BRES2018-0324Titi
78-495 CALLE TAMPICO 0 D
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Permit Type/Subtype: BUILDING RESIDENTIAL/REMODEL
Application Number: BRES2018-0324
Property Address: 78970 BAYBERRY LN LN
APN: 604302010
Application Description: WHITCOMB / MASTER BATH REMODEL
Property Zoning:
Application Valuation: $35,000.00
Applicant:
KATHRYN WHITCOMB
78970 BAYBERRY LN
LA QUINTGA, CA 92253
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 fcommencing with Section 70001 of Division 3 of the Business and Professions Code,
and my License is in full force and effect.
License Class: License No.: 7CONV:1405281111254103950
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
%_�- "5 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
s e did not build or improve for the purpose of sale.).
as owner of the property, am exclusively contracting with licensed contractors
o construct 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
t rectors' State License Law.).
0
Wam exempt under Sec. B.&P.C. for this reason
"I 0 • I 1' W�! Owne
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 Name:
Lender's Add
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/11/2018
0
Owner: m
cn
KATHRYN WHITCOMB z
78970 BAYBERRY LN Q,
LA QUINTGA, CA 9225t� 52 p
m� n
m
z 'Q
� C N
Contractor: v o
KATHRYN WHITCOMB 8 a O°
78970 BAYBERRY LN Eci
LA QUINTGA, CA 9225A
(760)772-1971
Llc. No.::CONV:140528101254103950
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 3700 of the Labor Code, for the performance
of the work for which this permit is issued.
I have and will maintain workers' compensation insurance, as required by
Section 3700 of the Labor Code, for the performance of the work for which this permit
is issued. My workers' compensation insurance carrier and policy number are:
Ca ie Policy Number:
Ca
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. . _
�tI -I I. Ie Applicant.
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.
Dafe: I ' + N �7/ Signature (Applicant or Agent
Application Number:
Property Address:
APN:
Application Description
Property Zoning:
Application Valuation:
Applicant:
KATHRYN WHITCOMB
78970 BAYBERRY LN
LA QUINTGA, CA 92253
BRES2018-0324
78970 BAYBERRY LN LN
604302010
WHITCOMB / MASTER BATH REMODEL
$35,000.00
Me-. 10`11/2018
Owner:
KATHRYN WHITCOMB
78970 BAYBERRY LN
LA QUINTGA, CA 92253
Contractor:
KATHRYN WHITCOMB
78970 BAYBERRY LN
LA QUINTGA, CA 92253
(760)772-1971
Llc. No.::CONV:140528101254103950
Detail: MASTER BATHROOM REMODEL [CONVENTIONAL] THIS PERMIT DOES NOT INCLUDE ALTERATION TO LOAD BEARING OR LATERAL RESISTING
CONSTRUCTION OR ADDITIONAL CONDITIONED SQUARE FOOTAGE, AND ANY FUTURE PLUMBING WILL REQUIRE SEPARATE PERMIT FOR FINISHED
INSTALLATION.-2016 CALIFORNIA BUILDING CODES.
i"j j
r
't�4
DESCRIPTION
ACCOUNT CITY AMOUNT
BSAS SB1473 FEE
101-0000-20306 0 $2.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $2.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
DEVICES, FIRST 20
101-0000-42403
0
$26.68
DESCRIPTION
ACCOUNT
CITY
AMOUNT
DEVICES, FIRST 20 PC
101-0000-42600
0
$26.68
Total Paid for ELECTRICAL: $53.36
DESCRIPTION
ACCOUNT
CITY
AMOUNT
VENT FAN
101-0000-42402
0
$13.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
VENT FAN PC
101-0000-42600
0
$5.20
Total Paid for MECHANICAL: $18.20
DESCRIPTION
ACCOUNT
CITY
AMOUNT
FIXTURE/TRAP
101-0000-42401
0
$52.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
FIXTURE/TRAP PC
101-0000-42600
0
$52.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
WATER SYSTEM INST/ALT/REP
101-0000-42401
0
$13.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
WATER SYSTEM INST/ALT/REP PC
101-0000-42600
0
$13.00
Total Paid for PLUMBING FEES: $130.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
REMODEL, EA ADDITIONAL 500 SF
101-0000-42400
0
$24.01
DESCRIPTION
ACCOUNT
CITY
AMOUNT
REMODEL, EA ADDITIONAL 500 SF PC
101-0000-42600
0
$19.21
DESCRIPTION
ACCOUNT
CITY
AMOUNT
REMODEL, FIRST 100 SF
101-0000-42400
0
$54.43
DESCRIPTION
ACCOUNT
CITY
AMOUNT
REMODEL, FIRST 500 SF PC
101-0000-42600
0
$148.89
Total Paid for REMODEL: $246.54
DESCRIPTION
ACCOUNT
CITY
AMOUNT
SMI - RESIDENTIAL
101-0000-20308
0
$4.55
Total Paid for STRONG MOTION INSTRUMENTATION SMI: $4.55
DESCRIPTION
ACCOUNT
CITY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
4V Qua
— c,r,a
Project Address: -7 970
APN #:
Applicant Name: Kt
Address: 9
City, ST, Zip: z4 M_
Telephone:C ( -
Email: lo� PV' r t4 l
Contractor Name:
Address:
City, St, Zip
Telephone:
Email:
State Lic:
Arch/Eng Name:
Address:
City, St, Zip
Telephone:
Email:
State Lic:
Property Owner's Name:
Address:
City, ST, Zip
Telephone:
Email:
tCa+►n
ffJ.JU.A5WJIiaA i
•
City Bus Lic:
City Bus Lic:
PERMIT # — (33
PLAN LOCATION:
Project Description: Pool, Remodel, Add't, Elect, Plumb, Mech
Valuatiow f FWooiect S 1 22
New SFD Construction:
Conditioned Space
Garage
Patio/Porch
Fire Sprinklers
Construction Type:
Grading:
Bedrooms: Stories:
SF
SF
SF
SF
Occupancy:
# Units:
New Commercial / Tenant Improvements:
Tr QA,
Total Building SF
Construction Type: Occupancy:
78495 CALLE TAMPICO
LA QUINTA, CA 92253
760-777-7000
OFFICE USE ONLY
# I Submittal I Req'd I Rec'd
Plan Sets
Structural Calcs
Truss Calcs
Title 24 Calcs
, :
Soils Report ... % , : •
Grading Plan (PM10)
Landscape Plan
Subcontractor List
Grant Deed
HOA Approval
School Fees
Burrtec Debris Plan
Planning approval
Public Works approval
Fire approval
City Business License
cRC)ll 4MALL CGSA4-----------------
CITY.OF LA QUINTA
BUILDING DIVISION
cr y REVIErWED FOR E
E j � I T•. k � � ! i
COMPLIANCE
DATE1Olt, 611,8Yc- bnc 1-1
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CITY OF LA QUI NTA
8 ILDING DIVISION
f REVIEWED. FOR
i COPE
S
A COMPLIANCE
DAT BY
�E
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CITY OF LA QUINTA
�\ ,l ,! i BUILDING DIVISION'
REVIEWED FOR CODE
k ` . f E E COMPLIANCE
DATE BY
SECTION A - GENERAL
1) Provide the Assessor's Parcel Number (APN) and complete legal description of Project on the first sheet of
Plans. Note that lot numbers do not include letters. For example, "Lot 16, Tract 29349-1" is a valid legal
description; "Lot 36B at [Club Name]" is not.
2) Provide on each sheet of resubmitted Plans and cover sheet of bound Calculations the preparer's name and
telephone number and wet -signature. If the preparer is a licensed architect or engineer, all documents
prepared by that licensed individual shall also bear his/her stamp as prescribed by California Business and
Professions Code §5536. Resubmittals will not be accepted with signatures missing.
3) Note on Plans: "All construction shall comply with the 2016 California Residential, Mechanical, Electrical,
Plumbing, Green Building and Energy Codes and the La Quinta Munigipal Code." Remove notes referencing
other Codes.
4) Note on Plans: "All `or equal' substitutions must be submitted to, and approved by the Building Official prior
to installation of the item."
SECTION C - ARCHITECTURAL
1) Show on Floor Plan all locations of windows requiring safety glazing. (CRC §R308.4) See Floor Plan for area
not in compliance.
2) Mechanical exhaust ventilation at bathrooms shall have humidity controls (manual or automatic.)
(CALGreen §4.506 (pg. 32))
3) Note on Plans: "Provide at least one 120-volt, 20-ampere branch circuit to serve bathroom receptacles.
Such circuit(s) shall have no other outlets." (CEC §210.11(C)(3); 210.52(D))
4) Provide at least one wall receptacle outlet within thirty-six (36) inches of the outside edge of each
bathroom basin. The receptacle outlet shall be located on a wall or partition that is adjacent to the basin or
basin countertop, located on the counter top, or installed on the side or face of the basin cabinet. In no case
shall the receptacle be located more than twelve (12) inches below the top of the basin. (CEC §210.52(D))
5) The clear space in front of a water closet, lavatory or bidet shall be not less than 24 inches. (CPC §402.5)
6) Show compliance with CEC 150.2(b)1 and Table 150.2-B for this project. The CF-IR-ALT-02-E form shall be
used to document the minimum energy requirements needed for alterations to an existing dwelling. Please
note that once further information is provided a Performance Compliance method may be required to show
compliance.
7) Specify the following information from Energy Calculations at altered window on the Floor Plan: Area of
glazing (in square feet) and Required U-factor/SHGC Ratings.
8) Note on Plans: "All luminaires shall be high efficacy in accordance with Table 150.0-A. Specify in lighting
schedule for each luminaire, the luminaire and lamp types, wattage and whether light source requires
certification with Reference Joint Appendix JAB, such as required for all screw -base luminaires and recessed
down lighting." (CEC §150.0(k)1A)
9) Note on Plans: "All down light luminaires recessed in ceilings (notjust those in insulated ceilings) shall
contain light sources that are certified JA8 compliant that are not of the screw -based type; and those that
are enclosed, such as those often used in showers, must utilize a JA8-E compliant lamp rated for use at
elevated temperatures; and be listed for zero -clearance insulation contact (IC Rated) and are certified
airtight (air leakage less than 2.0 CFM at 75 Pascals); and have a gasket or caulked sealing between the
luminaire housing and ceiling."
Residential Plan Check Correction List Page 41W 7
4 -0&a"
10) Note on Plans: "Lighting shall be switched separately from exhaust fans and when provided under cabinets
from other lighting systems." (CEC §150.0(k)2B & L)
11) Note on Plans: "In bathrooms at least one luminaire must be controlled by a vacancy sensor, all other
recessed luminaires are required to be controlled by dimmer or vacancy sensor." (CEC §150.0(k)2J)
12) Provide a table on the plans that contains the following requirements:
FIXTURE FLOW RATES
FIXTURE TYPE MAXIMUM FLOW RATE
Showerheads 2 gpm @ 80 psi
Multiple Showerheads 2 gpm@80 psi (per valve)
Lavatory faucets 1.2 gpm @ 60 psi
Water closets 1.28 gallons/flush
SECTION K - MISCELLANEOUS COMMENTS
1) Red marks on Plans, even if not specifically mentioned in this list, indicate items needing correction. Revise
Plans as necessary and provide written response, noting where correction can be found.
2) Provide one copy each of the Site Plan and Floor Plan for the County Assessor's office. While not required for
resubmittal, this administrative item must be addressed prior to issuance of building permit.
3) Provide a current Certificate of Workers Compensation Insurance covering this project.
4) Provide a complete list of subcontractors.
5) Inadequate information has been provided at this submittal to calculate fees for this project. Fee
calculation will be performed when Plans are complete.
END CORRECTION LIST
As further information is provided and reviewed, additional corrections may be required.
Residential Plan Check Correction List Page isOf
STATE OF CALIFORNIA
Prescriptive Residential Alterations That Do Not Require HERS Field Verification
163
CEC-CF1 R-ALT-05-E (Revised W16) CALIFORNIA ENERGY COMMiSSION�
CERTIFICATE OF COMPLIANCE CF111-ALT-05-E
Prescriptive Residential Alterations That Do Not Require HERS Field Verification Page 1 of
Piclxt Klaw- Date prepared:
This compliance document is only applicable to
with a HERS Provider Data Registry.
not require HERS verification for compliance. When HERS verification is required, a CFSR-ALT- 01 shall
Alterations to Space Conditioning Systems that are exempt from HERS verification requirements may use the CF1R-ALT-05 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 ore not exempt from HERS verification, then a CF1R-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 CF1R-ALT-01 with a HERS Provider Data
Registry. /\
If more than one person has responsibility for installation of the items on this certificate, each
responsible. Alternatively, the person with chief responsibility for construction shall prepare a.
Temporary labels shall not be removed before verification by the building inspector. /.
and sign a certificate applicable to the portion of construction for which they are
Apr the entire construction. All applicable Mandatory Measures shall be met.
A. General Information
01
Project Name
f1
Date Prepared:
03
Project Location:
78-970 Ba r
A. ^V�!
®� ^
04
Building Front Orientation (deg or cardinal):
South
05
CA City:
La Qui
92253
06
Number of Altered Dwelling Units:
1
07
Zip Code:
08
Fuel Type:
Natural Gas
09
Climate Zone:
15
QP
10
Total Conditioned Floor Area (ft):
2,008
11
Building Type:
Single Family
12
Slab Area (ft)
2,008
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 0✓ D. & F. Fenestration/Glazing - REPLACE H. Water Heating System Include Mandatory Measures?
72.
CA Building,Energy Efficiency Standards - 2016 Residential Compliance
OCT 10 2018
CITY OF IA QUU+fiA
DM MD DMWMW DORTW April 2016
STATE OF CALIFORNIA
Prescriptive Residential Alterations That Do Not Require HERS Field Verification
CEC-CF1 R-ALT-05-E Revised 04116) CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE ^~ CF1R-ALT-05-E
Prescriptive Residential Alterations That Do Not Require HERS Field Verification Page 2 of4
D. Fenestration/Glazing Allowed Areas and Efficiencies (Section 150.2(b)1)
01 02 03 04 05 06 07
Maximum Maximum Existing
Allowed Allowed Fenestration Existing Maximum Maximum Maximum Maximum
Fenestration West -Facing for All West -Facing Allowed Allowed Allowed Allowed
Alteration for All i Fenestration Orientations Fenestration U-Factor U-Factor SHGC SHGC
Type Orientations (ftZ) Area Only (ftZ) (ftZ) Area (ftZ) (Windows) (Skylights) (Windows) (Skylights) Comments
Replacing fenestration ` 402 100 <400 <100 32 N/A .25 N/A 1
F. Fenestration/Glazing Proposed Areas and Efficiencies - Replace (Section 150.2(b)1B)
01
02
03
04
05
06
07
08
09
10
11
12
13
14
Tag/ID
Fenestration
Type
FrameFrameIe Type
Dynamic
Glazing
Orientation
(N, S, W, E)
Area
Removed
(ftZ)
Area
` Added
(ftZ)
Net
Added
Area (ftZ)
U-factor
Source
SHGC
Exterior
Source Shading Device
Combined
SHGC from
CF1R-ENV-03
Bath
y �ii� 1�� ld� f}L°•V I'n. N/A
0
AddRowDelete Row
15
Net Added West -facing Fenestration Area
14�lk
1171
A A 1 fT77n I A
16
Is Net Added Fenestration Area <_ for west -facing fenestration?
4 Yes C No
17
Net Added Fenestration Area (all orientations)
18
Is Net Added Fenestration Area <_ 0 for all orientations?
/ Yes C No
19
Proposed Fenestration U-factor (Windows)
[ ]
20
Required Fenestration U-factor (Windows)
.32
21
Is the proposed Fenestration U-factor <_ the Required Fenestration U-factor?
r Yes r No
22
Proposed Fenestration SHGC (Windows)
[ ]
23
Required Fenestration SHGC (Windows)
.25
24
Is the Proposed Fenestration SHGC <_ the Required Fenestration SHGC?
r Yes r No
25
Proposed Fenestration U-factor (Skylights)
N/A
26
Required Fenestration U-factor (Skylights)
N/A
27
Is the proposed Fenestration U-factor 5 the Required Fenestration U-factor?
■ Yes r No
28
Proposed Fenestration SHGC
N/A
. - . 1 r vY 1 V VI-1 ( _ _- rr
CA Building Energy Efficiency Standards - 2016 Residential Compliance
April 2016
STATE OF CALIFORNIA
.Prescirip#ive Residential Alterations That Do Not Require HERS Field Verification
CEC-CFI R-ALT-05-E (Ravis-ad 04115)
CERTIFICATE OF COMPLIANCE
Prescriptive Residential Alterations That Do Not Require HERS Field Verification
Project Nam ,
29
30
Required Fenestration SHGC N/A
Is the Proposed Fenestration SHGC <_ the Required Fenestration SHGC?I 4 Yes r No
W4TFan�
-1 _ T/z 1171
t
_ CALIFORNIA ENERGY COMMISSION
MR-ALT-05-E
Page 3 of 4
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
CERTIFICATE OF COMPLIANCE
Prescriptive Residential Alterations That Do Not Require HERS Field Verificat
Pr Ject Name:
DOCUMENTATION AUTHOR'S DECLARATION STATEMENT
that
pany:
RESPONSIBLE PERSON'S D
nce documentation is accurate and complete.
STATEMENT
CALI
CF1R-ALT-05-E
Page 4 of 4
I certify the following under penalty of perjury, under -the laws of the State at cal#tornia�
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 Lem 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) issued for the 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.
^-----_ ^-- ---_ "__-. -Fz—oonsae 0esicnerSianature: a l
-it) .10�)
se:
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
Mllgard Order Form
HENR
Order Name: Kelly Whitcomb
Sales Representative: Luis Gonzalez Mobile:
luisg@glazcon.com
Comments:
Billing Information
Name:
Henry's Glazcon
Address:
79-919 Country Club Dr.
Bermuda Dunes, CA 92203
Phone:
760-360-2800
Fax:
760-360-3808
Email:
Henry's Glazcon
79-919 Country Club Dr.
Bermuda Dunes, CA 92203
760-360-2800
Order Number:
Created Date:
Modified Date:
PO Number:
Total Units:
Total Sci Ft:
Est. Delivery:
SOPRM000082
9/21/2018
9/21/2018
19639
2
20.00
Shipping Information - — -- -
Name:
Address:
Phone:
Fax:
Email:
Line: 1 Location:
Quantity: 1 Tuscany, 8360T, PWR, 1" Setback, Ext White /Int White
U-Factor:.26, SHGC:.22, VT:.50
1/8" SunCoatIVAX (Low-E) Tempered over 5/32" Rain Vert (Obscur
Tempered
Argon Gas Filled
Size: Net Frame 47 1/4" x 47 1/2" Net Frame 47
1/4" X 47 1/2"
Model: Slider Picture
Glass: 1/8" SunCoatMAX (Low-E) Tempered
over 5/32" Rain Vert (Obscure) Tempered
Other Glass: Gray Foam Spacer with Argon
Frame Accessories: Stucco Key
Other Options: Glass Breakage Warranty
Ratings: STC: No Rating, OITC: No Rating,
Tested: CW50
Other Ratings: CPD: MIL-A-236-05580-00002
Viewed From Exterior
Order Number: SOPRM000082 Print Date: 10/10/2018 Page 1 of 3
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
(760)777-7012
FAX (760) 777-70._I?;
PROPERTYOWNER'S PACKAGE, . r % • ; .t
Disclosures & Forms for Owner -Builders Applying for Construction Permits
IMPORTANT! NOTICE TO PROPERTY OWNER
Dear Property Owner:
An application for a building errnit cen submitted "
improvements specified at your na listigvoujse�ilfa"he buiuilder o�roperty
We are providing you with an er-Builder cknowled nt and Information eoto mdke 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
DIREC71011IS: Read and initial each statement below to signs you understand or verify this information.
1. I understand a frequent practice of unlicensed persons is.P have the property
building permit that errorre 1 lies lhat the property o►'�f' o�bt�in � Owner -Builder
y p perty owner is pr 0ibing Ws or her oven 6boi and material personally. I, as
an Owner -Builder, may be field 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
'own hmyy property.
VvZ. 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.
I understand as an "Owner -Builder" I am the responsible party
myself from potential financial risk by.hiring a licensed Contract and having he permit f dtin his dor hername 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
perrryits and contracts.
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,
I understand if I am considered an "employer" under state and federal law, I must register with the state and federal
government, withhold payroll taxes, 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 me to serious financial
�risk.
/
1F1� W i understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential
structures cannot legally build them with the intent to offer them for sale, unless all work is performed by Iicensed
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.
VA I understand as an Owncr-Builder if I seIl 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
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 Califoniia Contractors' State License Board (CSLB) at 1-
800-32I-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors.
&0. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the
party a ally • financiallyerp resporfibl` for r propos� � c7aucti� activ�y,, the following address:
f r ■
I agree that, as the party legally and financially responsible for this proposed conitruction. activity, I will abide by all
applicable laws and requirements that govern Owner -Builders as -well as employers.
14&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 I,ice4se Board niay be �ina}sIe tv?a iarg'h�u with any financial loss
you may sustain as a result aAa complalnt<aY.our only: remedy%6inst untieen ed. roritraetots may be in civil court. It is also
important for you to understand that if an unlicensed Contractor or employee of that individual ol: 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 hue 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
Date: ID • 1c ',1?>
Note: The following Au rim is required to be completed by the property owner only when designating
an agent of the properly 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): l
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 owner's signature.
, •f 4
Property Owner's Signature:
Date: l_ .i 1t
�PlCITY OF LA QUINTA SUB-CXNFR
T1�ACTOR L T
I �� ��� _
JOB ADDRESS PERMIT NUMBER�'� --T C6_ _ „BUILDER
This form shall be nosted on the 'ob with t e Building Ins ecti n Card at all times in a cons is ous place. Only persons appearing on this list or their employees are authorized to work
on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance
of building permit. For each applicable trade, all information requested below must be compfeted by applicant. "On File" is not an acceptable response.
t:onu4q;iq..r State Con;IBctpr's.L.icense,:
Company Name Classification License Number Exp. Date
(e.g. A, B, C-8) (xxxxxx) (xx/xx/xx)
EARTHWORK (C-12)
ONCi;TE (G-S)
RAMING (C-5)
STRUCT. STEEL (C-51)
MASONRY (C-29)
LUMBING (C-36)
LATH, PLASTER (C-35)
DRYWALL (C=9:)
LECTRICAL (C-1 d)
ROOFING (C-39)
SHEET METAL (G-.43)
FLOORING (CA5)
GLAZING (C-17)
INSULATION :(C-2)
SEWAGE DISP.
PAINTING (C-33.)
CERAMIC TILE (C-54)
CABINETS (C-6)
FENCING (C-13)
LANDSCAPING' W: 27)
POOL CC-531
Worker's: Corrlp.ensatlon,
Carrier Name
(e.g. State Fund, CalComp)
Insurance
CIt.Y Bu5;4Kle$s.Lice.n$e
Policy Number
(Format Varies)
Exp. Date
(xx/xx/xx)
License Number
(xxxx)
Exp. Date
(xxlxx/xx)
i