11-0002 (RR)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA; CALIFORNIA 92253
Application Number: --1`1-00000002
Property Address: 54730 AVENIDA OBREGON
APN: 774-274-025-12 -000000-
Application description: RE -ROOF
Property Zoning: COVE RESIDENTIAL
Application valuation: 7500
Tiht. 4 4 Q"
Applicant: Architect or Engineer:
�IY
BUILDING & SAFETY DEPARTMENT'
BUILDING PERMIT
Owner:
SUZETTE BLACKMAN
54730 AVENIDA OBREGON
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 Professionals 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 yvith 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
a y pplicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
( I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
the structure is not intended or offered for sale (Sec. 7044, 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.).
(_ 1 1, as owner of the property, am exclusively contracting, with licensed contractors to 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 the Contractors' State License Law.).
(_ I I am exempt under Sec. , B.&P.C. for this reason
r. /j%j�ailOdc(.,
/ 0
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:
LQPERAIIT
Contractor:
Owner
VOICE (760) 777-7012 '
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 1/03/11
a
J�1t�V � t
�1uri.
1,A
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:
Carrier Policy Number
I certify that, in the performance of the work for which this permit is issued, I shall not employ any
person in any manner sous 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 Labo=Codl forthwith compl ith those provisions.
ate:s
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 Director of Building and Safety 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 th' ounty to enter upon the above-mentioned prope for ins/.pee/
`inspecton p(uurrrpHeesss... �t
Date: / ignature (Applicant or Agent�9/ 1V2,rte cL-iP/%
Application Number . . . . . 11-00000002
Permit . . .
. RE -ROOF
Additional desc .
Permit Fee
30.00
Plan Check Fee
00
Issue Date . . .
.
Valuation . . .
. 0
Expiration Date
7/02/11
Qty Unit Charge
Per
Extension
BASE
FEE
30.00
---------------------------------------------------
••Special Notes and
Comments
-------------------------
RE -ROOF WITH HOT
MOP MATERIALS.
2007/2008 CODES.
------------------------------------------------------------
Other Fees
-----------------
, BLDG STDS ADMIN (SB1473)
1.00
Fee summary
-----------------
Charged
--------------------
Paid Credited
----------
Due
Permit Fee Total
30:00
----------
..00 .00
30.00
Plan Check Total
.00
.00 .00
.00
Other Fee Total
1.00
.00 .00
1.00.
Grand Total
31.00
.00 00
31.00
LQPERA4TT
Prescriptive Certificate of
Project Address: ��11
lance: Residential Reroof
Rvvrrr��a r-K000l:l5 (COOL ROOFS) §151012
CF -1 R-ALT-ReRoof
Zone Permit fl
5
"nerr ore area Or exterior roof surface to be replaced exceeds 50% of the existing roof area, or 1;000 , whichever Is less, the new
roofing area must meet the roofing product "Cool Roof, requirements of §152(b)1 HI, 152(b)1Hii, or 152(b)1HIII.
Check applicable alternative or exception below if the roof alteration is exempt from the roofing product -Cool Roof requirements::
❑ Cool roofs not required in Climates Zones 1-12,14, and 16 with a low sloped roof pitch gess or 2:12 pitch)
❑ .Cool roofs not required in Climates Zones`l-9, and 16 with a steep sloped roofsreater and
Alternatives to §152(b)1 HI and §152(b)HII, Steep -slope roof (pitch > 2:12) (g ch than 2:12 ) product weightless than 5/lt>✓it�.
❑ Insulation with a thermal -resistance of at least 0.85 hr-fe-*F/Btu or at least a 3/4 inch air -space is added to the roof deck over an attic; or
❑ Existing duds in the attic are insulated and sealed according to §15i (f)10; or
❑ In climate zones 10, 12 and 13, with 1 f12 of free ventilation area of attic ventilation for every 150 ft2 of attic floor area, and
where at least 30 percent of the free ventilation area is within 2 feet vertical distance of the roof ridge; or
- j Building has at least R-30 oeiling insulation; or
❑ Building has radiant barrier in the attic meeting the requirements of §151(02; or
❑ Building has no duds in the attic; or
❑ In climate zones 10, 11,13 and 14.-R-3 or greater roof deck insulation above vented attic.
Exception to §152(b)l Hill, Low -slope roof ( pitch 5 2:12)
❑ Building has no ducts in the attic.
Other Exceptions
❑ Roofing area is covered by building integrated; photovoltaic panels and solar thermal panels are exempt from the Cool Roof criteria -
0. Roof Constructions that have thermal mass over the roof membrane with at least 25 Ib/ft2 are exempt from the Cool Roof criteria.
NOTE: If any one of. the alfemavves or exception is Checked the Aged Solar Reflectance and Thermal Emittance requirements for roofing
products in §118(1) are not applicable. Do not fill table below.
Roof Slope
ID Number 5 2:12 > 2:
L w
( w
Note: If no CRRG1 label is available, this comppance method cannot be used use the Performance Approach to show compliance,
The CRRC Product /D Number can be obtained from the Cool Roof type Rating Council's Rated Product Directonr.caalroofs.oro/oroducts/sea►ch aho
Indicate the of product is being used for the roof top, ry at i.e. single-lyroof, asphalt roof metal roof, etc.
11 the Aged Reflectance is not available in the Cool Roof Rating
directory and Counca s Rated Pmdud Diredory th
then use e Initial Refledance value fivm the same
use the equation (0.2'0.7(p�„ _ 0.2) to obtain a calculated aged value. Where p is the Initial Solar Reflectance.
Check box if the Aged Reflectance is a calculated value using the equation above.
Calculate the SRI value by using the SRI- Worksheet at hlfnJ/ivww enerev.— —
acopy of the SRI- Worksheet to the CF -1R. --and enter the resulting value /n the SRI Column above and attach
o apply Liquid Field Applied Coatings, the coating must be applied akxoss the entire roof surface and meet the dry mil thickness or covera
)commended by the Coatings manufacturer and meet minimum performance requirements listed in §118(1)4. Select the applicable Coating:
L3 Aluminum -Pigmented Asphalt Roof Coating ❑ Cement -Based Roof Coating ❑ Other
NOTE When a Cool Roof l's required, the installing contractor shall complete and submit the CF -6R -ENV-(
Declaration Statement
Product Weight
5lb/fe Z NMI?
Product
T z
Aged Solar
Reflectance?
Thermal<
Emittance
SRIs
❑
!EO3
EY❑
❑4
for final
• 1 certify under penalty of perjury, under the laws of the State of California, the information provided on this form is accurate and complete.
• 1 certify that the energy features and performance specifications identified on this Certificate of Compliance conform to the requirements of Title 24, Part
1 and 6 of the Califomia Code of Regulations.
!" Ut -Z,e_ - r `b-P�o.l<
Company:
Date:
:'ss:
License:
City/State/Zip:
Phone:
For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300.
•off
/ 1
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 -Bidders Applying for Construction Permits
IWORMATI NOTICE TO pROPER"I'Y OWNER
Dear Property Owner
An. application for a building permit has been mitted in your listing yourself as the builder of the property
improvements specified at — 7 v
We are providing you with an Owner -Builder Acknowledgment and Informafion 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 butiding.permit until you Iiave 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.
rormation.
V1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder"
building permit that erroneously implies that the property owner is providing his or her own labor and material personally. 1, 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 perry.
I understand building permits are not required tobe signed by property owners unless they are responsible for the
$Z2-
nstruction and are not hiring a licensed Contractor to assume this responsibility.
3. I understand as an "Owner -Builder" I am dee responsible party of record on the permit. I understand that Imay 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.
4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on
p;5.'l
itand contracts.
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- 1 understand if I am considered an "employee" under state and federal law, I must register with the state and federal
government, withhold payroll taxes, provide workers' compensation disability insurance, andcontribute to unemployment
compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial
risrisk.0 7. 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 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.
8. 1 understand as an Owner -Builder if I sell the property for which this' jermit is issued, I may be held liable for any
financial or personal_ uries sustained. b P
P � by.any subsequent owner(s) that result from any latent constriction defects in the
workmanship or materials.
fZ,-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 (CS -LB) at 1-
800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors.
1,4Z 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 and financially responsible for proposed construction activity at the following address:
v
1 L I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all
�1(ws and requirements that govern Owner -Builders as well as employers.
gree 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 Beard 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 amployee of that 'individual or firm is injured while woddng
on your property, you may be heldliable for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors,
You will be responsMe 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 issu€ttg; tthe.permit. Note: A copy of the property owner's Qtiver's ticgnse; farm notarieathvn; or
Other verification acceptable to the agency is required to be presented when the permit is Ensued to verify the property
owner's signature.
Signature of property owner , i�T ��k� iDate:
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 BERn
Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize
the following persons) -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:
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 Co be presented when the permit is issued to verify the property owner's signature.
Property Owner's Signature: ' Date:
Bin #
City of La Quinta
Building 8r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (7601777.7012
Building Permit Application and Tracking Sheet
Permit #O��-
Q
1�
Project Address:
Owner's Name: L-A-ekn
A. P. Number:
Legal Description:
Address: Ve 2�1i1" /
City, ST, Zip. '
Contractor:
6
Telephone: -P, -o 3,f % '%g/)
Address:
Project Description:
City, ST, Zip:
Telephone:
State Lic. # :
City Lie. #;
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person;
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: # Stories: # Units:
Estimated Value of Project: S
Telephone # of Contact Person:
APPLICANT:
DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item Amount
Structural Cala
Reviewed, ready for corrections
Plan Check Deposit
Plan Cheek Balance.
Truss Cala.
CalledContact Person
Title 24 Cala.
Plans picked up
Construction
Mechanical
Electrical
Plumbing
S.M:L
Flood plain plan
Plans resubmitted
Grading plan
2" Review, ready for corrections/issue
Subeongetor Liat
Called Contact Person
Grant Deed
Plans picked up
H.O.A. Approval
Plans resubmitted
Grading
Developer Impact Fee
IN HOUSE: -
3" Review, ready for correcdonsAssue
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit Issue
School Fees
Total Permit Fee