BRES2017-0028LICENSED CONTRACTOR'S DECLARATION
I hereby affiim 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
permit subjects the applicant to a civil penalty of not more than five hundred dollars
0
,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
,Xe she did not build or improve for the purpose of sale.).
I, as owner of the property, am exclusively contracting with licensed contractors
nstruct 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 contr or(s) licensed pursuant to
t�ontractors' State License Law.).
f[1X�J I am exempt under Sec. & .C. for th re son
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 N
Lender's Add
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of fhe 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:
1 certify that in the performance of the work for which this permit is issued, I
sha I not employ any person in any mannerso o become subject to the workers'
compensation laws of California, and agree that; i hould beco s bject to the
workers' compensation provisions of Section 37 f he Labor o e I shall r
]0 rthwith
comply wi those rovisions.
��
Date: Applicants_ _ Fi
WARNING FAILURE TO SECURE WORKERS' COMPENSATIONVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES ND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,0001. IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOR °N 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 applic9tion 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 applicc-tion becomes null and void.if work is
not commenced within 180 days from date of isuance of such permit, or cessation of
work for 180 days will subject permit to cancell 9tion.
1 certify that I have read this application and state that the aboveinfor ation is correct.
I agree to comply with all city and county ordinances'and st�e law elating to building .
construction, and hereby authorize representatives of this ci to ter u on the
above -me tioned operty for inspection purposes.
Da . — L,79 I Signature (Applicant or Agent F'-
TAt!/ 40"
VOICE (760) 777-7125.
78-495 CALLE TAMPICO -
D
FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253
DESIGN & DEVELOPMENT DEPARTMENT
INSPECTIONS (760) 777-7153
BUILDING PERMIT
A-1
Date: 3/13/2017
Application Number: BRES2017-0028
Owner:
Property Address: 51315 CALLE GUATAMALA
MARIA REYES
APN: 770161004
Application Description: REYES / ROOF REPAIR/ ELECTRICAL/ CHANGE OUT (2) WINDOWS
92253
Property Zoning:
Application Valuation: $2,000.00
n
v D
�o
Applicant:
Contractor:
, o
��-..
ALMA TAMAYO
OWNER BUILDER
r_r5i fD
51315 CALLE GUATAMALA
o z rv;
O
LA QUINTA, CA 92253
n D v
9
m
Llc. No.:
LICENSED CONTRACTOR'S DECLARATION
I hereby affiim 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
permit subjects the applicant to a civil penalty of not more than five hundred dollars
0
,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
,Xe she did not build or improve for the purpose of sale.).
I, as owner of the property, am exclusively contracting with licensed contractors
nstruct 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 contr or(s) licensed pursuant to
t�ontractors' State License Law.).
f[1X�J I am exempt under Sec. & .C. for th re son
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 N
Lender's Add
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of fhe 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:
1 certify that in the performance of the work for which this permit is issued, I
sha I not employ any person in any mannerso o become subject to the workers'
compensation laws of California, and agree that; i hould beco s bject to the
workers' compensation provisions of Section 37 f he Labor o e I shall r
]0 rthwith
comply wi those rovisions.
��
Date: Applicants_ _ Fi
WARNING FAILURE TO SECURE WORKERS' COMPENSATIONVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES ND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,0001. IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOR °N 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 applic9tion 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 applicc-tion becomes null and void.if work is
not commenced within 180 days from date of isuance of such permit, or cessation of
work for 180 days will subject permit to cancell 9tion.
1 certify that I have read this application and state that the aboveinfor ation is correct.
I agree to comply with all city and county ordinances'and st�e law elating to building .
construction, and hereby authorize representatives of this ci to ter u on the
above -me tioned operty for inspection purposes.
Da . — L,79 I Signature (Applicant or Agent F'-
i
Date: 3/13/2017
Application Number:
BRES2017-0028 Owner:
Property Address:
51315 CALLE GUATAMALA MARIA REYES
APN:
770161004
Application Description:
REYES / ROOF REPAIR / ELECTRICAL / CHANGE OUT (2) WINDOWS 92253
Property Zoning:
Application Valuation:
$2,000.00
Applicant: Contractor:
ALMA TAMAYO OWNER BUILDER
51315 CALLE GUATAMALA
LA QUINTA, CA 92253
Llc. No.:
---------------------------------------------------------------------------------------------
Detail: REMODEL - REPAIR ROOF, REPLACE INSULATION TO COMPY, CHANGE OUT (2)WINDOWS, AND ADD (4) ELECTRICAL RECEPTACLES IN GARAGE. 2016
CALIFORNIA BUILDING CODES.
11
FINANCIAL INFORMATION
DESCRIPTION ACCOUNT CTY AMOUNT
BSAS SB1473 FEE 101-0000-20306 0 $1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION 3SA: $1.00
DESCRIPTION
ACCOUNT
C!TY
AMOUNT
DEVICES, FIRST 20
101-0000-42403
i0
$25.33
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DEVICES, FIRST 20 PC
101-0000-42600
0
$25.33
Total Paid for ELECTRICAL: $50.66
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PERMIT ISSUANCE
101-0000-42404
0
$96.27
Total Paid for PERMIT ISSUANCE: $96.27
DESCRIPTION
ACCOUNT
QTY
AMOUNT
RE -ROOF - FIRST 2,000 SF
101-0000-42404
0
$51.68
DESCRIPTION
ACCOUNT
QTY
AMOUNT
RE -ROOF - FIRST 2,000 SF PC
101-0000-42600
0
.$103.36
Total Paid for RE -ROOF: $1SS.04
DESCRIPTION
ACCOUNT
QTY
AMOUNT
SMI - RESIDENTIAL
101-0000-20308
0
$0.50
Total Paid for STRONG MOTION INSTRUMENTATION SMI: $O.SO
DESCRIPTION
ACCOUNT
-D.TY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMEN— FEE: $5.00
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 7 PC
101-0000-42600
0
$62.32
Total Paid for WINDOW/SLIDING GLASS DOOR/FENESTRATION: $126.16
STATE OF CALIFORNIA
RESIDENTIAL ALTERATIONS. .
CEC-CFIR-ALT-01-E Revised 09/16 CALIFORNIA ENERGY COMMISSION '
CE,RTIFICATE'OF COMPLIANCE CFIR-ALT-01-E
Prescriptive, Residential Alterations. (Page 1 of 6)
Project Name: Date Prepared: ?j
A. General Information
Insulation Details — Framed (Section 150.2(b)1)
01
01
Project Name: t✓
02
Date Prepared:
03
Project Location:
04
Building Front Orientation (deg or cardinal); %'`
05
CA City: U I tv
06
Number of Altered Dwelling Units: a ,
07
`Lip Code:
06
Fuel Type:. y.. ,.
09
Climate Zone: -
10
Total Conditioned Floor Areajft�) w
.11
Building Type:
12
Slab Area (ft
13
Project Scope: `��_h1�L YTVWI►A' ? wl h.�t.J
O
�w'
Exceptions to Minimu A' ed&lar Ref IectanceN
and Minimum Thermal FmiAtance or SRL:
A
B. Building
Insulation Details — Framed (Section 150.2(b)1)
01
02
03
04
05
06 ,;; - 07 081"11669
10
11
Tag/ID
Assembly Type
Frame
Type
Frame
Depth
(inches)
Frame
Spacing
(inches)
Proposed
Continuous
Insulation
R -value
Required
�.
Comments.
Cavity
R -value
Continuous
. Insulation .
R -value. t , a_tor
'Appendix JA4
Reference
U -Factor
Table- Cell
=R
yoz- -
10._ ..
i
Note: 1
• Where insulation is installed above the roofing membranbporabove the layer used to 'eal the roof from water penetration, the insulation shall have a maximum water.absorption of 0.3
percent by volume when tested, according to AST MSSta dard`C272.
Building Insulation Details - Non -framed
01
02
%3%,04
;j—
05 06' . 1 07 1 08 1 09
10
11
Tag/ID
Assembly
-
Assembly
s(inches)
Material0
VN
�.
Thickness
- Proposed
Required
-
Comments—
Core
In4ulatlon
R -value
Continuous
Insulation
R -value
U -factor-
Appendix JA4
Reference "
Required
Table Cell
U -factor
from
Package A '
STATE OF CALIFORNIA
RESIDENTIAL ALTERATIONS
CEC-CFIR-ALT-01-E Revised 09/16 CALIFORNIA ENERGY COMMISSION -
CERTIFICATE OF COMPLIANCE CF1R-ALT-01-E
Prescriptive Residential Alterations - (Page 2 of 6)
Project Name: y Date Prepared:.
D. Building Insulation Details — Mass Walls
01
02
03
04
05
06
07-- 08 09 10 11
Tag/ID
Wall Above'
Grade
Mass Type
'Ma'ss'
Thickness
(inches)
Interior
Furring
Strip
Thickness
(inches)
Exterior
Fuming
5trIp
Thickness"
(inches)
Proposed t� Required
Interior irisulailun
E,rlei iuidosulation
AppendrkdA4
R f;%nce "4 Inteko! Ins latinn
FxtPrinr Insulation_
R -value U -factor
R -value
U-- ccttoA
� R=value
U -factor
R -value U -factor
125r2�o
Fenestrraati o
CRRC
Maximum
Maximum Maximum
Proposedsa
Minimum Required
Fenestration
Area for All Fenestration
Allowed
Aged Solar Aged Solar .
Allowed Allowed
'Alteration ;
Orientations,
Product
Orientations Area
R -value
Tag/
Method of
Roof.
E. Roof Replacement (Section 150.2(b)1H) _
01
02
03
0
05'`.06
07
Maximum
''Max utn
`
01
02
03"
04
05
06.
07 '
08
9 0 11
12
13-
14
`
Fenestrraati o
CRRC
Maximum
Maximum Maximum
Proposedsa
Minimum Required
Fenestration
Area for All Fenestration
Allowed
Aged Solar Aged Solar .
Allowed Allowed
'Alteration ;
Orientations,
Product
Orientations Area
R -value
Tag/
Method of
Roof.
Type-
ID
Product
Deck �Irial�5olar
(Windows)
Aged4Solar
��,ermal SRI
Reflectance Reflectance Thermal SRI
ID
Compliance
Pitch
Exception
Number
Type
Insulation
Reflectance
Reflectance
mttance(Optional)Y
(Max) (Min) Emittance (Optional)
E� J
.�
P
Notes:
• Roof area covered by building integrated photovoltaicp5nels and solar. V�m5hpanels are exem�frkdmtheabove Cool Roof requirements.
field frrom s'eection
• Liquid applied coatings must comply with installation criteria 110.8(i)4.AP
F. Fenestration/Glazing Allowed Area§and efficiencies (Se ctio"n150.2(b)1)
01
02
03
0
05'`.06
07
Maximum
''Max utn
`
a
Allowed
(Iowad'West-ExistIQ�
Facing
Existing tWest:
�. Fenestration Facing
`
Fenestrraati o
Maximum
Maximum
Maximum Maximum
Area+For Ail1
Fenestration
Area for All Fenestration
Allowed
Allowed
Allowed Allowed
'Alteration ;
Orientations,
Area Only
Orientations Area
U -factor
U -factor
SHGC SHGC
-
Type-
(ftZ)O
(ft?) -(ft)
(Windows)
(Skylights) "
(Windows) - " (Skylights) •
Comments
r
j�,
STATE OF CALIFORNIA
RESIDENTIAL ALTERATIONS
CEC-CFI1R-ALT-01=E Revised 09116 CALIFORNIA ENERGY COMMISSION. -
CERTIFICATE OF COMPLIANCE MR=ALT-01-E
Prescriptive Residential Alterations (Page 3 of 6)
Project Name: Date Prepared:
G. Fenestration/Glazing Proposed Areas and Efficiencies—Add (Sectiori'150.2(b)1A)
01
02
03
04
0S
06
07.
.08
09
10
12
13
14 -
Tag/ID
Fenestration Type
Frame
Type-
Dynamic
Glazing
Orientation,
N, S W, E
iJul"ob'er
of
Panes
Proposcd
Fenestration
Area (ft)
Proposed
Wcst Facing
Fenestration
Area (ftZ)
_
Proposed
U factor,,
I
Source
-
Proposed
SH C
Source
Fxterinr
Shading
Device
Combined
SHGC from
CF1R-ENV-03
XOD
rvi
. _
�
�
. •
,�; •�=
X022
�
.
15
Existing + Proposed Fenestrate n Area
Mv
16
Maximum Allowed Fenestration Area
'
r�
17
Compliance Statement:
18
Existing + Proposed West -Facing Fenestration Area
19
Maximum Allowed West Fenestration Area
20
Compliance Statement:
21
Proposed Fenestration U -factor (Windows)
22
Required Fenestration U -factor (Windows)
23 .
Compliance Statement:
24
Proposed Fenestration SHGC (Windows)
25
Required Fenestration SHGC (Windows)
26
Compliance Statement:
7.
27.
Proposed Fenestration U-factor((-Skyl ghts
.
28_
Required Fenestration Ujffactto—r,(Sk` Lig s) �
29
Compliance Statement:
14
30
Proposed Fenestrra„t o SHGC (Skylights)
'~
31'. ..
Required Fe est�ati n SHGC (Skylights)
32
Compliance 5 atement: a.
STATE OF CALIFORNIA
RESIDENTIAL ALTERATIONS
CEC-CFIR-ALT-01-E Revised 09/16 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CFIR:ALT-01-E
Prescriptive Residential Alterations (Page 4 of 6)
Project Name: Date Prepared:
n
H. Fenestration/G lazing Proposed Areas and Efficiencies — Replace (5ecti6n'150.2(b)1B).
01
02
03
'" 04
05
06 "
07
08
.9
'10
1.1
X12
13
14
-Dynamic--
Area
Area
Net
Exterior
CombinedSHGC
Tag/
Fenestration
Frame "
Orientation
rRemoved
Added-
Added. _
;Proposed •
Pr�opo ed
_
Shading
from
ID
Type
Type
Glazing
N, S, W, E
(ftz)
(ftz)
Area (ft)
U -factor
Source
SHGC
Source
Device
CFIR-ENV-03
15
Net Added West -facing Fenestration Area
16
Is Net Added Fenestration Area 5 0 for West -Facing Fenestration?
17
Net Added Fenestration Area (all orientations) ;
18
Is"Net Added Fenestration Area 5 0 for All Orientations?'.
�,
-
V
` .
_
19
20
Proposed Fenestration U -factor (Windows) L
Required Fenestration U -factor (Windows)
,
21
V
Compliance Statement:
22
Proposed Fenestration SHGC'(Windows)
23
Required Fenestration SHGC (Windows)%,
24
Compliance Statement:
—
25 .
Proposed Fenestration U -factor (Skylights);
26
Required Fenestration U -factor (Skylights).
'27
Compliance Statement: _
28'
Proposed Fenestration SHGC (SkyIT, tsa M
29
,
Required. Fenestration U-factorr�(Skyl ghts) 41Ae
30
Compliance Statement'-,,,
STATE OF CALIFORNIA
'RESIDENTIAL ALTERATIONS -
CEC-CFIR-ALT-01-E Revised 09116 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CFIR=ALT-01-E
Prescriptive Residential Alterations .(Page 5 Of 6)
Project Na e: Date Prepared:
S ce Conditioning (SC) Systems - Heating/Cooling (Section, 150.2(b)) .
.MA
01 .. 02 03 '
welling Unit Name Dwelling Unit Total CFA (ft) Commenfs
. ..- IV
y
J. ater Heating Systems (Section 150.2(b)1G)
IV
AX4Vw
01
02
03
04
05
06
07
08
09
10
it
X12
13:
14
15
ter
# of
Water
Hea •ng
Water
Water
Heater
aeatirig
Back -Up
Central DHW
Dwelling Unit
System
Identification.
Heating
System
Water
Heater
Heaters
Storage
Volume
Fuel
Rated
Input
Rated
r. Input
Heating
Effici ey
Efficiency
Standby,
losers
Exterior
Insul.
Solar
Savings
System
Distribution
DHW System
Distribution
in
or Name
Type' •
Type
System
(gal)
Type
Type
Value
Type
VaIugol
,0 (%)
R -Value
Fraction
Type
Type
Sp a Conditioning Systems and Water Heating Systems in Multifamily , welling U,n*it
01
02
0� e
04 0..
05
•'06
\DIIing Unit Name
Dwelling Unit Total CFA.
(ftZ)
Central Water Heating
System Identification b
Named
Dwelling, nit
WaterHeating6ystem
IdenUfi atio or Name
Dwelling Unit:
Alteration to Existing or
Installtion of Space••
Conditioning System(s)7
_.
Comments
_gym
STATE OF CALIFORNIA
RESIDENTIAL ALTERATIONS
CEC-CFIR-ALT-01-E Revised 09/16 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF, COMPLIANCE y MR -ALT -01-E
Prescriptive Residential Alterations ; (Page,6 of 6)
Project Name: Date Prepared:;
DOCUMENTATION AUTHOR'S DECLARATION STATEMENT
1. 1 certify that this Certificate of Compliance documentation is accurate and complete. r2 .
Documentation Author Nm�^
' Documentation Author Signature: xi .
w
CumpauY•
Signature Date: ^
Address:
CEA/ HERS Certification.ldentification (ifapplicablel:
.,
City/State/Zip:
- - .' _
Phone:
RESPONSIBLE PERSON'S DECLARATION STATEMENT'
I certify the following under penalty of perjury, tinder the laws of the State of California:
1. The information provided on.this.Certificate of Compliance is true and correct. NW
2. 1 am eligible. under Division 3 of the Business and Professions Code to accept responsibility fo! the ilding design or syste design identified on this Certificate of Compliance (responsible
.
designer).
3. That the features and specifications,'materials; components, and manufactured devices,forr the "building design system design identified this Certificate
energy performance or on of
Compliance , conform to the requirements of Title 24, Part 1 and Part 6 of the Californ` a G de of ReguIati -
or features this
4. The building design features system design identified on Certi of Complian rree con stent with t, information provided on other applicable compliance documents,
worksheets, calculations; plans and. specifications submitted to the enforcement agency for approval WWthis bu'lldiiFghppermit application.
5. 1 will ensure that a registered copy of this Certificate of Compliance shall be made availaa ( with th-e building perm�it,(s)Aissued for the building,. and made available to the enforcement agency
for.all applicable inspections. I understand that a registered copy of this Certificate of�Cdrnoliance is required`to be included.witli the documentation the builder provides to the building.
owner at occupancy.
Responsible Designer Name: -
ResponsiblgDesigner Signature:
Company: t.
Date5lgned:
Address:
> t
License:
City/State/Zip: - " •
-
41.,X0
Phone:-
-
Bin #
.Y CV.-O.Cu Quill
Building &i Safety Division
Fermi[ ' 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-701,2
S Z�� Building'Permit Application and Tracking Sheet
Project Address: 1 S TEL PURI A Owner's Name:
A. P. Number: l —90 "t• Address:13 �-
Legal Description: �� $ CAC -1 q C-t'T�r Cit~ ST, Zi
w.I\T ;t 2 Y> P= Cps 1 3
ContractorA Tele hone:
P -;;;;«-::.;:-;;;:-;:;;.;:•;:-::«.;:;:;::>:>:
Address:.�
Project Description:,�,�
City, ST, Zip:
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Telephone:
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State Lic. # :
Arch., Engr., Designer:fJ�_
City Lie.
Address:
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City, ST, Zip:
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Telephone:
StateLic. 9: •ProJect
of Contact Person:
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Construction TYPe: Occupancy:
type (circle one): New Add'n Alter Repair.air Demo
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ries: #Units:Name
Sq. Ft.: #Sto
Telephone # of Contact Person: -7
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
9
Sdbmittal
Req'd
Rcc'd
TRACKING
PERMIT TEES
Plan Sets
f
Plan Check submitted
Item
Amount
Structural Cafes.
Reviewed, ready for corrections
Pian Check Deposit
Truss Cates.
Called Contact Person
Plan Check Balance,
Title 24 Calcs.
Plans picked up
Construction '
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Review, ready for corrections/issue
Electrical''
Subcontact'or Lis(
Called Contact Person
Plumbing
Gran( Deed
Plans picked up
SACT.
IT.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
''d. Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees,
1
Total Pcrmit Fees
r
BUILDING &. SAFETY DEPARTMENT
78-495 CALLE TAMPICO (760) 777-7012
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011
Considering Becoming an Owner -Builder?
Important information you need to know BEFORE pulling your permit!
The term "Owner -Builder" can mean three different things:
"Owner as Worker", "Owner as Contractor" or "Owner as Employer"
Understand each has Benefits or Risk, and it is possible to combine. them!
Hiring a California Licensed Contractor means you do not personally perform any of the construction work, the permit is not taken
out in your name, you are not personally responsible for the construction and you are not an Owner -Builder. Instead, you become a
"Customer" and California law provides you the benefit of protection from poor workmanship, failure to finish the job and financial
risk due to worker injury.
Benefit/Risk: Hiehest Benefits and the Least amount of Risk
Owner -as -Worker is a type of Owner -Builder where you personally perform the construction. work, the permit is taken out in your
name and you are personally responsible for the construction management, knowledge, workmanship, and ompletion of the job. You
benefit by not paying others to perform this work for you and your risk depends on your own ability to complete the job successfully.
Benefit/Risk:. Possible Benefit with Low Financial Risk.
Owner=as-Contractor is a type of owner -Builder where you personally act as your own General Contractor, the permit is taken out in
your name and you hire California licensed sub-contra'tors to perform portions of the construction work. WARNING: The benefit of
protection provided by law when you hire only California licensed sub -contractors can turn to serious financial risk if you hire
unlicensed contractors to perform any of the work.
Benefit/Risk: Possible Benefit and Sii2nificant Financial Risk
Owner -as -Employer is a type of.Owner-Builder where you pay any unlicensed individual to perform any construction work valued at
more than $500.00, the permit is taken .out in your name and you are. personally responsible for their employment requirements,
supervision, performance, safety and welfare while on your property. WARNING: Cost savings benefit can turn*to serious financial
risk if you fail to deduct payroll taxes or provide workers compensation insurance for each worker.
Benefit/Risk: Possible Benefit with Significant Financial Risk
(Health and Safety Code Section 19827) The California Legislature declares an "urgent and statewide
public interest in assuring" that contractors comply with Contractors' License Law, Business and
Professions Code and Workers' Compensation Insurance requirements to ensure property owners are
informed about, and protected from the following when improving their property as Owner -Builders -
Fraudulent representations • Liability for worker's injuries • Liability for material and labor costs unpaid by
contractors - Licensing requirements • Employers tax liabilities
Over 20,000 consumer complaints are filed each year. Many complaints relate to owner/builder projects
and include workmanship and workers' compensation issues Homeowners suffer financial harm due to
defective workmanship and injured employees.
Following are alarming examples of what has occurred with Owner -Builder permits:
Example 1: Homeowner received insurance money to rebuild burned -down home.
■ Owner/Builder permit pulled to rebuild structure.
■ Unlicensed contractor built substandard structure — must be torn down and replaced.
■ Estimated financial injury is $225,000.
■ Additional financial injury - IRS threatened to tax insurance payout if house not completed by the end of
the year.
Example 2: Brother-in-law had active license but fled an exemption from Workers Comp.
■ Owner -Builder hires.brother-in-law to install a new roof.
■ Employee falls and sustains multiple spinal and extremity fractures -as. well as a head injuryand
remains in a coma to this day.
■ The Owner -Builder, who has sold the home, is now a defendant. in a lawsuit for reimbursement for
benefits paid to the injured worker.
Example 3: Employee of contractor without Workers Comp is hired by Owner -Builder to install septic
system and suffers injury that results in permanent disability..
■ The Owner -Builder did not have a homeowner's insurance policy on the house against which to submit
a claim.
■ The -Owner -Builder is now a defendant in a lawsuit for reimbursement for benefits paid to the injured
worker.
Did you know— unlicensed persons frequently have the property. owner obtain an "Owner -Builder" building
permit which erroneously implies that the property owner is providing his or her own labor and material
personally?
Did you know — your homeowner's insurance may not provide coverage for injuries sustained on your
property by an unlicensed contractor and his/her employees?
Did you know — if you are considered an "employer" under state and federal law, you must register with
the state and federal government; withhold payroll taxes, provide workers compensation and disability
insurance and contribute to unemployment compensation for each "employee"?
Did you know — that if you fail to abide by these laws you may be subjected to serious financial risk?.
OWNERS BEWARE AND CONSIDER -THE RISK BEFORE ACCEPTING_ FULL RESPONSIBILITY FOR
YOUR CONSTRUCTION PERMIT .
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
IMPORTANT! NOTICE TO PROPERTY OWNER
Dear Property Owner:
An application for a build' t b e subrrly�d in your name lis ourself as the Imilder of the property
improvements specified at � � , �LSj p p
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.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
DIRECTIONS: Read and initial each statement below to signify you understand or verify this information.
1. I understand a frequent practice of unlicensedersons is to have the
p property owner obtain an "Owner -Builder"
Xuilqing permit that erroneously implies that the pioperty owner is providing. his or her own labor and material personally. I, as
an Owner -Builder, may be held liable and subject to serious financiatrisk for any injuries sustained by an unlicensed person
and his or her employees while working on my property. My homeowner's insurance may'not pro%ide 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
Ty property.
2. 1 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. 1 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 aer name instead of my
own.
4. 1 understand Contractors are required by law to be licensed and bonded in California and to list Heir license numbers on
permits and contracts.
5.4 understand if I employ or otherwise engage any persons, other than California licensed Contrac-ors, 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.
1 understand if I am considered an "employer" under state and federal law, I must register with the state and federal
government, withhold payroll taxes ral
p yro ,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 nne to.serious financial -
risk.
7. I understand under California Contractors' State License Law, an Owner=Buildei who builds si-igle-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.
k8. 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 owners) that result from any latent construction defects' in the
workmanship or materials.
9. I 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 (CSLB) at 1-
800-321-CSLB (2752) or www.cslb.ca'.gov.for more information about licensed contractors.
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10. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the
party legally:. an� financially respRnsible,,,for Rr psed cpstwction activity at the following address:
,,::;j' 111. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all
7 pplic ble laws and requirements that govern Owner -Builders asmell as employers.
12. 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 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 fum 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 buildingpermit 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 notarimdon, or
other verification acceptable to the agency is required to -be presented when the permit is issued to verif .the property
owner's signature.
1/ e 2
Signature of property owner J L/ Date: `, 3
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 understand is my personal -responsibility, I hereby authorize
the following person(s) to act as my agent(s)'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: t✓� 1 Z1 15
Name of Authorized Agent: � m '��Ct'Y\ (� Tel No I U�
Address of Authorized Agent: CA' I e— 6�CAM��YlfYlA-
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 theowner's driver's license, form notarization, or other verification
acceptable to theagency is required to be presente when permit is issued to verify theroper owners signature.
}
Property Owner's Signature: Date: `�
Product Type Sliding Window
Screen jHalf Unit Screen
Series 10 Basic New Construction
Shape +Rectangle
. ]Sill Adaptor INo
Unit A UI 48.000
VENT CALLOUT i 18.000
Vent Glz Thk 2.5MM
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WEIGHT . 15.638
Wall Depth. ; 1 5/16"
SN: P5202402206 - Vintage: 04/15/2015 —
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U -Factor Open
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;Visible Transmittance Open
0.53
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SN: P5201568028 - Vintage: 02/13/2012 -
Schedule Ship Date
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Bingo Number
723P
Serial Number
P5201568028
- Schedule Number
84437943
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12 013 Master Hallmark Results Template
WMDA License Number
411-H-820
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108. Type
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