENTER /LOT NUMBER... ECT.) 04- E I6)6 iI-, /I J./iglAl C G S ARCHITECT F 0IF ^, rX �'V ENGINE �' _ GENERAII CONTRACTOR M / iVIA* ! L! SfLit SUB CONTRAC OR`" DESCRIPTION OF WORK INSPECTED I WELDERS NAME I CERTIFYING AGENCY'S NAME AND ID NUMBER I PROCESS AND ELECTRODE 1 SAMPLE INFORMATION ILOGAIILIN: I I I N /I I TO THE BEST OF MY KNOWLEDGE, WORK INSPECTED WAS IN ACCORDANCE WITH THE. BUILDING DEPARTMENT APPROVED PLANS, SPECIFICATION AND APPLICABLE WORKMANSHIP PROVISIONS OF THE IBC EXCEPT NOTED ABOVE INSPECTORS - 14 INSPECTORS CERTIFICATI( Q--0 l /.Aj �-r/a/ j 04- E I6)6 iI-, /I J./iglAl C G S l�l / / L.,� � -F i . � oma, ALoi,i'k%4P -If -'7";t )44-0r" 1 La 4-a, r _ v . � 4 e7r- ^-t- ct w<i Ore) Q exp( &11 P I/ -/o O.S w2✓e.- - ry r-, Ao at .Sr,_A h'-1 d Ale)t1 /it 10- fb phoVIJ- � � f I WELDERS NAME I CERTIFYING AGENCY'S NAME AND ID NUMBER I PROCESS AND ELECTRODE 1 SAMPLE INFORMATION ILOGAIILIN: I I I N /I I TO THE BEST OF MY KNOWLEDGE, WORK INSPECTED WAS IN ACCORDANCE WITH THE. BUILDING DEPARTMENT APPROVED PLANS, SPECIFICATION AND APPLICABLE WORKMANSHIP PROVISIONS OF THE IBC EXCEPT NOTED ABOVE INSPECTORS - 14 INSPECTORS CERTIFICATI( CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page I of 4) CF-IR Project Title /_ 4 0Ce"T/ `/' Date Project Address C ffZ & L Documentation Author Telepll z Building Permit # Plan Check / Date Field Check / Date Compliance MethodVrescribLive) Climatic Zone l f Enforcement Agency Use Only ✓ ❑ Alternative Component Package Method: (check one) C D D (Alternative) Package C and Package D choices require HERS rater field verification an o diagnostic testing (see CF-1 R page 3) For Package D Alternative see Appendix B Table 151-C Footnotes 7-14 GENERAL INFORMATION Total Conditioned Floor Area (CFA) Zr ft' Average Ceiling Height: ft Maximum Allowed West Facing Fenestration Products Per Table 151-B or 151-C ---- (5% X CFA) ftZ Maximum Allowed Total Fenestration Products Per Table 151-B or 151-C ---- (20% X CFA) f ✓ ❑ Building Type: (check one or more) Single Family Multifamily 5addition Alteration (If adding fenestration fill out WS-4R, Fenestration Maximum Allowed Area Worksheet and see Section 8.3.2 for Additions and 8.3 3 for Alterations.) Number of Stories: Numb t of Dwelling Units;.` Floor Construction Type: Slab/Raised Floor (circle one or both) Front Orientation: North / South / East / West / All Orientations (input front orientation in degrees from True North and circle one) ✓ ❑ RADIANT BARRIER (required in climate zones 2.4. 8-1 OPAQUE SURFACES INCLUDING OPAQUE DOORS Component Type (Wall, Roof, Floor, Slab Edge, Doors) Frame Type (Wood or Metal) Cavity Insulation R-Value Continuous Insulation R-Value Assembly U- factor (for wood, metal frame and mass assemblies Joint Appendix IV Reference Roof Radiant Barrier Installed Yes or No Location/Comments (attic, garage, typical, etc.) 1) See Joint Appendix IV in Section IV.2, IV.3 and IVA' which is the basis for the U-factor criterion. U-factors can not exceed prescriptive value to show equivalence to R-values. CITY OF LAQUINTA BUILDING & SAFETY DEPT. APPROVED FOR CONS RUCTION DALa-SiQ-L * oIB• J Residential Compliance Forms March 2005 CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 2 of 4) CF-IR Project Title Date FENESTRATION PRODUCTS — U-FACTOR AND SHGC ✓ ❑ FENESTRATION MAXIMUM ALLOWED AREA WORKSHEET WS-4R—must be included for New Construction, Additions and Alterations. Fenestration #/Type/Pos. Exterior (Front, Left, Orien- Shading/Overhangs6,' Rear, Right, tation, Area U-factor SHGC ✓ box if WS-3R is S li ht) N, S, E, W' (ft2 U-factor? Source' SHGC4 Sources included El G r � _ ❑ ❑ 11 11 Skvlwiohtc nrP nn El - — -- mm ". Loe sKyirgnts are tuteO to me west or tilted in any direction when the pitch is less than 1:12. See § 151(f)3C and in Section 3.2.3 of the Residential Manual 2) Enter values in this column are either NFRC Rated value or from Standards default Table 116A. 3) Indicate source either from NFRC or Table I I6A, 4) Enter values in this column from NFRC or from Standards Default Table 116B or adjusted SHGC from WS-31L 5) Indicate source either from NFRC or Table 116B. 6) Shading Devices are defined in Table 3-3 in the Residential Manual and see WS-3R to calculate Exterior Shading devices. 7) See Section 3.2A in the Residential Manual. HVAC SYSTEMS Heating Equipment Minimum �:d tion "Type and Capacity Efficiency Typocation Duct or Piping Thermostat Conti on lace. heat um §oiler etc. AFIJE or HSPF ti etcJ R-Value Tune r�,s r.. ai Cooling Equipment Minimum Type and Capacity EfficiencyL�(_ ct LocatioDuct Thermostat Configurationheat um ewe. coolin) _ER-ValuIvneor tic,etc.) R rt.,s r. t ,.�rUzneti Residential Compliance Forms March 2005 'MANDATORY MEASURES SUMMARY: RESIDENTIAL (Page 1 of 2) MF-1R Project Title Date Note_ Low-rise 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 supersede 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. Instructions: Check or initial applicable boxes when completed or check NA if not applicable. DESCRIPTION NA Designer Enforce -ment Building Envelope Measures: * §I50(a): Minimum R-19 in wood frame ceiling insulation or equivalent U-factor in metal frame ceiling. §I50(b): Loose fill insulation manufacturer's labeled R-Value: ❑ ❑ ❑ * §I 50(c): Minimum R-13 wall insulation in wood framed walls or equivalent U-factor in metal frame walls (does not apply to exterior mass walls). * §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. closeable metal or glass door covering the entire opening of the firebox ❑ ❑ b. outside air intake with damper and control, flue damper and control ❑ El2. 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. §I50(g): Vapor barriers mandatory in Climate Zones 14 and 16 only. ❑ ❑ ❑ § 150(1) : Slab edge insulation - water absorption rate for the insulation material alone without facings no greater than 11 03%, water vapor peTmeance rate no ester than ?.0 rmlin . §118: Insulation specified or installed meets insulation installation quality standards. Indicate type and include CF-6R Farm: §116-17: Fenestration Products, Exterior Doors, and Infiltration/Exfrltration Controls. 1. Doors and windows between conditioned and unconditioned spaces designed to limit air leakage. ❑ El 11 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. Space Conditioning, Water 1].eatin and Plumbitl S stem Measures: §I I 0-§113: HVAC equipment, water heaters, showerheads and faucets certified by the Energy Commission. §1 SO(h): Heating and/or cooling loads calculated in accordance with ASHRAE, SMACNA or ACCA. §150(i): Setback thermostat on all applicable heating and/or cooling systems. ❑ ❑ ❑ §1 SOO): Water system pipe and tank insulation and cooling systems line insulation. ❑ ❑ i. Storage gas water heaters rated with an Energy Factor less than 0.58 must be externally wrapped cos insulation havmg an installed thermal resistance of R-32oiKreater, 2. Back-up tanks for solar system, 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-AB 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 2ipes shall be insulated to Table 150B. 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 Egi2tion 150-A. 4. Steam hydronic heating systems or hot water systems >15 psi, meet requirements of Table 123-A. Residential Compliance Forms March 2005 MANDATORY MEASURES SUMMARY: RESIDENTIAL (Page 2 of 2) MF-IR Space Conditioning, Water Heating and Plumbing System Measures: (continued) 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 Corpbration. t §1*m): Ducts and.Fans 1. All ducts and plenums installed sealed and insulated to meet the requirement of the CIVIC Sermons 601, 602, 603, 604, 605 and Standard 6-5; supply -air and retum-air ducts and plenums are insulated to a minimum installed level of R-4.2 or enclosed entirely in conditioned space. Openings shall be sealed with mastic, tape or other duct -closure system that meets the applicable requirements of UL 181, UL 181 A, or UL 181 B or aerosol sealant that meets the requirements of UL 723. If mastic or tape is used to sea] 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 sealed sheet metal, duct board or flexible duct shall not be used for conveying conditioned air. l uilbkng cavities and support platforms may contain ducts. Ducts installed in cavities and supportplatfo l be co ressed to cause reductions in the cross -sectional area of the ducts. 3_ Joints and seams of duct systems and their components shall not be sealed with ba r adh ive duct tapes unless such to is used in combination with mastic and draw bands. 4. Exhaust fan systems have back draft or automatic dampers. 5. Gravity ventilating systems serving conditioned space have either automatic or r ily accessible, manually operated dampers. 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 retardant and provides shielding from solar radiation that can cause degradation of the material. 7. Flexible ducts cannot have porous inner cores. 114: Pool and Spa Heating S sterns and ui ment. 1. A thermal efficiency that complies with the Appliance Efficiency Regulations, on -off switch heater, weatherproofgperating instructions no electric resistance heating and no pilot I ight, 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 NA f I Designer I Enforce V11 -ment 0 n 11 n outside of the I ❑ 3. Pool system has directional inlets and a circulation pump time switch. § 115: Gas feed fan -type central furnaces, pool heaters, spa heaters or household cooking appliances have no burning Pilot light, ce tion: Non -electrical cooking appliances with pilot < 150 Btul g) § I I8(i): Cool Roof material meets specified criteria Residential LightingLigbting Measures- § 150(k)] : HIGH EFFICACY LUMNAIRES OTHER THAN OUTDOOR HI13: contain only high efficacy lamps as outlined in Table 150-C, and do not contain a medium screw base socket (E24/E26). Ballast for lamps 13 watts or greater are electronic and have an output frequency no less than 20 kHz §150(k)l: HIGH EFFICACY LUMINAIRES - OUTDOOR HID: contain only high efficacy lamps as outlined in Table 150-C, hardwired ballasts and if the ballast is eleciramagnetit has a medium screw base socket. _ §150(k)2: Permanently installed luminaires in kitchens shall be high efficacy luminaires. Up to 50 percent of the total rated wattage of permanently installed luminaires (based on nominal rated wattage ofbigit efficacy lamps) 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 hi&h efficacy luminaires. §150(k)3: Permanently installed luminaires in bathrooms, garages, laundry rooms utility rooms shall be high efficacy Inmthaims. OR are controlled by an occupant sensor(s) certified to comply with Section 119(d) that does not turn on automatically or have an always on a tion. §I50(k)4: Permanently installed luminaires located other than in kitchens, bathrooms, garages, iaundry rooms, and utility rooms shall be high efficacy luminaires (except closets less than 70fo): OR are controlled by a dimmer switch OR are controlled by an occupant sensor that complies with Section 1 i9(d) that does not turn on automatically or have an always on option, § 150(k)5: L.umfnaims that are recessed into insulated ceilings are approved for zero clearance insulation cover (IC) and are rated to ASTM E283 and labeled as air ti ht A to less than 2.0 CFM at 75 Pascals. §150(k)6: Luminairr s providing outdoor h&ting.and permanently mounted to a residential building or to other buildings on the same lot shall be high efficacy luminaires (not including lighting around swimming pools/water features or other Article 680 locations) OR are controlled by occupant sensors with integral photo control certified to comply with Section § 150(k)7: Lighting for parking lots for 8 or more vehicles shall have lighting that complies with See. 130, 132, and 147. lighting for parking garages for 8 or more vehicles shall have light inthat cam Lies with Sec. 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 I19[d Residential Compliance Forms C 711 W Im im LE 7 G an ■ 09ME 0M ❑ ❑ 1 ❑ March 2005