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BRER2014-1030(760)345-5600 Oct 3 12014 Llc. No.: :LIC -0100756 ----------------------------------------------------------------------- rnumj INITV DEVElAPV1ENT DEPARTMENT LICENSED CONTRACTOR'S DECLARATIO I hereby affirm under penalty of perjury that I am license er provisi ns of Chapter 9 (commencing with Section 70001 of Division 3 oft usiness and P essions Code,' and my License is in full force and effect. License Class: License No.: :LIC -010 6 Dateit)-3/— / (! OWNER -BUILDER DEC'LA'RATION 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 ($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 Address: 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 perfomanner �ifl is perms i shall not employ any person in any ome subject to the workers' compensation laws of California, a ut ubject to the workers' compensation prov' ' ns of Section 3700 a Lab ae, I shall f with comply with those 1 ns. Date: /©-- 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 relay ildin construction, and hereby authorize representatives of this city to r up e o mentioned property for inspection purposes. Date: �� 3/,L Signature (Applicant or A nt): Q�i a1�I1I�/ VOICE (760)777-7125 78-495 CALLE TAMPICO D FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 10/31/2014 Application Number: BRER2014-1030 Owner: Property Address: 49865 LAGO DR PHYLLIS SALATICH APN: 658270019 49865LAGO DR Application Description: REMOVE ROCK & DIRT REPLACE WITH FOAM LA QUANTA, CA 92253 Property Zoning: Application Valuation: $0.00�C 2f uv Applicant: Contractor: SPRAY FOAM OF SOUTHERN CA SPRAY FOAM OF SOUTHERN CA OUTSIDE CITY LIMITS OUTSIDE CITY LIMITS LA QUINTA, CA 92253 n n n LA QUINTA, CA 92253 (760)345-5600 Oct 3 12014 Llc. No.: :LIC -0100756 ----------------------------------------------------------------------- rnumj INITV DEVElAPV1ENT DEPARTMENT LICENSED CONTRACTOR'S DECLARATIO I hereby affirm under penalty of perjury that I am license er provisi ns of Chapter 9 (commencing with Section 70001 of Division 3 oft usiness and P essions Code,' and my License is in full force and effect. License Class: License No.: :LIC -010 6 Dateit)-3/— / (! OWNER -BUILDER DEC'LA'RATION 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 ($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 Address: 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 perfomanner �ifl is perms i shall not employ any person in any ome subject to the workers' compensation laws of California, a ut ubject to the workers' compensation prov' ' ns of Section 3700 a Lab ae, I shall f with comply with those 1 ns. Date: /©-- 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 relay ildin construction, and hereby authorize representatives of this city to r up e o mentioned property for inspection purposes. Date: �� 3/,L Signature (Applicant or A nt): FINANCIAL •1• DESCRIPTION ACCOUNT CITY AMOUNT PAID PAID DATE RE -ROOF -FIRST 2,000 SF 101-0000-42404 0 $49.31 $0.00 PAID BY - - METHOD .F RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT CITY 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: $147.93 $0.00 • • •• Description: REMOVE ROCK & DIRT REPLACE WITH FOAM Type: RE -ROOF Subtype: Status: SUBMITTED Applied: 10/31/2014 PJU- Approved: Parcel No: 658270019 Site Address: 49865 LAGO DR LA QUINTA,CA 92253 Subdivision: TR 3941 & INT IN COMMON AREAS Block: Lot: 19 Issued: Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $0.00 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0 Details: REMOVE DIRT & ROCK AND REROOF WITH URETHANE FOAM ROOFUING SYSTEM 2013 CALIFORNIA BUILDING CODES. ADDITIONAL SITES DESCRIPTIONI ACCOUNT I QTY I AMOUNT I PAID I PAID DATE I RECEIPT # I CHECK # I METHOD I PAID BY I CBD RE -ROOF -FIRST 2,000 I 101-0000-42404 I 0 I $49.31 I $0.00SF I I I I I I Printed: Friday, October 31, 2014 12:17:34 PM 1 of 2 CRWYSTEMs DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY CLTD BY RE -ROOF - FIRST 2,000 101-0000-42600 0 $98.62 $0.00 SF PC Total Paid for RE -ROOF: $147.93 $0.00 TOTALS:00 REVIEWS REVIEW TYPE REVIEWER SENT DATE DUE DATE RETURNED STATUS REMARKS NOTES DATE f ATTACHMENTS Printed: Friday, October 31, 2014 12:17:34 PM 2 of 2 CN?WYSTEMS INSPECTIONS SEQID INSPECTION TYPE INSPECTOR SCHEDULED COMPLETED DATE DATE . RESULT REMARKS NOTES FINAL" PRE -ROOF REVIEWS REVIEW TYPE REVIEWER SENT DATE DUE DATE RETURNED STATUS REMARKS NOTES DATE f ATTACHMENTS Printed: Friday, October 31, 2014 12:17:34 PM 2 of 2 CN?WYSTEMS Bln.# _ City. of" La Quinta Building 8t• Safety Division P.O. Box 1504,'78-495 Calle Tamptco La.Quinta, CA 92253 -:(760) 777-7012 Building Permit Application"and Tracking Sheet PeriWt # Project Address: L49 Owner's Name:. A. P. Number. Address: Legal Description:�" Contractor. 11 ivy D 1� '�`T e vlx-, City, ST, Zip: il. e/ ZZS—J Telephone: Project Description: Address: —qcf a W)-2.i eAl I /� City, ST, Zip: 6W4,, es g ,- c —G 2.7 ( t Telephone---70 State Lic. # : 77 City Lic. #; +QO-7 �, iZ M Arch, Eng., Designer Address: City., ST, Zip: Telephone: Construction Type: , Rcp .N Occupancy: State Lic. #: y�','� ' Project type (circle one): New Add'n Alter Repair Demo Name of Contact Person: j � s• Sq_ Ft: `L�0() # Stories: # Units: Telephone # of Contact Person: — Estimated Value of Project: C920,06 APPLICANT: DO NOT WRITE BELOW THIS UNE fl Submittal Req'd Recd TRACKING PERMrrFEES- Plan Sets Plan Check submitted.Item Amount Structural Cates. Reviewed, ready for corrections Plan Check Deposit. . Truss Cates. Called Contact Person Plan Check Balance- Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted.*. Mechanical Grading plan 2.1 Review, ready for correctionsfissue Electrical Subcontattor Ust Called ContactPerson- Plumbing Grant Deed Plans picked up SALL H.O.A. Approval Plans resubmitted Gradlag IN ROUSE:- 3a Review; ready for correetions!issae Developer Impact Fee Planning Approval. Called Contaet Person Pub. Wks. Appr " Date of permit issue School Fees Total Permit Fees STATE OF CALIFORNIA RESIDENTIAL ALTERATIONS CERTIFICATE OF COMPLIANCE CF1R-ALT-01-E Prescriptive Residential Alterations (Page 4 of 4) Project Name: /l/f, , i l 1 C S�4-/,t1 T� �/-, l� �'i.-S�'6S IJ,d c,n nit . L2 C � U1 -/a I Date Prepared: /n_ 7l —1 c/ IA DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Compliance documentation is accurate and complete. Docume tatlon Author Name: Document h Sl Se- - Company: _ Signature Date: Add ess: v CEA/ HERS Certification Identification (If applicable): City/State/Zlp: /j/ ^ piµ / Phone: /V/' /✓/� R SPONSIBLE PERSON'S DECLARATIOIlf 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. S. I 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 required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Designer Name: Responslbl s ner Si tures `2, o izTS C pang: Dat ned: A dress: � / / d /V License. City/State/Zip: ACC 2-Z-/ l Phone: I i 6 For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300. Registration Number: Registration Date/Time: HERS Provider: CA Building Energy Efficiency Standards - 2013 Residential Compliance June 2014 STATE OF CALIFORNIA RESIDENTIAL ALTERATIONS CEC-CF1 R -ALT -01-E iRevised 06/14 CALIFORNIA ENERGY COMMISSION CEO CERTIFICATE OF COMPLIANCE CF1R-ALT-01-E Prescriptive Residential Alterations (Page 1 of 4) Project Name: p/-, ; )1, < <:�.a-l.4 -T) r- /, 1 can ,ter► / A /'7.�',►J 7-/J I Date Prepared: In --Z I_ / q A. GENERAL INFORMATION 01 02 01 Project Name: , / .S i G 02 Date Prepared: — 03 Project Location: 04 Building Front Orientation deg or cardinal): 05 CA City: (_ A 06 Number of Altered Dwelling Units: 07 Zip Code: 08 Fuel Ty e: Climate Zone: 10 Total Conditioned Floor Area (ft2): L09 11 Building Type / l -T- 12 Slab Area (ft2 13 Project Scope: Jr, ti Table Cell Aged Solar Thermal SRI Reflectance Emittance (Optional) B. BUILDING INSULATION DETAILS (Section 150.2(b)1) 01 02 03 04 05 06 07 08 1 09 10 11 Tag/ID I Assembly Type Frame I Type Frame Depth I (inches) Frame Spacing inches) Proposed Required Comments Cavity R -value Continuous Insulation R -value LI -factor Appendix JA4 Reference LI -Factor Table Cell Aged Solar Thermal SRI Reflectance Emittance (Optional) O -6),74'r4 ,0 1— D, ,S 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---T-08 09 10 11 12 13 Method of Compliance Roof Pitch Exception CRRC Product ID Number Product Type R -value Deck Insulation Proposed Minimum Required Initial Solar Aged Solar Thermal SRI Reflectance Reflectance Emittance (Optional) Aged Solar Thermal SRI Reflectance Emittance (Optional) O -6),74'r4 ,0 1— D, ,S 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: CA Building Energy Efficiency Standards - 2013 Residential Compliance HERS Provider: June 2014 Sprayfoam of Southern California 43-890 Warner Trail Palm Desert, CA 92211 (760)345-5599 (760) 345-5159 fax 675959 Residential - Proposal and Contract # DC2114 Thursday, October 30, 2014 There shall be no liability for delays in, or failure to complete, delivery or installation of all or any of the herein mentioned merchandise, if due to fire, strikes, war, governmental regulations, or any cause beyond our control. Any changes made by you in the specifications herein, necessitating additional materials or labor shall not be covered by this proposal, but shall be provided for under separate and additional order from you. Signature: �,. Date: �S/ Authorized Completion of above job will be estimated Total at 10 days from the commencement of work unless otherwise specified.here: $6,890.00 Agreed upon begining date: TOTAL PAID UPON COMPLETION ~'`Iiiiiiit ^' iiii I illl,'i UNLESS OTHERWISE SPECIFIED IN THE CONTRACT L^; I� l:.::iji?!`:i:�; r Contractors are required by law to be licensed and regulated by the Contractors' State License Board. Questions concerning a contractor may be referred to the registrar of the board whose address is: Contractors' State License Board 1020 North Street Sacramento, CA 95814 Valid for 30 days from the proposal dare indicated above