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11-0621 (RR)4 P.O. BOX 1504 VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 11/21/11 Application Number: "t11-00000621-. -A Owner: Property Address: 178845 LA PALMA DR KUCHYT CHRIS APN: 604-163-017-117 -23269 - 78845 LA'PAMA DRIVE h, Application description: REMODEL - RESIDENTIAL LA QUINTA, CA 92253 Property Zoning: LOW DENSITY -RESIDENTIAL U� Application valuati6n: 2000 O Contractor: €'^ Applicant: Architect or Engineer: Owner, ------------------------------------------------------------------------------------------------- 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).: ('*�z 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 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 am exempt under Sec. , BAP.C. for this reason ' CONSTRUCTION f G AGENCY I hereby affirm under penalty of perjury that there is a constr lending agency for the performance of the Work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name: Lender's Address: LQPERMIT 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 c=at, 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 sub' �tt() th workers' compe ion provisions of Section �e 37000 of the Labor Code, f a I y with the rov' i ns. (cant: -- WARNING: FAILURE TO SECURE WORKERS' COMPE ION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTI ND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE @ ST 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 all city and county ordinances and state laws relating to building constructio and herby authorize r esentatives of this county to enter upon the above-mentioned property f r s "Gr s JYdief g nature (Applicant or Agent): Application Number . . . . . 11-00000621 ------ Structure Information 232SF PATIO COVER WITH BALCONY [ENG] ----- Other struct info . . . . . CODE EDITION ---------------------------------------------------------------------------- 2010 Permit . . . BUILDING PERMIT INV FEE Additional desc . Permit Fee . . . . 90.00 Plan Check Fee 29.25 Issue Date . . . . Valuation . . . . 2000 Expiration Date . . . 5/19/12 Qty Unit Charge Per Extension BASE FEE 30.00 15.00 4.0000 HND BLDG 501-2,000 --------------------------- ------------------------------------------------ 60.00 Permit . . . ELEC-MISCELLANEOUS INV FEE Additional desc . . Permit Fee 37.50 Plan Check Fee 4.69 Issue Date . . . . Valuation . . . . 0 Expiration Date 5/19/12 Qty Unit Charge Per Extension BASE FEE 30.00 5.00 1.5000 PER ELEC DEVICE/FIXTURE 1ST 20 7.50 ---------------------------------------------------------------------------- Special Notes and Comments 232 -SF PATIO COVER W/ BALCONY INCLUDING (2) 2ND FLOOR WINDOW CHANGE OUTS TO DOORS FOR ACCESS [ENGINEERED] THIS PERMIT DOES NOT INCLUDE ALTERATIONS TO THE INTERIOR OR ELECTRICAL AT 1ST FLOOR PATIO AREA. CODE CASE: 11-2156,[KM] ***INVESTIGATION FEE ASSESSED PER 2010 CALIFORNIA RESIDENTIAL CODE CHAPTER 1 §108.6 FOR WORK COMMENCING BEFORE PERMIT ISSUANCE*** 2010 CALIFORNIA CODES. November 17, 2011 5:13:25 PM AORTEGA SUPPLEMENTAL REVISION - ROOF DECK REQUIRED TO BE COVERED FOR WEATHER PROTECTION OF PLYWOOD DIAPHRAGM. DURADEK [ESR -2151] PROPOSED FOR USE BY APPLICANT. November 21,.2011 2:36:15 PM AORTEGA --------------------------------------------------------------- Other Fees • .•. . . . . . . . BLDG STDS ADMIN (SB1473) ------------- 1.00 ENERGY REVIEW FEE 2.93 STRONG MOTION (SMI) - RES .50 Application Number 11-00000621 Fee summary Charged Paid Credited ---------- Due ----------------- Permit Fee Total ---------- 127.50 ---------- .00 ---------- .00 127.50 Plan Check Total 33.94 .00 .00 33.94 Other Fee Total .4.43 .00 .00 4.43 Grand Total 165.87 .00 .00 165.87 iA i3fn # Q Of tv. Quin Building a Safety Division..,; P.O. Box 1504,78-495 Calle Tampico La.Quinta, CA 92253 - (760) 777-7012 Building Permit Application .and Tracking Sheet Permit # Project Address: Owner's Name: A. P. Number. Address: Legal Description: Contractor: City, ST, Zip: xd'ss Address: 8�� Project Description: City, ST, Zip: ,•° Telephoneeee!5?571-1;1M� k � E��• State Lic. # : City Lic. Arch., Engr., Designer.,1 Address: City., ST, Zip: Telephone: v Y ` '`� '' State Lic. #:�, y u r Name of Contact Person: Construction Type:. Occupancy: project type (circle one): New Add'n Alt Repair o Sq. Ft.: #Stories: #Units: Telephone # of Contact Person: Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS UNE # Submittal Req'd Recd TRACMG PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit. . Truss C21cs• Called Contact Person Pian Check Balance Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted.. Mechanical Grading plan tad Review, ready for corrections%ssue Electrical . Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up SALL H.O.A. Approval Plans resubmitted Grading IN HOUSE- '^' Review, ready for correctionstissue Developer Impact Fee Planning Approval. Called Contact Person P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees �I CITY OF LA Q U I IV TA Z BUILDING & SAFETY DEPARTMENT; s .(760) 777-7012.... t INSPECTION REQUEST.LINE c� (760) 777-7153 J. wn S KUCHYT nntr�nt r d 6, ER%BUILDER •. • Pe ler 11-0621 � � ON JOB IN CONSPICUOUS PLACE INSPECTOR MUST SIGN ALL.APPLICABLE SPACES JOB ADDRESS 78-845 LA PALMA DRIVE 232SF PATIO COVER W/ BALCONY INCLUDING (2) 2ND FLOOR WINDOW CHANGE OUTS TO DOORS FOR ACCESS [ENGINEERED) THIS PERMIT DOES NOT INCLUDE ALTERATIONS TO THE INTERIOR OR ELECTRICAL AT 1ST TEMPORARY POWER SETBACKS U/G PLUMBING / WASTE U/G ELECTRICAL / GROUNDING FOOTINGS / STEEL CONCRETE SLAB DO NOT POUR CONCRETE UNTIL ABOVE SIGNED rnHroiirvu kuUnnull im I ROUGH ELECTRIC INSULATION COVER NO WORK UNTIL ABOVE SIGNED INTERIOR GYP. BD. DRYWALL EXTERIOR LATH GAS TEST SEPTIC ABANDONMENT SEWER CONNECTION SEPTIC / GREASE INTERCEPTOR MASONRY INSPECTIONS FOOTINGS / STEEL BOND BEAM POOL / SPA / WATER FEATURE INSPECTIONS PRE-GUNITE / SETBACKS U/G PLUMBING U/G GAS U/G ELECTRICAL PRE -PLASTER ALARMS / BARRIERS DECK BONDING FINAL INSPECTIONS TEMP. -USE OF PERMANENT POWER ELECTRICAL PLUMBING MECHANICAL PUBLIC WORKS DEPARTMENT COMMUNITY DEVELOPM ENT DEPT. FINAL-/ JOB COMPLETED r r rARRnN MONOXIDE DETECTORS SHALL— REVISION 1. REMOVE BALCONY USE AND CANCEL WINDOW CHANGE OUT AT 2ND FLOOR - WORK PREVIOUSLY STARTED WITHOUT PERMITS, CODE CASE: 11-2156 [KMI INSPECTIONS REQUIRED TO REPLACE WINDOWS WHERE PREVIOUSLY EXISTING, ADDITIONALLY NEW WINDOWS ARE REQUIRED AND MUST MEET SPECIFICATIONS OF CURRENTLY APPROVED ENERGY CALCULATIONS. THIS REVISION DOES NOT CLOSE, OR RECONCILE THE REQUIREMENTS OF THE EXISTING CODE CASE. February 21, 2012 8:58:20 AM AORTEGA le Bin .# Cit}/ Of Lai' Quinta . Bultding 8t Safety Division . . P.O. Box 1504,78-495 Calle.Tamplco '. La.Quinta, CA 92253 -(760) 777-7012 Building Permit Application and Tracking Sheet Permit # • °� Project Address: '%gglj� `f ��¢��?�• Owner's Name:. A. P. Number. Legal Description: wz7l c9 �ie',e City, ST, Zip: x3�:4�� Contractor: ��it_F�� Telephone .. ,,0M a{� Project Description: j City, ST, zip: Telephone e State Lie. # : City Lie'. M.yrs 5 'G Arch., Engr., Designer. Address: City., ST, Zip: Telephone: . Construction Type:. Occupancy: State Lie. #: Project type (circle one): New Add'n Alter Repair Demo Name of Contact Person: Sq. Ft.: #Stories: #Univ: Telephone # of Contact Person: Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Cheek submitted Item Amount Structural Cales. Reviewed, ready for corrections Plan Check Deposit. . 'mss Cates. Called Contact Person Plan Check Balance Title 24 Cates. Pians picked up Construction Flood plain plan Plans resubmitted.. Mechanical Grading plan Review, ready for correctionsfissue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M., H.O.A. Approval Plans resubmitted Grading IN HOUSE:- '^` Review; ready for correctionslissue eveloper Impact Fee Planning Approval. Called Contact Person AJ.- P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees RAFTER SIZE AND SPACING . SPECIFY ROOFING AND SHEATHING OR OPEN LATTVCE -, _ (SEE ROOFING NOTE ON REVERSE) - - - - - - - - - - - - - -------------------- - ROOF CHlow CONTIIUoUS LEDGER. (SAME SIZE AS RAFTERS) I HEADER SIZE a• ---------- 1 LENGTH: LENGTH: O Nr a SETBACK SEDC SETBACK I 2000 PS.I CONCRETE ---.N I �F*MUSH GRADE FINISH GRADE L.__ OPEN LATTICE; PATIO COVERS WAY BE AT TO EXISTING FASCIA O VIA ONE 1/t' r S LAG SCREW THROUGH FASCIA INTO FJICH RAFTER TAIL LAG SCREWS MO STUDS AT 16' O.C.7 r— CONTtNUOUS LEDGER / Joisr' HANGER OR SOLID BLOCKING NAI RAFTER TO BLOCIONG U -STRAP OR AN( NON -CORROSIVE (4)- '16d NAILS OR BOLT (4)- 16d NAILS OR BOLT PROVIDE 1" CLEARANCE BETWEEN POST AND CONCRETE BUILDING DEPARTMENT APPROVAL BELOW ANCHOR BOLT (EMBED — ��^: ,' • O�� T MIN. INTO CONCRETE) TYPICAL PATIO COVER DATE OF APPUCAT*N OwNER'S NAME STREET ADDRESS CRY, ST ZIP TELEPHONE H.O.A APPROVAL `'T AND T.' STRAPS ' I 6*lCXI'tl/6" MPRH I I (M) 16a NAILS OR 801T I i POST SPACING:_-- e � OVEPA11• -NGTH. _ 1 POST SIZE: (t•.c- UN.) I V— WH. Inti FOOTING , I L--1 ff BELOW GRADE L --J PROVIDE 1" CLEARANCE BETWEEN POST AND CONCRETE U -STRAP OR AN( NON -CORROSIVE (4)- '16d NAILS OR BOLT (4)- 16d NAILS OR BOLT PROVIDE 1" CLEARANCE BETWEEN POST AND CONCRETE BUILDING DEPARTMENT APPROVAL BELOW ANCHOR BOLT (EMBED — ��^: ,' • O�� T MIN. INTO CONCRETE) TYPICAL PATIO COVER DATE OF APPUCAT*N OwNER'S NAME STREET ADDRESS CRY, ST ZIP TELEPHONE H.O.A APPROVAL Q�• Q' RAFTER SPAN. TABLE GRADING -RULES c' `-7. `o PS 20-70 (FEET ac INCHES) 2x4 f 6" O.C. 24" 10'-6, 9'-6" 7'-5 a _q• 2x6 16" C. 15'-0" 14' 10'-9" 13'-0 24` 12'- 1'- . 8'= 10'-6" 32" ` 10'-0". 8' " N A N/A 2x8 16' O.C. - 17'.- ` 13'-� 16'-0' 24" t . - -6" 11'-0 13'-0` NOTES: 1. 32" RAFTER SPACING IS ALLOWABLE ,o 'k s ALL CONSTRUCTION SHALL CONFORM TO THE. PROVISIONS OF THE i SUPPLEMENTAL NOTES: FOR OPEN LATTICE PATIO COVERS ONLY. 2. FOR SOLID; PATIO COVERS (NOT LATTICE) RAFTER SPAN IS LIMITED TO. 10'-0" USING THIS STANDARD. LATTICE ROOF BUILT-UP ROOF HEADERS HEADERS DOUGLAS FIR NO. 1 DOUGLAS FIR. NO. 1 S17E SPAN SIZE SPAN ROOFING NOTES• 4x.4 5'-0" 4x4 4'-0" A. BUILT-UP, ROLLED ROOF: SLOPE TO DRAIN. 4x6 8'-0" 4X'6 6'-0' 4x.8. 1 v-0" 4x8 81_0" B. ROCK ROOF:. 3/ 12 ..MAXIMUM PITCH. 4.x10 14 -0 400_ . 10'_0" 4x12 17'-0" 412 .6x8 14'-0" 6x 6x 10 17'=0' 10 14 n r- Bin # City of LQ uinta Building 8f Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # Project Address: �88 �s ��, Owner's Name: .401`r A. P. Number: Address: 7BB,4s 54L,,0 Legal Description:: D Contractor:telephone V� T— City, ST, Zip: • ;:::.•..::::::•.,.,,:i;:.:::;,..;::.:;.<:�<;r:: r .:Oi '.rimi::Ktt:: nx'ii� •`.:Y� "ii: Address: .`5:: i:i Project Description:�Zc�C�o�G.�,t City, ST, Zip: Telephone: •�:4�::i\}:;.iC:y<f:in:ryii �i1:L:i�i:�i:� :'1..�i�'iCv<:i?:' State Lic. # : City Lic. ol.J �iQ�%/ Arch., Engr., Designer: Aar Address: Gl a•� l�C% �/�� s%/i�it/D City, ST, Zip: / _ Telephone: <:.•': j« a°<<�:zv':;::::;;?:::;:;<;;: +.3:: �:��.n;{i%fiY.•+jii::.nl: _-'moi\�2 iir V ii:i::i�Sr?{�:f:�f�::t!`•v. J{:i State Lic. #: "'<"4<>;r. c:;°><::; :°>:;;:':a:%"%:r»x:<:i..: Construction Type: Occupancy: . project'type (circle one): New Add'n Alter Repair Demo Name of Contact Person: 000'C 9"T Sq. Ft.: # Stories: # Units: Telephone # of Contact Perso �� Estimated Value of Project: J � e;QQO APPLICANT: DO NOT WRITE BELOW THIS LINE k # Submittal Req'd Rec'd TRACKING PERMIT FEES Plan Sets Plan Check submitted (p Item Amount Structural Calcs. Reviewed, ready for corrections i Plan Check Deposit r' Truss CaICs. Called Contact Person kPlan Check Balance. Title 24 Calcs. Plans picked up, ra Coustruction dk7. Flood plain plan Plans resubmitted Mechanical Grading plan 2°" Review, readyr correct' s ue Q �ll Electrical T, Subcontactor List ' < Called Contact Persons Plumbing �► Grant Deed Plans picked up p ,�1% I S.M.I. emu H.O.A. Approval Plans resubmitted I Grading IN HOUSE:- 'nd Review, ready forrecti�ssue �� Developer Impact Fee ^ Planning Approval Called Contact Person to I A.I.P.P. ^ Pub. Wks. APpr Date of wr;;*kissee– X f i A �3 School Fees A /1Ulu,SiD ' ,aA Total Permit Fees b ztlZ•a — �1S�C'[R `` �` ` N1 ,'AuA4-- --> Pari. ► 1 ly cW. i��011 1 < In I'1e11- Ns �sTrz ti1N2 bl4St.G 9lu keu — NS�S[Q etc, j b- I I - Sr2 - DA -1c to -,?4-11 y A �F�a�rw P.O. Box 1504 LA QUINTA, CALIFORNIA 92247-1504 78-495 CALLE 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 IMPORTANT! NOTICE TO PROPERTY OWNER Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at We are providing you with an Owner -Builder Acknowledgment and Information Verification Form 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 our 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 INFORMATION DIRECTIONS: Read and initial each statement below to signify you understand or verify this information. 1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder" uilding permit that erroneously implies that the property owner is providing his or her own labor and material personally. 1, 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 my property. Z%V12 I understand building permits are not required to be signed by property howners 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 hiring a licensed Contractor and having the permit filed in his or her name instead of my own. 6=4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. C�/T 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. 14 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 "employee." I also understand my failure to abide by.,these laws may subject me to serious financial risk. 7. 1 understand under California Contractors' State License Law, an 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 exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. 8. 1 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 workmanship or materials. 4019. I understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue Service, the United States Small Business Administration, the California Department 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- 800-321=CSLB-(2752) or www.cslb.ca.gov for more information ibouf licensed contractors. 0. 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 and financially responsible for proposed construction activity at the following address: /� l 1. 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 govem Owner -Builders as well as employers. 12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have 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, the 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 employee of that individual or 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 must 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 notarization, or other verification acceptable to the agency is required to be presented when the permit is issued to verify the property owner's signature. _ A_ A Signature of property owner �G Date: 6 _8 — " Note: The 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. AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, 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 Permit for my project. Scope of Construction Project (or Description of Work): Project Location or Address:T88�3' Name of Authorized Agent: L��5 �� Tel No Address of Authorized Agent: I declare under penalty of perjury 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's driver's license, form notarization, or other verification acceptable to the agency is required to be presented when a permit is issued to verify the property owner's signature. Property Owner's Signature: Date: 71.. 780 &ih Jacinto Dr:; Ste: E2; Rancho Mrrage Ca; 92270 p.i, (760) 83.4_.8860 Letter of Transmittal To: City of La Quinta Today's Date: 11-14-11 78-495 Calle Tampico City Due Date: 11-15-11 La Quinta, CA 92253 Project Address: 78-845 La Palma Attn: Kay Plan Check #: Submittal: ❑ 1St ❑ 2nd ❑ 3rd 11-621 ® 4th ❑ 5th ❑ Other: We are forwarding: ® By Messenger ❑ By Mail (Fed Ex or UPS) ❑ Your Pickup Includes: # Of Descriptions: Includes: # Of Descriptions: Copies: Copies: ❑ Structural Plans ® 1 Revised Structural Plans ❑ Structural Calculations ® 1 Revised Struct. Calcs ❑ Truss Calculations ❑ Revised Truss ❑ Soils Report ❑ Revised Soils Report ® 1 Structural Comment List ❑ Approved Structural Plans ® 3 Redlined Structural Plans ❑ Approved Structural Calcs ® 3 Redlined Structural Calcs ❑ Approved Truss Calcs ❑ Redlined Truss Calcs ❑ Approved Soils Report ❑ Redlined Soils Reports ❑ Other: Comments: Structural content is approvable. ! CEIVED NQV 14 '1011 This Material Sent f -or: ❑ Your Files ❑ Your Review ❑ Checking Other: ❑ By: John W. Thompson Rancho Mirage Office: ® (760) 834-8860 Other: ❑ ® Per Your Request ❑ Approval ❑ At the request of: