BRER2015-0071LICENSED CONTRACTOR'S DECLARATION
I hereby affirm.under penalty of perjurj tl\at I am licensed under provisions of Chapter
9 (commencing with Section 7000) of Divist(k 3 of the Business and Professions Code,
and my License is in full force and effect.
License Class: B. C39 License No.: 235717%/ /J
Date 7 ss°//i Contractor1/A
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 I, 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 Add
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certificate o8 consent to self -insure for workers'
compensation, as provided for by Section 3700 ofthe Labor Code, for the performance
of the w k 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: _ Polity Number:
_ I certify that in the performance of thework 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, i; I should become subject to the
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with those provisions.
Date: _ �.9� 'Applicant-�:
WARNING: FAILURE TO SECURE WORKERS' COMP'=NSATION 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 INSECTION 3706 OF THE LABOR CODE,
INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT: Application is hereby made to the Bailding Official for a permit subject to
the conditions and restrictions set forth on this application.
1. Each person upon whose behalf this applicatbn is made, each person at whose
request and for whose benefit work is performed :ender 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 Cit- 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 issLance of such permit, or cessation of
work for 180 days will subject permit to cancellatim.
I certify that I have read this application and statethat 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 ro efrty for inspection purposes.
o//A�
Date: 4 to �) Signature (Applicant or.kgent):" �( ,! ,
1
ai�IN�/
�
VOICE (760) 777-7125 .
, 78 495 CALLE TAMPICO
D
FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253
COMMUNITY DEVELOPMENT DEPARTMENT
INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 9/10/2015
Application Number:
BRER2015-0071
Owner:
Property -Address:
55424 RIVIERA
STYLES ROBERT & LISA
APN:
775153049
55424 RIVIERA
Application Description:
REROOF WITH FIELD APPLIED
WHITE FOAM [CRRC: 0626-0010]
LA QUINTA, CA 92253
z
Property Zoning:
Application Valuation:
$3,045.00U-7
a
o z �
Applicant:
Contractor:
r-= cv w
cL
WESTERN PACIFIC ROOFING CORP
WESTERN PACIFIC ROOFING COR ® g o
J
2229 EAST AVENUE Q
PALMDALE, CA 93550
2229 EAST AVENUE Q
PALMDALE, CA 93550
ILL
r -4 10W
[� v
LAJ
z
(661)273-1336
g
Llc. No.: 235717
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm.under penalty of perjurj tl\at I am licensed under provisions of Chapter
9 (commencing with Section 7000) of Divist(k 3 of the Business and Professions Code,
and my License is in full force and effect.
License Class: B. C39 License No.: 235717%/ /J
Date 7 ss°//i Contractor1/A
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 I, 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 Add
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certificate o8 consent to self -insure for workers'
compensation, as provided for by Section 3700 ofthe Labor Code, for the performance
of the w k 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: _ Polity Number:
_ I certify that in the performance of thework 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, i; I should become subject to the
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with those provisions.
Date: _ �.9� 'Applicant-�:
WARNING: FAILURE TO SECURE WORKERS' COMP'=NSATION 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 INSECTION 3706 OF THE LABOR CODE,
INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT: Application is hereby made to the Bailding Official for a permit subject to
the conditions and restrictions set forth on this application.
1. Each person upon whose behalf this applicatbn is made, each person at whose
request and for whose benefit work is performed :ender 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 Cit- 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 issLance of such permit, or cessation of
work for 180 days will subject permit to cancellatim.
I certify that I have read this application and statethat 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 ro efrty for inspection purposes.
o//A�
Date: 4 to �) Signature (Applicant or.kgent):" �( ,! ,
I
FINANCIAL • 1 •
,
SnDESCRIPTION ACCOUNTQTY
i,.
AMOUNT =`'..
PAID, PAIDbATE`
' n " eye�4.f
_
BSAS SB1473 FEE 101-0000-20306 0
$1.00
$0.00
. w 9
+L
.r, .. 6,V*" k r• "E`ax =f i Z
' PAIDsBY w '.� r r- `METHOD `RECEIP,T # t
.. x
s ti CHECK #
CLTD BY
,• F:,
r. 1• G ;ra I .is �. 3 . e. t' r �iY r 1+_ CS.4
a
Total Paid forBUILDING STANDARDS ADMINISTRATION BSA $1.00 $0.00
'^ `i()ESCRIPTION
A000UNT
AMOUNT X x
L "PAID '
PAID:DATE
, •
RE -ROOF - FIRST 2,000 SF
101-0000-42404
0
$49.31
$0.00
r PAID BYE '
"?� `
RECEIPT # `�
CHECK #
CLTD BY'=
A . !
f ,�' ,METHOD.{� ,`
I±ti.
Total Paid forRE-ROOF: $49.31 $0.00
TOTALS:00
I
r
F
Description: REROOF WITH FIELD APPLIED WHITE FOAM [CRRC: 0626-0010]
Type: RE -ROOF .
Subtype: Status: APPROVED
Applied: 9/3/2015 AOR
Approved: 9/10/2015 SKH
Parcel No: 775153049 Site Address: 55424 RIVIERA LA QUINTA,CA 92253
Subdivision: TR 21846-5
Block: Lot: 2
Issued:
Lot Sq Ft: 0
Building Scl Ft: 0 Zoning•:
Finaled:
Valuation: $3,045.00
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.
7 '�.
Applied to Approved'
CLTD
DESCRIP.TION3 -ACCOUNT �I '4 QTY 'AMOUNT + PAID PAID DATE'. ;RECEIPT.# CHECK METH '�: , K
PAID BY
BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00
Total Paid forBUILDING STANDARDS ADMINISTRATION $1.00 $0.00
BSA:
Printed: Thursday, September 10, 2015 11:21:56 AM 1 of 2 R SYSTEMS
1�7
-, -
''AMOUNT
fV - " �-- , ,- 1�
c - "�, - :, . �
PAID DATE
RECEIPT #
7
ECI(4�,
MET HOD
0t
PAID BY 7'
CLTD.
DESCRIPTIO
-ACCOUNT�,,"_�� -
-PAID,
-V
Y,
BLD
441°
FINAL"
BLD
RE -ROOF - FIRST 2,000
101-0000-42404
0
$49.31
$0.00
SF
Total Paid for RE -ROOF: $49.31 $0.00
TOTALS: $50.31 $0.00
PARENT PROJECTS
BOND INFORMATION
ATTACHMENTS
I -
Printed: Thursday, September 10, 2015 11:21:56 AM 2 of 2 CRWSYSTEMS
INSPECTIONS
:SE I6 17 INSPECTION TY P
-K,INSPEC OR.. SCHED LEDCOMPLETED,4RES "RE
IS
�%DATE
PRE -ROOF
BLD
FINAL"
BLD
PARENT PROJECTS
BOND INFORMATION
ATTACHMENTS
I -
Printed: Thursday, September 10, 2015 11:21:56 AM 2 of 2 CRWSYSTEMS
STATE OF CALIFORNIA Pb
RESIDENTIAL ALTERATIONS Im
CEC-CFIR-ALT-01-E Revised 06/14 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CFIR-ALT-01-E
Prescriptive Residential Alterations (Page 1 of 4)
Project Name: PG &- LJ4=t;T Date Prepared: ut 11 i <-
A.
A. GENERAL INFORMATION
01
AVA
01
Project Name: GA- UJ s
02
Date Prepared: ,, -0 " 4 11-
03
Project Location:; p`
04
Building Front dSngr at on (deg or cardinal):
05
CA City:
06
Number of Alte_rpa'b elling Units: 4r^
07
tip Code:
08
Fuel Type- % „ %.,,W
09
Climate Zone:
30
Total C;rid tinned FlooDArea (h2):�
11
Building Type
12
1 slabb i4WS 0t2) 4L%1* ' -
13
Project Scope: l�si�o 0. 0�
c- ar. f eo 5 5�e.+� _
I i :'�'%'*
B. BUILDING INSULATION DETAILS (Section 150.2(b)1) a VL
01
02
03
04
05 06 _ �� 07 08t' 99
10
11
Tag/ID
Assembly Type
Frame
Type
Frame
Depth
(inches)
roposed q0 w
+Appendix JA4
Frame Continuous
Spacing Cavity NInsulation Reference
(inches) R-valu- R -valued U,Jaetor Table. Cell
Required
Comments
U -Factor
a Qtluct Type Insulation
Reflectance Reflectance Emittance (Optional) Reflectance ittance[(OPESRI
! C % 10%X I
s:�0 ..,G _ lSo► ate' i 1d 1 X`�
!Thermal
e -7 y '7
--
Vit 0.' '$ tc.10
NOTES "$
• Roof area covered by, builaiingjntegrated
C. ROOF REPLACEMENT (Prescriptive Alteration, ;i fn"�.'50.2(b)1H)� 4w
tl
See
03 02 03 04 0%, N P 06
Ir 0670 1 08 09 10 11 12 13
,� R -value 1
Proposed Minimum Required
,Initial Solar Aged Solar Thermal SRI Aged Solar
Method of
Compliance
Roof
Pitch
Exception
C R�C�-PT'o ID Decck
Npmber
a Qtluct Type Insulation
Reflectance Reflectance Emittance (Optional) Reflectance ittance[(OPESRI
s:�0 ..,G _ lSo► ate' i 1d 1 X`�
!Thermal
e -7 y '7
NOTES "$
• Roof area covered by, builaiingjntegrated
photovo taic-panels and solar thermal panels are exempt
• Liquid field epplicd aoetiT5g3 �ti�uSt LUI 1rply -1 LI n lallatiun eilreria from section 1lusiiia.
from the above Cool Roof requirements.
Registration Number: Registration Date/Time: HERS Provider:
CA Building Energy Efficiency Standards - 2013 Residential Compliance June 2014
STATE OF CALIFORNIA
RESIDENTIAL ALTERATIONS
CEC-CFIR-ALT-01-E Revised 06/14 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CF1R-ALT-01-E
Prescriptive Residential Alterations (Page 4 of 4)
Project Name: V6,14- �6 A- w i I Date Prepared: '/4 h Y -
DOCUMENTATION AUTHOR'S DECLARATION STATEMENT
1. 1 certify that this Certificate of Compliance documentation is accurate and complete.
Documentation Author Name:
k
Documentatlon Author at :y. A
(J W l n
/ /
Company: n
6---o-
Signature Date: "'WE
Address: I
CEA/ HERS Certification IderrM '-,9&(if applicable): :$
�GZ ani a
AP
City/State/Zip:
(011A S ✓'I0'\s CA-
Phone:
00-'i1(0
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
provided on of
,
true and correct. cm....
2: I am eligible under Division 3 of the Business and Professions Code to accept responsib afor the building�esi"ggin or system design identified on this Certificate of Compliance (responsible
designer).
3. That the energy features and performance specifications, materials, componvents, and manufacturred llev ie 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 daaMornia Co a of egulatlons.
4. The building design features or system design features identified onntthi Irtificate . Iiance;'are consistent e![Ql�'elnformation'proviclecl on other applicable compliance documents,
a lkcement ager>$c t building
worksheets, calculations, plans and specifications submitted to t�'Cu
,,,foypproval with is permit application.
5. 1 will ensure that a registered copy of this Certificate of Compllaall be mad ��vailabl@with the building pQrmlt(s) issued for the building, and made available to the enforcement agency
for all applicable inspections. I understand that a registeeret16this CCerti lcateYO�f Complianceeiis (equi�'W to be included with the documentation the builder provides to the building
owner at occupancy.Aft
Responsible Designer Name: ®
ifkes nsible Designer Signature:
Company: —
Date Signed:
6l A VC1/s'
Address:
License:
City/State/Zip: Ar 1W 'Si '°'
I(ew
Phone:
For assistance Orouestions 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