11-1331 (RER)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
TAh '4Q
t4
Application Number: 11-00001331
Property Address: 52570 AVENIDA DIAZ
APN: 773-282-004-20 -000000-
Application description: REMODEL - RESIDENTIAL
Property Zoning: COVE RESIDENTIAL
Application valuation: 500
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 and Professionals Code, and my License is in full force and effect.
Licensee Class: B License No.: 766896
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).:
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.).
(_ 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.).
(_) 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:
LQPERMIT
Owner:
NOREEN SILVERMAN
52570 AVENIDA DIAZ
LA QUINTA, CA 92253
Contractor:
PIKE BUILDERS/DEVELOPMNT,
77305 MINNESOTA AVENUE
PALM DESERT, CA 92211
(760)851-9998
Lic. No.: 766896
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 12/15/11
-----------------------------------------------
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 whicNthis 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 NORGUARD INS CO Policy Number MIWC236194
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 workers' compensation provisions of Section
3700 of the Labor Code, I shall fort—h�ith�with those provisions.
Date: �� `(Applicant: f
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($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.
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, indemnity 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. 1 agree to comply with all
city and county ordinances and state laws relating to building construction, and ereby authorize representatives
of this county to enter upon the above-mentioned property for inspec
'Date: �t Signature (Applicant or Agent):
Application Number . . . . . 11-00001331
Permit . . . BUILDING PERMIT INV FEE
Additional desc .
Permit Fee . . . . 30.00 Plan Check Fee
9.75
Issue Date . . . . Valuation . . .
. 500
Expiration Date 6/12/12
Qty. Unit Charge Per
Extension
BASE FEE
30.00
---------------------------------- -----------------------------------------
Special Notes and Comments
REPLACE (2) 6' X 6' SLIDING GLASS DOORS
2010 CODES. INVESTIGATION FEE ASSESSED
PER 1997 UNIFORM ADMINISTRATIVE CODE
§304.5 FOR WORK BEGUN WITHOUT BUILDING.
PERMIT.
-----------------------------------------------------------------------=----
.Other Fees . . . . BLDG STDS ADMIN (SB1473)
1.00
ENERGY REVIEW FEE
.98
Fee summary Charged Paid Credited
---------------------------•------------------------------
Due
Permit Fee Total 30.00 .00 00
30.00
Plan Check Total 9.75 .00 .00
9.75
Other Fee Total 1.98 .00 .00
1.98
Grand Total 41.73 .00 .00
41.73
LQPERMIT
i
Prescriptive Certificate of Compliance: Residential
Residential Alterations
Project Name:
CF -IR -ALT
(Page I'd
Climate Zone N I N of Stories
General Information
Site Address: Enforcement Agency: Date:
Building Type ❑ Single Family O Multi Family Circle the Front Orientation: N, E, S, W. or degrees
Conditioned Floor Area (CFA): Project Type: O Alterations O Envelope O Fenestration O Roof O HVAC
Rcp1amment. or Change Out ❑ Duct Re laeement ❑ Water Hater
NQTF: lWis form is not to be used for Newly Constructed BmUdIIInp or Ad&fions.
insulation Values For Opaque Surfaces (for Furring use the Mass and Furring Strips Construction table below)
Assembly Alteratioa
O Opening of framed cavity slant - Alterations that involve the opening of the framed cavity of a wall, ceiling, or floor must install the
mandatory minimum insulation value per §150 for the altered assembly. Fill in Columns A -C and enter mandatory insulation value in Column H.
O Replacement of entire assembly - Replacement of an entire wall, ceiling, or floor assembly requires the installation of Component
Package- D insulation values in Table 151-C. Fill in Columns A - J.
Opaq ue• Surface Details For the furred artioned of Mass Walls we Furring Strips Construction Table below.
A BE D E F G H I J
Pro Standard Values From JA4 able
Framing Thicirness, Framed C mtinuous lA4 Proposed
Tap Assembly Name Material I Spacing, .U_ JA4 Tabk I avity Insulation Assembly
iD I or Type' I and Size, or Other' factor Numbers R -value° R -Value' I Cell Value
Noir. For frond nsxmbliesaccounting for Continuous Insulation R -value, see Page JA4-1 and Equation 4-1. For ealadating cared Malls ase the Mars and
Farring Conurmion table below.
1. For Tag.'ID indicate the identification name that matches the building plans.
2. Indicate the Assembly Name or type: RooflCeiling, Walls, Floors, Slabs, Crawl Space, Doors and etc ... Indicate the Frame type and Size: For
Wood, .Ketal, Metal Buildings, Mass, enter 2x4, 2x6, or etc... see JA for other possible frame type assemblies.
3. Fitter the thicbhess for mass in inches or Spacing between framing members enter: 16 "or 24 "OC: or Other for all other assembly description
such as Concrete Sandwich Panel, Spans el Panel, Logs, Straw Bale Panel and etc....
4. Based on the Climate Zone: enter the Standard U factor from Table 151-8, C or D for each different assembly Name or type.
5. Enter the Table number that closely resembles the proposed assembly.
6. Enter the R -vale that is being installed in the wall cavity or between the framing; otherwise, enter
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 J, must be equal to or less than the Standard U factor in Column E to comply.
Furring Strips Construction Table for Mass Wails Oral
A B 1 C I D
E
F I G I H I J
K
L M
Proposed Properties of Masonry and Concrete
Added Interior or Exterior Insulation
Walls From Reference
in Furring Space from Reference
Joint A adix Table 4.3. 4.3.6 4.3.7
Joint Appendix Tabk 43.13
Assembly
j
Q c F' o i'a�
%A
' s3
a
Final
Assembld'
Mass Name or JA4 Table a
'
E $ w
x L° 0 ' < >
U-factor6'T Comment
Thickrkss' T Number' < >
Registration Number:
2008 Residential Compliance Forms
Registration Date.Time:
HERS Provider:
August 200
Mass anAFurrinStns Construction ootnoles
1. indicate the type of assembly to include: Hollow ('nit ,Nasonn, Walls, Solid Unit MasonrY. Solid Concrete Walls, Etc. Additional assemblies can
befound Reference Joint Appendix JA4.
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.
4. The Calculated R -t alue 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 1. Column K is the inverse from column J.
7. insert the calculated U factor value on to the Opaque Surface Details in Column J
FENESTRATION PROPOSED AREAS
Weplacing window alone — Replacement windows shall meet the U -Factor and SHGC Value requirements of Component Package D in
Table 151-C The Total Fenestration and West facing Area requirements are not applicable.
❑ Adding SORA or less of window area —Newly installed windows shall meet the U -Factor and SHGC Value requirements of Component
Package D in Table 151-C
❑ Adding more than SOW of window arts — .Newly installed windows shall meet the (Y -Factor and SHGC V alue and the Fenestration
Area requirements of Component Package D in Table 15 1 -C. Complete the Altered Fenestration Allowed Area Table on Page 2 of the CF -IR -ALT
Orientation
Fenestration Type and Frame (North. East. PropsedArea' Maximum Maximum NFRC or Default
window, Glass Door or Skylight) South, West) (ft) U-factorl 3 SHGC 3.4 values
SS o(l S SoNr�l , 3Z 31
1. Fenestration area is the area of total glazed product (i. e. glass plus frame). Exception: When a door is less than 50'0 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-ENVForm shall be equivalent to or have a lower r,, factor and/or a lower
SHGC value than that specified on the CF- I R ALT Form.
d. Submit a completed WS -3R Form if a reduced SHGC is calculated with exterior shading.
5.ffapplicable at this stage enter "NFRC" or NFRC Certified windows or are CEC ,Default " valuesfound inlable / 16-A or B.
ALTERED FENESTRATION ALLOWED AREAS (Comptete If more than 5W o enestr+adon Is added)
A
B C D E F G
Allowed Existing Fenestration Total Area
CFA of Entire
% of Fenestration Area Fenestration Allowed Proposed Area
Dwelling
CFA Area Removed Area Added A x B) (E -D) + C
Total Fenestration Area
20 —
West Fenestration Area
(Required In
.05
CZ's 2,4&7-15)
/. West Fenestration Area includes west -sloping skylights and any skylights with a pitch less than 1:12.
2. West facing glaring area removed cannot be "counted - twice. " 1n order to distribute the west gla=ing area removed to the other orientations
input the west glaring area removed in the Total Fenestration Area row, 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'Time: HERS Provider:
2008 Residential Compliance Forms August 2
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.
YES ❑ NO YES: In Climate Zones 2 and 9-16. if more than 40 linear feet of new or replacement ducts are installed in unconditioned
space. the ducts are to be sealed per § 152(b) I Dii and the newly installed ducts are to be insulated per §15 4010.
❑ EXCEPTION: Existing duct systems that are extended, which are constructed, insulated or seated with asbestos.
• YES ❑ 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 § 152(b) I Di.
❑ YES 17 NO YES: In ClimateZones 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)IE.
❑ 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.
❑ EXCEPTION: Duct systems with less than 40 linear feet in unconditioned space.
❑ EXCEPTION: Existing ducts stems constructed, insulated or sealed with asbestos.
Refrigerant Charge - Split System HERS verification is required for this measure.
E3 YES 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 mmurement shall be verified per § t 52(b) I F.
Central Fan Integrated (CFn Ventilation System and Fan Watt Draw
The ventilation requirements of § 15 o do not apply to existing residential homes.
Ducted Split Systems - Air Conditioners and Heat Pumps: Airflow HERS verification is required for this measure.
E YES 0 NO YES: In Climate Zones 10 through 15, when the existing space -conditioning system (HVAC equipment and ducting) is
replacedL the airflow and fan watt draw shall be verified per § 152 b ICi to meet the requirements of § 151 7B.
Documentation Author's Declaration Statement
• 1 certify that this Certificate of Compliance documentation is accurate and complete.
Name:
Company: H, /� n �� / S Date: `
19
Address:, If Applicable ❑ CEA or ❑ CEPE
77 3 Z 7 #
14 rh-A1-,v ,o- — (Certification ):
City/S te/Zip: Phone:
2A.e- t z��Sa-7LT I Com- 7 2.2.
Responsible Building Designer's Declaration Statement
• 1 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 conform
to the requirements of Title 24. Parts I 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, plans and specifications submitted to the enforcement
enc • for approval 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: 1-800-772-3300.
Registration Number: _ Registration Date -Time: HERS Provider:
2008 Residential Compliance Forms August
Bin # '
City of La Quints
Building 8t Sarety Division
P.O. Box 1504, 78-495 Calle Tampico
!.a Quinta, CA 92253 - (760) 777-7012 '
Building Permit Application and Tracking Sheet
Permit #
Project Address: Sot S'70 &sv,„4- —0i A-1-7— .
Owner's Name:
A. P. Number: �.
Ad4ress: S 2S 70 4vs� ,9,t A -7 -
Legal Description: Sr,l,� /Q ,tiG do C /✓
; ST, Zip: �A Q,� i
z::ICityv j
Contiactor•
Address: %73�� irf(yJ,/s�jT{} �t/�
Project Description:
City, ST, Zip: %✓�'L�� QSS dl2.r ZZ U
�.l;;..
Tele hone % O.. s.. ;
o
2) 6 SL/Dw G
State Lie. # :9746 $ q i
City Lie.
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:ti
�`ax::.::.'���q,• ��...• • .� �;.�
State Lie. #a+z'U::L• Nw9;41T
>�f” } '' ``�"
Name of Contact Person:
Conshvction Type: an
type(circle
circle one): New Add'n Alter Repair Demo
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project: $—c7 -
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKNG
PERMIT FEES
Plan Sets
Pian Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Cheek Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Cafes.
Plans picked up
Construction
Floodplain plan P P
Plans resubmitted
Mechanical
Grading plan
2' Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
1r4 Review, ready for corrections/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