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RR (11-0077)c P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Tilht -4.4v Qam�i BUILDING & SAFETY DEPARTMENT BUILDING PERMIT P/ -------------------------------------------------- LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty ofperjurythat I am.licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 oft ess aV,9essoDa1s Cpde, and my License is in full force and effect. �. License Cl ss: 39 B Li ��rise '�No.: 3209 Date /1Z� l/ (N�.r 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 (5500): (_) 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 th�akhe 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 Address: P LQPERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 1/21/11 Owner: . CARRILLO GILBERT 53220 AVENIDA MENDOZA LA QUINTA, CA 92.253 Contractor: FREDERICK RI�tLfbN CONST PO BOX 6083 MECCA, CA 92254 CITYOF LAQU'NTA ( 951) 653 - 613.2>r------`�f DEPT. Lic. No.: 643209 ---------- - ------- 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 STATE FUND 10/01/19nlicyNumber 1322260-2010 _ I certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner asqSubject to the workers' compensation laws of California, and agree tha ' should be orkers' c pensation provisions of Section 700 of t Labor Code ywith th a previsions. �� ��licant:V/WARNING: FAILURE TO SECU WORKEN 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 th a ve infor is rect. I agree to comply with all city and c unty ordinances and state laws relatLpoperty uilding on u tion, and re authorize r r.17 resentatives /of/tpis�/c/o%�Q'nty enter u on the above-mentio i pecti pur ses S/// Date% Signature (Applicant or Ag Application Number: 1-11-00000077 Property Address: 53220 AVENIDA MENDOZA APN: 774-063-011-14 -000000- Application description: RE -ROOF Property Zoning: COVE RESIDENTIAL Application valuation:. 3000 Applicant: n / Architect or Engineer: P/ -------------------------------------------------- LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty ofperjurythat I am.licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 oft ess aV,9essoDa1s Cpde, and my License is in full force and effect. �. License Cl ss: 39 B Li ��rise '�No.: 3209 Date /1Z� l/ (N�.r 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 (5500): (_) 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 th�akhe 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 Address: P LQPERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 1/21/11 Owner: . CARRILLO GILBERT 53220 AVENIDA MENDOZA LA QUINTA, CA 92.253 Contractor: FREDERICK RI�tLfbN CONST PO BOX 6083 MECCA, CA 92254 CITYOF LAQU'NTA ( 951) 653 - 613.2>r------`�f DEPT. Lic. No.: 643209 ---------- - ------- 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 STATE FUND 10/01/19nlicyNumber 1322260-2010 _ I certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner asqSubject to the workers' compensation laws of California, and agree tha ' should be orkers' c pensation provisions of Section 700 of t Labor Code ywith th a previsions. �� ��licant:V/WARNING: FAILURE TO SECU WORKEN 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 th a ve infor is rect. I agree to comply with all city and c unty ordinances and state laws relatLpoperty uilding on u tion, and re authorize r r.17 resentatives /of/tpis�/c/o%�Q'nty enter u on the above-mentio i pecti pur ses S/// Date% Signature (Applicant or Ag Application Number 11-00000077 Permit RE -ROOF Additional desc . Permit. Fee 30.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 0 Expiration Date 7/20/11 Qty Unit Charge Per Extension BASE . FEE 30.00' ---------------------------------------------------------------------------- Special Notes and Comments RE -ROOF WITH OWENS-CORNING SHASTA WHITE COMPOSITION SHINGLES. 2010 CODES. ------------------------ --------------------------------- 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 • • �• V. %,#,g %oate or pomp lance• Residential Reroof Project Address -2 ,�-� ,,� O KUUNNU VKUUUCTS (COOL ROOFS) §151(012 IA, -•-- - a w—wi1 uiv ►ca or ex[enor roof surface to be replaced exceeds 50% of the i roofing area must meet the roofing product "Cool Roof" requirements of § Check applicable alternative or exception below if the roof alteration is exempt CF -1 R-ALT-ReRoof Permit # 7 /�/ /0 - 7g roof area, or 1,000 ft", whichever is less, the new i)1 Hl, 152(b)1 Hil, or 152(b)1 Hill. the roofing product'Cool Roof requirements:: ❑ Cool roofs notrequired 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 weightless than 5Ab/f Alternatives to §152(b)1HI and §152(b)HII, Steep -slope roof (pitch'> 2:12) ❑ Insulation with a thermal.resistarrce of at least 0.85 hrft •°F/Btu or at least a 314 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(010; or ❑ In climate zones 10, 12 and 13, with 1 ft2 of free ventilation area of attic ventilation for every 150 ft2 of attic flow 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 §151(02; or , ❑ Building has no duds 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)l Hill, Low -slope roof ( pitch 5 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 Cool Roof criteria. ❑ . Roof constructions that have thermal mass over the roof membrane' with at least 25 Iexempt from Cool Roof _b/ft2 are .VOTE: if any one of the alternatives or exception is checked the Aged products in § 1180) are not applicable. Do not fill table below. Roof Slope Pr( CRRC Product ID Number' S 2:12 > 2:12 < 51 0 81l 0 670. I ❑ ti for )dud Weight b/ftz a 51btf Product s Aged Solar Thermal T Reflectance'" Emittance SRI5 ❑ e ❑4 , a 9 • 9 z 3 �. . i ❑ ❑4 Note: If no CRRC-1 label is available, this compliance Method cannot be used use the Penbrmance Approach to'show compliance, The CRRC Product 1D Number can be obtained from the Cool Roof Rating dWnc_1/'s Rated Product Directory at www cxrolroofs om/bralucts/�earr"h ohm Indicate the type of product is being used for the roof top, i.e. single -ply roof, asphalt roof, metal roof, etc. If the Aged Reluctance is not available in the Cool Roof Rating Councils Rated Product Directory then use the Initial Reflectance value from the same directory and. use the equation (0.24,a 7(pkwa — 0.2) to obtain a calculated aged value. Where p is the Initial Solar Reflectance. Check box if the Aged Reflectance is a calculated value using the equation above. Calculate the SRI value by using the SRI- Worksheet at htfn✓iivHnv enerov oovle aoopy of the SRI- Worksheet to the CF -1 R. 241 and enter the resulting value in the SRI Column above and attach o apply Liquid Field Applied Coatings, the -coating must be applied across the entire roof surface and meet the dry mil thickness or covera . )commended by the coatings manufacturer and meet minimum performance requirements listed in §118()4. Select the applicable coating: Aluminum -Pigmented Asphalt Roof Coating ❑ Cement -Based Roof Coating ❑ Other When a is required, the installing contractor shall complete and Declaration Statement for final inspection. • I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is accurate and complete. • 1 certify that the energy features and performance specifications ' s Ce ifl Hance conform to the requirements of Title 24, Part: 1 and 6 of the California Code of Re ulations. Name: 4'V �� ��'��.� Sign i��y Date:. 02l / P ss: V•. �� �t��'� VQ� License: A ,2,,�Ci� / (./P / ^ Ur Pho��( For assistance or questio s regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300. CRRC Prod. ID 0890-0001 Manufacturer Information (sorted +) '' Owens Corning' Brand Classic®. Model . �" Color' Category Product Type Shingles Solar'Reflect inif• 0.27' - .0.29 Therm Emit: init 0:89"0 92,nn SRI init Slope Application Steep Shasta Bright- Darrel, Higgs •` Suoreme® White• : e. White or 0890-0007 Owens Corning Duration® Shasta $right. ' `Shingles 0.25 0..28, -0;94 20,9,1. .27 . 30 Steep Darrel Higgs White White. or ;. '(419-248-7060) Shakes 0890-0002 Owens Corning Oakridge®; Shasta Bright Shingles 0.27 0.28,, 0.89 0.91, 28 ,30 Steep Darrel Higgs. Duration<_ White White or , (419=248-7060) ' Premium® Shakes Duration® s #. Bin # Qty of LQ Quinta Building 8t 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: 63- � 4V6A ) A- V�JpZ Owner's Name: � 4 LJ -,D' A. P. Number: Address: Av&gl A P6,JAQak Legal Description: City, ST, Zip: t,, Contractor.. ' ir Telephone: tgo- Address: o �0�3 Project Description: W6 jSX City, ST, Zip: Qfl A-` C -A 99-S'5f C01 -i C7sxtiu,:� � Nl JGl , 1 e6- 1&o f Telephone: ry s,:1 ,>,' State Lic. #: (-P 41, Zf City Lic. #•: N6t45-4 Arch., Engr., Designer- esignerAddress: Address: City., ST, Zip: Telephone: , : :,`.vk • luS, , !„' : y,>: Construction T e: (4%2f Occupancy: Project type circle one): New Add'n Alter a ai) Demo State Lic. #: Name of Contact Person: Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: ( 2A 21- 131 Z1W Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Re4'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cales. Reviewed, ready for corrections Plan Check Deposit Truss Cales. Called Contact Person Plan Check Balance Title 24 Cates. Plans picked up Construction Flood plain plan Pians resubmitted Mechanical Grading plan 2” Review, ready for correctionstissue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE: ''" Review, ready for correctionstissue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees • Wit•• ..,� ._�_. � -. _ `rte-�.'�- _ _. _ � ]' moi_. -' .:�-= 't.r. __..,....-:--4..a'hJ'y_.!._``�.'.....`i'�_..�..r f COq K WATER DISTRICT 1�0 434-61 famm DETAIL 111. `Irl�.il� f�L l��y` 1. �`� �� •h ;.. Date:✓~�,'4 �'j�J J ! J { /. Received From: ;a �l C ,�, tJ i �.V lJu I � �'•_3 - . Lr .:.;•��. �.f_'\ io�o1 i' 1 . Address:, C Account No. (' _�` '' r 'J _ Lot(s) ` Tract G.A. Code Service Address yi ❑ Meter(s) ❑ Service(s) ❑ Backflow(s) ❑ House Lateral(s) ❑ Detector Check(s) Cl Meter Surchargeani-,—. -,.,�5 ;J� tation Capacity Charge ❑ W.S.B.F.C. ❑ Temporary Construction Meter ❑ Turn on Charge s ❑ Uncollected Account -Name ❑ Inspection Fee - Tract - Fee- Y ❑ Plan Check Fees Water I Sewer - - 'r Tract- 0 ract-❑ Bond Payment - A.D. - Bond Assmt. ❑ Customer Deposit " ❑ Other 2 Y, UJ TOTAL $ =f` Remarks: (3 copy to: 1� •��- R. Water Service ' . , Cash t; Check Money Cashier. �EH Order CVWD-438 (11189) ;: 3 .