12-0963 (RR)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Tt-t!t °F 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
P/A
---------------------------------------------------
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 Busin s apo Professionals Code, d my License is in full force and effect.
LicenseeClass: C39 / Licens • 774482
ZD.tJ5se'�,� ontactor: 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).:
(_ 1 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.). -
(_) 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 contractors) licensed
pursuant to the Contractors' State License Law.).
1 _ 1 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 Name:
Lender's -Address:
LQPERMIT
Owner:
PGA WEST RES. II
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/23/12;
C/O MONARCH GROUP -�-)
43875 WASHINGTON STREETC I
PALM DESERT, CA 92211
AUG 2 9 2012
Contractor:
WILLIAMS ROOFING CITY OF LA QUINTA
P.O. sox 391841 FINANCE DEPT
ANZA, CA 92539 -
(760)399-9394
Lic. No.: 774482
------------------
WORKER'S COMPENSATION DECLARATION
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 STATE FUND Policy Number 1890178-2011
_ 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 Ishoul"ecgirrie subject to the worker ' compensation provisions of Section
3700 of the Labor Cod sh I f hwi comply it s
/atee ovisions.
D�pli
v cant:
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 Quihta, 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 buildin cons uction, and hereby autho ' e representatives `
of this county to enter upon the above-mentioned property in ction purp ses. r
D � ignature (Applicant or Agar
Application Number:
.172-000009634
Property Address:
56180 RIVIERA '
APN:
762-021-009- - -
Application description:
RE -ROOF
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
1500
Applicant:
Architect or Engineer:
P/A
---------------------------------------------------
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 Busin s apo Professionals Code, d my License is in full force and effect.
LicenseeClass: C39 / Licens • 774482
ZD.tJ5se'�,� ontactor: 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).:
(_ 1 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.). -
(_) 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 contractors) licensed
pursuant to the Contractors' State License Law.).
1 _ 1 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 Name:
Lender's -Address:
LQPERMIT
Owner:
PGA WEST RES. II
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/23/12;
C/O MONARCH GROUP -�-)
43875 WASHINGTON STREETC I
PALM DESERT, CA 92211
AUG 2 9 2012
Contractor:
WILLIAMS ROOFING CITY OF LA QUINTA
P.O. sox 391841 FINANCE DEPT
ANZA, CA 92539 -
(760)399-9394
Lic. No.: 774482
------------------
WORKER'S COMPENSATION DECLARATION
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 STATE FUND Policy Number 1890178-2011
_ 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 Ishoul"ecgirrie subject to the worker ' compensation provisions of Section
3700 of the Labor Cod sh I f hwi comply it s
/atee ovisions.
D�pli
v cant:
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 Quihta, 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 buildin cons uction, and hereby autho ' e representatives `
of this county to enter upon the above-mentioned property in ction purp ses. r
D � ignature (Applicant or Agar
Application Number
. . . . 12-00000963
Permit . .
. RE -ROOF
Additional desc .
Permit Fee '. . .
. 30.00
Plan Check Fee
.00
Issue Date
Valuation . . .
. 0
Expiration Date
2/19/13
,
. Qty Unit Charge
Per
Extension
BASE
FEE
30.00
----------------------------------------------------------------------------
Specia-1 Noteo and
Comments—
RE-ROOF OVER EXISTING
WITH URETHANE
FOAM. 2010 CODES.
----------------------------------------------------------------------------
{
Other Fees . . .
. . . . . . BLDG STDS ADMIN (SB14.73)
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
P.O. Box 391841, Anza, Ca. 92539 951-763-0769
!So -855 Washington St. 2c, # 130, La Quinta, Ca. 92253 760-399-9
Contract #Soot
For: Monarch Management Trust, 39-755 Berkey Suite A, Palm Desert, Ca. 9226o
Attn: JoAnne Rose Date: July 15, 2012
• Job Addresses: 56-180. Riviera, La Quinta, Ca. 92253
Schedule of extras if annlicable:
During the repair process, if any asbestos is discovered, the removal and disposal cost would be borne by owner. Any dry rot
will be replaced for an additional charge based on $8i.00 per hour labor and ix6 or ix8 materials at $ 2.50 per foot. Any
damaged rafter ends will be replaced for an additional charge based on s iog.00 each and fascia board at s ia.00 per lin. Ft. Any
CDX/OSB plywood to be replaced at an additional charge based on $ a.00 per sq. foot, labor included. .
Scope of Work as follows; Urethane foam roof system as follows on the above
rear patio flat deck only: Clean and prep roof decks to accept new materials.
Install new edge metals as needed. Wipe down and prime edge metals.
Install 1" 3.0 SPF Poly Urethane foam roof system as per manufactures
specifications. Install Acrylic roof coating as per manufactures specifications
@ a rate of 12" on perimeter and to receive 4 gallons per every loo square feet.
Remainder of roof system to receive 3 gallons per every loo square feet as per,
manufactures specifications. (This roof system is Title 24 Compliant)
Contract Price: $ 4500.00
Payment to be made as follows: To be paid upon regular billing cycle. (As completed)
Williams Roofing to leave jobsite clean and free of debris.
**Ten year workmanship warranty on all work performed by Williams Roofing only**
Owner/Agent Contractor li&
Prescriptive Certificate of Compile ce: Residential Reroof CF -1 R-ALT-ReRoc
Project Address: ki yl-eeA
Climate Zone
Permit 5
I ROOFING PRODUCTS (COOL ROOFS) §151(012
When the area of exterior roof surface to be replaced exceeds 50% of the existing root area, or 1,000 fr, whichever /s less, the net,
roofing area must meet the roofing product "Cool Roof" requirements of§152(b)1H1, 152(b)1HN, or 152(b)1HI11.
Check applicable alternative or exception below if the roof alteration is exempt from the roofing product "Cool Root" requirements::
❑ Cool rodfs rW required in Climates Zones 1-12,14, and 16 with a low sloped roof pitch (less or 2:12 pitch).
❑ Cod roofs not required in Climates Zones 1-9, and 16 with a steep -sloped roofs (greater pitch than 2:12) and product weightless than SAM
Alternatives to §152(b)1H1 and §152(b)HII, Steep -slope roof (pitch > 2:12)
❑ Insulation with a thermal resistance of at least 0.95 heft'-°F/Btu or at least a 3(4 inch air -space is added to the roof deck over an attic; or
❑ Existing ducts in the attic are insulated and sealed according to §151010; or
❑ In climate zones 10, 12 and 13, with 1 ft2 of free ventilation area of attic ventilation for every 150 tt2 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
❑ Building has at least R-30 ceiling Insulation; or
❑ Building has radiant barrier in the attic meeting the requirements of §15102: or
❑ Building has no ducts 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)1 Hill, Low -slope roof ( pitch s 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 Cod Roof criteria.
❑ Roof constructions that have thermal mass over the roof membrane with at least 25 Ib/ft2 are exempt from the Cool Roof criteria.
NO If any one of the alternatives 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.
N TE: When a Cool Root is required, the installing contractor shall complete and submit the CF -6R -ENV -01 for final inspection.
Declaration Statement
• I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is.accurate and complete.
• I certify that the energy features and performance specifications iderititled on this Certificate of Compliance conform to the requirements of Title 24, Part!
1 and 6 of the California Code of Regulations.
Name: d6ek
Signature•
Compan=kid
Date:
Addre s:v License:LN
t i
City/State/Zi Phone:
For assistance or questlons regarding the Energy Standards, contact the Energy Hotline at; 1-800.772-3300.
Roof Slope
Product Weight
Product
Aged Solar
Thermal
CRRC Product ID Number'
s 2:12 > 2:12
< 5lb/fe a 51b/ft2
TYPe2
Reflectance3'4
Emittarice
SRI
❑
❑
❑
0
❑4
.'13
❑
❑
❑
❑
❑4
Note: N no CRRC-1 label /s available, this compliance method cannot be used, use the Performance Approach to show compliance,
1. The CRRC Product ID Number can be'obtained from the Cool Roof Rating Council's Rat Product Directory at www cootroofs.ordnroducts✓search.nhn
2. Indicate the type of product is being used for the roof top, I. e. single -ply root, asphalt roof, metal roof, etc.
3. If the Aged Reflectance is not available in the Cool Roof Rating Council's Rated Product Directory then use the Initial Reflectance value from the same
directory and use the equation (0.2+0.7(p,,w - 0.2) to obtain a calculated aged value. Where p is the Initial Solar Reflectance.
4. Check box if the Aged Reflectance is a calculated value using the equation above.
5. Calculate the SRI value by using the SRI- Worksheet at htfvYAmm.eneray.ca.00v/title241 and enter the resulting value in the SRI Column above and attach
acopy of the SRI- Worksheet to the CF- i R.
To apply Liquid Field Applied Coatings, the coating must be applied across the entire roof surface and meet the dry mil thickness or cover
recommended by the coatings manufacturer and meet minimum performance requirements listed in §118(1)4. Select the applicable coating:
❑ Aluminum -Pigmented Asphalt Roof Coating ❑ Cement -Based Roof Coating ❑ Other
N TE: When a Cool Root is required, the installing contractor shall complete and submit the CF -6R -ENV -01 for final inspection.
Declaration Statement
• I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is.accurate and complete.
• I certify that the energy features and performance specifications iderititled on this Certificate of Compliance conform to the requirements of Title 24, Part!
1 and 6 of the California Code of Regulations.
Name: d6ek
Signature•
Compan=kid
Date:
Addre s:v License:LN
t i
City/State/Zi Phone:
For assistance or questlons regarding the Energy Standards, contact the Energy Hotline at; 1-800.772-3300.
bin ff
Permit #
\1
JC LNoject Address:
A. P. Number:
# Submittal
Plan Sets
Structural Calcs.
Truss Calcs.
Title 24 Calcs.
Flood plain plan
Grading plan
Subcontactor List
Grant Deed
H.O.A. Approval
IN HOUSE: -
Planning Approval
Pub. Wks. Appr
School Fees
City of La Quinta , z
Building 8t Safety Division
P.O. Box 1504, 78-49S Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
(%/ f aner's Name:
Address:
City, ST, Zip: ,
Lic. #:
Description:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: # Stories: # Units:
r Estimated Value of Projec
APPLICANT: DO NOT WRITE BELOW THIS LINE
Recd TRACKING
Plan Check submitted
Reviewed, ready for corrections
Called Contact Person
Plans picked up
Plans resubmitted
2"' Review, ready for corrections/issue
Called Contact Person
Plans picked up
Plans resubmitted
Review, ready for corrections/issue
Called Contact Person
Date of permit issue
PERMIT FEES
Item Amount
Plan Check Deposit
Plan Check Balance
Construction
Mechanical
Electrical
Plumbing
S.AI.I.
Grading
Developer Impact Fee
A.I.P.P.
Total Permit Fees
Contractor:
Address:
City. ST, Zip: ki fl
Telephone: Zb0-31 1
jC
State Lic. # :
Arch., Engr., Designer:
Address:
City. ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person:
Telephone # of Contact Person:
# Submittal
Plan Sets
Structural Calcs.
Truss Calcs.
Title 24 Calcs.
Flood plain plan
Grading plan
Subcontactor List
Grant Deed
H.O.A. Approval
IN HOUSE: -
Planning Approval
Pub. Wks. Appr
School Fees
City of La Quinta , z
Building 8t Safety Division
P.O. Box 1504, 78-49S Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
(%/ f aner's Name:
Address:
City, ST, Zip: ,
Lic. #:
Description:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: # Stories: # Units:
r Estimated Value of Projec
APPLICANT: DO NOT WRITE BELOW THIS LINE
Recd TRACKING
Plan Check submitted
Reviewed, ready for corrections
Called Contact Person
Plans picked up
Plans resubmitted
2"' Review, ready for corrections/issue
Called Contact Person
Plans picked up
Plans resubmitted
Review, ready for corrections/issue
Called Contact Person
Date of permit issue
PERMIT FEES
Item Amount
Plan Check Deposit
Plan Check Balance
Construction
Mechanical
Electrical
Plumbing
S.AI.I.
Grading
Developer Impact Fee
A.I.P.P.
Total Permit Fees