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0311-094 (RER)LICENSED CONTRACTOR 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 # ' Lic. Class Exp. Date 4537 B Hlor-�� 1 013iraC Dated ` Signature of Contra cto ; OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason: ( ) 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). ( ) I am exempt under Section , B&P.C. for this reason Date Signature'of Owner 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 & policy no. are: Carrier Po.pnFtlum l;I,noy Policy No. 8+1'ICN-149640.2 (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 I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code ,<I shall forthwith comply with 0ose provisions. / Date: <r1 f SIGH Applicant— Warning: pplicant 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 auttiorize`rebresentatives of this City to enter upon the above-mentioned properly for inspection purposes. Signature (Owner/Agent)W," A W(-6- Date b`( t - BUILDING PERMIT PERMIT# 0311-(YA1 $i8,CP72.#3i1 10 DATE VALUATION LOT TRACT { „�.. �•_ 4,� ! 2$11 � '' JOB SITE APN T' ADDRESS 762 23"2!0R .J OWNER 80-2f6, >i; QZMff.AG1 :f AQLWA USE OF PERMIT Rn31JMIAL RF14,01M.. CONTRACTOR / DESIGNER / ENGINEER BOB EtMR.1:3S C;O%IMUMON 79.920 FWrA.: VWE CA 92213 u-,Ql'JWA CA 92253 (760)773.7943 Cl, 3212 Tdi~>MIOCiWADDITION OF 933F TO 13r R.NOOK 1-'.12,!F,A. & 139 SF TO GUEST ROOM. 2001 GDC, CUSTOM C ONOTRUCTiC' N 232.00 SF X51MAIF-D COST OF CONS''�` UC110H 1814372.8+ 3?1MOT I WE iST31tTAU:€ Y CONST'AlUC:T10144 ;='R 101-000-41&-000 &-000 3198.00 PLAN GI• WX FEE 101-000-439-318 b-314 $1.66.48 MECHANICAL FEE 101-000-421-000 $19,50 f.1..f..CTR tCA1., ftLtg 101.000-420-000 $56.12 P Lum, 8IN0ItIl: 101.000.4.19-000 $24.00 sTRO140 MOTIOM FEE- RESID 101-000-241-000 $1.81 SM-MMAL CONMUCMON AND ?'LAN 0-13ECK I $465.91 1,9219 PRE -PAP.) FES $0.00 (� (r-,1 L " PER Irt FUS TRIN-1`1OW, $�5i 65-91 �Eg 042004 CITY OF LA Qt1iNTA ( RECEIPT`DTTE�y- r �'BY � IDATE5170 I INSPECT L/ OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade - ReturnAir Steel Combustion Air _ Roof Deck��s D� i Exhaust Fans O.K. to Wrap .pc / F.A.U. Framing / f 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 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 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 Low Voltage Wiring Fudures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final - Z7 g Z11 Utility Notice (Perm) e ;CEATIFICATE OF COMPLIANCE; RESIDENTIAL CGu�f Pro tTitle Prov TG 7��j�to Compliance Method (Package or Computer) Climate Zone 1 of 3) CF -1R Building Pennit # Plan Check / Date Field Check / Date GENERAL INFORMATION Total Conditioned Floor Area 921Z. ft' a� Average Ceiling Height: I C�' ft Conditioned Slab Floor Area ft Building Type:S�amily 'Addition (check one or more) Multi -Family Existing -Plus -Addition 0 Front Orientation: North /South East West / All Orientations 1 (input front orients on in degrees from True North and circle one) Number of Stories 1 Number of Dwelling Units: FI C oor onstruction Type. /Si�Ratsed Floor (circle one ur both) RADIANT BARRIER (required in climate zones 2.4.8-15) Required for this submittal! yes -/no L) BUILDING ENVELOPE INSULATION Component Type Frame Type wd = wood stl = steel Cavity Sheathing Total R- Insulation Insulation Value R -Value R -Value Assembly Location/Comments U -Factor (attic, garage, typical, etc.) Wall Wall Roof �. r Roof Floor I TA FloorDE Slab Ede r, ror orescnpnve comnttance, t otat .K-vatue ang as! insulation requirements for the Prescriptive Package. FENESTRATION awoog FOR DATE -2—a-1-2 BY Compliance Forms August 2001 A-2 J Area ry ,t Compliance Forms August 2001 A-2 J ry ,t `CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 2 of 3) CF -IR 11/12;�Os HVAC SYSTEMS Note: Input hydronic or combined hydronic data under Water Heating Systems, except Design Heating Load. Distribution Heating Equipment Minimum Type and Duct or Heat Pump Type (furnace, heat Efficiency Location Piping Thermostat Configuration Cooling Equipment Minimum Duct Heat Pump Type (air conditioner, Efficiency Location Duct Thermostat Configuration heat numn. evan. cooline) (SEER) (attic. etc.) R -Value Tvne (split or aackaec) SEALED DUCTS and TXVs (or Alternative Measures) 0 Sealed Ducts (all climate zones) (Installer testing and certification and HERS rater field verification required) 01 TXVs, readily accessible (climate zones 2 and 9-15 only) (installer testing and certification and HERS Rater or field verification required) ❑ Refrigerant Charge/Air Flow (climate zones 2 and 8-15 only) (Installer testing and certification and HERS Rater or field verification required) 4 ` OR 0 Alternative to Sealed Ducts and TXVs (see Package C or D Alternative Package Features for Project Climate Zone) Climate Zone Window SHGC Window U -Factor SEER I Heating WATER HEATING SYSTEMS Energy' External Rated' Tank Factor or Tank Water Heater Distribution Number Input (kW Capacity Recovery Standby' Insulation Type Type in System or Btu/hr) (gallons) Efficiency Loss (%) R-Value 50.000 1. For small gas storage water heaters (rated inputs of less than or equal to 75,000 Btu/hr), electric resistance, and heat pump water heaters, list Energy Factor. For large gas storage water heaters (rated input of greater than 75,000 Btu/hr), list Rated Input, Recovery Efficiency and Standby Loss. For instantaneous gas water heaters, list rated input and recovery efficiencies. SPECIAL FEATURES (add extra sheets if necessary). Package C and D: TXVs, Sealed Ducts, Radiant Barriers (see installation requirements for radiant barriers in Section 8.13 of the 2001 Residential Manual). Package C: thermal mass (thermal mass type, covering, thickness, and description). Compliance Forms August 2001 A-3 f =J CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 3 of 3) CF -1R Axx:>tVVKt COMPLIANCE STATEMENT it //7/03; This certificate of compliance lists the building features and performance specifications needed to comply with Title 24, Parts 1 and 6 of the California Code of Regulations, and the administrative regulations to implement them. This certificate has been signed by the individual with overall design responsibility. When this certificate of compliance is submitted for a single building plan to be built in multiple orientations, any shading feature that is varied is indicated in the Special Features/Remarks section. The undersigned recognize that compliance using duct sealing and TXVs requires installer testing and certification and field verification by an approved HERS rater. Designer or Owner (per Business and Professions Code) Name: ZEE�v Documentation Author Name: UVP,- P<7C Address:i w� Telephone:,i ,.. r/ 1 1111110 (date) I�signewtu Enforcement Agency Name: Title: Agency: Telephone: (signature; stamp) (date) Complianoe Forms August 2001 A-4 cti! MANDATORY MEASURES CHECKLIST: RESIDENTIAL (Page 1 of2) MF -1R Note: Lowrise residential buildings subject to the Standards must contain these measures regardless of the compliance approach used. Items marked with an asterisk (*) may be superseded by more stringent compliance requirements listed on the Certificate of Compliance. When this checklist is incorporated into the permit documents, the features noted shall be considered by all parties as minimum component performance specifications for the mandatory measures whether they are shown elsewhere in the documents or on this checklist only. Instructions: Check or initial applicable boxes when completed or enter N/A if not applicable. DESCRIPTION DESIGNER ENFORCEMENT . Building Envelope Measures: * §150(a): Minimum R-19 ceiling insulation. § I50(b): Loose fill insulation manufacturer's labeled R -Value. N * §150(c): Minimum R-13 wall insulation in wood framed walls or equivalent U -Factor in metal frame walls does not apply to exterior mass walls . V • §150(d): Minimum R-13 raised floor insulation in framed floors. §150(1) : Stab edge insulation - water absorption rate no greater than 0.3%, water vapor transmission rate no eater than 2.0perm/inch. §118: Insulation specified or installed meets insulation quality standards. Indicate type and form. §t I6-17: Fenestration Products, Exterior Doors, and InfiltrationtExfSltration Controls I. Doors and windows between conditioned and unconditioned spaces designed to limit air leakage. 2. Fenestration products. (except field -fabricated) have label with certified U -Factor, certified Solar Heat Gain Coefficient (SHGC), and infiltration certification, ✓ I 3. Exterior doors and windows weatherstripped; all joints and penetrations caulked and sealed. § 150(g): Vapor barriers mandatory in Climate Zones 14 and 16 only. § 150(f): Special infiltration barrier installed to comply with § 151 meets Commission quality standards. §00(c): installation of Fireplaces, Decorative Gas Appliances and Gas Logs. j 1. Masonry and factory -built fireplaces have: a. Closeable metal or glass door b. Outside air intake with damper and control c. Flue damper and control 2. No continuous burning lights NIA gas pilot allowed. Space Conditioning, Water Heating and Plumbing System Measures: §110+13: 113: HVAC equipment, water heaters, showerheads and faucets certified by the Conunission. § t50(h): Heating and/or cooling loads calculated in accordance with ASHRAE, SMACNA or ACCA. § 150(i): Setback thermostat on all applicable heating and/or cooling systems. §1506): Pipe and tank insulation L Storage gas water heaters rated with an Energy Factor less than 0.58 must be externally wrapped with insulation having an installed thermal resistance of R-12 or greater. 2. First 5 feet of pipes closest to water heater tank, non -recirculating systems, insulated (R-4 or greater) 3. Back-up tanks for solar system, unfired storage tanks, or other indirect hat water tanks have R-12 external insulation or R-16 combined internal/external insulation. 4. All buried or exposed piping insulated in recirculating sections of hot water systems. 5. Cooling system piping below 55° F insulated. 6. Piping insulated between heating source and indirect hot water tank, Compliance Forms August 2001 A-5 f MANDATORY MEASURES CHECKLIST: RESIDENTIAL (Page i of 2) MF -1R Note: Lowrise residential buildings subject to the Standards must contain these measures regardless of the compliance approach used. Items marked with an asterisk (') may be superseded by more stringent compliance requirements listed on the Certificate of Compliance. When this checklist is incorporated into the permit documents, the features noted shall be considered by all parties as minimum component performance specifications for the mandatory measures whether they are shown elsewhere in the documents or on this checklist only. Instructions: Check or initial applicable boxes when completed or enter N/A if not applicable. DESCRIPTION DESIGNER ENFORCEMENT Space Conditioning, Water Heating and Plumbing System Measures: (continued) §I50(m): Ducts and Fans I . All ducts and plenums installed, sealed and insulated to meet the requirement of the 1998 CMC Sections 601, 603, 604, and Standard 6-3; ducts insulated to a minimum installed level ofR-4.2 or enclosed entirely in conditioned space. Openings shall be sealed with mastic, tape, aerosol sealant, or other duct -closure system that meets the applicable requirements of UL 181, UL 181 A. or UL 181 B. If mastic or tape is used to scat openings greater than 1/4 inch, the combination of mastic and either mesh or tape shall be used. Building cavities shall not be used for conveying conditioned air. Joints and seams of duct systems and their components shall not be sealed with cloth back rubber adhesive duct tapes unless such tape is used in combination with mastic and drawbands. 2. Building cavities, support platforms for air handlers, and plenums defined or constructed with materials other than sealed sheet metal, duct board or flexible duct shall not be used for conveying conditioned air. Building cavities and support platforms may contain ducts. Ducts installed in cavities and support platforms shall not be compressed to cause reductions in the cross-sectional ams of the ducts. 3. Joints and seams of duct systems and their components shall not be sealed with cloth back tubber adhesive duct tapes unless such tape is used in combination with mastic and drawbands. 4. Exhaust fan systems have back draft or automatic dampers. 5. Gravity ventilating systems serving conditioned space have either automatic or readily accessible, . manually operated dampers. 6. Protection of Insulation. Insulation shall be protected from damage, including that due to sunlight, moisture, equipment maintenance, and wind but not limited to the following: Insulation exposed to weather shall be suitable for outdoor service e.g., protected by aluminum, sheet metal, painted canvas, C ` or plastic cover. Cellular foam insulation shall be protected as above or painted with a coating that is I l� water retardant and provides shielding from solar radiation that can cause degradation of the material. §114: Pool and Spa Heating Systems and Equipment. 1. System is certified with 78% thermal efficiency, on-off switch, weatherproof operating instructions, no . electric resistance heating and no pilot light. 2. System is installed with: a. At least 36" of pipe between filter and heater for future solar heating. b. Cover for outdoor pools or outdoor spas. 3. Pool system has directional inlets and a circulation pump time switch. § 115: Gas fired central furnaces, pool beaters, spa heaters or household cooking appliances have no j k continuously burning pilot light. (Exception: Non -electrical cooking appliances with pilot < 150 Btu/h')�4 Y' §118(f): Cool Roof material meet specified criteria Lighting Measures: �T §150(k)l.: Luminaires for general lighting in kitchens shall have lamps with an efficacy of 401umens/watt or greater for general lighting in kitchens. Tbis general lighting shall be controlled by a switch on a readily accessible lighting control panel at an entrance to the kitchen. § 150(k)2.: Rooms with a shower or bathtub must have either at least one luminaire with lamps with an efficacy of 40 lumens/watt or greater switched at the entrance to the room or one of the alternatives to this / requirement allowed in § I50(k)2.; and incandescent recessed ceiling fixtures are IC (insulation cover) approved. Compliance Forms August 2001 A-6 .,- REGISTERED INSPECTOR'S WEEKLY REPORT JON TANDY 78-194 Elenbrook Ct. Palm Desert, CA 92211 Office (760) 772-7192 Fax (760) 772-7193 Pager (760) 776-3338 TYPE OF INSPECTION PERFORMED O REINFORCED CONCRETE l STRUCT. STEEL ASSEMBLY ❑ IS* 1p ❑ POST TENSIONED CONCRETE ❑ ASPHALT CjVTHER ❑'REINFORCED- MASONRY ❑ FIRE PROOFING JOB LOCATION REPORT SEOUENCEE N0. TYP OMUCTURE.. orf y""�� - PERMIT NO. DATE ] DAY OF WEEK MATERIAL DESCRIPTION /� q 7 A ARCHITECT I HRS. CHARGED ENGINEER ASSISTANTS HRS. CHARGED ' INSP - SUB O TEECTION s� CONTRAGENECTOR Q� " i.�jl{i►t s CONTRACTOR - U/'1 � �-Cjjea, Stv ke- fl&Tl�s 4-� S duelersS SXSk `� � �- S _ f - EAW-r6k-S Sr t toad COPY SENT TO CLIENT O C=D ON NEXT PAGE O '' PAGE OF CERTIFICATION OF COMPLIANCE ' I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MY KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE GOVERNING BUILDING LAWS. l� a TUR OF REGIST ED INSPECTOR DATE dF R PORT REGISTER NUMBER .SPECIAL INSPECTION SERVICF REGISTERED INSPECTOR'S WEEKLY REPORT JON TANDY 78-194 Elenbrook Ct. Palm Desert, CA 92211 Office (760) 772-7192 Fax (760) 772-7193 Pager (760) 776-3338 TYPE OF INSPECTION PERFORMED ❑ REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLY ❑ POST TENSIONED CONCRETE ❑ ASPHALT ❑ REINFORCED MASONRY ❑ FIRE PROOFING ❑ ❑ OTHER D x� JOB LOCATION / � �R � 1 ��, f T REPORT SEQUENCE NO TYPE 0� U�[URE S lv 1` PERMIT N9I` DATE' 0 DAY OF WEEK MATERIAL DESCRIPTION .4RCHILTrEJCyTD f l 1 L� INS-PVCR a HRS CHARGED ENG NEER ASSISTANTS HRS CHARGED INSPECTION DATE GENERAL �E7 SUB CONTRACTOR (_� W YC� CONTRACTOR 1 os=Sekt&—_Vcs [Aue '- f�� I C) J (V%-L � pp COPY SENT TO CLIENT O INLIED ON NEXT P E O PAGE OF CERTIFICATION OF COMPLIANCE I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MN KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE NOTED I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE GOVERNING BUILDING LAWS SIG ATURE OF REGI T D INSPECTOR a - D T F REPO T REGISTER NUMBER