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BRER2016-0096` WORKER'S COMPENSATION DECLARATION Q�i 78-495 CALLE TAMPICO 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, D DEQ„ 4 LA QUINTA, CALIFORNIA 92253 DESIGN &DEVELOPMENT DEPARTMENT License Class: C39 License No.: 907600 of, the work for which this permit is issued. BUILDING PERMIT Application Number: BRER2016-0096 is issued. My workers' compensation insurance carrier and policy number are: Property Address: 55747 OAK HILL I hereby affirm under penalty of perjury. that l am exempt from the Contractor's State APN: 775231030 _ I certify that in the performance of the work for which this permit is issued, I Application Description: PGA WEST HOA / POLYURETHANE FOAM ROOF Property Zoning: compensation laws of California, and agree that, if I should become subject to the signed statement that he or she is licensed pursuant to the provisions of the Application Valuation: $936.25 comply with those provisions. Applicant: B R S ROOFING INC 777 SOUTH LUGO AVE SAN BERNARDINO, CA 92408 VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 11/7/2016 Owner: PGA WEST RESIDENTIAL ASSOCIATION S4320SOUTHERN HILLS LA QUINTA, CA 92253 Contractor: B R S ROOFING INC 777 SOUTH LUGO AVE SAN BERNARDINO, CA 92408 (909)884-8505 Llc. No.: 907600 LICENSED CONTRACTOR'S DECLARATION ' WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter I hereby affirm under penalty of perjury one of the following declarations: 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, _ I have and will maintain a certificate of consent to self -insure for workers' and my License is in full force and effect. compensation, as provided for by Section 3700 of the Labor Code, for the performance License Class: C39 License No.: 907600 of, the work for which this permit is issued. Date: r/� Contractor t PIML �I`have and will maintain workers' compensation insurance, as required by 5700 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: OWNER -BUILDER DECLARATION Carrier: STATE COMPENSATION INSURANCE FUND Policy Number: 9141962 I hereby affirm under penalty of perjury. that l am exempt from the Contractor's State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any _ I certify that in the performance of the work for which this permit is issued, I city or county that requires a permit to construct, alter, improve, demolish, or repair shall not employ any person in any manner so as to become subject to the workers' any structure, prior to its issuance, also requires the applicant for the permit to file a compensation laws of California, and agree that, if I should become subject to the signed statement that he or she is licensed pursuant to the provisions of the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division comply with those provisions. 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 fora Dat tApplican�i permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: WARNING: FAILURE TO SECURE WORK COM SATION COVERAGE IS UNLAWFUL, (� I, as owner of the property, or my employees with wages.as their sole AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO compensation, will do the work, and the structure is not intended or offered for sale. ONE HUNDRED THOUSAND DOLLARS ($10d,000). IN ADDITION TO THE COST OF (Sec. 7044, Business and Professions Code: The Contractors' State License Law.does not COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, apply to an owner of property who builds or improves thereon, and who does the work INTEREST, AND ATTORNEY'S FEES. 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 APPLICANT ACKNOWLEDGEMENT within one year of completion, the owner -builder will have the burden of proving that . IMPORTANT, Application is,hereby made to the Building Official for a permit subject to he or she did not build or improve for the purpose of sale.). the conditions and restrictions set forth on this application. I ) 1,•as owner of the property, am exclusively contracting with licensed contractors 1. Each person upon whose behalf this application is made, each person at whose to construct the project. (Sec. 7044, Business and Professions Code: The Contractors' request and for whose benefit work is performed under or pursuant to any permit State License Law does not apply to an owner of property who buildsor improves , issued as a result of this application., the owner, and the applicant, each agrees to, and thereon, and who contracts for the projects with a contra_ ctor(s) licensed pursuant to shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and the Contractors' State License Law.). employees for any act or omission related to the work being performed under or (_) I am exempt under Sec. B.&P.C. for this reason 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 Date: Owner: work for 180 days will subject permit to cancellation. 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 Address: 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 ui)owMe above-mentioned property for inspection purposes. Da Signature (Applicant or Agent): Application Number: BRER2016-0096 Property Address: 55747 OAK HILL APN: 775231030 Application Description: PGA WEST HOA / POLYURETHANE FOAM ROOF Property Zoning: Application Valuation: $936.25 Applicant: B R S ROOFING INC 777 SOUTH LUGO AVE SAN BERNARDINO, CA 92408 Date: 11/7/2016 Owner: PGA WEST RESIDENTIAL ASSOCIATION 54320 SOUTHERN HILLS LA QUINTA, CA 92253 Contractor: B R S ROOFING INC 777 SOUTH LUGO AVE SAN BERNARDINO, CA 92408 (909)884-8505 Llc. No.: 907600 Detail: REROOF WITH POLYURETAHNE FOAM - LA POLLA COATINGS[CRRC: 0770-0002) 2013 CALIFORNIA ENERGY CODE y DESCRIPTION " ACCOUNTS QTY AMOUNT BSAS SB1473 FEE 101-0000-20306 0 $1.00 •Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 DESCRIPTION • ACCOUNT QTY AMOUNT RE -ROOF - FIRST 2,000 SF: 101-0000-42404 ' 0 $51.68 y , t Total;Paid for RE -ROOF: $51.68 .t c • Bir, • Qty of La Quin to Buiidiny &T Safety Division Permit;; � 78-495 Calle Tampico La Quillta, CA 92253 - (760) 777-701,2 _. _ Building Permit Application and Tracking Sheet Project Address: i"i��`' Owner's Name: �� A. P. Number:01�= T L Address: J, 1 L/P City, ST, Zip: Legal Description: Contractor: C Tele hone• P . Address: Project Description: n I boe City_ ST, Zip: — of` Telephone:i r r/ State Lie. # : City Lie. #c I Arch., Engr., Designer: Address: City, ST, Zip: Telephone: If O ecu eY P tract oe: �Con nTY P State Lie. one • New Add'n Alter Repairair Demo Name of Contact Person: Sq. Ft.: # Stories: # Units: Telephone # of Contact on:liVJ2Estimated Value of Project: -APPLICANT: DONOT WRITE BELOW THIS LINE ff Submittal Rcq'd Rcc'd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cafes. Reviewed, ready for corrections Plan Check Deposit Truss Cates. Called Contact Person Plan Check Balance. Title 24 Cates. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2°" Review, ready for corrections/issue Electrical Subcontactor List ,Called Contact Pcrson Plumbing Grant Deed Plans picked up Ii.O.A. Approval Plans resubmitted Grading IN HOUSE:- ". Rcyiew, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I_I'.P. Pub. Wks. Appr Date of permit issue School Pecs, l Total Permit Fecs STATE OF CALIFORNIA RESIDENTIAL ALTERATIONS CEC-CF1R-ALT-01-E (Revised 06/14) CALIFORNIA ENERGY COMMISSION '•W�4ijg CERTIFICATE OF COMPLIANCE CF1R-ALT-01-E Prescriptive Residential Alterations i I Page 1 of 4) Project Name: Date Prepared: A. GENERAL INFORMATION 01 02 01 01 01 05 Project Name: V 6-7 ri Project Location rK CA City: tZi-4- 02 2 r04 0 06 Date Prepared: Building Front 'n'(degorcar&al): i crrkq pt�ip Number of Alrepealp-w—elling Units: rA i 07 Zip Code- 08 0 Fuel Type: 09 Climate Zone: 10 Ir, [,-deg, di rop (42)1� If n6d Floor.A' r? 1. T"P A 1, eir? 1Building 'type /it 12 Sraikh�,ra (ft2) , %p 1 13 1 Project Scope: Ir ":`% 10 . - % _, INA I '* B. BUILDING INSULATION DETAILS (Section 150.2(b)1) 01 02 03 04 05 0608-j- X-09 10 11 01 02 03 04 Aft,r Ppo'sed 420 W Required tf' '07 - 08 69 lo 11 11 12 1 13 put.''D 1 ,Appendix JA % Proposed Minimum Required Frame Frame co tinuous 4 - % Reference Initial Solar Aged Solar Thermal SRI Aged Solar Thermal SRI Frame Depth Spacing Cavity Cavi �K �,Ansulation wd, 11 3 �-—I T Reflectance ectance Reflectance Emittance (Optional) Tag/ID Assembly Type Type I (inches) I (inches) I R-value� R -value; IM '141fator Table Cell LI -Factor comments q4, • Roof area covered by bVII'a*tqRJniegrated phb%4QItaic panels and solar thermal panels are exempt from the above Cool Roof requirements. • Liquid field appliedkqoa§ngsmust comply JtKh,.installa.tion criteria from section 110.8(i)4. C. ROOF REPLACEMENT (Prescriptive Alteration, Se -eft Vr onv150.2(b)1H) 01 02 03 04 05& 06 tf' '07 - 08 69 lo 11 11 12 1 13 put.''D R -value It % Proposed Minimum Required Method of Roof CRRC�ro•4 Initial Solar Aged Solar Thermal SRI Aged Solar Thermal SRI Cornpliance Pitch Exception C�o Number d!hp'�uct Type la-�'A Reflectance ectance Reflectance Emittance (Optional) I Reflectance Emittance (optional) 44,1 1 . , NOTES 0-1" � V 1-; • Roof area covered by bVII'a*tqRJniegrated phb%4QItaic panels and solar thermal panels are exempt from the above Cool Roof requirements. • Liquid field appliedkqoa§ngsmust comply JtKh,.installa.tion criteria from section 110.8(i)4. Registration Number: Registration Date/Time: HERS Provider: ider: CA Building Energy Efficiency Standards - 2013 Residential Compliance T . June 2014 STATE OF CALIFORNIA ! QT. RESIDENTIAL ALTERATIONS j r�; CEC-CFIR-ALT-01-E Revised 06/14 CALIFORNIA ENERGY COMMISSION+ CERTIFICATE OF COMPLIANCE I CF111-ALT-01-E Prescriptive Residential Alterations i (Page 4 of 4) Project Name: yc I Date Prepared: , DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify`ihat this Certificate of Compliance documentation is accurate and complete. Documentation Author Name: Documentation Author Si na v' Signature: P g � u rV Company Signature Date: Address: ,Ide fi I i�n4if pplicable) d- `t, I CEA/HERS CertificationLC City/State/41P:,,� �� Phone RESPONSIBL' "PERSON'S DECLARATION STATEMENT I certify the following,under penalty of perjury, under the laws of.the State of California: - is `� 1. The information provided on this Certificate of Compliance true and correct.." 2: I am eligible under Division 3 of the Business and Professions Code to accept respons bifIlty for the building defgor system design identified on this Certificate of Compliance (responsible designer). 3. That the ener features and erformance s ecifications; materials, to ci nen'tsP�pnnd manufact edd de for the buildin design or system design identified'on thi Certificate of gY. P P P y} g g Y g_ Compliance conform.to the requirements of Title 24, Part 1 and Part.6,,of� t,he California Code oYRe.gulatlons. I 4. The building design features or system design features identified on tkifs'Certif!cate of Co plianceare cons!stenw!tiJe information provided on other applicable compliance documents, I'M, worksheets, calculations, plans and.spe41cations subMittecl,ro the en agerl - pproval with th sbilding permit application. . `$.x wr i 5. 1 will ensure that a registered copy of this Certificate of CompllanCe�shall be madq,& ai)able with the building perm!t(s) issued for the building, and made available to the enforcement agency cop. for al -applicable inspections. I understand that a registeered of this Certifidt&f Compliance !s regyi .to be included with the documentation the builder provides to the building owner at occupancy. 'Responsible Designer ame:.. fRessponsible Designer Signature: Company;.} Date Signed: i Address:J f'i, License: City/State/Zip: /1 ` `""'.'' '`'iFk "M1Q11 w` - Phone: ! r 511,5W For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300. Registration Number: Registration Date/Time: HERS Provider: CA Building Energy Efficiency Standards - 2013 Residential Compliance i June 2014