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09-0960 (RER)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 09-00000960; Property Address: 53065 AVENIDA VILLA APN: 774-063-025-5 -000000- Application description: REMODEL - RESIDENTIAL Property Zoning: COVE RESIDENTIAL Application valuation: 2000 Tityl " BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Applicant: Architect or Engineer: 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).: ( .011 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.). (_ I I, as owner of the property, am exclusively contracting with licensed contractors to construct the project ISec. 70.1.1, 9-i—r, :,nn 9r9f499ionv :adoi The Cantraatwa' Gist„ Li..,,.,. Lu,, Jug:., iwr apply ru an uwnet of property who builds or improves thereon, and who contracts for the projects with a contractorls) licensed pursuant to the Contractors' State License Law.). (_) I am exempt under Sec. , B.&P.C. for this reason Date:_ i K -Owner: CONSTRUCTION LENDING AGENC #-- 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: HURWITZ,SHARON 300 ARROYO SALADO SANTA FE, NM 87501 (505)603-1963 Contractor: Owner VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 SEP 0 71009 QUI A Date: 9/08/09 WORKER'S COMPENSATION DECLARATION I hereby affjvffi 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 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 377n00 of the Labor Code, I shall forthwith mply with those provisions. Date: t/ Applicant: 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 LUnunwns ar1U 1eSUIC1101% set form on tnls applittt16h. 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 construction, and hereby authorize representatives of this Gcounty to enter upon the above-mentioned property for inspection purposes. _ Dater Signature (Applicant or Agent)' Application Number . . . . . 09-00000960 Permit . . . BUILDING PERMIT Additional desc . . Permit Fee . . . . 45.00 Plan Check Fee 29.25 Issue Date . . . . Valuation . . . . 2000 Expiration Date . . 3/07/10 Qty Unit Charge Per Extension BASE FEE 15.00 15.00 2.0000 HND BLDG 501-2,000 30.00 ---------------------------------------------------------------------------- Special Notes and Comments REMODEL WINDOW & DOOR REPLACEMENT (6)WINDOWS & (3)DOORS SAME FOR SAME. APROVED G.B. ---------------------------------------------------------------------------- Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 1:00 ENERGY REVIEW FEE 2.93 Fee summary Charged --------------------------- Paid Credited ------------------------------ Due Permit Fee Total 45.00 .00 .00 45.00 Plan Check Total 29.25 .00 .00 29.25 Other Fee Total 3.93 .00 .00 3.93 Grand Total 78.18 .00 .00 78.18 LQPERMIT Bin # Qty of La Q uin to Building &r Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Trackirg Sheet Permit # n, "V Project Address:'2 57 to,A 1%1 L`,� Owner's Name: A. P. Number: Address: -% b0 4(z tQv ^v -rA L -AC) o Legal Description: "Contractor:' S L• CCi h, ST Zip: C Tel e. eP , � h n o 3 4 (4 l0 Address: Project Description: I -)/,/\j D o'L ••` • 1�o�.eJ C/Z E LA -GE mE;' City, ST, Zip: ;.v 1 n .� Z>0 o OLS Telephone: P �"YYi �1!Y✓l I 2 State Lic. # : City Lic. Arch., Engr., Designer: Address: City, ST, Zip: Telephone: �':• State Lic. Name of Contact Person: Construction ton TY e: Occupancy: P Occu Y• Project t type (circle one): New ACd' n Alter Repair Demo Sq. Ft.: # Stories: # Units: Telephone # of Contact Person:`Estimated Value of Project: pa O , n V 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 Calcs. Called Contact Person Plan Check Balance Title 24 Calcs. Plans picked up Construation Flood plain plan Plans resubmitted Mechank:al Grading plan 2°d Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbin.; Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading fN HOUSE:- '"' Review, ready for correctionsrssue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees w K a ac.� �, c rb � � G t� U « W �I RU�fLDtNOG � SA !NTA DEPT. APPROVED LEOR 'ONSTRUCTION q 13YZ �k '3 G t� U « Cl.--Ill-IFICATI---Ol�-COM13L[ANCE: RESIDENTIAL (Page2ol'4) CF -IR (,J1t1CrvA) DOM E jO L -,A- 6 Ex) i—$ -0`t Proiccl hile Date S-30bS- Avon jo� LJjt.LA . r�l,�JION �PROI�WCT,--(� SI -1(.0 S FA -FACTOR AND ✓ I ,_\1,'STRAT10\ VNM[ A-1 ALLOWF-DAREA WORKSHI-El-\\'S-41Z must be included for \c\\ Construction. \ddillolle and Allerntioll'. 1:�:flcstrm loll 17 -xiefikil ricAl- ST-Ickee Shadinu.O .\ 1:111011. . SHCIC hos ll'\\'S-.,R is Sk.\ S. U-taclor i Source: SFIGIC Sohl -CC i included AL 0 s I- i de f_zj_ OT_ 0 !3 0 13o)06 -t-35- -3 5�H C1 3 Iii-.11ts are ii,i\% included in C.I-faciau. 1'elicstration area li'Illi' skyli2iltS are Idled 10 the \%CM or tilted ill direction hell 111C pitch is ICSS than 1:1_. See § 15 1(1:)3(' and in Section 1.2.3, of the Residential N-lamial clltles in Illi: cokillill are either NFRC Rated value or I'l-om Standards default Table 1 16A. source either from \FRC orTable 1 16A. Table I 16B kirad adjusted SHG -C From \VS -',R. �lllles ill 111i" column fromNFRC (it- from SIMIdOl-CIS DQfAIII I jlj(jl,:.11e source either I'l-om \FRC or -I 11613. S11.11dill'-, DC\ ice., are defined in T:ihle ', in the Residential Mantial and see \\*S-',IZ to calculate I:Ntel-iOl' Shadillu, de\ ices. See scciWmi .1.2-A in the Rcsiticnii,al Manual. W 30.*4F , .35 - Li 32- ?(8'0• 3 6, O.Tat L Ae)tA.- f I VAC SYSTEMS 1,\ Ile and C,1.lp:l,:i(\ 1 10 F1'1i,:icnc\ I 7__ T\ pc and Location I (ducts. 1111C. CIC DLICI or Ilipim Coil fil'u-m-al ioll I I * 1 '111 R -Valve T\ 1, t: sl Duel Location DLICI Thermostat Coll filu'llratioll pt: :111d Caplicil\ 17 fficiCllc\ Lu I i,pltl R.si(iemiai Compliance Forms \Ial-ch 200i CERTIFICATE OF COMPLIANCE: RESIDENTIAL w (-) i N P,9'u P 0 0/" 2 I-A-Cig: � 9F -la- r— Pk#O Tole 4-U-4-?tOA. AhLt^- q ProicclAddr AXd—� 3 ihmilmation Amlhor 1'elephone 1-hio 1'4) CF -IR BL111'1111_ 1'1�1;1 (-'hCCk Ojtc Field (Ateck 1);11C Compliance Method (Prcscriplive) Climme tole 1i111*or'xmcm ( 'C 1 )111% ✓ I Alternalikc Component Package Method: (check one) C. I.Alternali\C) Packa,-,e C and Packa---c 1) choices reclihm I MRS rater field verinGuion andwilia ycomic wstmg twe CK I R. page.") For Package DAWmake we Anmulix B KNe 15 KC Foonwws 7-14 GTNFRAL. INFORMATION 'I o1al CondiliOriCki Floor \rea (CFA) 1-1: \Iasiumm A11o\\ed " aq Facing FowsbAkWas Per We 154B or 1514- -- ON N CFAI ti \I:Ixinnnn :\Ilo\\e(I Total Fenestration Product. )'r] ahle 15 1 -11 or 151-C (-'0('., X ClAi.__ ✓ AW, Ty pa jheck one or more) SO& FamHy,,,, Vlulbfamil�_ WbOon , Xlteration Ofaddin--- lencsiratkn OH wo WS4R. Fenestration Maximm" AHmwd Area "hrkMwo and see Section 83.2 t6l- Additions I'(11-Alteralions.) Number ol'Siorics: (:nits: L Floor Construction 1-\ lie: Slah` \'aisP41-loor (circle one or both) From Orientation: th `Sou11, eq A H OrientraWs (Olmn lim orientation h"degrees hvm Tme \ord) and circle ones. V 0 RADI.A.'N"T 13ARI2LEll (required in climate zones'. 4. 8-15► OPAQUE -SURFACES IN"CLUDING. OPAQUE- DOORS Component I) PC (\\;III. 1-1001'. Slab Doors) I Frame T\ pc Ca\ it\ (Wood Insulalion 1 Or VILTII I R -Value I Assemhl\ L' - I'actor (661- I t C '111inuou'; wood. metal I�ISUIali0u* frame and R-\ WC 1 assemblies), I 10iin Appendi\ 1\ Itclerence I R-�ofltadiant Barrier i Location Comments 'I Installed I (;titic. gara'-'e. i Yes oi- No I ) Sz.-C Joint Appendi.\ IV it] Section IV.'. IV..) and IVA %Akh is We Wk Or the' 1:-SIC101 CAWL I -Actors can not exceed prescriptive value to sho" equivalence to Ito aluet Residential Compliance Forms WNUN5 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 LHEORTANT! 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 _ -Q0 6 S AV-evt (43A UC LL, A 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. OVM- ER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION DIRECTIONS: Read and initial each statement below to signify you understand or verify this information. 5 fL` 1. I 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. 2. I understand building permits are not required to be signed by property owners unless they are responsible for the constgrction and are not hiring a licensed Contractor to assume this responsibility. S— 11 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 understand Contractors ar c� rs e required by law to be licensed and bonded in California and to list then license numbers on permind contracts. 5. 1 understand if 1 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" and state and federal law. 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 A . I understand under California Contractors' StateLicense 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. V-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. 9. 1 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 (CS LB) at 1- 00800- 21-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. J� 10. I am aware of and consent to an. Own er-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: ��1 L I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all appl�ic tile'laws and requirements that govern Owner -Builders as well as employers. 12. 1 agree to notify the issuer of this form i of the information I g fy s o immediately of any additions; deletions, or changes to any 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,tthe.permit. Note: A copy of the property owner's driver'sKeense; 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. Signature of property owner Date: o 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 understandis my personal responsibility, 1 hereby authorize the following person(s) to act as. my agents) 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: 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 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 the permit is issued to verify the property owner's signature.. Property Owner's Signature: Date: `-brAL 4j & bbA Aj 415 A Ai 13 P /<E Pr- )r- vrsIne a3-°9 wcTZ A:�� APPROVED BY PLANNING DEPARTMENT • BY L DATE EXHIBIT Wood CASE NO. S