RR (11-0971)77511 Calle Madrid
11-0971
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
11-00000971
Property Address:
77511 CALLE MADRID
APN:
774-243-001-24 -000000-
Application description:
RE -ROOF
Property Zoning:
COVE RESIDENTIAL
Application valuation:
2000 .
Applicant: Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
LUNA MANUEL OSUNA
77511 CALLE MADRID
LA QUINTA, CA 92253
Contractor:
Owner
1'J
-------------------------4--
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/08/11
U
QSP 0 9 2011
CITY OF LA QUINTA
F!'. IPkNCE DEPT
------------------------------------------------———----------—----------------------——-----------
LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
1 hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
_ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: License No.:
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
Date: Contractor:
_ 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
OWNER -BUILDER DECLARATION
insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
Carrier itPolicy Number
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to
I certify that, in the performance of the work for which this permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
person in any manner so as to become subject to the workers' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
and agree that, if I should become subject to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
3700 of the Labor Code, I shall forthw' ply with those provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031..5 by
Ji.
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
Date: Applicant: iLs ✓"
(_ 1 I; as owner of the property, or my employees with wages as their sole compensation, will do the work, and
I —^
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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: 8 / r 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
APPLICANT ACKNOWLEDGEMENT C -I
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 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 county to enter upon the above-mentioned prop rt f ur oses.
Date: „ . Signature (Applicant or Agent):
Application Number . . . . .. 11-00000971
Permit . .
. RE -ROOF
Additional desc .
.
Permit Fee . . .
. 30.00
Plan Check Fee
.00
Issue Date . . .
.
Valuation . . .
. 0
Expiration Date
3/06/12
Qty Unit Charge Per
Extension
BASE FEE
30.00
------------------------------------------------------------------=---------
.Special Notes and
Comments
REROOF WITH GAF ROLLED ROOFING (COOL
ROOF EXEMPT - NO DUCTS IN ATTIC] 2010
CALIFORNIA ENERGY
CODE.
September 8, 2011
4:14:22 PM AORTEGA
----------------------------------------------------------------------------
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
LQPERMIT
mss"= til./ OR
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r l ' a •
\;" .EXPIR S09=— DRIV,ERyUCENSE4'
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l`AdUINTA CA 92253`%,
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PROPERTY 0' ERI)S
BUILDING & SAFETY DEPARTMENT
PACKAGE
(760) 7 77 -7012
FAX (760) 777-7011
Disclosures & Forms for Owner-Bullders Applying for Construction Permits
4D iPMT,4 V NOTICE TO )a)2l7PFRTY OwNEE
Dear Property Owner.
An application for a building permit has been submitted in your name listing yourself as the builder of the Property
improvements specified at 144e1E /t"OgAZI GA 0 04,y f t_
Vire are providing you with ani Owner -Builder Acknowledgment and lnformatien Verification Form to make you aware of your
responsibilities and possible risk you may incur by having this permit issued in your name as the
Owner -Builder. we will not issue a building permit until you have read, initialed your understanding of each provision,
signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice
unless you, the property owner, obtain the prior approval of the permitting authority.
OV &'S ACKWZWLEDG E AMID VERIFICATION OF 94FOR-MAU—ON
DfRECUONS: Read and initial each statement below to signify you understand or verify this information.
I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder"
ding permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as
an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person
and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those
injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers
on y property.
I understand building permits are not required to be signed by property owners unless they are responsible for the
construction and are not hiring a licensed Contractor to assume this responsibility.
ikI understand as an "Owner -Builder" I am the responsible party of record on the permit I understand that I may Protect
li from Potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my
own.
4 4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on
rmits and contracts.
6. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value
of my construction is at. least five hundred dollars ($500), including labot.and materials, l may be considered an "employer"
under state and federal law.
. I understand if I am considered an "employee' under state and federal law, I must register with the state and federal
government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemploymem
compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financia
risk.
7. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residenti2
structures cannot .legally build them with the intent to offer them for sale, unless all work is performed by license
subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performe
under contract with a licensed general building Contractor.
I. understand as an Owner -Builder if I sell the property for .which this permit is issued; I may. be held liable for any
financial or, personal, igjuries sustained. by any subsequent owner(s) that result from any, latent construction. defects in the • .
workmanship or materials.
9 I understand I may obtain'more ,information regarding my obligations as -an "employer" from the Internal Revenue
Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California
Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-
800-321-CSLB (2752) or www.csib.ca.gov for more information about licensed contractors.
o0.o
I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the
"le all _ and financi following address:
P7' g Y ally responsible for proposed construction activity at the ng
%%LLP- I agree that, as the party legally.and financially responsible for this proposed construction activity, I will abide by all
applicable laws and requirements that govern Owner -Builders as well as employers.
I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I
have provided on this form Licensed contractors are regulated by laws designed to protect the public. If you contract with
someone who does not. have a license,. the Contractors' State License Board may be unable to assist you with any financial loss
you may sustain as a result of a complaint Your only remedy against unlicensed Contractors may be in civil court It is also
important for you to. understand than if an unlicensed Contractor or employee of that individual or firm • is injured while working
on your property, you may be held, tiable for damages. If you obtain a permit as Owner -Builder and wish to Dire Cgniractors,
you will be revonsible for verifying whether or not those Contractors are ..pwimiyl_icetrs and the status of their workers'
compensation insurance coverage.
Before a building permit can be issued, dds form must be completed and signed by the property owner and returned to
the agency responsible for issuing dic.permiL Note: A copy of the property owner's driver'sReaftse, form nota n3 or
other verification acceptable to tke agency is required to be presented when the permit is issued to verify the property
owner's signature.
Signature of property owner Date:
Note: The following Authorization Form is required to be completed by the property owner only when designating
an agent of the property owner to apply for a construction permit for the Owner -Builder.
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNRR'S BEHALF
Excluding the Notice to Property Owner, the exewtion of which I understand. is my personal responsibility, I hereby authorize
the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner -Builder
Permit for my project.
Scope of Construction Project (or Description of Work):
Project Location or Address:
Name of Authorized Agent:
Address of Authorized Agent:
Tel No
I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above
information and certify its accuracy. Note: A copy of the owner's driver's license, form notarization, or other verification
acceptable to the agency is required to be presented when the permit is issued to verify the property owner's signature.
Property Owner's Signature: Date:
Prescriptive Certificate of.Com liance:- Residential Reroof
Project Address: CF -1 R-ALT-ReF
Climate Zone Permit #
ROOFING PRODUCTS .(COOL ROOFS) §151(012
When the area of wderfor roof surface to be replaced exceeds 500/6 of the existing roof area, or 1,000 fe, whichever is less, the new
roofing area must meet the tooting product "Cool Roof" requirements of §152(b)1H1, 152(b)1Hil, or 152(b)1H111.
Check applicable alternative or exception below if the roof alteration is exempt from the roofing product "Cool Roof" requirements::
❑ Cool roofs not required in Climates Zones 1-12,14, and 16 with a low sloped roof pitch (less or 2:12 pitch).
❑ Cool roofs not required in Climates Zones 1-9, and 16 with a steep -sloped roofs (greater pitch than 2:12) and product weight less than 5AbI
Alternatives to §152(b)1 Hi and §152(b)HII, Steep-610pe roof (pitch > 2:12)
❑ Insulation with a thermal resistance of at least 085 hr•fe.'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 §151(f)10; or
❑ In climate zones 10, 12 and 13, with 1 ft2 of free ventilation area of attic ventilation for every 150 ft2 of attic floor area, and
where at least 30 WWA 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 §151(f12; 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 bulking integrated; photovoltaic panels and solar thermal panels are exempt from the Cool Roof criteria.
❑ Roof constructions that have thermal mass over the roof membrane with at least 25"tbJR2 are exemot from the Coot Rnof c nt—
Y, OTE: if any one of the altematlives or exception is checked
products in §118(1) are not applicable. Do not fill table below.
CRRC Product ID Number'I Roof Slope
5 2:12 > 2:
0r
u
and Thermal
for roofing
12
Product Weight
< 5lb/ft i 51b/fl
Product
Aged Solar
Thermal
T
RefiectanceI
Emittance
SRIS
HE3 ❑
❑4
❑
❑4
Note: If no CRRC-1 labsl is available; this compliance method cannot be used, use the Performance Approach to show compliance,
1. The CRRC Product ," Number can be obtained lrorn the Cool Roof Rating Council's Rated Product Directory at
2. Indicate the type of product is being used for the roof top, i.e. single -ply roof, asphalt roof, metal mot etc.
I. If the aged Reflectance is not available in the Coo/ Roof Reting Council's Rated Product Di
directory and l use the Reflectance
4. Check box If the floe equation (0.2+0.7(*&, - 0.2) to obtain a calculated aged value. Whep is then Initial Solarleflectance. value horn the same
Aped Reflectance is a calculated value uslrrp the equation above.
5. Calculate the SRI value by using the SRI- Worksheet at http Avww,enemv CA
aoopy of the SRI- Worksheet to the CF -1 R and enter the resulting value in the SRI Column above and attach
To apply Liquid Field Applied Coatings, the coating must be applied across the entire roof surface and meet the dry ml thickness or coveral
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
' TE: When a Cool Roof is required, the Installing contractor shall complete and submit the Cl~6R-ENV-01 for
Declaration Statement
• I certify under penalty of perjury, under the taws of the State of California, the information provided on this form is accurate and complete.
• I certify that the energy features and performance specifications !dented on this Certificate of Compliance conform to the requirements of Title 24, Parts
1 and 6 of the California Code of R utations.
Name:
A44"&L Cv o2 i - sign e:
Company:
City/State/Zip.
i
/,
?
For assistance or quest/ons regarding the Energy_ / I
Standards, contact the Energy Hotline at: 1-800-772-3300.
s;R #•
City La Q of uinta . .
Building 8L 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: f 7 6'// 4244&E X1i4D 12 In
Owner's Name: Q
A. P. Number: A
JA
Address: -*?7C-/,( 4!141lei 104 1
Legal Description:
Contractor.
Address:
City, ST, Zip: /4J7 ?s-3
•, ' .
,Telephone:' 0 _ —/ :.w.. ,.• . 4.` ,
Project Description:
City, ST, zip:
Telephone: ,,. t.`'ts. •t' >3(( ; • ,.:;y , s' ' :%'-
State Lic. #: City Lic. #;
Arch., Engr., Designer.
v /
W c .
Address:
City, ST, Zip:
Telephone: `
State Lic. #:
Name of contact Person:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. FL:
# Stories:
# Units:
\
Telephone # of Contact Person: Estimated Value of Project: ° U
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Plan Sets
Req'd
Req'd
TRACMG PERMIT FEES
Plan Check submitted 9 / Item Amount
Structural Cala.
Reviewed, ready for corrections Plan Cheek Deposit
Truss Cala.
Called Contact Person Plan Check Balance
Title 24 Cala.
Plans picked cep Construction
Flood plain plan
Plans resubmitted Mechanical
Grading plan
2'! Review, ready for corrections/issue Eleetriai
Subcontactor List
Called Contact Person Plumbing
Grant Deed
Plans picked up S.M.I.
H.O.A. Approval
Plans resubmitted Grading
IN HOUSE:-
3" Review, ready for corr•ecdonsAssae Developer Impact Fee
Planning Approval
Called Contact Person ✓I A.1.P.P.
Pub. Wks. Appr
Date of permit issue f
School Fees
Total Permit Fees
6,4
106 Z<:52,0
Id 6