14975 (AR)P.O. BOX 1504
Buil"
.g 78-495 CALLE TAMPICO
Address 48e-638 Vista 'Maraca LAQUINTA,CALIFORNIA92253
Owner r ...
Address Sade 'ay ABove
City ZipTel.
La Quinta 1..92253 771 0443•
Contractor =
Larry Gertz Construction
Address .
78-365 Etia'hi#ay 111 .8te #148
CityZip Tel.`
La Qui nta 92253 564--6927
State Lica City
7—
& Classif.' 42400-8 Lic. # 2789
Arch'., Engr.;
Designer _
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION. • . I ' .
I hereby affirm that I.am licensed under provisions of Chapter 9 (commencing with Section
X7000) of,Diividlon 3 of the Business and Professions Code,.and my license t§ ip full,jgr a and
OWNER -BUILDER DECLARATION ' " . '
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,11usiness and Professions Code:- Any city, or county which, requires a
permit to construct, atter, improve, demolish, or repair any 'structure,. prior to its issuance also
requires the applicant for such .permit to Nle a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter. 9 (commencing with Section .7000) of
Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for the alleged exemption. Any violation or Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penaltyof 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, Buisness and
Profes_slons Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon and .who does such work himself or through his own employees,
provided that such 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 did not build or Improve for the purpose of sale.) - -
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-,
struct the project. (Sec. 7044,Business and .Professions Code: The Contractor's License Law
does not apply to an owner of propertywhobuilds or Improves thereon, and who contracts for
such projects with a contractors) pcensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B. ti P:C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof: (Sec. 3800, Labor Code.)
Policy,No. Company
7�I 1 opy is filed with the city, ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed If the permit is for one hundred dollars ($100) va'uation
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.
Date Owner
NOTICE_ TO APPLICANT: It, after making this Certificate of .Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked. • . •,
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.
This is a building permit when properly. filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
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 city to enter the above-..'
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zlp
No. -4975
JILDING:• TYPE CONST. OCC: GRP.
P. Number
gal Description
oject Description: Ins'tall 40"x32" Glass Block
Window in Bathroom.
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line X11,\
Rear Setback from Rear Prop�n
Side Street Setback from r Line
Side Setback.from Pro'' rt y Li ye
FINAL DATE INSPECTOR
CPIssued by: ^ r '-, Date. -Permit Z
Validated b
Validation:.
Sq. Ft. No.
q
Size Stories
No. Dw.
Units
New ❑ Add ❑ Alter ❑ .
Repair ❑ `Demolition;❑
Estimated Valuation
AASO. 00
t
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
14 _ 75
Const.
I _Q
Mech.
Electrical -
Plumbing.
S. M.I.
Si 5
Grading
Driveway Enc:
Infrastructure
TOTAL
REMARKS'
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line X11,\
Rear Setback from Rear Prop�n
Side Street Setback from r Line
Side Setback.from Pro'' rt y Li ye
FINAL DATE INSPECTOR
CPIssued by: ^ r '-, Date. -Permit Z
Validated b
Validation:.
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIW FEES
IST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SO. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS r
CAR P. SO. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. FT.
OTHER APP.IEOUIP.
DRINKING FOUNTAIN
SO. FT. ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
GAR. FIREWALL
SO.FT.GAR ® 3/ac
HOUSE SEWER
LATHING
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCKSTORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL 7d
-
J
Q .
y'a�—Z
e CC —Z
LD
LD
`
.�� U
` t
Q) 0
s�
0yj
�.
Lij
o
.
�rtivica:a �� fOmj3iiance: Resident -alt Pace r of CF -1 R
Date
oiecf Title
Builainq Permit a.
,_�ojec Address
/ r/ Cj ) .
C 7 ('— Plan CnecK i Date
4 ocumentatio�arr
1
Telephone
Field Ch@CK i. Date
�mplianee Method ( Package, Point System or Computer Climate Zone cntorcoment r►gey use Only
!ENERAL INFORMATION
oral Conditioned Floor Area:
ft2
'Wilding Type:
Single Family Addition
Existing -Plus -Addition
- :heck one or morel
:ront
Mufti --Family:
North / East / South / West / All Orientations .9
Orientation:
(Input orientation in degrees and circle one.l
Aumber of Dwelling Units:
`
r
loon Construction Type:
Slab / Raised Floor (circle one or both)
BUILDING SHELL INSULATION
`
Construction
3omponent Insulation
Assembly LocationjComments
typical, etc.)
i' 1 e R -Value'
U-Value (attic, to arade,
Wall ..............
t Walt..:.......
Roof .............
l Roof
Floor .............
t- Floor ...........:.
Stab Edge..:..
FENESTRATION
Shading Devices
Fenestration Area Fenestration Interior Exterior Overhang) Framing Type
(roller blind, etc.) (shadescreen, etc.) Yes/not (metaltwood/yinyl)
Orientation (sf)
U Value
Front..... ( )
Front..... ( )_'
-
Lett . -
7 ,7
Left ....... ( )
r
Rear ..... ( )
• Rear ..... ( )
Right..... ( )
.Right..... (" )
Skylight
. ,
Skylight .......
THERMAL MASS
Type/Covering
Area -Thickness
(St) (inches) ' LocatioryDescription (kitchen bam. etc.)
Sslab/exposed the etc)
7
Ravi"d Jani ary 1992
y ;
Certificate of Compliance: Residential (Page 2 of 2) CF -1 R
." Project Title
as Date
-HVAC SYSTEMS
Note: Input hydronic or combined hydmnic data under Water Heating Systems, except Design Heaong.l oad.
Distribution
Heating Equipment Minimum Type and Duct or
Type (furnace, heat -Efficiency Location Piping Thermostat
umo. etc.) IAFUE/HSI PFI'
(ducts/attic. etc.1 R -Value Type
Cooling Equipment Minimum Duct
Type (air conditioner, Efficiency Location Duct Thermostat Configuration
heat umo, evao. cooling (SEER) . ' attic, etc.1 R -Value T
e split or package)
WATER HEATING.SYSTEMS
t Energy External .
Water HeaterRated Tank Factor or • Tank
Distribution Number Input (kW Capacity RecoveryStandby', Insulation
Type
Tvnp - in System. or Btu/hr)(gallons) Efficiency, Loss % . R -Value
1. For small gas storage (rated input s 75.000 Btu/hr), electric resistance and heat pump water heaters, list Erergy Factor. ,
For large gas storage wstsnhestom (rated input a 75,000 Btu/hr). list Rated input, Recovery Efficiency and Standby Loss.
For Instantaneous gas water hesterf, list Rated Input and RecoveryEfficiency.
SPECIAL FEATURES/REMARKS (Add extra sheets if necessary)
COMPLIANCE STATEMENT
This certificate of compliance lists the building features and performance specifications needed to comply with Title 24, Parts 1 and 6, of
E -the California Code of Regulations, and the administrative regulations to.lmplement 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 FeatureslRemarks section.
i
Designer or Owner - -
g (per euslness 8 Professions code) Documentation Author
Name:
Tide/Finn: Name:' ,
Tide/Firm:
Address:- ,
Address:<
Telephone:
Lic. s:
Telephone:
(signature) (date) (signature) •,
(dam)
Enforcement Agency
Name:
Agency
Telephone:
(spnatureistam
(date)
Rsvlawjanuary 1992
ARCHITECTURAL.VARIANCE REQUEST
Unit • �/ Date
Street Address
�f�- �381�.r7f %E,e,eA
Local. Phone DW5K3 Other Phone
To the Architectural Committee:
we, the undersigned owners, request your approval of the
modifications proposed on the reverseside of this form.
"AOta;.hed are driw.in_gs 'of ;the'wor.k to be•dore; types of
material to'be used are indicated on the crewings. we
understand tnat building permits for home improvements are
required by the City Of La Quina and that tte cost of the
permits and responsibility of obtaining permits and
subsequent inspections will be borne by 'us.
we acko.wledoe that all approved changes in. the original
design will be -a '
t our expense;. that any damage to or
relocation of.existing' sprinkler systems, und.erground
utilities, building structure and exterior landscaping or
other damage resulting from construction of these permitted
improvements will be at our expense; and that maintenance o,t
the permitted improvements will be at our expense..
Signature of all owners:
Please provide as much
Committee may consider approval lritho�tdelssi'aysb1e so .that
the
Z NS7e4 <
rf. V X04,
/71f�>/ON
The above proposal has been
Committee aid h e e n ^ rev.ev,ed by the Architectural
:
APPROVED
- RE:.ECT_0 O P=VOINC FURTHE4
INFORMATrON .
.Comments:
ommiiiee
Member mm ee
l/ yen e' Committee
Member
,ti