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10-1097 (RER).P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 10-00001097 Property Address: 51725 AVENIDA DIAZ APN: 773-114-012-4 -000000- Application description: REMODEL - RESIDENTIAL Property Zoning: COVE RESIDENTIAL Application valuation: 1000 c&ht 4 4 a" Applicant: Architect or Engineer: BUILDING & SAFETY DEPARTMENT BUILDING PERMIT LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License Class: License No.: Date: Contractor: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to _ construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: (_) I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). ( J) 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 _ 1 I am exempt under Sec. , B.&P.C. forVs reason Date: Owner: / CONSTRUCTION LENDING AGENCY 1 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: LQPERMIT Owner: JOHNSON BRIAN 51725 AVENIDA DIAZ LA QUINTA, CA 92253 ( Contractor: Owner . VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 10/25/10 D � � OCT 25 2010 Il . CITY OF !-A QWNVA WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. _ I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier - - - - - - - - - - - - - --- - -- - -- - Policy Number _ I certify that, in the performance ofth ork for which this permit is issued, I shall not employ any person in any manner so as to be me subject to the workers' compensation laws of California, and agree that, if I shou b cc subject to the workers' compensation provisions of Section .3.7700 of the Labor Co I orthwith comply with those provisions. Date:/G1//O Applicant: WARNING: FAI`LIUURE TOS KERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS 15100,0001. IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application. 1 . Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application, the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that 1 have read this application and stale that the above inf ation is correct. I agree to comply with all city and county ordinances and state laws relating to building cons ction, and hereby authorize representatives of thiscou ty toe ter upon the above-mentioned property r n action purposes. Date: /6 ZS �Q Signature (Applicant or Agent)' Application Number . . . . . 10-00001097 Permit . . . BUILDING PERMIT Additional desc . Permit Fee . . . . 25.00 Plan Check Fee 16.25 Issue Date Valuation . . . . 1000 Expiration Date 4/23/11 Qty Unit Charge Per Extension BASE FEE 15.00 5.00 2.0000 HND BLDG 501-2,000 10.00 ---------------------------------------------------------------------------- Special Notes and Comments RE -MODEL WINDOW REPLACEMENT SIX WINDOWS PER APPROVED PLAN. ---------------------------------------------------------------------------- Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 ENERGY REVIEW FEE 1.63 Fee summary ----------------- Charged Paid Credited ---------------------------------------- Due Permit Fee Total 25.00 .00 .00 25.00 Plan Check Total 16.25 .00 .00 16.25 Other Fee Total 2.63 .00 .00 2.63 Grand Total -43.88 .00 .00 43:88 LQPERAIIT Prescriptive Certificate of Compliance: Residential CF -IR -ALT Residenthd Alterations e I of ProJect Name: ClimateZone * M of Stories ,S'/ 7Z� A -u Cu ,� , k z 1 General Information Site A ,Z v �� J4 Enforceme t ncy: Date: Building Type IN Single Family O Multi Family Circle the Front Orientation: N, W, or degrxs Conditioned Floor Area (CFA): Project Type: Ad Alterations (3 elope O Fenestration 13 Root O HVAC Env B I C I D I E Replacement or Change Out 0 Dud ROVIACCUICUt 13 Water Heater - : iitb; ort►t it niit'foTe diseafor New Co»strrrded Buildings ar Additions Insulation Values For Opaque Surfaces (for Fuming use the Mass and Furring Strips Construction table below) Assembly Alteration O Opening of framed cavity alone - Alterations that involve the opening of the framed cavity of a wall, ceiling, or floor must install the nrasrdatory m&UMun insulation value per §130 for dw altered assembly. Fill in Columns A -C and eater mandatory insulation valw in Cal~ H. G Replacement of entire assesably - Replacement of an entire wall, celilrt& or floor assembly regt&a die hQtallatt w of Compone"i Package- D insulation vOua in Table 15 1-C. Fill in Columns A - J. Opaque Surface Deta is For the furred pardoned of Mass Walls see Furring Strips Construe0on Table below. A B I C D E F I G I f3 I I. I J ProStandard Valu= From JA4 Table Framing Tbidmess, Framed Contihuous 1A4 Pcoposod T Assembly Name Material Spacing, U- JA4 Table Cavity Insulation Assmtmbiy Assemblx IDaq or T l and Sues or Othe? factor Numbers R -value° R -Value Cell Valuo� U•factoe Nae: For fiord assemblies, amvvm* mg)or Conran uom Insulation R -valve, see Page JAI -3 and F4xadon 4-1. For caladatfng f_*d walb xse die AJara and Furring Coaosawion table below. 1. For ToOD indicate the identification name that matches the building plans. 2. Indicate the Assembly None or type: Roof)Cei1M Walls, Floors, Slabs, Crawl Space, Doors and etc ... Indicate the Frame type and Size: For Wood Metal, Metal Buildings, Mass, enter 2x4, 2x6, or etc... see JA4 for other possible frame type assemblies. 3. Enter the thiabvess for mars in inches or Spacing between frwning members enter. 16 "or 24 "OC; or Other for all other assembly desrxlp"on such as Concrete Sandwich Panel, Soandb+el Panel, Logs, Straw Bale Panel and etc.... 4. Based on the Climate Zone: enter the Standard 11factor from Table 15 I -B, C or D for each different ascan* Nanus or type. S. Enter the Table number rivet closely resembles the proposed assembly. 6. Enter the R -value that is being installed in the wall cavity or between tide framing; otherwise. enter 1.0" 7. Enter the Continuous Insulation R -value for the proposed assembly; otherwise, enter "0 ". 8. Enter the row and column of the U factor value based on Column F Table Number and enter the Assembly U factor in Column J 9. The Proposed Assembly U factor, Column A must be equal to or less than the Standard U factor in Column E to comply. F S!j4 Construction Table -for Mass Walls Only A I B I C I D I E F I G I H I J K I• M Proposed Properties of Masonry and Concrete Added Interior or Exterior Insulation Walls From Reference in Furring Space from Reference Joint A ppendix Table 4.3.5 43.6 43.7 Joint Appendix Table 4.3.13 U. Assembly j ` ' $ Z KI 2 Final Mass Thickness Name or JA4 Table _ T Numbers < > t o re S Q < > Assembl t U•factor� Comment Registration Number: Registration DamTime: 2008 Residential Compliance Forms HERS Provider: August 200 Mass and Furring Construction(footnotes) 1. indicate the type of assembly to include: Hollow Unit Masonry Walls, Solid Unit Masonry, Solid Concrete Walls. Etc. Additional assemblies can found Reference Joint Appendix J44. 2. This is the U -Factor based on the thickness of the assembly in inches. 3. The R -value of the insulation to be added on the interior or exterior of the assembly. I. The Calculated R- Value is the R -value of the furred out section of the assembly. -6. The Final Assembly is calculated using Equation 4-2 or Equation 4-4of the Reference Joint Appendix JA4. The equation is the inverse of Column -added-to, Column I Column-K-isthe inverse from column J. 7. Insert the calculated U factor value on to the Ooaaue Surface Details in Column J FENESTRATION PROPOSED AREAS 0 Replacing window alone — Replacement windows shall meet the U -Factor and SHGC Venue requirements O'Component Package D in Table ISI -C. 77te Total Fenestration and West facing Area requirements are not applicable - 0 Adding 502 or less ofwindow area —.Newly installed windows shall meet the U -Factor and SHGC Value requirements of Component Package D in Table 151-C 0 Adding more than SOW of window area — Newly installed windows shall et the U -Factor and SHGC Value and the Fenestration Area requirements of Component Package D in Tme able 131-0. Complete the Altered Fenestration Aflowed Area Table. on Page 2 of the CF -IR -ALT Orientation Fenestration Type and Frame (North, East, PropsodArea' Maximum Maximum NFRC or Default window, Glass Door or S I' Sou WPM Me) U-factorl. I SHGC13' ` Values 66 0. -30 0,Z 0 6.2 3 IV �iL C t„�cNalev r 6 r O O tU .1,t�s7 22 3 Z3 ry FIXL L Fenestration area.is the area of iotat glazed product (i.e. glass plus frame). Exception: When a door is less than 50% glass. the fenestration area may be the glass area plus a -2 inch frame " around the glass. 2. Enter value from Component Package D Requirements in Table 151-C. 3. Actual fenestration products installed and as indicated in CF -6R -ENV Form shall be equivalent to or have a lower U factor andlor a lower SHGC value than that specified on the CF -1 R ALT Form. 4. Submit a completed WS -3R Form if a reduced SHGC is calculated with exterior shading. SJ licable at this stage enter "NFRC" or NFRC Certified windows or are CEC "Default "values ourui in Table 116-A or B. ALTERED FENESTRATION ALLOWED AREAS (Co de I nwre than Soft, o enearadon is added) A B C D E F G Allowed . Existing Fenestration Total Arca CFA of Entire % of Fenestration Area Fenestration Allowed Proposed Arei DwellinR CFA Area Removed Area Added (E -D) + C Total Fenestration Area � .20 — 'West Fenestration Area (Required In .05 CZ's 2,4&7-15 I. West Fenestration Area includes west -sloping skylights and any skylights with a pitch less than 1:12. 2. West facing glazing area removed cannot be -counted" twice. " In order to distribute the west glazing area removed to the other orientations input the west glazing area removed in the Total Fenestration Area raw, column D. 3. Include the Proposed Area of the West facing fenestration in both Area columns below. 4. To meet compliance, the Proposed Area must be less than orequal to the Total Allowed Area or BOTH the Total and West Fenestration Are( Registration Number: Registration Date?ime: HERS Provider: 2008 Residential Compliance Forms August 2 PresHpdve Certificate of Compliance: Residential CF -IR -ALT Residential Alterations age 5 of 5 Project Name: Climate Zone tf # of Stories 'Fl -725 ►-VG,,,bA e AZ HERS VERIFICATION SUMMARY The enforcement agency should pay special attention to the HERS Measures specified in this checklist below. A completed and signed CF -4R Form for all the measures specified shall be submitted to the building inspector before final inspection Duct Sealing & Testing HERS verification is required for this measure. 13 YES 0 NO YES: In Climate Zones 2 and 9-16, if more than 40 linear feet of new or replacement ducts are installed in unconditioned s _we_, ft_dmas. are to be sWcd per.§.152(b)1 DR and.the newly installed_ducts.are to.be insuulatcd-mr 05401.0 13 EXCEPTION: Existing duct systems that are extended, which are constructed, insulated or sealed with asbestos, 13 YES O NO YES: In Climate Zones 2 and 9-16, if the existing space -conditioning system (HVAC equipment and ducting) is replaced, the ducts are to be sealed per §I52(b)IDi. ❑ YES 0 NO YES: In Climate Zones 2 and 9-16, if the existing HVAC equipment is replaced (including the replacement of the air handler, outdoor condensing unit of a split system, cooling or heating coil, or the furnace heat exchanger) the ducts are to be sealed per § 152(b)l E. 17 EXCEPTION: Duct systems that are documented to have been previously sealed confirmed through HERS verification in accordance with procedures in the Reference Residential Appendix RA3. E3 EXCEPTION: Duct systems with less than 40 linear feet in unconditioned space. O EXCEPTION: Existing duct systems constructed, insulated or sealed with asbestos. Refrigerant Charge - Split System HERS verification is required for this measure. LTYES O NO YES: in Climate Zones 2 and 8-15, when the existing HVAC equipment is replaced (including the replacement of the air handler, outdoor condensing unit of a split system A/C or heat pump, cooling or heating coil, or the furnace heat exchanger) a refrigerant charge neeasumnemt shall be verified tS tF. Central Fan Integrated (CF1) Ventilation System and Fan Watt Draw The ventilation requirements of § I 50(o) do not apply to existing residential homers. Ducted Split Systems - Air Conditioners and Hatt Pumps: Airflow HERS verification is required for this measure. 13 YES 0 NO YES: In Climate Zones 10 through 15, when the existing space -conditioning system (HVAC equipment and ducting) is laced, the airflow and fan wan draw shall be verified per § 15 b lCi to meet the requirements of § 151 7B. Documentation Author's Declaration Statement • I certify that this Certificate of Compliance documentation is accurate and corn Name Kms' l _ 1`� �- Signature: Company: Date: Address: If Applicable O CEA or O CEPE f 72 S P, %J C`U t ,>4, I. *Z (Certification fl: City/Star�- telZip: Phon � ��- `�zZ�3 e: Responsible Building Designer's Declaration Statement • I am.eligible under Division 3 of the California Business and Professions Code to accept responsibility for the building design identified on this Certificate of Compliance. • 1 certify that the energy features and performance specifications for the building design identified on this Certificate of Compliance cwnforn to the requirements of Title 24, Parts l and 6 of the California Code of Regulations. • The building design features identified on this Certificate of Compliance are consistent with the information provided to document this building design on the other applicable compliance forms, worksheets, calculations, pl d specifications submitted to the enforcement agency, for aperoval with this building permit application. Name:, Signature - Company: Date: Address: License: City/State/Zip: Phone, For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800.772-1300. Registration Number: Registration DatelTime: HERS Provider: 2008 Residential Compliance Forms August .,p -mss 90� RI �yi W �� �� N�►g+�-r P.O. Box 1504 LA QUINTA, CALIFORNIA 92247-1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT PROPERTY, OVMEW S PACKAGE (7'60) 777-7012 FAX (760) 777-7011 Disclosures & Forms for Owner -Builders Applying for Construction Permits MWMTANTr NOWE TO )i'ROVERTY QVRWR. Dear Property Owner. An. application for a building permit has been submitted in your name listing yourself as the buildef of the .property improvements specified at 99 ' 7' _ j% %.-0P% 1),—Z We are providing you with an Owner -Builder Acknowledgment and informati©n Verification Form to make you aware.of your responsibilities and possible risk you may incur by having this permittissued in your name as the Owner -Builder. We will not Issue a building permit until you•have read, initialed your understanding of each'provUlon, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute thi&.,notice unless you, the property owner, obtain the prior approval of the permitting authority. OVA'S ACflMM%EVQW NTNVT�CTION O�OONI� fllll'EETI-OIVS: Dead and irrrittiat eachhstatement below Ed signify you understand orverify this information. ]61. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder" building permit that erroneously implies 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 my property. PT2. 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. 13. 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. 'VI- 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. r 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. 6. I .understand if I am considered an "employer" under state and federal 1aw, 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 ► 7. I 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 personat b mries sued by any subsequent owner(s) that result from any latent construction defects in the . workmanship or materials. ' 9. I understand I may obtain more information regarding my obligations as an "employee" front the uftroat PIekenue Service, the United States Small Business Administration, the California Depactrnent of Benefit P.aymet9s, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State I-icense Board (CSI -B) at I- 8 f021-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. ` 10. I am aware of and consent to an,Owner-Budder building permit applied for in my name, and understand that I am the Party legally. and >inancialty-- �spo=Me €or proposed construction activity at the following address: 1.l I agree that, as the party. legally and financially responsible for this proposed construction activity, I will abide by all pticabie laws and teg�irentents that govern Owner -Builders as well at employes. f12.1 agree to notify the issuer of this form immediately of any additions, dele 0M,.br• c68*s to any of the informa&n I ave provided on this form Licensed contractors are regulated by taws designed to protect the public. If you contract with -someone who does not have a Bowser dw Contractors' State License Board may be unable to. MSM You with any financial loss you may sustain as a result of a complaint. Your only remedy; against unlicensed Contractors may be inn' ivil court It is also tiMportant foryouto understand that if w unhoensed.C©ntractor or employee of that individuater firm is Owed wbile working on your property, you may .be � liable for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible for veri�ring add os moi those Contractors are properly flcensed and the status of thou woftcers' eomtion 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 issu ; ths..Vw=t . NoW A copy of dre propeny owiw.'a dWv&'m ei farad s or other verification aeceptaMe to the ag; is.regUAW to be piwgnted when. (fila pg �' xerify ' owner's signature. ' Signature of property. owner Date. Note: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner toapply fox a construction permit for the Owner -Builder. AiTFRORMATION OF AGLNTTO ACT ONTROPERTY S BOUIX E7wluding.the Notice to Property,. Owner, the eaewtion of which I understand is my personal rMponsibihty, I hereby authorize the following person(sy to act as my agent(s). to apply for, sign;. and file the documents necessarj .to 4bttairiit an O.wnet-Builder Permit 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 of perjury that I am the property owner for the address listed above and.1 personally filled out the above information and certify its accuracy. Note: A copy of the owner's driver's ticense, foam no'tariaation,.or other verification acceptable=to the agency is required w be presented when the permit is issued to verify the property owner's signature.. Property Owner's Signature: Date: Bin # Qty Of La Quient Building 8r Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-70-12 Permit Application and Tracking Sheet Permit # TBuilding Project Address: 7Z <� A V Eu . 4)r q Owner's Name: F i ja-" Sc1t�J A. P. Number: Address: 5-1 72'5 6VCLt w �tia2 Legal Description: City, ST, Zip: (� Q7W C(4 ZZ� Contractor: Tel hone: 'y Project Description: w , #j jiLNO 'E u4Cc Address: City, ST, Zip: 1 �, , L Gtr ' Telephone: i J OI., State Lie. # : City Lie. #: Arch., Engr., Designer Address: City., ST, Zip: Telephone: �„\ �'/q�;•v Construction Type: Occupancy: Project type (circle one): New Add'n Alter Repair Demo State Lie. #:rl� , fi .. Name of Contact Person: Sq. Ft.: J # Stories: # Units: 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 Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Cates. Called Contact Person Plan Check Balance Title 24 Cates. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 20° Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.1. H.O.A. Approval Pians resubmitted Grading IN HOUSE:- ''d Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.LP.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees