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0301-222 (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 Date Signature of Contractor OWNER -BUILDER DECLARATION I herebyaffirm under penalty of perjury that I am exempt from the Contractor's Lice se.Law for the following reason: I, as owner of the property, or my employees with wages as their sole chi pensation, 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 jBeam exempt under Section ,,B&P.0 or thi dfr' ae sonl` Date lh c F le-, "I Signature of Owner WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of, perjury;one of the following declarations: �)r 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:. Carder Policy No. (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 those provisions. Date: Applicant 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, indemnity & 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. l agree to comply with all City, and State -laws relating to the building construction, and hereby authorize representatives of4this City to enter upon, the above-mentioned property forrinspection purposes"1 f Signature (Owner/Agent) Date"°. !' ,r PERMIT�k1^ - l,UILDING-PERMIT . 30222 DATE �r 11 Siff.!iLUATION LOT TRACT JOB SITE ADDRESS `575 �3,��11d'. A T��Tr'�LE�N A JAPN y OWNER CONTRACTOR / DESIGNER / ENGINEER 554.0 :`►'TSMA WAY CA 9283S USE OF PERMIT RLPt.ACF? g't;§`INI;7OWS, 2 -DO OP-% PER .dAPPRf..7VV) PLANS VALUATION MOP ?,.S ESMULTM) cosr U-91 L.OITIMUSCITON t�4�A��it�t►e:":t`%�i� %�1t;� �L?1-©i��sN4ii3�Ofl%1 �i3��t� F. 149S FREWPAW, RES S '. $0,00 JAN 15 200,110' 00,,0 Fr_M y 1.0U° 0 W $15.00 1i";,; X CITY OF LA QUINTA FINANCE DEPT. RECEIPT DATE BY DATE FINALED INSP t INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K. to Wrap F.A.U. FramingCompressor Insulation _ Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation O Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final �%%% 03 �_ _ BLOCKWALL APPROVALS Final POOLS - SPAS steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final I Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Heater'Final ater Piping Plumbing Final F`umbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test M Appliances Final Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: OWNER / BUILDER INFORMATION 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. For your protection you should be aware that as "Owner/ Builder" you are the responsible party of record on such a permit. Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself%you.may protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded.by the State of California and to have a business license from the City or County..They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be aware of the following information for your benefit and protection: If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is $200.00 or more for the entire project, and such persons are not licensed as contractors or subcontractors, then you may be an employer. If you are an employer, you.must register with the State and Federal Goverririient as an employer and you are subject to several obligations including State and Federal income tax withholding, federal social security taxes, worker's corripeasafi& insurance, disability insurance costs and unemployment -compensation contributions. There may. be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to worker's compensation insurance. For more specific information about your obligations under Federal Law, contact the Internal Revenue Service (and, if you wish, the U.S. Small Business Adminstration). For more specific information about your obligations under State Law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally or through their own employees, without.a. licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an "Owner/ Builder" building permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your community or at 1020 N. Street, Sacramento, California 95814. Please complete and return the enclosed owner -builder verification form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. Very truly yours, CITY OF LA QUINTA DEPT. OF BUILDING AND SAFETY 78-495 Calle Tampico La Quin2/� (760) , O1 ATURE / DATE J-211-575 ,mac • PROPERTY ADDRESS 1730 (- Z 22 PERMIT NUMBER(s) I CERTIFICATE OF COM-P-LIANCE: RESIDENTIAL Documentation Author Telep l�i4G1�G'►t6,F J Compliance Method (Package or Computer) Climate Zone GENERAL INFORMATION Total Conditioned Floor Area ft2 Average Ceiling Conditioned Slab Floor Area ft2 Building Type: Single Family Addition (check one or more) Multi -Family Existing -Plus -Addition Front Orientation: North / South / East / West / All Orientations (input front orientation in degrees from True North and circle one) Number of Stories Number of Dwelling Units: Floor Construction Type: Slab/Raised Floor (circle one or both) RADIANT BARRIER (required in climate zones 2.4,8-15) BUILDING ENVELOPE INSULATION ;e I of 3) CF -1R .te Building Permit # Plan Check / Date Field Check / Date To 3 Co I OF LA QUINTA BUILDING & SAFETY DEPT. APPROVED FOR CONSTRUCTION DATE 0.3 BY Required for this submittal_ yes (&no Component Frame Type Cavity Sheathing Total R- Assembly Location/Comments Type wd = wood Insulation Insulation Value' U -Factors (attic, garage, typical, etc.) stl = steel R -Value R -Value Wall Wall Roof Roof Floor Floor Slab Edge For prescriptive compliance, Total R -Value and Assembly U -Factor are not required for a wood -framed wall that meets cavity R -value insulation requirements for the Prescriptive Package: FENESTRATION Shading Devices Fenestration #/T e/Pos. Orien- tation(ft') Area Fenestration U -Factor Fenestration Exterior Overhangs/ SHGC Shading Att. Fins Front Chsr r Front J v S • 30 Left ov ttf 7,S- O Rear p/l Rear —Right Right —Skylight 'Skylight Compliance Forms August 2001 A-2 CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 2 of 3) CF -1R Project Title Date HVAC SYSTEMS Note: Input hydronic or combined hydronic data under Water Heating Systems, except Design Heating Load. SEALED DUCTS and TXVs (or Alternative Measures) ❑ Sealed Ducts (all climate zones) (Installer testing and certification and HERS rater field verification required) ❑ TXVs, readily accessible (climate zones 2 and 8-15 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) OR ❑ 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 Distribution Heating Zs -30 Heating Equipment Minimum Type and Duct or Heat Pump Type (furnace, heat Efficiency Location Piping Thermostat Configuration pump, etc.) (AFUE or HSPF) (ducts, attic, etc.) R -Value Type (split or package) !>r % A - Cooling Equipment Minimum Duct Recovery Standby' Insulation Heat Pump Type (air conditioner, Efficiency Location Duct Thermostat Configuration heat pump, eva . cooling) (SEER) attic, etc. R -Value Type (split or package) all A� SEALED DUCTS and TXVs (or Alternative Measures) ❑ Sealed Ducts (all climate zones) (Installer testing and certification and HERS rater field verification required) ❑ TXVs, readily accessible (climate zones 2 and 8-15 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) OR ❑ 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 Heating Zs -30 '7S A/A ^' WATER HEATING SYSTEMS Energy' Extemal 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 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 11 CERTIFICATE OF COMPLIANCE: RESIDENTIAL. (Page 3 of 3) CF -1R Project Title COMPLIANCE STATEMENT Date 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 Feld verification by an approved HERS rater. Designer or. Owner (per Business and Professions Code) Name: Title/Firm: Address: �`- Telephone: Lic. #: -Z (signature(date) Enforcement Agency Name: Title: Agency: Telephone: (signature/ stamp) , (date) Compliance Forms August Documentation Author Name: Title/Firm: Address: Telephone: G (s nature)( (date) MANDATORY MEASURES CHECKLIST: RESIDENTIAL (Page i of 2) MF -1R (vote: Lowfise 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. § 150(b): Loose fill insulation manufacturer's labeled R -Value. • §150(c): Minimum R-13 wail insulation in wood framed walls or equivalent U -Factor in metal frame walls does not apply to exterior mass walls). • §150(d): Minimum R-13 raised floor insulation in framed floors. § 150(1) : Slab 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. § 116-17: Fenestration Products, Exterior Doors, and Infiltration/Exfiltration Controls 1. 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 f Gain Coefficient (SHGC), and infiltration certification. lam/ 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(0: Special infiltration barrier installed to comply with § 151 meets Commission quality standards. § 150(e): Installation of Fireplaces, Decorative Gas Appliances and Gas Logs. 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 gas pilot lights allowed. Space Conditioning, Water Heating and Plumbing System Measures: § 110-§ 113: HVAC equipment, water heaters, showerheads and faucets certified by the Commission. §150(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. § 150(i): Pipe and tank insulation I. 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 hot water tanks have R-12 external insulation or R-16 combined intemal/extemal 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 MANDATORY MEASURES CHECKLIST: RESIDENTIAL (Page 2 of 2) MF—IR Mote: 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) * §150(m): Ducts and Fans 1. 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 of R-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 seal 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 area of the ducts. 3. 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. 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 t weather shall be suitable for outdoor service e.g., protected by aluminum, sheet metal, painted canvas, or plastic cover. Cellular foam insulation shall be protected as above or painted with a coating that is 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 79% 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 heaters, spa heaters or household cooking appliances have no continuously burning pilot light. (Exception: Non -electrical cooking appliances with pilot < 150 Btulhr §118 (f): Cool Roof material meet specified criteria Lighting Measures: § 150(k)l.: Luminaires for general lighting in kitchens shall have lamps with an efficacy of 40 lumens/watt or greater for general lighting in kitchens. This general lighting shall be controlled by a switch on a readily accessible lighting control panel at an entrance to the kitchen. § I50(k)2.: Rooms with a shower or bathtub must have either at least one luminaire with lamps with an erficacy of 40 lumens/wen 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