BRER2014-1026Q914rcu VOICE (760) 777-7125
79-495 CALLE TAMPICO 4,4 FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 10/28/2014
Application Number: BRER2014-1026 D Q caner:
Property Address: 53760 AVENIDA MONTEZUMA OBERT HUTCHESON
APN: 774141001 OCT 28 2014
Application Description: URETHANE FOAM REROOF 92253
Property Zoning: CITY OF LA QUINTA
Application Valuation: $5,250.00 COMMUNfiYDEVELOPMENTDEPARWENT
Applicant:
URETHANE FOAM SPECIALISTS INC
72-875 SONORA DRIVE
PALM DESERT, CA 92260-2734
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: C39 License No.: 922766
Date: —1:31--1 Con
trac r:
OWNER -BUILDER D CLARATION
1 hereby affirm under penalty of perjury that I am exempt from the ontractor'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.).
( ) 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 Name:
Lender's
Contractor:
URETHANE FOAM SPECIALISTS INC
72-875 SONORA DRIVE
PALM DESERT, CA 92260-2734
(760)346-0667
Llc. No.: 922766
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: _ 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,[ should become subject to the
workers' compensation provisions of Section 3700 of th Labor Code, I shall forthwith
comply with those provisions.
Da,/. A t:
i
WARNING: FAILURE TO SECURE WORKERS' CO PENSATION COVERAGE I 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.
Date: _ Signature (Applicant or A nt):
/ .1i
FINANCIAL
M DESCRIPTION ACCOUNT QTY AMOUNT
PAID PAID DATE
BSAS SB1473 FEE 101-0000-20306
0
$1.00
$1.00 10/28/14
PAID BY METHOD
RECEIPT #
CHECK # CLTD BY
URETHANE FOAM SPECIALISTS INC CHECK
R2473
4815 MFA
Total Paid forBUILDING STANDARDS ADMINISTRATION BSA $1.00 $1.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
RE -ROOF - EA ADDITIONAL 1,000 SF
101-0000-42404,
0
$11.60
$11.60
10/28/14
PAID BY
• METHOD
RECEIPT #
CHECK #
CLTD BY .
URETHANE FOAM SPECIALISTS INC
CHECK
R2473
4815
MFA
DESCRIPTION ..
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
RE -ROOF - FIRST 2,000 SF
101-0000-42404
0
$49.31
$49.31
10/28/14
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
URETHANE FOAM SPECIALISTS INC
CHECK
R2473
4815
MFA
DESCRIPTION
ACCOUNT
QTY
AMOUNT.
PAID
PAID DATE
RE -ROOF - FIRST 2,000 SF PC
101-0000-42600
0
$98.62
$98.62
10/28/14
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
URETHANE FOAM SPECIALISTS INC
CHECK
R2473
4815
MFA
Total Paid forRE-ROOF: $159.53 $159.53
• 1 .0 .0
Description: URETHANE FOAM REROOF
CONDITIONS
Type: RE -ROOF Subtype:
Status: APPROVED
Applied: 10/28/2014 MFA
Approved: 10/28/2014 MFA
Parcel No: 774141001 Site Address: 53760 AVENIDA MONTEZUMA LA QUINTA,CA 92253
Subdivision: SANTA CARMELITA AT VALE LA QUINTA Block: 196
Lot: 23
Issued:
UNIT 19
CONTACTS
Lot Sq Ft: 0 Building Sq Ft: 0
Zoning:
Finaled:
Valuation: $5,250.00 Occupancy Type:
Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0
No. Unites: 0
STATE
Details: REOOF OVER EXISTING. URATHANE FOAM PER 2013 CALIFORNIA ENERGY CODE
PHONE
CHRONOLOGY
CONDITIONS
CONTACTS
NAME TYPE
NAME
ADDRESSI
CITY
STATE
ZIP
PHONE
FAX
EMAIL
APPLICANT
URETHANE FOAM SPECIALISTS INC
72-875 SONORA DRIVE
PALM DESERT
CA
92260-
2734
CONTRACTOR
URETHANE FOAM SPECIALISTS INC
72-87S SONORA DRIVE
PALM DESERT
CA
92260-
2734
OWNER
ROBERT HUTCHESON
92253
FINANCIAL INFORMATION
Printed: Tuesday, October 28, 2014 8:27:08 AM 1 of 2 RAMS,
SYSTEMS
PAKEN Ij PROJECTS
Printed: Tuesday, October 28, 2014 8:27:08 AM 2 of 2
SYSTEMS
CLTD
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK #
METHOD
PAID By
BY
URETHANE FOAM
BSAS SB1473 FEE
101-0000-20306
0
$1.00
$1.00
10/28/14
R2473
4815
CHECK
MFA
SPECIALISTS INC
Total Paid forBUILDING STANDARDS ADMINISTRATION
$1.00 $1.00
BSA:
RE -ROOF -
101-0000-42404
0
$11.60
$11.60
10/28/14
R2473
4815
CHECK
URETHANE FOAM
MFA
ADDITIONAL 1,00000 SF
SPECIALISTS INC
RE -ROOF - FIRST 2,000
101-0000-42404
0
$49.31
10/28/14
R2473
4815
CHECK
URETHANE FOAM
MFA
SF
.$49.31
SPECIALISTS INC
RE -ROOF - FIRST 2,000
101-0000-426000
1
$98.62
1
$98.62
1
10/28/14
1
R2473
1
4815
1
CHECK
URETHANE FOAM
MFA
SF PC
1
1 SPECIALISTS INC
Total Paid for RE -ROOF: $159.53 $159.53
$160.53 $160.53
PAKEN Ij PROJECTS
Printed: Tuesday, October 28, 2014 8:27:08 AM 2 of 2
SYSTEMS
Bin.#
Qty Of Quinta
Building & Safety Division
P.O. Box 1504,78-495 Calle Tampico
La.Quinta, CA 92253 - (760) 777-7012
Building Permit Application* and Tracking Sheet :
Permit #
Project Address:Owner's
Name:. q.0b Yq
A. P. Number.
Address: S —'6 d Al
Legal Description:
City, ST, Zip: Xe 3
Contractor.
r.Z1111.llleAhe¢ S
U
Tel ephone: µ..'
Address: �j
Project Description:
1�.
City, $T, Zip:
Telephone U
r✓�'
State Lie. #: City Lia #;
Arch., Engr., Designer.
Address:
City, ST, Zip:
Telephone:` -
Construction Type:. Occupancy:
State Lic. #: Project type (circle one): New Add Alter Repair Demo
Name of Contact Person:Sq. Ft.: (V CJ # Stories: #Units:
Telephone # of Contact Person:
Estimated Value of Project ✓� 60
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Recd
TRACIMG
PERMIPFEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cafes.
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Calcs•
Called Contact Person
Plan Check Balance,
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted..
Mechanical
Grading plear.
Review, ready for corrections/issue
Electrical
Subeontactor Ust
Called Contact Person
Plumbing
Grant Deed
Plans picked up
SALL
H.O.A. Approval
Plans resabmitted
Grading
IN ROUSE:-
'"' Review', ready for eorrectionsirmsue
Developer Impact Fee
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
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:. LSWR +404C+1iP-5b6Date Prepared: l D-/ 9-/(P
DOCUMENTATION AUTHOR'S DECLARATION STATEMENT
1. I certify that this Certificate of Compliance documentation is accurate and complete. 1.
Documentatio uthorName: Do t tion arS n ure:
14Za& a.
Comp ny: ^�
Signat re Date:
1�
Address: 72- Sa-�r- tee.
CEA/ HERS Certification Identification (if applicable):
C*mX75
tate/Zip:
"" 2�
Phone:
7 - 3 �Ko
RESPONSIBLE PERSON'S DECLARATION STATEMENT
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.
2. 1 am eligible.under Division.3 of the Business and Professions Code to accept responsibility for the building design or system design identified on this Certificate of Compliance>(responsible
designer).
3. That the energy features and performance specifications, materials, components, and manufactured devices 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 California Code of Regulations.
4. The building design features or system design features identified on this Certificate of Compliance are consistent with the information provided on other applicable compliance documents,
worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with this building permit application.
5. 1 will ensure that a registered copy of this Certificate of Compliance shall be made available with the building permit(s) issued for the building, and made available to the enforcement agency
for all applicable inspections. I understand that a registered copy of this Certificate of Compliance is quired to be in luded with the documentation the builder provides to the building
owner at occupancy.
Responsible D er Name:
r
Respo9R!T!
t Gerl,
Company:
Date Signed:
Address:
License:
74o
CI / ate/Zip:
esu
Phone:
-3 l -o 10
For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300.
Registration Number: Registration Date/Time:
CA Building Energy Efficiency Stand rdi- 2013 Residential Compliance
HERS Provider:
June 2014
STATE OF CALIFORNIA
RESIDENTIAL ALTERATIONS
CEC-CF1 R -ALT -01-E Revised 06114 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CF.1R-ALT-01-E
Prescriptive Residential Alterations (Page 1 of 4)
Proiect Name: IHR Date Prepared:
A. GENERAL INFORMATION
01
02
01 Project Name: 50 tg MoTnu micoo
02
Date Prepared:
03 Project Location: 3 p 1tj"A jN!LtngZvLAhd
04
Building Front Orientation (deg or cardinal):
05 CA City: I. Q�t06
Assembly Type
Number of Altered Dwelling Units:
07 Zip Code: Q TZS 7 Y
08
Fuel Type:
09 Climate Zone:
10
Total Conditioned Floor Area (112):
11 1 Building Type
12
Slab Area (ft2)
13 1 Project Scope:
2.
B. BUILDING INSULATION DETAILS (Section 150.2(b)1)
01
02
03
04
05
06 07 08 1 09
10
it
Tag/ID
Assembly Type
Frame
Type I
Frame
Depth
(inches)
Frame
Spacing
(inches)
Proposed
Required
Comments
Continuous
Cavity Insulation
R -value R -value
Appendix JA4
Reference
U -factor Table Cell
1 LI -Factor
Aged Solar Thermal SRI
Reflectance Emittance (Optional)
2.
ik
NOTES
• Roof area covered by building integrated photovoltaic panels and solar thermal panels are exempt from the above Cool Roof requirements.
• Liquid field applied.coatings must comply with installation criteria from section 110.8(i)4.
C. ROOF REPLACEMENT (Prescriptive Alteration, Section 150.2(b)1H)
01
02
03
04
05
06
07 08 09 10
11 12 13
Method of
Compliance
Roof
pitch
Exception
CRRC Product ID
Number
Product Tye
R -value
Deck
Insulation
Proposed
Minimum Required
Initial Solar Aged Solar Thermal SRI
Reflectance Refl ct nce Emiltance I (Optional)
Aged Solar Thermal SRI
Reflectance Emittance (Optional)
2.
ik
NOTES
• Roof area covered by building integrated photovoltaic panels and solar thermal panels are exempt from the above Cool Roof requirements.
• Liquid field applied.coatings must comply with installation criteria from section 110.8(i)4.
Registration Number: Registration Date/Time: HERS Provider:
CA Building Energy Efficiency Standards - 2013 Residential Compliance June 2014