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BRER2015-0081LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my License is in full force and effect. License Class: B. C39 License No.: 235717 DaEte Contractor: ��✓/ OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division 3' of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: () 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, 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 am exempt under Sec. B.&P.C. for this reason Date: Owner: 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 Lender's 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. 3_ 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 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. /J Date: Applicants: //. AV 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. 4 ",-/. /V� Date: � Signature (Applicant or Agenoo� 78-495 CALLE TAMPICO VOICE (760) 777-7125 FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 9/4/2015 Application Number: BRER2015-0081 Owner: Property Address: 54591 RIVIERA OLSEN P & INSPRUCKER R APN: 775031020 54591 RIVIERA w Application Description: REROOF WITH FIELD APPLIED WHITE FOAM [CRRC: 0626-0010] LA QUINTA, CA 92253 s Property Zoning: Ln a w Application Valuation: $4,450.00 N z Q �w Applicant: Contractor: � � O ® WESTERN PACIFIC ROOFING CORP 2229 EAST AVENUE WESTERN PACIFIC ROOFING C 1� d W t 3 Q 2229 EAST AVENUE Q PALMDALE, CA 93550 PALMDALE, CA 93550 C) l� (661)273-1336 Llc. No.: 235717 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my License is in full force and effect. License Class: B. C39 License No.: 235717 DaEte Contractor: ��✓/ OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division 3' of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: () 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, 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 am exempt under Sec. B.&P.C. for this reason Date: Owner: 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 Lender's 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. 3_ 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 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. /J Date: Applicants: //. AV 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. 4 ",-/. /V� Date: � Signature (Applicant or Agenoo� FINANCIAL • • DESCRIPTION hwj p� ACCOUNT Fxa 1Y QTYY- AMOUNT +' PAID PAID DATE: ,; I BSAS SB1473 FEE 101-0000-20306 0 $1.00 i $0.00 PAID BY '-METHOD ` RECEIPT # « CHECK #' 'CLTD BY r,�` Sa` a i .*t r , Total Paid forBUILDING STANDARDS ADMINISTRATION BSA $1.00 $0.00 ACCOUNT�"'' r "` QTY AMOUNT : , PAID j PAID DATE . ;_ta RE -ROOF - FIRST 2,000 SF 101-0000-42404 0 $49.31 $0.00 PAID BY" t�" 1 z t ?� r, METHOD .; RECEIPT # -, CHECK # _ CLTD BY r k.. " ; . Total Paid forRE-ROOF: $49.31 $0.00. TOTALS:• • •• i i a I • • i r i i Description: REROOF WITH FIELD APPLIED WHITE FOAM [CRRC: 0626-00101 Type: RE -ROOF Subtype: Status: APPROVED Applied: 9/3/2015 AOR Approved: 9/4/2015 SKH Parcel No: 775031020 Site Address: 54591 RIVIERA LA QUINTA,CA 92253 Subdivision: TR 24317-1 Block: Lot: 2 Issued: Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $4,450.00 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0 Details: REROOF WITH LIGHT -NATIONAL COATINGS CORPORATION ACRYSHIELD-A510 WHITE [CRRC: 0626-0010] 2013 CALIFORNIA ENERGY CODE. 2229 EAST AVENUE Q PALMDALE ADDITIONAL SITES CONDITIONS Printed: Friday, September 04, 2015 2:41:33 PM 1 of 2 C SYSTEMS PHONE vh y a *'r NAME TYPE' : 4 5 'NAME CONTACTS ADDRESSI �, CITY, :.� t STATE ZIP' APPLICANT WESTERN PACIFIC ROOFING CORP 2229 EAST AVENUE Q PALMDALE CA 93550 CONTRACTOR WESTERN PACIFIC ROOFING CORP 2229 EAST AVENUE Q PALMDALE CA 93550 OWNER OLSEN P & INSPRUCKER R 54591 RIVIERA LA QUINTA CA 92253 Printed: Friday, September 04, 2015 2:41:33 PM 1 of 2 C SYSTEMS o �of DESCRIPTION -ACCOUNT QTY-, AMOUNT 3L PAID PAID DATE. 7,z -RECEIPT !'- CHECK i. , - %'4 - !�METHOD_ -77777 PAID BY CLfD BY RE -ROOF - FIRST 2,000 101-0000-42404 0 $49.31 $0.00 SF FINAL" BLD Total Paid for RE -ROOF: $49.31 $0.00 TOTALS: $50.31 $0.00 IPARENT PROJECTS BOND INFORMATION ATTACHMENTS Printed: Friday, September 04, 2015 2:41:33 PIVI 2 of 2 C07W.1ySTIMS INSPECTIONS Y' INSPECTOR 'SCHE5UIED, _COMPLETED RESULT'. 'REMARKS S -5, ,'INSPECTIONTYP 'P DATE DATE, PRE -ROOF BLD FINAL" BLD IPARENT PROJECTS BOND INFORMATION ATTACHMENTS Printed: Friday, September 04, 2015 2:41:33 PIVI 2 of 2 C07W.1ySTIMS STATE OF CALIFORNIA RESIDENTIAL ALTERATIONS CERTIFICATE OF COMPLIANCE CFIR-ALT-01-E Prescriptive Residential Alterations (Page 1 of 4) Project Name: _P<oA- t,,JCgT(ZeS ici _, Lc�\ . n AAL \ Date Prepared: q j r A. GENERAL INFORMATION 01 02 01 Project Name: GA- uJ T es' den & v- 1 02 Date Prepared: , "'r `( 03 Project Location: 45'7 R i J ' c 04 Building Front Ciiier ,Latj'Pd1deg or cardinal): 05 CA City: L4L.06 Exception Number of Altered+Dwelling Units: e^ 07 Zip Code:08 Fuel Type: a sink 09 Climate Zone: 10 Tota CkrAilitioned FlooDArea (ft2) � 11 Building Type 12 Slab A'tga(ft2) %'V 13 Project Scope: 1 a.�10 d o\ nc, c,,.+ f eo 5 She„^ _ V111 VA 'I- B. BUILDING INSULATION DETAILS (Section 150.2(b)1) 01 02 03 04 05 06 , t,'1. 07 I 08J14Ja9 10 11 06 R -value "U7 08 09 10 11 12 13 Proposed Minimum Required Initial Solar Aged Solar Thermal SRI Aged Solar Thermal SRI Method of Compliance Roof Pitch Exception C RCiWodu IDDecker *,Q jipFiM ,o Required Reflectance Reflectance Emittance (Optional) Reflectance Emittance (Optional) _ �401 OLMW6- poi �,' �1-L �' : {Appendix JA4 6'7 Z '1 IL Frame Frame ontinuous Reference NOTES Vr • Roof area covered by, bNil'diinng integrated p ..`oto o to e'panels and solar thermal panels are exempt from the above Cool Roof requirements. • Liquid field applied�coatKngs must comply 'nstallation from wit criteria section 110.8(1)4. Frame Depth Spacing Cavity Insulation Tag/ID Assembly Type I Type I (inches) I (inches) I R-valu_ R-valued+Wlfoor Table. Cell - I U -Factor I Comments 011 VrX '% _ tco C. ROOF REPLACEMENT (Prescriptive Alteration, nn S6.2(b)11-11 Sect 01 02 03 04 , 05'x, " ,,,� 06 R -value "U7 08 09 10 11 12 13 Proposed Minimum Required Initial Solar Aged Solar Thermal SRI Aged Solar Thermal SRI Method of Compliance Roof Pitch Exception C RCiWodu IDDecker *,Q Amber uct Type - fns lation Reflectance Reflectance Emittance (Optional) Reflectance Emittance (Optional) _ �401 OLMW6- poi �,' �1-L �' : X' 6'7 Z '1 IL NOTES Vr • Roof area covered by, bNil'diinng integrated p ..`oto o to e'panels and solar thermal panels are exempt from the above Cool Roof requirements. • Liquid field applied�coatKngs must comply 'nstallation from wit criteria section 110.8(1)4. Registration Number: Registration Date/Time: HERS Provider: CA Building Energy Efficiency Standards - 2013 Residential Compliance June 2014 STATE OF CALIFORNIA RESIDENTIAL ALTERATIONS CERTIFICATE OF COMPLIANCE CF1R-ALT-01-E Prescriptive Residential Alterations (Pace 4 of 4) I Proiect Name: 4-tiA- I* 1 I Date Prepared: Vu h%- I DOCUMENTATION AUTHOR'S DECLARATION STATEMENT . 1. 1 certify that this Certificate of Compliance documentation is accurate and complete. s Documentation Author Name: kC- Documentation Author at "J,W 1 11 / / . Company: !� -vNr 6,C12, Signature Date: y 6 �'{ Trr �c� t1 c �. ell Address: CEA/ HERS Certification ,r Idem atL9W(if applicable): ". � 3q( ? ani a City)'State/Zip: I��l M S✓ �. s CA- Phone: 1.60 '1 c 6 �� 7 RESPONSIBLE PERSON'S DECLARATION STA EMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information this Certificate Compliance is and 0 provided on of true correct. 2: 1 am eligible under Division 3 of the Business and Professions Code to accept responsibi i for the building'Cle'sl : or system design identified on this Certificate of Compliance (responsible designer). °� 3. That the energy features and performance specifications, materials, components, a,: d manufactured eQc!41 z+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 off Calll ornia Code ofrRve�gulaL of ns. `� ,the � 11 4. The building design features or system design features identified on tH��is, Geertificate of LOpliiance�'are consiistep ww tlhlne information provided on other applicable compliance documents, worksheets, calculations, plans and specifications submitted Y* a !"- '% ement ager�e�r foWpproval with his BuiVA 4A q lding permit application. 5. 1 will ensure that a registered copy of this Certificate of Compliant hall be made� availably with the bu Idinn permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a registeeredtaopJ-of this Cert i IcateYo Compliancyliequirei to be included with the documentation the builder provides to the building owner at occupancy. 41h, a -4V Q01 Responsible Designer Name: '%Nes onsible Designer Signature: Company: @% lil Date Signed: Address: License: City/State/Zip: V Phone: +v � 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 June 2014