12-0617 (RR)P.O. PDX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253. .
Application Number:
12-000 0 0617)
Property Address:
51611 AVENIDA RUBIO
APN:
773-121-012-2 -000000-
Application description:
RE -ROOF
Property Zoning:
COVE RESIDENTIAL
Application valuation:
4000
c&ht.4.4Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Applicant: Architect or Engineer:
--------------------------------------------------
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.: _
Contractor:
j 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 pplicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
( �C) .1, -as owner of the property, or my employees with wages as their sole compensation, will do the work, .and
,
7-� 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: R
i
CONSTRUCTION DIN AG eY--
I hereby affirm under penalty of perjury that there is a construction len mg agency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
LQPERMIT
Owner:
LINDSEY MEDLEY
51611 AVENIDA RUBIO
LA QUINTA, CA 92253
-----------------------
Contractor:
Owner .
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
------------------
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
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 or C , I shall to
rthwit y wi se provisions.
ate plicant:
WARNING: FAILURE TO E PE
RE WORKERS' COM NS, VERAGE IS UNLAWFUL, ND S
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED T OUSAND
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, indemnity 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.
1 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�n ere y orize representatives
of this ounty to enter upon thea ve-mentioned propert o inspe purposes.
ate Sig re (APPlicant or Agent):
12
LQPERMIT
Application Number . . . . . 12-00000617
Permit RE -ROOF INV FEE
Additional desc .
Permit Fee 60.00 Plan Check Fee
.00
Issue Date . . . Valuation
0
Expiration Date 12/01/12
Qty Unit Charge Per
Extension
BASE FEE
60.00
----------------------------------------------------------------------------
Special Notes and Comments
RE -ROOF WITH COOL ROOF RATING COUNCIL
APPROVED OWENS CORNING SHINGLE. 2010
CODES.INVESTIGATION FEE ASSESSED PER
1997 UNIFORM ADMINISTRATIVE CODE §304.5
FOR WORK BEGUN WITHOUT BUILDING PERMIT.
-----------------_----------------------------------------------------------
Other Fees . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid Credited
Due
---------------------------------------------------------
Permit Fee Total 60.00 .00 .00
60.00
Plan Check Total .00 .00 ..00
.00
Other Fee Total 1.00 .00 .00
1.00
Grand Total 61.00 .00 .0.0
61.00
P.O. Box 1504
LA QUINTA, CALIFORNIA 92247-1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
PROPERTY OV�i` - ER' S PACKAGE
(760) 777-7012
FAX (760) 777-7011
Disclosures & For m's* for Owner -Builders Applying for Construction Pelr»its-
1 NOTI<CF T() I�R(1PFUTY rWh
Dear Property Owner:
An. application fora bu' M . permit has been suball m your name listing if as the builder of tete .party
improvements specified at V0 . l }�
We are providing you with an Owner -Builder i4.ekno,104edgment and I f n� eenVKification Fom to make you avain of your
MSPonsibilities and possible risk you may incur by having tbas permit.issued. m your name as the
Owner -Builder. We'WW not issue a building -permit untlt you have read, lnldided your. auderrstanding of eadt'provision,
signed, and returned this form to us at our emetal address indicated. An agent of the owner cannot execute this•:notice
unless you, the property owner, obtain the prior approval of the permitting authority.
QVRW Ver A" � OF WOEMAWON
D&LMONS &ad and irraud ea h:Vatenrenrb-teWvty signify You aierstand or verb tkis iii annai6ion.
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 pessoaaily.1, 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 o€ the limits of my insurance coverage for injuries to workers
on my party.
2. I understand building permits are not required to be signed by property owners unless they are responsible for the
cons etion attd are. not hiring a licensed Contractor to assume this responsibility.
I understand as. an "Owner -Builder" I am tie responsi61e pparty 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.
�. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers -on
permits and contracts.
I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value
of m construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer"
under state and federal law.
ciaI understand if I am considered an "employee' under state and federal law, I must register with the state and federal
oveLl ent, withhold payroll taxes, provide workers' compensation disability msurance, 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.
7. 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.
j8. 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. it cries sua�ned by any subsequent owners) that result from any latent construction defects in the
wortananship or materials.
*9. I understand I may obtain more information regarding my obligations as an -employee, 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 (CSLM at 1-
800-321-CSLB (2752) or www.csib.ca.gov for more information about licensed contractors.
�0I 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 Onancially responsible for proposed construction activity at the following address:
�y V\I L I agree that,. as the party legally and ftnaacially responsible for this proposed construction activity, l will abide by all
applicable laws and requirements that govern dvfler=builders as well as employers.
AtA 12.1 agree to notify the issuer of this form immediately of any additions; deletions, or cliguga many of the information I
have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you eontraet with
someone who doenot have a license, the ContractorsState 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 inVivil court. It is also
important for you tom understand that.if an unlicensed .Centractor or employee of that individual or firm is injuted while worldag
on your property; you may be held liable for damages. If you obtain a permit as Owner -Builder and with to Mira ConUactors,
You will be responsMe for verifying. vAmthea or not those Contractors are propedy licensed and &e stators of tfieir workers'
coon 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 .dw-yernait. Now A copy of *. propetV owngr s. farm tt WWdmq or
other verification acceptable to the agency is reg" to be preseerted when the permit is izued to uerit the pwperty
owner's signature. ,
Signature of Property DLo.19 12U2,—
Note: Thefollowing 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 AGEW TO ACT ON PROPERTY OWNAR'S BERW
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 agent(s) to apply for, sign, and file the documents necessary to obtain an Owuea-Builder
Permit for my project.
Scope of Construction Project (or Description of Work): _WQR
Project Location or Address: b.WU Ak/ ,Q A 1 CAS
Name of (authorized Agent: Tel No
Address of Authorized Agent:
I declare under penalty of perjurythat 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 signa(ure.
Property Owner's Signature: _ _ Date:
Certificate of
al Reroof CF -1 R-ALT-ReRoof
ROOFING PRODUCTS (COOL ROOFS) §151(012
When the area of exterior roof surface to be replaced exceeds 50% of the existing roof area, or 1,000, h
wh/c
roofing area must meet the rooting product "Cool.Roof'requirements of §152(b)1 Hi,152(b)1Hil, or 152, whi h
'heck applicable alternative or exception below if the roof alteration is exempt from the.roofing product "Cool Roor n
Is less, the new
❑ Cool roofs iiol required In Climates Zones 1-12,14, and 16 with a low sloped roof pitch (less or 2:12 pitch).
❑ Cool roofs iLot required in Climates Zones 1-9, and 16 with a steep -stoped roofs (greater pitch than 2:12) and product weight less than 5/1b/ft2.
Alternatives to §152(b)1HI and §152(b)HIi, Steep -slope roof (pitch > 2:12)
❑ Insulation with a themnal resistance of at least 0.85 heft •'Preto
❑ or at least a 314 inch air -space is added to the roof deck over an attic; or
Existing duds in the attic are Insulated and seated according to §151(1)10; or
❑ In dimate 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 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(f)2; 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)1 Hili, 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 lb/11:2 are exempt from.the Cool Roof criteria.
10 : if anyone of the alternatives or exception is checked the Aged Solar Reflectance and Thermal Emittance requirements for roofing
roducts in §118(1) are not applicable. Do not rill table below.
CRRC Product Roof Slope.
I Number 5 2:12 > 2:1
-0003 ❑
MC
Product Weight
< 51bR a 51be
Product
Type?
Aged Solar
Reflectance3.4
Thermal
Emittance
SRIS
❑
OT,
2- 57
,-)S
p
❑
❑4
/Vote: if no CRRC-1 label is available, this compliance method cannot be used, use the Performance Approach to show compliance,
The CRRC Product ID Number can be obtained from the Cool Roof Rating Councr7 S Rated Product Directoryat www. coo/roofs orn/orod w-seardm -ch-why
Indicate the OW of product Is being used for the. roof top, i.e. single�mly mot, asphalt roof, metal roof, etc.
If the aged Reflectance is not available in the Cool Roof Rating Council's Rated Product Directory then use the Initial Reftectanoe value born the same
directory and use the equation (0.2+0.7(ph„ _ 0, 2) to obtain a calculated aged value. Where pis the 4nitial Solar Reflectance.
Check box ff the Aged Refledance Is a calculated value using the equation above.
Calculate the SRI value by using the SRI_ Worksheet at hfh)Z iMW anerov ca oo00624/ and enfer.the resultlrmg value in the SRI Column above and attach
acopy of the SRI- Wotksheet to the CF -1R.
To apply Liquid Field Applied Coatings, the coating must be applied across the entire roof surface and meet the dry mil thickness or coverag.
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
NO When a. Cool Roof Is required, the installing contractor shall complete and submit the Ci 6R -ENV -01 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.perfornance specifications identified on this Certificate of Compliance conform to the requirements of Title 24, Parts
I and 6 of the Califomia Code of Regulations.
ame:
1 ,t v-,Ael— o- - 1\ A n, t o I Signature:
A .ss:
License:
C
For assistance or. questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300.
Bin. #
—
CIt}/ Of .,d QuIn' to
But/ding at Safety Division
P.O. Box 1504;"78-495 Caffe Tampico
La.Qulnta, CA 92253 - (760) 777-7012
Building Pennit Application and Tracking Sheet
Permit #/1
Project Address:
Owner's Name:.
A. P. Number.
Add =1511Ra 10A01
Legal Description:
Contractor.
City, ST, Zip:
Telephone: -
Address:
Project Description: Q
City, ST, Zip:
Telephone:
•`'
City Lir #;
State Lit #:
Ar'efi, Engr , Designer
Address:
City., ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person:
g
Construction Type:. Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: 4w 3)
# Stories:
# Unix
Telephone # of Contact Person:
Estimated' Value of Project:
APPLICANT:
DO NOT WRITE BELOW THIS LINE
p
Submittal
Req'd
Reed
TRACIMG
PERMIT FEES
Plan Sete
Plan Cheek submitted
Item
Amount
Structural Cafes
Reviewed, ready for cofrections
Plau Check Deposit. .
Truss Cates.
Called Contact Person
Plan Check Balance.
Title 24 Calm
Plans picked up
Construction
Flood plain plan
Plans resubmitted..
Mechanical
Giadlag plea
V Review, ready for cormetioneissue
Electrical
Subeontactor List
Called Contact Person
Plumbiug
Grant Deed
Plans picked up
&rvLL
ILO.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'i6 Review, ready for correctlonslissae
Developer Impact Fee
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. Appr ' .
Date of permit issue
School Fees
Total Permit Fees