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0004-189 (AR)LICENSED CONTRACTOR DECLARATION _1 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 # Lic. Class Exp. Date Signature of Contractor OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason: ( ✓)d 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). ; j /.1J --- )..I am exempt under Section , B&P.C.;for,ihis reasonf rr._ r t 1' ''r Date /" C t Signature of Owner +r' 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 •( ) 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 & policy no. are: Carrier Policy No. (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 11 should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those' provisions, J }Date: f r_ Applicant W ���' !A- i Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $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. 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 any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, 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 correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. Signature (Owner/Agent) '''' ?` Date ' "- --BUILDING PERMIT DATE �_2( G'_ VALUATION LOT 00 JOB SITE ADDRESS 44-swvir OWNER MARK IONTER 44.551tIRMiNA I.A QU E T:€`A CA 92253 USE OF PERMIT "MENUAL Ax3DT 014 8014US ROOM 1 OFFICF, 150 SQ. P.T. ADDITION 00(A-169 APN CONTRACTOR/DESIGNER/ 44-55 VERBENA I'. k QUINTA (7190)360-3370 130,00 SIP LrNr t>FATID COST OF CONSA i1'C`no f PLAN CHECK FRE 101.000.439-318 M" CONSTRUCTION FEE 101-000-418-000 >Z108.00 ELECTRICAL FEE: 101.000-420-000 SI5.00 fk _!4 � - r TRACT Cµ.{ -VS �I+�►tr CA 92253 CPA114 8,4 45.00 SUB- i C?TAL COld41`t3.U'C1 ON AND PLAN CHEM I..ESS PRE-PAW3 FEW TOTAL PFI MST F'IB`S DUE 14Oif4' RECEIPT DACE/ s - �^ ' •r BY�✓�✓ f' f DATE FINALED INSPECTOR $193.20 $1100 $293.20 0 SUB- i C?TAL COld41`t3.U'C1 ON AND PLAN CHEM I..ESS PRE-PAW3 FEW TOTAL PFI MST F'IB`S DUE 14Oif4' RECEIPT DACE/ s - �^ ' •r BY�✓�✓ f' f DATE FINALED INSPECTOR $193.20 $1100 $293.20 OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans 0. K. to Wrap F.A.U. Framing a o0 Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath �p Final Final POOLS - SPAS " ' BLOCKWALL APPROVALS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final I I Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines 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 COMMENTS: Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring p8 Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) 1 1 5 I' MAIr4 ENTRY` _ (2;� k+EF�T�• f-1 IN. 55 Hu'H ►ham W'�1 5�`� SIX s rti _ (PAD Fly OMIT GAR ACE DOOR AN AD „ ALL DRYER _ AND CENTER Yr 1NDU'•r; -CSU KL GLAZE 11 ~ INE'.,,' F AU CL0S'ET i o `„t ITH PL ATFi Rtl S X 5� ROOM TO T)i_HT FIT. DOOR 10 TES F:Etl AIh1 �o3b1�. 2y. poars � II V' PROVIDE PROVIDE tV IDE I ,N 1 lL T{ 0N. TCi 1;,1 rS H <rDRY'l-I ALL 'T� � t_:E IL IN CE IL iNG r � • SELF CLOSE.a 11 NE',r PARTITION '•rr ALL RATED DOOR, ! 5/8 TYPE -X AND R-1? INE:UL AT ION � w b'x l6 d 6 N 5 ADD 5/e, TYPE X DRYWALL TO E I:::TING GARAGE C-EIL. l k'rd C+G►I lr;' D. 0 119'9" 1 EX IST ING G ARGE DOUR TO REM A IN i Additions of less than 1,000 square feet meet the requirements of package D for the applicable climate zone with the following exceptions: walls meet only the mandatory insulation level of R-13 in a wood frame; glass area 'is limited to the percentage allowed by the'' package plus any glass removed -because of the addition. Additions of 1, 000 square feet or more meet all of the requirements of package D. Dual -Glazed Skylights and Dual -Glazed Greenhouse Windows Dual -glazed skylights or dual -glazed greenhouse windows are treated as though they have the U - value required for prescriptive compliance. Dual -glazed skylights and dual -glazed greenhouse windows should be included in compliance calculations as a fenestration product with a U -value equivalent to the Package D requirement for the appropriate climate zone (or 0.75 for additions of less than 500 square feet). Table 7-1: Prescriptive Compliance of Additions - Summary of Section 152(a)1 Requirements of the Standards > 500 but COMPONENT < 1001t2(') < 500 ft2 <1000 ft2 >1;000 ft2 Insulation Ceiling R-19 Package Package Package Wa113 R=13 R-13 R-13 Package Floor MEndatory' Package Package Package Fenestration Max. U -Value"_ 0.75 0.75 Package Package of CF.A < 50 ft2 Pkg. + Removedf Pkg. + Removed' Package Shading N/A Package Package Package Space Heating' Mandatory' Package Package `Package & Cooling (No electric) (No electric) (No electric) (No electric) Water Heating' Replacement N/A N/A N/A N/A Increase See Table 7-2 See Table 7-2 See Table 7-2 See Table 7-2 1. This approach does not allow credit for glass removed. Compliance with the requirements for additions of less than 500 square feet is allowed, in which case credit for glazing removed is allowed. 2. Meet the component prescriptive requirement for Package D (see Chapter 3) and all mandatory requirements. 3. "Heavy Mass" and "Light Mass" walls may mr- A the Package D requirements for mass in lation instead of R-13 (see Chapter 3). n 4. For addition and alteration compliance only, dual -glazed greenhou Qs, jCs l-gl ed skylights are assumed to meet this requirement. F� 5. The Package D fenestration area plus the area of any gl , eO abseP It[ 6. All applicable mandatory measures must be met (see Cha er���-� 7. No electric resistance space heating may be installed. Additions and Alterations July 1, 1999 OP 7-7 7 r c TABLE NO. I ZI5 ALTERNATIVE COMPONENT PACKAGES FOR CLIMATE ZONE 15 PACKAGE] COMPONENT A B C f.D BUILDING ENVELOPE Insulation Minimums2 Ceiling R30 R38 R49 R38 Wood Frame Walls R19 R19 R29 R21 "Heavy Mass" Walls (R5.5) (R4.5) NA (R4.76) "Light Mass" Walls [R7.0] [R6.0] _ NA NA Below Grade Walls NA NA NA RO Slab Floor Perimeter R7 R7 , R7 NR Raised Floors R19 R19 R21 R19 Concrete Raised Floors NA NA NA R4 GLAZING Maximum U-value3 0.65 0.65 0.40 0.65 Maximum Total Area NR 16% 16% 16% Maximum Total Nonsouth Facing Area 9.6% NR NR NR Minimum South Facing Area 6.4% NR NR NR SOLAR HEAT GAIN COEFFICIENT4 South Facing Glazing 0.15 0.15 i 0.40 0.40 West Facing Glazing 0.15 0.15 0.40 0.40 East Facing Glazing NR NR 0.40 0.40 North Facing Glazing NR NR NR NR THERMAL MASS5 REQ NR ' REQ NR INFILTRATION CONTROL Continuous Barrier NR REQ NR NR Air -to -Air Heat Exchanger NR REQ NR NR SPACE HEATING SYSTEM6 Electric Rsistant Allowed NO NO YES7 NO If Gas, AFUE = 78% 78% 78% MIN If Heat Pump, Split System HSPF18 = 6.8 6.8 6.8 MIN Single Package System HSPF = 6.6 6.6 6.6 MIN SPACE COOLING SYSTEM - If Split System A/C SEER = 10.0 10.0 If Single Package A/C, SEERS = 9.7 O< Q IN DOMESTIC WATER HEATING TYPE G\-� ` & C A System must meet budget, see N AN 151(6)1 and 15169 (9) AQP LEGEND: NR = Not Required; NA = Not Applicable; RE = Requ r Minimum SEE NOTES FOLLOWING TABLE NO. 1-Z16 8 �E 342 July 1, 1999 Residential Manual C CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 1 of 2) CF -1R C>T-rtL-C 3-ZLi-00 Proiect Title Date Documentation Author ;� Telephone Compliance Method (Package or Computer) Climate Zone GENERAL INFORMATION Total Conditioned Floor Area j y d ft Average Ceiling Height: ft Conditioned Slab Floor Area ft2 Building Type: C Single Family Addition (check one or more) Multi -Family Existing -Plus -Addition Front Orientation: North / SouthWest / All Orientations (input front orientation in degrees from True North and circle one) Number of Stories Number of Dwelling Units: Floor Construction Type: Ola ised Floor (circle one or both) BUILDING SHELL INSULATION Building Permit # Component Type Frame Type wd = wood stl = steel Cavity Sheathing Total R- Assembly Location/Comments Insulation Insulation Value' U -Value' (attic, garage, typical, etc.) R -Value R -Value Wall t w t2 d e - LI Wall Roof ZS Roof YU Standard Floor Floor Standard Slab Edge FENESTRATION Shadiniz Devices Fenestration #/Type/Pos. Orien- tation Area (ft2) Fenestration U -Value Fenestration SHGC Interior Exterior Overhangs Shading Shading Att. /Fins Att.2 Front ZS . `? YU Standard Front Standard Left Standard Left Standard Rear Standard Rear Right 11J ZS 25 Al ✓t Standard StandaFKj Right n Skylight S Fk Skylight . ' For prescriptive compliance, Total R -Value and Assembly U -Value cavity R -value insulation requirement for the Prescriptive Package. 2 For prescriptive compliance, there are no credits for any interior shE default interior shading devices (draperies) need not be installed for c July 1, 1999 ire n4e�u�ired fora 9oihfr i all that meets or"Standard" drapery. These n CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 2 of 2) CF -IR Project Title Date HVAC SYSTEMS Note. Input hNchonic of cnm!vtr:., 11vc1011il d,!!:1 ti;:&.1 t IIra!ln,` $vst,rt>. OAX'It hesien hleaiine Load Z-7 ( sfin.)) Cooling Equipment Mininrtnrt Duct Heat Pump Type (air conditioner. Eiliciencv Location Duct Thermostat Configuration heat pump. evap. cooling) (S61i1t) (attic. etc) R -Value Type )p, e (splitor.packa_e) WATER HEATING SYSTEMS Energy' External Rated' Tank . Factor or Tank Water Heater Distribution Number Input (IAN: Capacity Recovery Standby' Insulation Type Type in wstent or Biti'hr) (ga!lons) Efficiency Loss (%) R -Value 1. For small gas storage water heaters (rated inputs of Icss Ilmn or equal to 75.000 But/hr). electric resistance, and heat pump water heaters, list Energy Factor. For large pas stomcc e=ater h_atctc (rated input of greater th;m 75.OD6 litu/hr). list Rated Input. Recovery Efficiency and Standby Loss. CFor instantaneous gas water heaters. list rated input and efficiencies. SPECIAL FEATURES and MODELING ASSUMPTIONS (Add extra sheets if necessary) Including Thermal Mass (thermal mass type, covering. thickness. and description) COMPLIANCE STATILAIENT This certificate of compliance listss the building fcututc:. and performa,.cr specifications needed to comply with Title 24, Parts 1 and 6 of the California Code of Regulations, and the adminktrativ c regulations to implement them. This certificate has been signed by the individual with overtll design responsibilin . WI n this certif icatc of compliance is submitted for a single building plan to be built in multiple orientations. any shadim-, f6i me (hat is \aril:d is indicated in the Special Features / Remarks section. Designer o Owner )er lushness and Professions Code) Name:.—--- Titic'Firm: _ Address: �t (4 ec `— – Telephone: Z �, O- Z 3 6 Lic. r: _ 3 Zyaj (signature) (dal-: i Enforcement Agency Name: Title: Aeency: Telephone: (signature / stamp) (dil=) Documentation Author Name: 'I illoTirnt: Address: 1 cicphunt:: (si^1111 ,11111' 11 1999 G\` UN SP`(`,�j� N \ (date) N� PQ Gp'o-c 'OP% J Heating Fquipment Minimum Type and Duct or Heat Pump Type (furnace. heat Eff iciencv location Piping Thermostat Configuration pump. m:.) (AFUE w 1NIT) Idattic. etc:.) R -Value Type (split or package) Z-7 ( sfin.)) Cooling Equipment Mininrtnrt Duct Heat Pump Type (air conditioner. Eiliciencv Location Duct Thermostat Configuration heat pump. evap. cooling) (S61i1t) (attic. etc) R -Value Type )p, e (splitor.packa_e) WATER HEATING SYSTEMS Energy' External Rated' Tank . Factor or Tank Water Heater Distribution Number Input (IAN: Capacity Recovery Standby' Insulation Type Type in wstent or Biti'hr) (ga!lons) Efficiency Loss (%) R -Value 1. For small gas storage water heaters (rated inputs of Icss Ilmn or equal to 75.000 But/hr). electric resistance, and heat pump water heaters, list Energy Factor. For large pas stomcc e=ater h_atctc (rated input of greater th;m 75.OD6 litu/hr). list Rated Input. Recovery Efficiency and Standby Loss. CFor instantaneous gas water heaters. list rated input and efficiencies. SPECIAL FEATURES and MODELING ASSUMPTIONS (Add extra sheets if necessary) Including Thermal Mass (thermal mass type, covering. thickness. and description) COMPLIANCE STATILAIENT This certificate of compliance listss the building fcututc:. and performa,.cr specifications needed to comply with Title 24, Parts 1 and 6 of the California Code of Regulations, and the adminktrativ c regulations to implement them. This certificate has been signed by the individual with overtll design responsibilin . WI n this certif icatc of compliance is submitted for a single building plan to be built in multiple orientations. any shadim-, f6i me (hat is \aril:d is indicated in the Special Features / Remarks section. Designer o Owner )er lushness and Professions Code) Name:.—--- Titic'Firm: _ Address: �t (4 ec `— – Telephone: Z �, O- Z 3 6 Lic. r: _ 3 Zyaj (signature) (dal-: i Enforcement Agency Name: Title: Aeency: Telephone: (signature / stamp) (dil=) Documentation Author Name: 'I illoTirnt: Address: 1 cicphunt:: (si^1111 ,11111' 11 1999 G\` UN SP`(`,�j� N \ (date) N� PQ Gp'o-c 'OP% J OWNER/BUILDER INFORMATION Dear Property Owner: An application fora building permit has been submitted in your name listing yourself as the builder of the property improvements specified. For your protection you should be aware that as "Owner/ Builder" you are the responsible party of record on such a permit. Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself, you may protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the City or County. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be aware of the following information for your benefit and protection: If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is $200.00 or more for the entire project, and such persons are not licensed as contractors or subcontractors, then you may be an employer. If you are an employer, you must register with the -State and Federal Government as an employer -and you are subject to several obligations including State and Federal income tax withholding, federil social security taxes, worker's compensation insurance, disability insurance costs and unemployment compensation contributions. There may be financial risks foi you if you do not carry out these obligations, and these risks are especially serious with respect to worker's compensation insurance. For more specific information about your obligations under.Federal Law, contact the Internal Revenue Service (and, if you wish, the U.S. Small Business Adminstration). For more specific information about your obligations under State Law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally'or`through their own employees, without•a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an " Owner/ Builder" building permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing 'their own work personally. r _ Information about' licensed contractors may be obtained by contacting the Contractors' State License Board in your community or at 1020 N. Street, Sacramento, California 95814. Please complete and return the enclosed owner -builder verification form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. Very truly yours, CITY OF LA QUINTA DEPT. OF BUILDING AND SAFETY 78-495 Calle Tampico La Quinta, CA 92253 (760)777-7012 FAX (760) 777-7 r OWNER'S SIGNATURE/DATE PROPERTY ADDRESS PERMIT BER(s)