12-1070 (RR)- iiiii►iiiisiiii�iiiiiiiii
P.O. BOX 1504 IE
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
55T4t�v 4 4 "
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number:
12-00001070
Property Address:
49805 ADELITO DR
APN:
646-240-015- -
Application description:
RE -ROOF
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
14477
Applicant: Architect or Engineer:
k4V
------------------
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 Pro ionals Code, and my License is in full force and effect.
License Cla s: 39 License No.: 868171
Date: L 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).:
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.).
(_ 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.).
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:
FLORSHEIM RESIDENCE
49805 ADELITO
LA QUINTA, CA 92253
(2 09) 992 - 0562
Contractor:
FOAMBOND CORPORATION
255 N. EL CIELO STE 140-65
PALM SPRINGS, CA 92262
(866)404-5440
Lic. No.: 868171
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/18/12
D°
4c 2012
CITY OF LA QUINTA
FINANCE DEPT,
-----------------------------------------------
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 CA INS Policy Number 468463140101
_ 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 rs' compensation laws of California,
and agree that, if I should become subject to the r rs' ompensation provisions of Section
�0 of the Labor Code, I shall forthwith co Y it ose Provisions.
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 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 informatio �corec3gr!e to comply with all
city and county ordinances and state laws relating to building constructsrize representatives
of this county to ter upon the above-mentioned property for inspe on inoses.
Date: Signature (Applicant or Agent):
-
LQPERMIT
Application Number . . . . . 12-00001070
Permit RE -ROOF
Additional desc . .
Permit Fee . . . . 30.00
Plan Check Fee
.00
Issue Date . . . .
Valuation . . .
. 0
Expiration Date . . 3/17/13
Qty Unit Charge Per
Extension
BASE FEE
30.00
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Special Notes and Comments
RE -ROOF REMOVE EXISTING TILE INSTALL NEW
UNDERLEYMENT & NEW TILE. FLAT AREAS
GRAVEL SWEEP INSTALL NEW POLYURETHANE
FOAM ROOF SYSTEM OVER EXISTING. 2010
CODES APPROVED PER A.J.
----------------------------------------------------------------------------
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
Ttmcate of Comma
11491dOntral °i�eroof
climate 2
ROOFING PRODUCTS (COOL ROOFS) §151012
When the area of exterfor roof surface to be replaced exi
roofing area must meet the roofing product _Cool Roof
,heck applicable altemauv9 or exception below 5
of the existing roof area, or 1,000 fe, whichever is less, the new
Its of §152(b)1H1, 152(b)1Hii, or 152(b)1H111.
the roof $nersuon is exempt from the roofing product 'Cool Roof requirements::
❑ Cool roofs D9 required in Cues Zones 1-12,14, and 16 with a low sloped roof pitch (less or 2:12 pitch).
❑ Cool roofs W required in Cturrates Zones 1-9. and 16 with a
Alternatives to §152(b)l HI and §152(b)Hii, Steep -slope roof fthsteep> :f2 ped roofs (gresder pitch #w 2:12) and productweigh less than 5f1b/tt�.
❑ Insulation with a thermal � (P�h > 2:12) .
re ns of at least 0.85 hr•tt •'FBtu or at least a 3/4 Inch air -space is added to the roof deck overan attic; or
❑ Existing ducts in the attic are insulated and sealed according to 6151(f)10; or
❑ In clmate'zones 10, 12 and 13, with 1 ft2 of free ventilation area of attic vo*IW n for every 150 ft2 of attic floor area, and
where at least 30 percent of the free ve lobo area is W tan 2 feet vertical distance of the roof ridge; or
❑ Building has at least R-30 ceamg insulation; or ,
❑ Building has radiant barrier in the attic meeting the requirements of §151(f)2; or
O 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)1Hill, Low slope roof (pftrh S 2:12)
❑ Building has no duds in the attic.
Other Exceptions
❑ Roofing area is covered by bu kkV wed: PhobvIolta is panels and solar themnad
❑ Roof constructions that have thermal mass over the roof Panels are exempt from the Cod Roof criteria.
NOTE N any one o1 the alt "' 1e ""M at least 2511 {12 are exempt from the Cool Rod criteria.
products in 11 i are not emauves or exception is dl(N ked the Aged Soar Redectanoe and Thermal C -fiance
§ 6(J applicable. Do not fill table below. requirements for roofing
CRRC Product ID Number' Roof Slop
5 2:12 >
-a og6 ❑
-00017 1 ❑
e
;:12
Product Weight
< 5lb e 2 51611
Product
T s
Aged Solar
RefledanceI
Thermal .
Emilia nce
SRI
❑
❑
E!EEI
%1 4,
❑4 . l'3
l
Asa ><R
❑4
6 .
!O
Note: Hno CRRC-1 label is available, this oomp#arioe me#W cannot be used, use the Per�onnance Approach to show
1. nue CRRC Prodruct ID Mumber can ole oerarred from a►e Cod Roof woe.
2. /rr a CR ala type dpodYuct h baJrp used for pie roele.XrS Rated Product Obedory a!
I. Hale. i�l)' moo+. asphdt roof metal roCf etc.
&�AOed Reuse ft fledarrce is not available in are Cod Roof Raarp CounI Rated Product ptr y plan use flue lrrXial Reflectance
value iom the same
III' Check box M the equation f 0 2+0.7(A�w — 0.2) to obtain a calpitated aped value: Where p is the bwtfat Solar Reflectance.
Aged Repedance Is a calculated value uslrrp the equation above.
i. Calculate the SRI value by using the SRI- wo+ksheet at
&Copy of the SRI- Wb►ksheol to are CF -1R. and enter the resuttirp value in the SRI Column above and attach
fo apply Liquid Field A,ppUed Coatings, the coating must
by applied across the entire roof surface and meet the dry rte thickness or covers
ecorrxnrended the coatings manufacturer and meet minimum performance requirements Dated in §118(i}4. Select the applicable coating:
Aiuminum-Pigmented Asphalt Roof Coating
When a Coo! Roof Is required, the instellinfl
Declaration Statement
❑ Cement -Based Roof Coating ❑ Other
complete and submit the
inspection.
• I certify under Penalty of perjury, under the laws of the State of California, the information
• 1 certify that the alter__ features and performance Provided on tt►is form is accurate and complete.
1 and 6 of the California Code of ulatbns. on this Certificate of Compliance conform b the requiremer+ts of Idle 24, Part
Name:
Ail' ti � Tjy �., • `� Z Signature-
Company.-
1
ignature-Company.-
1 0 a ^4 Qp 4.-, of ,�ia� Date: g
A. .ss• /// I 17—
Z-
?_
z S yU G S 6 License: �'
City/StateRip: /
. �6f �! T Z ! Z Phone:
For assistance or questions reyard/ng the Energyo f-4 / - 0 6 ,76
Standards, contact the Energy Hotline at. 1-800-772-3300.
Permit #
JC Project Address: T
A. P. Number:
F
al Description:
tractor:
Address: ZS S
- City. ST, Zip:
Telephone: �p 7. 8- /, d C 6
FA
esigner:
ress:
Cita•, ST, Zip:
Tele h
City of La Quinta
Building 6t Safety Division
P.O. Box 1504, 78-495 Calle Tampico
of Project: G
La Quinta, CA 92253. (760) 777-7012
'
Building Permit APPlication Trirkine
a^,' Sheet
G
1t 0 9, - wner's Name; to
,
APPLICANT:
Address:
LINE
N
Submittal
Cita•. ST, Zip:
Recd
D r ti / ti elephone: 2 0 Y_ 112 - 6 S� Z
C , IWO 6r4 Project Description:
s l- f z 'L G
w er/
l.c
W
L► tl
Gvca_
City Lic. #:
ra G
e v
r c L� .c
PERMIT FEES
p one.
Construction Type:
Occupancy:
State Lic. I?:
Project type (circle one): Nei Add'n
Name of Contact Person: rvl Alter Repair Demo
� v
Sq. Ft.: k Stories: H Units:
Telephone # of Contact Person: L
Total Permit Fees
- /- 6stimated Value
of Project: G
�
G
APPLICANT:
DO NOT WRITE BELOW THIS
LINE
N
Submittal
Req'd
Recd
TRACKING
Plan Sets
PERMIT FEES
Plan Check submitted
Structural Calcs.
Item Amount
Reviewed, ready for corrections
Truss Calcs.
Plan Check Deposit
Called Contact Person
Title 24 Calcs.
Plan Check Balance
Plans picked up
Flood plan plan
Construction
Plans resubmitted
Grading plan
Mechanical
Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Grant Deed
Plumbing
Plans picked up
II.O.A. Approval
S.M.I.
Plans resubmitted
IN HOUSE: -
Grading
Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
Pub. Wks. Appr
A.I.P.P.
Date of permit issue
School Fees
Total Permit Fees