BRES2017-0077C&t�t a
rt I,
78-495 CALLE TAMPICO D �i4lIl�Cl/
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: , BRES2017-0077
Property Address:
51955 AVENIDA ALVARADO
APN:
773162026
Application Description:
CROSS / 7 WINDOWS 1 PATIO DOOR REPLACEMENT
Property Zoning:
Application Valuation:
$2,000.00
Applicant:
JOHN CROSS
51955 AVENIDA ALVARADO
LA QUINTA, CA 92253
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 Professions 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).:
14) I, as owner.of the property, or my employees with wages,as their sole
Ebrmpensation, 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.).
Vi I, as owner of the property, am exclusively contracting with licensed contractors to
co struct 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
ontractors' State License Law.).
I am exempt under Sec. B.&P.C. for this reason
Date: —'L{ Owner: � W
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 Na
Lender's Add
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
JOHN CROSS
51955 AVENIDA ALVARADO
LA QUINTA, CA 92253
Contractor:
OWNER BUILDER
Llc. No.
Date: 4/28/2017
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WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
1, 1 1 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 tha work for which this permit is issued.
II have and will maintain workers' compensation insurance, as required by
Sedtion3100 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
sha 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. o
Date: #Z-1-77—Applicant: M4 I—
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 Building Official 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, 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 city to enter upon the above-
mentioned property for inspection purposes.
Date: Y�L Q 1 z Signature (Applicant or Agent):
2
Dater 4/28/2017
Application Number:
BRES2017-0077
Owner:
Property Address:
51955 AVENIDA ALVARADO
JOHN CROSS
APN:
773162026
51955 AVENIDA ALVARADO
Application Description:
CROSS / 7 WINDOWS 1 PATIO DOOR REPLACEMENT
LA QUINTA, CA 92253
Property Zoning:
Application Valuation:
$2,000.00
Applicant:
Contractor:
JOHN CROSS
OWNER BUILDER
51955 AVENIDA ALVARADO
LA QUINTA, CA 92253
l
----------------------------------
Llc. No.:
----------------------------------------------------------
Detail: (8) WINDOW/SLIDING DOOR (7) WINDOWS (1) SLIDING DOOR. PER 2016 CALIFORNIA ELECTRICAL CODE
2
r
DESCRIPTION ACCOUNT QTY
AMOUNT
BSAS SB1473 FEE 101-0000-20306 0
$1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
FINANCIAL INFORMATION
ACCOUNT
QTY
AMOUNT
r
DESCRIPTION ACCOUNT QTY
AMOUNT
BSAS SB1473 FEE 101-0000-20306 0
$1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
Credit Card Fee
101-0000-43505
0
$2.58
Total Paid for Credit Card Fee: $2.58
DESCRIPTION
ACCOUNT
QTY
AMOUNT
SMI - RESIDENTIAL
101-0000-20308
0
$0.50
Total Paid for STRONG MOTION INSTRUMENTATION SMI: $0.50
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DOOR/WINDOW, RETRO/REPAIR, EA ADDITION 5
101-0000-42400
0
$10.64
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DOOR/WINDOW, RETRO/REPAIR, FIRST 7
101-0000-42400
0
$63.84
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DOOR/WINDOW, RETRO/REPAIR, FIRST PC
101-0000-42600
0
$62.32
t
Total Paid for WINDOW/SLIDING GLASS DOOR/FENESTRATION: $136.80
TOTALS:
wo
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Permit #/
Project -Address: S�
City of La Quinta
Building 8£ Safety Division
78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking ShEet
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A. P. Number:
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Telephone: f
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State Lic. # :
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Occupancy:
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Lic. #.
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Name of Contact Person: �� yv C 0
Sq. Ft.:
# Stories:
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-4-of Contact -Person: 6d— Z ��r _
Telephone
_Estimated Value -of Projecct'1 Z 000
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets'
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cafes.
Called Contact Person
Plan Check Balsnee.
Title 24 Cafes.
Plans picked up
Construction '
Flood plain plan
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.
II.O.A. Approval
Plans resubmitted r•
Grading
IN IiOUSE:-
Jrd Review, ready for corrections/issuc
Dcvcloper Impact Fee
.Planning Approval
Called Contact Person
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Date of permit issue
School Fees, .
+
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P.D. Box 1504
LA QUINTA, CALIFORNIA 92247-1504
78-495 CALLS 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
IMPORTANT! 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 SI F571�_i4-vs1vID.J /�G�/A2,�9,7 Lj�,¢ 7ZZ.S-3
We are providing you with an Owner -Builder Acknowledgment and Information Verification Form tc 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.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
DIRECTIONS: Read and initial each statement below to signs you understand or verify this informat;on.
I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder"
uilding 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.
a—K 2. I understand building permits are not required to be signed by property owners unless they are responsible for the
construction and are not hiring a licensed'Contractor to assume this responsibility.
3. I understand as an "Owner-Builder".I am the responsible party of record on the permit. I undestand 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.
tf-- 4. I understand Contractors are required by law to be licensed and bonded in California and to list taeir license numbers on
p� emuts and.contracts.
5. I understand if I 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".
under state and federal law.
6. I understand. if I am considered an "employer" under state and federal law; I must register wi h the state and federal
government, withhold payroll taxes, provide workers' compensation disability insurance; and contrioute to unemployment
compensation for each "employee." I also understand my failure to abide by these laws ma
risk. y subject me to.serious financial
C�. I understand under California Contractors' State License Law, an Owner -Builder who builds sEigle-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 rhe work is performed
under contract with a licensed general building Contractor.
8. I 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.
I understand I may obtain more information regarding my obligations as an "employer' from the Internal Revenue
S' ervice, 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 (CSLB) at 1-
800-321-CSLB (2752) or www.cslb.ca.gov.for more information about licensed contractors.
V
10. I am aware of and consent to an Owner -Builder building permit applied for_in my name, and understand that I am the
legally, and . financially responsible for. proposed construction activity at the following address:
I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all
a! pphcable laws and requirements that govern Owner -Builders as mell as employers.
2. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I
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 Contractois 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 the permit. Note.' A copy of the property 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.
Signature of property owner Date:
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 ACTON PROPERTY OWNER'S BEHALF
Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I 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 owners signature.
Property Owner's Signature: Date:
OF CALIFORNIA
Prescriptive Residential Alterations That Do Not Require HERS Field Verification
CEC-CF1 R -ALT -05-E Revised 04/16 CALIFORNIA ENERGY COMMISSION -
CERTIFICATE OF COMPLIANCE CFIR-ALT-05-E
Prescriptive Residential Alterations That Do Not Require HERS Field Verification Page 1 of
Project Name: Date Prepared:
Y-7111-1
to simple alterations that do not require HERS verification for compliance. When HERS verification is required, a CF1R-ALT- 01 shall first be registered
with a HERS Provider Data Registry.
Alterations to Space Conditioning Systems that are exempt from HERS verification requirements may use the CFIR-ALT-0.5 and CF2R- ALT -05 Compliance Documents. Possible exemptions from duct
leakage testing include: less than 40 ft of ducts were added or replaced, or the existing duct system was insulated with asbestos; or the existing duct system was previously tested and passed by a
HERS Rater. If space conditioning systems are altered and are not exempt from HERS verification, then a CFIR-ALT-02 must be completed and registered with a HERS Provider Data Registry.
Alterations that utilize close Cell Spray Polyurethane Foam (ccSPF) with a density of 1.5 to less than 2.5 pounds per cubic foot having an R -value other than 5.8 per inch, or Open Cell Spray
Polyurethane Foam (ocSPF) with a density of 0.4 to less than 1.5 pounds per cubic foot having an R -value of 3.6 per inch, shall complete and register a CFIR-ALT-01 with a HERS Provider Data
Registry.
If more than one person has responsibility for installation of the items on this certificate, each person shall prepare and sign a certificate applicable to the portion of construction for which they are
responsible. Alternatively, the person with chief responsibility for construction shall prepare and sign this certificate for the entire construction. All applicable Mandatory Measures shall be met.
Temporary labels shall not be removed before verification by the building inspector.
A. General Information '
01
Project Name:
02
Date Prepared:
03
Project Location:
S SS— vcN1 i>A. AL m
ov
04
Building Front Orientation (deg or cardinal):
/QST
OS
CA City:
L a V ZA,-r -
06
Number of Altered Dwelling Units:
l
07
Zip Code:
Z 25-3
08
Fuel Type:
EL+�GTd1tG
09
Climate Zone:
30
Total Conditioned Floor Area (ftz): _
LZ 30
11
Building Type:
/U
RES I DCZ
12
Slab Area (ft)
3 a
'13
Project Scope (Select all that apply):
❑ B. Insulation
❑ D. & E. Fenestration/Glazing ADD'
❑ G. Space Conditioning System (Heating, Cooling, Duct system)
❑ Lighting
❑ C. Roof Replacement✓❑ D. & F. Fenestration/Glazing - REPLACE ❑ H. Water Heating System ❑ Include Mandatory Measures?
CA Building Energy Efficiency Standards - 2016 Residential Compliance April 2016
STATE OF CALIFORNIA
Prescriptive Residential Alterations That Do Not Require HERS Field Verification
CEC-CFIR-ALT-05-E Revised 04/16 CALIFORNIA ENERGY COMMISSION�'�
CERTIFICATE OF COMPLIANCE CFIR-ALT-05-E
Prescriptive Residential Alterations That Do Not Require HERS Field Verification Page 2 of 4
Project Name: Date Prepared:'
D. Fenestration/Glazing Allowed Areas and Efficiencies (Section 150.2(b)1)
01 02 03 04 0S 06 07
01
Maximum
Maximum
Existing
05
06
07
08
09
10
11
Allowed
Allowed
Fenestration
Existing
Maximum
Maximum
Maximum
Maximum
Area
Removed
(ftz)
Area
Added
(ftZ)
Fenestration
West -Facing
for All
West -Facing
Allowed
Allowed
Allowed
Allowed
Alteration
for All
Fenestration
Orientations
Fenestration
U -Factor
U -Factor
SHGC
SHGC
Type
Orientations (ftZ)
Area Only (ftz)
(ftZ)
Area (ft')
(Windows)
(Skylights)
(Windows)
(Skylights)
Comments
. Z z
F. Fenestration/Glazing Proposed Areas and Efficiencies - Replace (Section 150.2(b)113)
01
02
03
04
05
06
07
08
09
10
11
12
13
14
Tag/ID
Fenestration
Type
Frame Type
Dynamic
Glazing
Orientation
(N, S, W, E)
Area
Removed
(ftz)
Area
Added
(ftZ)
Net
Added
Area (ftz)
U -factor
SHGC
Source
Exterior
Shading Device
Combined
SHGC from
CFIR-ENV-03
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5
0
. Z z
W
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0
2
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D
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Addy Row -
Delete'Row
15
Net Added West -facing Fenestration Area
16
Is Net Added Fenestration Area 5 for west -facing fenestration? r Yes %j No
CA Building Energy Efficiency Standards - 2016 Residential Compliance April 2016
STATE OF CALIFORNIA
CEC-CF1 R -ALT -05-E Revised 04/16 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CF1R-ALT-05-E
Prescriptive Residential Alterations That Do Not Require HERS Field Verification Page 3 of
Project Name: _ ` Date Prepared: L
C '
17
Net Added Fenestration Area (all orientations)
18
Is Net Added Fenestration Area <_ 0 for all orientations?
C? -Yes Ir No
19
Proposed Fenestration U -factor (Windows)
20
_ Required Fenestration U -factor (Windows)
21
Is the proposed Fenestration U -factor <_ the Required Fenestration U -factor?
Yes 0 No
22
Proposed Fenestration SHGC (Windows)
23
Required Fenestration SHGC (Windows)
24
Is the Proposed Fenestration SHGC 5 the Required Fenestration SHGC?
i Yes r No
25
Proposed Fenestration U-factor(Skylights)
26
Required Fenestration U -factor (Skylights)
27
Is the proposed Fenestration U -factor 5 the Required Fenestration U -factor?
= Yes %} No
28
Proposed Fenestration SHGC
29
Required Fenestration SHGC
30
Is the Proposed Fenestration SHGC:5 the Required Fenestration SHGC?
Yes rj No
t
CA Building Energy Efficiency Standards - 2016 Residential Compliance
April 2016
STATE OF CALIFORNIA
Prescriptive Residential Alterations That Do Not Require HERS Field Verification
TZ
EC -CFI R -ALT -05-E (Revised 04116) UALII-UKNIA ENEKGY GUMMISSIUN�
CERTIFICATE OF COMPLIANCE CF1R-ALT-05-E
Prescriptive Residential Alterations That Do Not Require HERS Field Verification Page 4 of 4
Project Name: Date Prepared:
DOCUMENTATION AUTHOR'S DECLARATION STATEMENT
1. . I certify that this Certificate of Compliance documentation is accurate and complete.
,re:
Documentation Author Name:
Documentation Author S' at
Company:
Signature Dat
V - Z 3 -Q
Address:
CEA/ HERS Certification Identification (if applicable):
y G V
City/State/Zip:
Phone:
`I' Z Z -5--3360
- z -G
RESPONSIBLE PERSON'S DECLARATION STATEMENT
I certify the following under penalty of perjury, under the laws of the State of California:
1. The information provided on this Certificate of Compliance is true and correct.
2. 1 am eligible under Division 3 of the Business and Professions Code to accept responsibility for the building design or system design identified on this Certificate of Compliance (responsible
designer).
3. That the energy features and performance specifications, materials, components, and manufactured devices for the building design or system design identified on this Certificate of
Compliance conform to the requirements of Title 24, Part 1 and Part 6 of the California Code of Regulations.
4. The building design features or system design features identified on this Certificate of Compliance are consistent with the information provided on other applicable compliance documents,
worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with this building permit application.
5. 1 will ensure that a registered copy of this Certificate of Compliance shall be made available with the building permit(s) issuedforthe building, and made available to the enforcement agency
for all applicable inspections. I understand that a registered copy of this Certificate of Compliance is required to be included with the documentation the builder provides to the building
.owner at occupancy.
Responsible Designer Name:
Responsible Designer Si ature:
Company:
Date ed:
Address:
License:
City/State/Zip:
Phone:
ri
I
For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300.
CA Building Energy Efficiency Standards - 2016 Residential Compliance _ April 2016