RR (11-0197)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA' 92253
Application Number:
11-00000197
Property Address:
51960 AVENIDA MENDOZA
APN:
773-182-011-14 -000000-
Application description:
RE -ROOF
Property Zoning:
COVE RESIDENTIAL .
Application valuation:
5000
Applicant: Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
--------------------------------------------------
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 Professionals Code, and my License is in full force and effect.
License Class: License No.:
Date: 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 or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
any pplicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
(_) 1, as owner oftheproperty, or my employees with wages as their sole compensation, will do the work, and
the structure is not intended or offered for sale (Sec. 70.44, 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.l.
(_) I am exempt under Sec. , B.&P.C. this Wson,
(-Date:
I hereby affirm under penalty of
work for which this permit is is:
Lender's Name:
Lender's Address:
LQPERMIT
/ COIfSTWCTION LENDING AGENCY
at there 'jpodonstruction lending agency for the performance of the
3097, M. C.).
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 2/24/11
Owner:
DELOMBA MISTY
51960 AVENIDA*MENDOZA
LA QUINTA,,CA 92253
-- ----------- ------
-i------- t�
Contractor: f 4L
Owner i
-----------------------------------------------
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
1 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 I should become subject to t workers' compensation provisions of Section
3700 of the, C AERS'
rthwit pl ith those provisions.
Date:Applic t:
WARNING: FAILURE TO SEC W SSATION 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 information is correct. I agree to comply with all
city and county ordinances and state laws relating to buildin construction, an eby authorize representatives
of this county to enter upon the above-mentione party pecti ose
Dat �� Signature (Applicant or A ant):
Application Number . . . . . 11-00000197
Permit . . . RE -ROOF
Additional desc .
Permit Fee . . . 30.00
Issue Date . . . .
Expiration Date 8/23/11
Plan Check Fee .
Valuation. . .
Qty Unit Charge Per.
Extension
• . BASE FEE.
30.00
----------------------------------------------------------------------------
Special Notes and Comments
REMOVE COMPOSITION ROCK ROOF & REPLACE
WITH NEW COMPOSITION SHINGLES OWENS
CORNING COOL ROOF DURATION
SHINGLES;FROSTED OAK #0890-0005.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
LQPERM[T
Certificate of Corrtpltance• Residential Reroof
Zone
CF -1 R-ALT-ReRoof
ROOFING PRODUCTS (COOL ROOFS) §151(1)12
When the area of exterfor roof surface to be rep/aced exceeds 50% of the existing roof area, or 1,000 fe, whichever is less, the new
roofing area must meet the rooting product "Cool Roof" requirements of 15
Check applicable altemaiuve or exception below if the roof alteration is exempt from the roofing product 'Cool ji
P 9 P requirements::
O. Cool roofs not required in Cfanates Zones 1-12, 14, and 16 with a low sloped roof pitch (less or 2:12 pitch).
Cool roofs rW required in Climates Zones 1-9, and 16 with a steep -sloped
Alternatives to §152(b)l HI and §152(b)HII, Steep -slope roof (pitch > 2:12)
(greater� than 2.12) and product weigh less than SAb/ft2.
❑ Insulation with a thermal resistance of at least 0.85 hr-f2-°F/Btu or at least a 3/4 inch air -space is added to the roof deck over an attic; or
❑ Existing duds 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 150 112 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
O Building has radiant barrier in the attic meeting the requirements of §151(f)2; or
❑ Building has no duds in the attic; or
O 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 (pitch S 2:12)
O Building has no duds in the attic.
Other Exceptions
❑ Roofing area is covered by building integrmted;
O photovoltaic panels and solar thermal panels are exempt from the Cool Roof criteria.
Roof uctions that have thermal mass over the roof membrane with at lei 25 are exemeit from the Cool Rrnf rYifstrrrn
.VOTE: If any one of the aitemawes or exception is checked the Aged Solar Reflectance
products in § 118(1) are not applicable. Do not till table below.
I
CRRC Product ID Number 5 Roof Slope
2.12 > 2:12
M�
requirements for roofing
Product Weight
< 51bR 2 5lb/ft
Product
T 2
Aged Solar
Refiectance3.4
Thermal
Emittanoe
SRIS
❑
❑
❑
❑4
❑4
Note: lf RR CRRC-1 label Is available, this comp/fano meMod cannot be used, use the Performance Approach to show compliance,
The CRRC Product /D Number can be obislned I►om the Cool Roof Rating Counpl's Rated Pmdud Diredoryat www. coohoofs orv/nroducts/search aho
Indicate the type of Product is being used for the roof top, is e. singte-ply root, asphalt roof, metal roof, etc.
If the Aged Reflectance q not n adabts(0.2+0. in the Coo/ Roof Rating Councl s Rated Product Directory then use the Initial Reflectance value hum the same
directory and use the equation (0.2+0.70„ _ 0.2) to Main a calculated aged value. Where pis the Initis! Solar Reflectance.
Check box it the Aged Ret%dance is a calo'dated value using the equation above.
Calculate the SRI value by using the SRI- Worksheet at hitn:/Avww.enerw cam 99vM24/ and enter the resulting value in the SRI Column above and attach
soapy of the SRI- Worksheet to the CF -1 R.
o apply Uquld Field Applied Coatings, the coating must be applied across the entire roof surface and meet the dry ml thickness or coverag
,commended by the coatings manufacturer and meet minimuni performance requirements listed in118(1)4. Select the
§applicable coating:
Aluminum -Pigmented Asphalt Roof Coating ❑ Cement -Based Roof Coating ❑ Other
When a Cool
Declaration Statement
. I ww.a:6._ _ _ _ ..
required, file installing contractor
submit
final
-- , _ -- P—.,"r "I ru►lury, 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 identified on this Certificate of Compliance conform to the requirements of Title 24, Parts
1 and 6 of the Califomia Code of Rulations.
ac
Company:
:ss:
License:
Phone:
For assistance or quest/ons regard/ng the Energy Standards, contact the Energy Hotline at: 1-800-772-3300.
P.O. BOX 1504
LA QUINTA, CALIFORNIA 92247-1504
78-495 CALLS TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
PROPERTY OWNER'S PACKAGE
(760) 777-7012
FAX (760) 777-7011
Disclosures & Forms for Owner -Builders Applying for Construction Permits
I1IIIWORTANT! NOTICE TO PROPERTY OWNER
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 / 1-92/-tij,Fy
Vile are providing you with anowner-Builder Acknowledgment and Information 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.
OVA'S AC1Qg0WLED(;MNT AND VERIFICATION OF VOORMAMN
DIRECTIONS: Read and initial each statement below to signify you understand or verify this information.
//G!' 1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder"
building 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 my property-
`%�2. I understand building permits are not required to be signed by property owners unless they are responsible for the
�co,,n'sstruction and are not hiring a licensed Contractor to assume this responsibility.
�/G(Y 3. I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect
myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my
own.
711V 4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on
permits and contracts.
5. 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 labor and materials, I may be considered an "employer"
under state and federal law.
'e6. I understand if I am considered an "employer" 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 unemployment
compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial
risk.
W7. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential
structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed
subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed
under contract with a licensed general building Contractor.
ry
—71W8. 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. prjuries sustained by any subsequent owners) that. result from any latent construction defects in the
workmanship or materials.
W9. 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 (CSL.B) at 1-
800-321-CSLB (2752) or www.csib.ca.gov for more information about licensed contractors.
10. 1 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the
party legally and financially responsible for proposed construction activity at the following address:
WWI L 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.
7412. 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 that if an urilicensed Contractor or employee of that individual or firm is injured while working
on your property; you may be held liable for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors,
You will be resYwn Ie for verifying whether or not those Contractors are properly licensed and the status of their workers'
compensation insurance coverage.
Before a building permit can be issued, this form must be completed and signed by the property owner and returned to
the agency responsible for issuing: the permit. Note: A copy of the property owner's driver's lfoense; farm noun; or
other verification acceptable to the agency is required to be presented when the permit is issued to verify the ply
owner's signature.
Signature of property owner 4tf'�GfG 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 OWNER'S BEHALF
Excluding the Notice to Property Owner, the execution of which I understand. is my personal responsibility,. I hereby authorize
the following person(s) to act as. my agents) 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): VQWIE�
Project Location or Address: 5) k Av6 MCS Q WA , 1 A LQ 0l lei A SCA
Name of Authorized Agent: IoM Dy Loa% Tel No l60' M - 27-79
Address of Authorized Agent: 9190 M e • i Nk))0 1 n't,
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 pres ed when the permit is issued to verify the property owner's signature.
Property Owner's Signature:Date: L ' )
Bin #
CI ty Of La Quinta
Building 8r 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:saig WAQr&a&z4Owner's
Name: 4,11
A. P. Number:
Address: �l 6o E
Legal Description:
City, ST, Zip: 44W�IE4
::ham \ry.�."''.j:'.:`•'':j:`4j: `t:'j;i4
Telephone:,:;.>:.>?�;:•.~:'.��:>:>H%s<:�>>:<r:<;•�;
Address:
Project Description:
City, ST, Zip:
Telephone:
:sr•,:k;•
State Lic. # :
City Lic. #
Arch., Engr., Designer:
&x
Address:
15A I
City., ST, Zip:
Telephone:
Y�'ri'AAnn }Y.�4�: r:; f�:{J'1..`*..; •:: �Cv.^.` n:i::::.`,`.':
i,i•:};j :.%gy:•.Y.vY:}JrjfF•i:fi}1C4':'
.�:•w�.s:�.;z;°>��:�;..„:�;:c.;`;; ...:...
. ' ?r•<'''>•' `
Construction Type: o f W1 Occupancy:
State Lic. #:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.:#Stories:
# Units:
Telephone # of Contact Person: % Z77
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
We 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
god Review, ready for correctionsfissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'rd Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees