0301-245 (RER)LICENSED CONTRACTOR 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 # Yta:�g�G.a�� Exp [Pate
/ ate f < J Signature of Contract ���
. /'OWNER -BUILDER
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) - 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 & Professionals Code).
( .') . I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).,
( )` I am exempt under Section B&P.C. for this reason
Date Signature of Owner
WORKER'S COMPENSATION. DECLARATION .sc
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-,� I have and will maintain workers' compensation insurance, as required by
$e t,on 3700 of the Labor Code,'for the performance of the work for which this
permit is issued. My workers' compensation insurance carrier & policy no. are:.
Carrier %�,TE FUNV Policy No. a`�g-tf'b21�rSi3.2 t9
(This section need not be completed if the permit valuation is for $100.00 or less).
( )' 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 ,Ilhould become
subject to I e workers' compo sation..prdvi ions of Section'3700 of the Labor
Code,I , ally orthwith comply wi thd;6 p ouisio s .
0- oApplicant �°, o -`
Warn4g: ailure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000,1n
addition to the cost of compensation, damages as provided for in Section 3706
nt
Code, interest and attorney's fees.
ofthe Labor _ .. _
IMPORTANT Application is hereby made to the Director of Building and Safety
for ,a permit subject to the conditions and restrictions set forth on his
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
anyrpermit issued.as a result of this.applicaton agrees to, & shall, indemnify
& hold harmless the Clty of La Quints, its officers, agents -and employees.
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
I
orrect. I agree to'comply with all City, and State laws,,relating to the building
construction, and hereby authorize reps entatives..ofrt;is City to ante - up�l
the above-mentioned pro erty for spection purpo es.
1 Signature (Owner/Agent)f%" j%' �' Date
BUILDING PERMIT PERMITN
DATE 1 VALUATION LOT TRACT
MOW00
JOB SITE !�`
ADDRESSX14. � 13 Y
APN
M&f
OWNER
CONTRACTOR/DESIGNER/EN (NEER
iso -589 31W -4121H BAY
44.106"..NIM01 7117 Ok
IAQL1I;1;+1TA "' CA 92.253
IMAM, WELLS CA 92210
(60)773-4487 CZVt W5
USE OF PERMIT
COIdV FASfOXI 0 I 240 SY, r-K)L I? CARTCARA09 TO T.V. F100M
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PIMNIT.rm, SUMMARY
14 FEE
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dadYCHANICAL IME
tElXt:3'RI AL° PEX 101-000-420-0009
WRONG MOTION ME - ita,MID 101.000.241.000 $P
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EAN4 23
<. CITY OF LA QUINTA
FINANCE DEPT.
SM -TOkAL COMMUCM014 AND A AW CHECK
$197.13
LESS PRE-PAW.FE101
$0.00
lr4y `kL PXTL'KIM'S DXJE now
$.197115
RECEIPT
DATE '
BY'�
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
f BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
FramingCompressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplax T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party gall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APP OVALS
Gas Test
Electric Final
Waste Lines Z //
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
`Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
i
'WWEST.
FAIRWAYS ASSOCIATION
i
January 23, 2003
Ms. Francesca Bowyer
80-589 Spanish Bay
La Quinta CA 92253
RE: Architectural Improvement
Dear Ms. Bowyer:
At the January 20'o', 2003 Architectural/Landscape Committee the plans you submitted
were reviewed and approved with the following conditions:
❖ Mark on the existing plan showing -where the garage is and where the changes
will be.
❖ Have neighbors sign off on the plan (Done).
❖ Submit a copy of the City permits.
-- If you have any questions, please give me a call.
Sincerely,
Associat on Manager
DM/ncp
Post Office Box 1658 a La Quinta, California 92253 • Phone (760) 564-3858 • Fax (760) 564-2329
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CERTIFICATE OF'COMPLIANM `RESIDDENTL&L ., page 1 of 3 CF IR
P1711:9,11:! Itle- i • .. .
• Project A �
C �te
Building Permit # `
ntati Author Gr✓ Plan Check/ Date
Tel ; � .�
L Field Check / Date
Compliance Me d (Package or Computer) Climate Zone
EntorcernEit. Agency Use Only
GENERAL INFORMATION
Total Conditioned Floor Area ft2 Average Ceiling Height:
Conditioned Slab Floor Area #
Building Type: Single Family " V1 Addition
(check one or more) Multi -Family' Existing -Plus -Addition
0
Front Orientation:_ North / South /ast West %All Orientations.
t . (input front orienta�nrrSn degrees from True North and circle
Number of Stories �_ one)' Ys
Number of Dwelling Units:
Floor Construction Tye: Slab%Raised Floor circle one or both)
RADIANT BARRIER !required in climate zones 2 4 8-15) Required for this submittal_
yes no
r
BUILDING ENVELOPE INSULATION
Component Frame Type Cavity Sheathing Total R- Assembly Location/Comments
Type wd �= wood Insulation Insulation Value', U -Factor' (attic, garage, typical, etc.)
stl = st 1 R -Value 'R -Value
Wall i
Wall I f _ i
Roof I
Roof
Floor
Floor
Slab Ede I t
Fenestration
#/ e/pos.
Front
Front
Left
Left
Rear, ,
Rear
Compliance Forms
1
rotal R -Value and Assembl U -Factor are not required for a wood -framed wall that meets cavi R -value
_Prescriptive Packages
M r
Shadin Devices
Area Fenestration Fenestration Exterior 1' Overhangs/
U -Factor . SHGC Sbadi Aft. Fi
w I•
A
T.
i
I
DATE BY
r August 2001 A-2
CERTIFICATE OF COMPLIANCE: RESIDENTIAL ' a e 2 of 3 "
. _ CF-1Rt
,Project Title f 7 R
Dat
HVAC SYSTEMS ,
Note: Input hydrottic or'combined hydronic data der Water Heating Systems, except Design Heating Load h .
f Distribution y '
Heating Equipment Minimum Type and `Duct or, Heat Pump.
Type ( heat Efficiency Location Piping Thermostat Configuration
yr M e AFUE > HSP dnc attic etc. R -Value T e
lit or e
�J ' . 4
Cooling Equipment + Mitiimum r
Duct Heat P
Type (air' 'tioaer, Efficiency Location Duct �'
heat . coofin ;} Thermostat Configuration
SE atti etc.)R-Value T it or
rl i
'SEALED DUCTS and TXVs or Alternative Measures
Sealed Ducts (all d' to zones) i r'
(Installer testing and cetEiScation and HERS rater field verification required)
4
❑ TXVs, readily acceIsible (climate nines 2 and 8 15 only)
(Installer testing and cation and HERS Rater or field verification required)
❑Refrigerant ChargeJAir Flow
(climate nines gland 8-15 only)
. (Installer. testing and cel ification and HERS Rater or field verification requited)
OR
' ❑ Aitemative to Seal Ducts and TXVs (s Package C or D Alternative Package Features for Project Climate Zone) ,
4
Climate" a inflow SHGC Window U -Factor SEER Heating
110
W TER HEATING SYSTEMS
` Rated' Energy' External' i
Water Heater Tank Factor or Tank'
Distribution Number Input (kw Capacity Recovery Standby' Insulation
T l T e' ink System OrBtuft lana EfficiencyLoss % R -Value
1. For small gas storage water heaters (rated inputs of les than or egral W 75,000 Btu/hr), electric resistance, and heat
Factor. For large. gas soorage water heaters (rated inpntlof greater than 75,000 Btu/hr), list Rated pmnp water heaters, list Energy
For instatttaaeons gas waterheaters, list rated ' t and recovery �4 Recovery Efficiency and Standby Loss.
mpu very efficiencies. `
r
SPECIAL FEA
S (add extra sheets if necessary). Package C and D: TXVs, Sealed Ducts, Radiant `
Barriers (see installation requirements for iadiant barriers in Section 8.13 of the 2001 Residential Manual). 1.
Package Ce ermal ass (thermal mass type, covering, thickness, and description). ,
Compliance Forms August 2001
A-3
CILRTIFICA E OF, COMPLIANCE; RESIDENTIAL (Page 3 of 3j CF -1R
i
i
Project Title ,
to
COMPLIANCE STATEMENT
This certificate of compliance lists the. b building!, features and performance -specifications needed to comply with
Title 24, Parts I and 6 of the California Code of Regulations, and the administrative regulations to implement
them. This certificate has been signed b4 the individual with overall design responsibility. When this certificate
of compliance is submitted for a single building plan to be built in multiple orientations, any shading feature that
is varied is indicated in the Special Features/Remarks section. The undersigned recognize that compliance using
duct sealing and Tis requires installer iesting:and certification and field verifi
rater. cation by an approved HERS
Designer or Own r 1
g I (per Business and P �ofessions Code) DOCultlent9tion A thor
Name: YO J Name:
• Title/Firm-
^�J Title/Firm:
Address: Address:
Telephone: '. 7I3.
Telephone:
Lic. #:
` date)
(date)
Enforcement Agenc .
Name:
Title:
Agency:
Telephone:
(signature / stamp)
(date)
Compliance. Forms August 2001
A-4
MANDATORY WAS CHECKLIST: RESIDENTIAL a of z) MF -1R
Note: Lowrise residedtial buildings subject to tNe Standards must contain these measures regardless of the compliance approach used.
Items marked A ith an asterisk (s) may be superseded by more stringent compliance requirements listed on the Certificate of
Compliance. 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 checkl}jit only. I s
Instructions: Check or initial applicable iboxes when completed or enter N/A if not applicable.
DESCRIPTION ( I •DESIGNER ENFORCEMENT
Building Envelope Nheasures:
" §150(a): Minimum R-19lceiling insulation.
§ 150(6): Loose fill insulation manufachuer's labeled R -Value. '
" §150(c): Minimum R-13lIwall insulation in wood framed walls or equivalent U -Factor in metal frame walls /
does not a 1 to ezteri8r mass ways).
;
§150(d): Minimum R-13 raised floor insulation in funned floors'.
§ 1500): Slab edge insulation -water absorption rate no greater than 0.3%, water vapor transmission rate no'
greater than 2.0 inch.
§118: Insulation specified or installed meets insulation quality standards. Indicate type and form.
§ 116-17: Fenestration Prc ducts, Exterior Doors, and Irifiltr'ation/EzSltration Controls
1. Doors and windowsbII etwe-n conditioned and unconditioned spaces designed to limit air leakage.. `
2. Fenestration productJ (except field -fabricated) have label with certified U -Factor, certified Solar Heat
Gain Coefficient (SH16C), and infiltration certification.
3. Exterior doors and windows weath
arstripped, all joints and penetrations caulked and sealed
§150(g): Vapor barriers mandatory m Climate Zones 14 and 16 only -
0
i
§ 150(t): Special infiltratioh barrier installed to comply with § 151 meets Commission quality standards.
§ 150(e): Installation of Firieplaces, Decorative Gas Appliances and Gas Logs.
1. Masonry and factory -Ir jilt fireplaces have: -
a Closeable metal orllglass'door `
b: Outside air intake cLith damper mud control
c. Flue damper and cc trol
2. No continuous burning gas pilot lights allowed /i )
a
KP2Ce Conditioning, Wjater, Heating and Pluriibing System Measures: a
-§ 113: HVAC equipn>lcent, water heaters, showerheads and laricets certified by the Commission.
----------------------
§ 150(h): Heating and/or cooling loads calculated in accordance with ASHRAE, SMACNA or ACCA.
§150(i): Setback thermostat� on all aFPlicable heating ug and/or cooling systems. �
§ 150(1): Pipe and tank insulation {
1. Storage gas water heat.1 rated with an Energy Factof less than t
0.58 must be externally
insulation having an installed thermal resistance of 8112 or greater. wrapped with
2. First 5 feet of pipes clos1st to water heater tank, non -recirculating systems, insulated RA or
� ( greater)
3. Back-up tanks for solar! ystem un fired storage tanks, or other indirect hot water tanks have R-12
external insulation or R-[6 coinbinedinternal/uternal insulation.
4. A11 buried or exposed pining insulated in recirculating sections of hot water systems.
5. Cooling system Piping i low SS' F insulated ' .
t
6_ Piping insulated between heating squrce'and indirect hot water tank.. /
C ?
Compliance Forms I August 2001 A-5
y
#.
MANDATO ' Y MEASURES CHECKLIST': RESIDENTIAL (page z of 2) MF -1R
Note: Lowrise residential buildings subject to thl Standards must contain these measures regardless of the compliance approach used.-
Items marked with an asterisk (') may be superseded by more stringent compliance requirements listed on the Certificate of
Compliance_ 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 docu
or on this check�ist only. ments
Instrilctions: Check' or initial applicable boxes when completed or enter N/A if not applicable.
DESCRIPTION (, DESIGNER ENFORCEMENT
Space Conditioning,Vater Heating and Plumbing System Measures: (continued)
• § 150(m): Ducts and Fans t
1. All ducts and plamms installed, sealed and insulated to meet the requirement of the 1998 CMC Sections 601,
' 603, 604, and Standard16-3- ducts insulated to a rtrinaintrn installed level of R4.2 or enclosed entirely in
conditioned space_ Openings shall be sealed with mastic, tape, aerosol sealant, or other duct -closure system
that meets the applicable requirements of UL 181, UT)181A, or UL 181 B. if mastic or tape is used toseal
ch,
openings greater than 1%4 inthe combination of mastic and either mesh or tape shall be used. Building
cavities shall not be used for conveying conditioned air. Joints and seams of duct systems and their
components shall not be sealed with cloth back' adhesive duct tapes unless such tape is used in
combination with mas{ic and drawbands.
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. Building cavities and support platforms may contain ducts. Ducts installed in cavities and support
Platforms shall not be "pressed 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 cloth back rubber
adhesive duct tapes unless such tape is used in comt6ation with mastic and drawbands.
4. Exhaust fan systems hilve back draft or automatic d �Impers.
5. Gravity ventilating systems serving conditioned space have either automatic or readily accessible,
manually operated dampers.
6. Protection of Insulation. Insolation shall be protected from damage, including that due to sunlight,
moisture, equipment »aemteaance, and wind but not limited to the following: Insulation exposed to
weather shall be suitabie for outdoor service e.g.,p nected by aluminum, sheet metal, painted carrvas
or plastic weer. Cellu�ar foam insulation shall be protected as above or painted with a coating that is
water retardant and mvides shielding from solar radiation that can cause de dation of the material.
§ 114: Pool and Spa Heating Systems and Equipment II
1. System is certified wi I78% thermal efficiency, on-off switch, weatherproof operating instructions, no
electric resistance heading and no pilot IighL
2. System is installed with.
+ a. At least 36" of pipebetweenfilter and heater forlfirture solar heating.
b_ Cover for outdoor pools or outdoor spas. I /
3. Pool system has directional inlets and a circulation pump timelswitch. jJ /
§ 115: Gas fined central fur aces, pool heaters, spa heaters or household cooking appliances have no
wrrtinuously burnin ilot li t tion: Non-electlical cocking amrlhtnces with ilot < 150 Btu/hr)
§ 118 (f): Cool Roof material meet speed criteria
Lighting Measures:
§ 150(k)l.: Luminaires for general lighting in kitchens shill have lamps with an efficacy of 40 lumens/watt
or greater for general lighting in kitchens. This general lighting shall be controlled by a.switch on a readily.
accessible li tin control anel at an entrance to the kitchen.
§150(k)2-: Rooms with ash er or bathtub must have either at least one luminaire with lamps with an
efficacy of 401umens/watt br greater switched at the entrance to the room or one of the alternatives
requirement allowed in § 150(k)L; and incandescent recessed ceiling fixtures are IC (insulation cover)to this
IIroved-
Compliance., Forms August 2001
A-6
w