BRER2015-002778-495 Cs LLE TAMPICO
LA QUINTA, CALIFORNIA
Application Number:
Property Address:
APN:
Application Description:
Property Zoning:
Application Valuation:
T4ht 4 4 Qumr(v
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
78540 HIGHWAY 111
604050037
ONE ELEVEN LA QUINTA PM25865
$5,000.00
Applicant:
AL MILLER & SONS ROOFING CO IN
68760 SUMMIT DRIVE
CATHEDRAL CITY,'CA 92234
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.: 336547
Date:CrVaol I
/ Contractor:
r—
OWNER-BUILDER D SIA ATI N
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
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 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
VOICE (760) 777-7125
FAX(760)777-7011
INSPECTIONS (760) 777-7153
Date: 3/6/2015
Owner:
WASHINGTON ADAM PARTNERSHIP
42620 CAROLINE CT 102
PALM DESERT, CA 92253
Contractor:
AL MILLER & SONS ROOFING CO IN
68760 SUMMIT DRIVE
CATHEDRAL CITY, CA 92234
(760)328-6616
Llc. No.: 336547
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 I should become subject to the
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with those provisions.
Date: 0 7 CAe i S Applicant: Teli,1
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 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: 403J04 (0Signature (Applicant or Agent):
T��OL mss.
STATE OF CALIFORNIA
ENVELOPE COMPONENT APPROACH
CEC-NRCC-ENV-01-E Revised 06/13 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE NRCC-ENV-01-E
Envelope Component Approach (Page 1 of 3)
Project Name: $_j r :5 may, L L e Date prepared:
A.
GENERAL INFORMATION
Project Location:
54• v (� \
6 Compliance Method: ❑ Component ❑ Unconditioned. (file
1
5
6
_��
Affidavit)
2
CA City and Zip Code:
G "i q'L2
7
Building Front Orientation (deg or cardinal):
Frame
Material
3.
Climate Zone:
i +5
8
Permitted Scope of Work ❑ New Construction ❑ Addition EAlteration
4
Total Conditioned Floor
v
9
Building Type(s)
❑ Nonresidential ❑ High -Rise Residential ❑ Hotel/Motel Guest Room
Area: .
1
5
❑ Schools (Public School) 0
Relocatable Public School Bldg. E3,.Conditioned Spaces
❑ Unconditioned Spaces
❑ Skylight Area for Large Enclosed Space a 5000 ft? (If checked include the NRCC-ENV-04-E with submittal) -
B. ENVELOPE DETAILS — Framed
1
2
3
4
5
6
7
8
9
10
11
Ta /ID
Assembly Type
Frame
Material
Frame
Depth
Frame
Spacing
Appendix JA4
Reference
Cavity
R -value
Continuous
Insulation
R -value
Proposed
U -Factor
Required U -Factor From
Tables, B, C, D
Comments
PAHild:..,.
c.. ,
C. ENVELOPE DETAILS — Non -framed
1
2
3
4
5
6
7
8
9
10
Tag/ID
Assembly Type
Assembly Materials
Thickness
(inches)
Interior or -
Core
Insulation
R -value
Continuous
Insulation
R -value
Appendix JA4
Reference
Proposed
U -Factor
Required U -factor from
Tables, B, C, D
Comments
Required U -Factor from
Tables, B, C, D
Comments
PAHild:..,.
c.. ,
D. ENVELOPE DETAILS — Mass
1
2
3
4
5
6
7
8
9
10
it
Tag/ID
Mass
Type
Density
(lb/ft 3
Mass
Thickness
(inches)
Furring Strip
Thickness
(inches)
Interior
Insulation
R -value
Exterior
Insulation
R -value
Appendix JA4
Reference
Proposed
Insulation
U -factor
Required U -Factor from
Tables, B, C, D
Comments
PAHild:..,.
c.. ,
., Su, ding I-neegy cniuent y Jtdnodras - [1113 Nonresidential Compliance June 2013
STATE OF CALIFORNIA
ENVELOPE COMPONENT APPROACH
CEC-NRCC-ENV-01-E (Revised 06113) CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE NRCC-ENV-01-E
Envelope Component Approach (Page 2 of 3)
Project Name: tLVC,.r
� k,0'il 4/t.`y`,5 5; Date Prepared: Q 3 / Q4•, � j
E. ROOFING PRODUCTS (COOL ROOF)
1
2
3
4
5 6 7
8.
9 10
.11
Mass Roof
25 Ib ft2
or greater
Roof Pitch
CRRC Product
ID Number
Product Type
Proposed
Minimum
Required
Comments
Aged Solar
Reflectance
Thermal
Emittance
SRI
(Optional)
Aged Solar
Reflectance
Thermal
Emittance
SRI
(optional)
❑
06314 --Mi
5"
❑'
. e
`t
Q CA
c2IZc
❑
❑'
❑
❑'
12 An aged solar reflectance less than 0.63 is allowed provided the maximum roof / ceiling U -factor in TABLE 140.3 is not exceeded
❑ High-rise residential buildings and Hotels and Motel's with low -sloped roofs in Climate Zones 1 through 8,12 and 16 are exempted from aged Solar
Reflectance and emittance requirements.
❑ High-rise residential buildings and Hotels and Motels with steep -sloped roofs in Climate Zones 1 and 16 are exempt from aged Solar Reflectance and
emittance requirements,
❑ The roof area covered by building integrated photovoltaic panels and building integrated solar thermal panels are exempt from aged Solar Reflectance
and emittance requirements
To apply Liquid Field Applied Coatings, the coating must be applied across the entire roof surface and meet the dry mil thickness or coverage recommended
by the coatings manufacturer and meet minimum performance requirements listed in §110.8(i)4. Select the applicable coating:
❑ Aluminum -Pigmented Asphalt Roof Coating
❑ Cement -Based Roof Coating
O Other
NOTES:
1. Check the box if the aged Solarreflectance was not avaiRdh&- in the Cool Roof Rating Council's Rated Product Directory, Then use the equation in Section 110.8(i)2 where the Initial Reflectance
vah a from the some directory and use the equation ('0.2+8(p;,,nre1— 0 Z) to obtain a calculated aged value. inhere p is the Initial Soler Reflectance and 0 is either set to 0 65 for Field -Applied
Coatings or it is set to 0.70for all other roofing products other the Field -Applied Coating.
2. Cabdate the SRI Value by using the SR/ -Worksheet at (TBD) and enter the resufting value in the SRI Column above and attach a copyfor LPoe SRI- Worksheet NRCC-EW-03-E to the to this form.
CA Building Energy Efficiency Standards - 2013. Nonresidential Compliance June 2013
CERTIFICATE OF COMPLIANCE — DATA FIELR DEFINITIONS,AND CALCULATIONS NRCC-ENV-01-E
Envelope Cofnponent Approach (Page 1 of 1)
DOCUMENTATION AUTHOR'S DECLARATION STATEMENT
1. I certify that this Certificate of Compliance documentation is accurate and complete.
Documentation Author Name:
Documentation Author Signatur
Company:A i ^ ��
j` tK1(f
Signature Date:
Address:
CEA/ HERS Certification Identification (if applicable):
_
City/State/Zip:
Phone:
RESPONSIBLE PERSON'S DECLARATION S ATEMENT
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. 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 completed signed 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 completed signed copy of this
Certificate of Compliance is required to be included with the documentation the builder provides to the building owner at occupancy.
Responsible Designer Name: r
Responsible Desi g cure:
Company:
Date Signed:
Address:
_ �,. . r�-c-
License:
33 ios if 1
City/State/1I. C
Phone:
CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance lune 2013
' I
FINANCIAL ••
1•
DESCRIPTION"•' -
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
BSAS SB1473 FEE
101-0000-20306
0
$1.00
$0.00
PAID BY -
,; • METHOD
RECEIPT #
CHECK #
CLTD BY '
Total Paid forBUILDING STANDARDS ADMINISTRATION BSA:
$1.00
$0.00
:;DESCRIPTION.
ACCOUNT`
QTY
:. AMOUNT
PAID
PAID DATE
RE -ROOF - FIRST 2,000 SF
101-0000-42404
0
$49.31
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
'DESCRIPTION
ACCOUNT_; :
;QTY
"AMOUNT
PAID.
PAID DATE
RE -ROOF - FIRST 2,000 SF PC
101-0000-42600
0
$98.62
$0.00
.PAID BY
METHOD _
RECEIPT #
CHECK #
CLTD BY
Total Paid forRE-ROOF:
TOTALS:•
$147.93
$0.00
00
Description: ONE ELEVEN LA QUINTA PM25865 '
CONDITIONS
Type: RE -ROOF
Subtype:
Status: APPROVED
Applied: 3/6/2015 AZA
Approved: 3/6/2015 AZA
Parcel No: 604050037 Site Address: 78540 HIGHWAY 111 LA QUINTA,CA 92253
Subdivision: PM 25865
Block:
Lot: 19
Issued:
Lot Sq Ft: 0
Building Sq Ft: 0
Zoning:
Finaled:
Valuation: $5,000.00
Occupancy Type:
Construction Type:
Expired:
No. Buildings: 0
No. Stories: 0
No. Unites: 0
ZIP
Details:
FAX
EMAIL
APPLICANT
CHRONOLOGY
CONDITIONS
CONTACTS
NAME TYPE
NAME
ADDRESS1
CITY
STATE
ZIP
PHONE
FAX
EMAIL
APPLICANT
AL MILLER & SONS ROOFING COIN
68760 SUMMIT DRIVE
CATHEDRAL
CITY
CA
92234
CONTRACTOR
AL MILLER & SONS ROOFING COIN
68760 SUMMIT DRIVE
CATHEDRAL
CITY
CA
92234
OWNER
WASHINGTON ADAM PARTNERSHIP
42620 CAROLINE CT
102
PALM DESERT
CA
92253
Printed: Friday, March 06, 2015 11:31:43 AM 1 of 2 ,RWYSreMs
REVIEW TYPE REVIEWER SENT DATE DUE DATE RETURNED STATUS REMARKS NOTES
DATE
BOND INFORMATION
Printed: Friday, March 06, 2015 11:31:43 AM 2 of 2
RWYSTEMS
INSPECTIONS
SECtID INSPECTION TYPE . INSPECTOR SCHEDULED COMPLETED
DATE DATE
RESULT REMARKS NOTES
PRE -ROOF
FINAL"
CLTD
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
RECEIPT # .
CHECK #
METHOD
PAID BY
BY
BSAS SB1473 FEE
101-0000-20306
0
$1.00
$0.00
Total Paid forBUILDING STANDARDS ADMINISTRATION $1.00 $0.00
BSA:
RE -ROOF - FIRST 2,000
101-0000-42404
0
$49.31
$0.00
SF
RE -ROOF - FIRST 2,000
101-0000-42600
0
$98.62
$0.00
SF PC
Total Paid forRE-ROOF: $147.93 $0.00
TOTALS:• 00
REVIEW TYPE REVIEWER SENT DATE DUE DATE RETURNED STATUS REMARKS NOTES
DATE
BOND INFORMATION
Printed: Friday, March 06, 2015 11:31:43 AM 2 of 2
RWYSTEMS
INSPECTIONS
SECtID INSPECTION TYPE . INSPECTOR SCHEDULED COMPLETED
DATE DATE
RESULT REMARKS NOTES
PRE -ROOF
FINAL"
REVIEW TYPE REVIEWER SENT DATE DUE DATE RETURNED STATUS REMARKS NOTES
DATE
BOND INFORMATION
Printed: Friday, March 06, 2015 11:31:43 AM 2 of 2
RWYSTEMS
J3ir1 #Cray
Permit #
�j�ZO�s.�bl7
of 1D. Quinto
-Building 8I' SafetyDivision
P.O. Box 1504, 78-495 Calle Tampico .
La Quinta, CA 92253- (760)'777-7012
Building Permit Application and Tracking Sheet
ProjcctAddress: jI2 5`q .Lj
l/ "1AP11—M
.0wncr'sName: (�,(4tv(yn4 AM )
Address:1f262a G�-1 ?0 4:_ GJ 410-2-
- A. P. Nurriber:
Legal: Description.:
City, ST, zip: . 922 s3
Contractor i ✓.
5 ) �«.► L t.b l�lG •
`Tcicphone:
Address: 65 �uk t 19sl
Project Description:
City, ST, zip: P/W &1
gZ1.3q
tM 5TIAr-�
'Tele }onc.l
v'9`•:-�:v:"v
r
�GO
�• 5
State Lic,1{ : �.3 S-7
cityLic. #;
LV1 ( /Ic-N I C;f}-LL AtGg
Arch, Engr, Designer
q.
Address:
City; S.T. Zip:.'..
Tcl hone:
cP
Name ofConiacfPcison:J,
. y
'<:; .;:}.: Y w=a=-:;_:wc:< �::>:,
w_..
Wl t L_L EE0_
Construction Typc:. Occupancy:
Projcci type (circle one):'Now' Add'n Alter Repair Demo
Sg.;I'� SO s
#.Stories:
*.Units:
ek-phone #;of Conjact Pcrson: — 2 Sly --7th Z 1 Estsrnatui Valuc:of Project *,57,000
APPLICANT: DO NOT WRITE BELOW THIS LINE
# ..: Submittal.. ..Rcq'd Rcc'dp
TRACXCINIG ERMIT FEES.
Plan Sets,;
P12n Check Submitted
Item
Amount
Strudural. talcs.
Reviewed, rcady'.for corrections :
Plan Check Deposit, .
Tru'si.Cilcs, ,CaUed
Contact Person
Plan.Chcck Balance
Title 24 Gla.
Elaas picked up _
Construction
Floodplain'plin
Plans resubiciittcd
Mechanical. .
Grading, plan
!a Rcvicw, ready for corrcctio►isrssue
Electrical
subcontac(or.List,
' Called Contact Person
Plumbing
Grant Decd
Plans picked up
H:O A Approval
'PI . ans resubmitted
'Grading... .
I?0i0USE:-
Rcvicw, ready for correctionsfissuc
Dcvdoper'Impact Fce.
Plarimng Approval
Called Contact,Peison
Pub. Wks. App r
'Date of permit issue
School Fccs
Total Permit Pccs