BRER2015-0087LICENSED 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 Cla s: License No.: 235717
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
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.. Q.
Lender's Name:
Lender's Address:
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.
k 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,
(IIsshall forthwith
comply with those provisions.
Z �
Date: 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.
i
s
Date: T� Signature (Applicant or Agent):.',,
78-495 CALLE TAMPICO
� D
,
VOICE (760) 777-7125
FAX (760) 777-7011COMMUNITY
LA QUINTA, CALIFORNIA 92253
DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT "
Date: 9/14/2015
Application Number:
BRER2015-0087
Owner:
Property Address:
54924 RIVIERA
SUNRISE DESERT PARTNERS
APN:
775153089
300 EAGLE DANCE CIR
Application Description:
REROOF WITH FIELD APPLIED WHITE FOAM [CRRC:0626-0010]
PALM DESERT, CA 92253
�
Property Zoning:
Application Valuation:
$3,330.00
a
O w
O N �Z
Applicant:
Contractor:
Lee
WESTERN PACIFIC ROOFING CORP
2229 EAST AVENUE Q2229
WESTERN PACIFIC ROOFING
EAST AVENUE
0 0
CL w
Q
PALMDALE, CA 93550
PALMDALE, CA 93550
vj v
(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 Cla s: License No.: 235717
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
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.. Q.
Lender's Name:
Lender's Address:
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.
k 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,
(IIsshall forthwith
comply with those provisions.
Z �
Date: 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.
i
s
Date: T� Signature (Applicant or Agent):.',,
FINANCIAL INFORMATION
' t s i., �X , , t
'DESCRIPTION
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�j'
``' � '�
QTY
'�"* AMOUNT .
�•�' PAID: � � * PAID DATE
4
# .ACCOUNT
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BSAS SB1473 FEE
101-0000-20306
0
$1.00
$0.00
.4
k ID BY r 3 .%.. x t.
MET, 'Y
CHECK;CLTD BY.'RECEIPT;#
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1
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Total Paid forBUILDING STANDARDS ADMINISTRATION BSA $1.00 $0.00
` 5': DESCRIP•TIONgi,' ?`r}� i>
�'ACCO.UNT }
QTY`
' AMOUNT.1
PAIDy
PAID, DATE'
tr
i
RE -ROOF - FIRST 2,000 SF
101-0000-42404
0
$49.31
' $0.00
4 v-
(,. PAID BY $ i3 r ": v
`., M, e s METHOD ;;' '
'•.' RECEIPT # -"
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Total Paid forRE-ROOF: $49.31 $0.00
TOTALS:•0
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Description: REROOF WITH FIELD APPLIED WHITE FOAM [CRRC:0626-0010]
Type: RE -ROOF
Subtype: Status: UNDER REVIEW -
Applied: 9/14/2015 SKH '-
Approved: 9/14/2015 SKH
Parcel No: 775153089 Site Address: 54924 RIVIERA LA QUINTA,CA 92253
Subdivision: TR 21846-5
Block: Lot: 2
Issued:
Lot Sci Ft: 0
Building Sci Ft: 0 Zoning:
Finaled:
Valuation: $3,330.00
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.
ADDITIONAL SITES
CHRONOLOGY
z . , CLTD'`
DESCRIPTION 4� ACCOUNT QTY ? 'AMOUNT PAID PAID DATEy RECEIPT # CHECK #. METHOD PAID BY>`�_
r
BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00
Total Paid for BUILDING STANDARDS ADMINISTRATION $1.00 $0.00
BSA:
Printed: Monday, September 14, 2015 6:25:38 PM 1 of 2 Cor
SYSTEMS
9
` DESCRIPTION
77,777-
°°-"ACCOUNT
QTY
-AMOUNT
• �~ ,PAID•
,PAID DATE
'.RECEIPT;#
CHECK+#t,
METHOD'
PAID BY '
BY`,!- �
RE-ROOF - FIRST 2,000
101-0000-42404.
0
$49.31
$0.00
r , z
_� ,,�
0
PRE -ROOF BLD
SF
0
FINAL" BLD
Total Paid for RE -ROOF: $49.31 $0.00
TOTALS:00
ATTACHMENTS
Printed: Monday, September 14, 2015 6:25:38 PM 2 of 2 C
SY57EMS
�SEQID $
„' INSPECTION TYPE j. ' { .} INSPECTORw �.
'
SCHEDULED ,COMPLETED
• RESULT y 'REMARKS
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ATTACHMENTS
Printed: Monday, September 14, 2015 6:25:38 PM 2 of 2 C
SY57EMS
STATE OF CALIFORNIA
RESIDENTIAL ALTERATIONS
CEC-CFIR-ALT-01-E Revised 06/14 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CHR -ALT -01-E
Prescriptive Residential Alterations of 4)
(Pagel
Project Name: GAr- (��,T (Ze5 ►c�en \ Date Prepared: j,
A. GENERAL INFORMATION
01
02
Ol
Project Name: GA- lJJ £ T (2 -es % de,h'ct
02
Date Prepared: y Pr
03
Project location: 15 4— d. ; Weeb.,
04
Building Front dFlentat on (deg or cardinal):
05
CA City:
06
Number of Altt eavwelling Units:
07
Zip Code: g
08
Fuel Type:,
09
Climate Zone:
10
::�Tofal,Condit ned Floorler ajft_2)
Il
Building Type
_ 12_:
,S 1b,Aiea (ft2)
13
Project Scope: �ry�.a1 a:�10 0 0. Do\ ✓
�c cvr. r•c, P, -5\1
B. BUILDING INSULATION DETAILS (Section 1S0.2(0)1)
01
02
03
04
05
06 _ , .` b7 08,t 09
10
11
Tag/ID
Assembly Type
Frame
Type
Frame
Depth
(inches)
Frame
Spacing
(inches)
,P,ropo d q� I-.11
Required
Comments
- v
Continuous
Cavity Insulation
R -value R-valued+QJf0or
)j(AppendixJA4
Reference
LI -Factor
Table Cell
tlutt
Solar Aged Solar Thermal SRI Aged Solar Thermal SRI
�. = it
Type _
nsulation
Reflectance Reflectance Emittance (Optional) Reflectance Emittance (Optional)
t
�s w -® � sv x v .. s •s
C. ROOF REPLACEMENT (Prescriptive Alteration, Se tIbn-X50.2(b)1H),
Ol
02
03
04 .da,' !
0%, A
0 06
ir '072 7 08 09 10 11 12 13
Method of
Roof
C R, C R Odutt ID
a
R -value 1A
Deck
Proposed Minimum Required
"(Initial
Compliance
Pitch
Exception
N�m'ber
tlutt
Solar Aged Solar Thermal SRI Aged Solar Thermal SRI
Type _
nsulation
Reflectance Reflectance Emittance (Optional) Reflectance Emittance (Optional)
t
v'47
NOTES ✓
• Roof area covered by, builaingantegrated photovoltaic'panels and solar thermal panels are exempt from the above Cool Roof requirements.
• Liquid field appliec'11coatAngsKust hdinstallation from 110.8(1)4.
comply wi criteria section
Registration Number: Registration Date/Time:
CA Building Energy Efficiency Standards - 2013 Residential Compliance
HERS Provider:
June 2014
STATE OF CALIFORNIA
RESIDENTIAL ALTERATIONS
CERTIFICATE OF COMPLIANCE CF1R-ALT-01-E
Prescriptive Residential Alterations (Page 4 of 4)
Project Name: A- Date Prepared: `�
DOCUMENTATION AUTHOR'S DECLARATION STATEMENT
1. I certify that this Certificate of Compliance documentation is accurate and complete.
Documentation Author Name:r
W;"k��
Documentation Author at
Company: '
Signature Date: fA
Address:
CEA/ HERS Certification'Idefif cai9n`(ifapplicable):
JIJ4.
City/State/Zip:
Phone:
RESPONSIBLE PERSON'S DECLARATION STA EMENT _%01
I certify the following under penalty of perjury, under the laws of the State of California:
1. The information provided on this Certificate of Compliance is true and correct.
ir %system
2: 1 am eligible under Division 3 of the Business and Professions Code to '.for
accept responsib trebruildi4derir-�i�n design identified on this Certificate of Compliance (responsible
designer).9
3. That the energy features and performance specifications, materials, components, and manufactu_rrg�d�`d'eva�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 the aarifornia Code of'Reguladons.
4. The building design features or system design features identified on this Certificate of Co—'Vopl ancee are cons sten sw�it( kie information provided on other applicable compliance documents,
worksheets, calculations, plans and specifications submitted to the enforcement ager)` approval with tthis� u11 Ing permit application.
5. I will ensure that a registered copy of this Certificate of Compl a� is all be made:availld6le with the bu'II ding permit(s) issued for the building, and made available to the enforcement agency
ao�y
for all applicable inspections. I understand that a registered of this Certificateetof Compliance is feq'ulrel to be included with the documentation the builder provides to the building
owner at occupancy.,
Responsible Designer Name:
Responsible Designer Signature:
Company:
Date Signed:
�e�
Address: �'
license:
City/State/Zip:`
Phone:
For assistance orquestions 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