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10-1325 (RR)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property. Address: - APN: Application description: Property Zoning: Application'valuation: Applicant. 1-6- 0 0 0 0-1-32'5 52700 AVENIDA RUBIO 773-283-025-13 -00000.0- RE-ROOF COVE RESIDENTIAL ,.250 Architect or Engineer: BUILDING & SAFETY DEPARTMENT BUILDING PERMIT '4W;(760)777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Owner: CARL FISHER----�"`�_ PO BOX 408 �! PALM SPRINGS; 922 ------------- ----------------- z _ Contractor: •.: ,,..., Owner (;ny OF /A ttUiNiP. mi, 'ns ---------------------------------- -LICENSED CONTRACTOR'S DECLARATION hereby affirm under penalty of perjury that. I am licensed undei. 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 Tam tam 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 Division3 of the Business and Professions Code) or that he 6r_she-isexempt'tnerefrom and the basis for the alleged exemption. :Any violation of -Section 7031.5 by applicant fora permit subjects the applicant to a civil7penalty of not more than five hundred dollars ($500).: yl V1, 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 man owner of property,who•builds"br improves thereon, ..and who does thework,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—) I am exempt under Sec. , BAP.C. for this reason ' ate: �Z L Zvlo ner: 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: r ` 1100 LQPERMIT Date: 12/06/10 W 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 6f 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 becomesubjectto the workers' compensation provisions of Section 3700 of'the Labor.Code I shall forthwith co those provisions. oo Date: %7 I� pplicant: 1^ WARNING:: FAILURE�TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT -'4N EMPLOYER TO CRIMINAL PENALTIES AND CIVIL•FINES.UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000)._ JN(ADDITION TO THE COST. OF COMPENSATION, DAMAGES AS PROVIDED FOR 1N 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 building construction, and hereby authorize representatives of county to enter upon the above-mentioned propertyfo m pectin r Date: / 2 C A 0 Signa (Applicant or Agent): r Application Number . . 10-00001325 Permit . . RE -ROOF Additional desc . Permit Fee . . . . 30.00 Plan Check. Fee .00 Issue Date . . . . Valuation . . . . 0 Expiration Date 6/04/11 ) Qty Unit Charge Per Extension BASE FEE 30.00 ---------------------------------=----------------------_-------------------- Special Notes and Comments REPAIR•ROOF R'& R ROOF TILES, REPLACE r: FELT; .REFAIR 'SHEATHIIING' AT-: NW• -CORNER.;' _. 2007 CODES.. ------------ ----- ` :Other: Fees BLDG^STDS•ADMIN-(SB1473) ----- 1.00 Fee summary Charged: Paid Credited Due.: ----- Permit .Fee :Total 30.:.00:: .00•.- .00 30.010' - Plan'Check total 00:.: .00. .00,:_ .00. Other.Fee'Total 1.00 00 .00 1.00 Grand Total 31:00._ .00 .00' 31.0Q. rf O C O n r Z O r ��m E n r Z O r • J P.O. Box 1504 LA•QUINTA, CALIFORNIA 92247-1504 BUILDING & SAFETY DEPARTMENT 78-495 CA[:LE TwMPIco (760) 777-7012 LA QUINTA, CALIFORNIA 92253 PROPERTY OWNER'S' PACKAGE FAX (760) 777-7011 Disclosures & Forms for Owner -Builders Applying for Construction Permits F PfrL� 'Af'1 PIQTIC)C ©ear Pvverty Owner Aii. application for a permit. has beery oibmitled in as the huiWeE of the . impPvwemeets spocified at _ Yom- � > � Y1 ps'Y 5Z70o AvE►�I�A. 2�C�co Ve are Vmvidiag you Widt an Owner BudderAcknowtodpma and lnfosmat en VetiBeatkn.Foim to make you avm o€ your TeSPOSMbilities andpossible naryyeu may inert' by;m you nun as the Owux4kdder. we � sot issu,e.n un� y� have road, i elf your. of ea& prw4Aon, signed, and returned this form'to us at our otiietal`:address indicated. An agent of the owner cannot eatecn t tgs:'notice unless You, the Property owner, obtain the prior approval of the permitting.authority. 1KS Read and atitfal oa k. stuteritertt etaw F 'aigiufy you orvpi y does hgbrma�oR. understand a frequent practice of unlicensed person is 'to have the property owner obtain an "Ower -Builder" building permit that mrroneously'iniplies brat the property owner is providing.his or her own labor and nvderW peusousft. I, as an Owner -Builder, my be held liable and subject -to, risk for'anY injtsfies sustained by an unlicensed person and his or her employees while . on m "' oa a for those worlang Y PI' Y My homeowners insu ance, may not Proms �g .injuries. I am willfu!!y acting as -an Owner -Builder awi'aj:n awaie'of the limits of my insurance -coverage for injuries to workers onmy proPertY v11 2. I understand b urlding.permits are not regrricvd to be signed by property owners unless they are responsible for the construction and are not.hiring a Licensed Contractor to. assume tfiis responsibility. /3. I understand as an:"Owner=Builder" I asi,e resnon'sible:party of record on the permit. I understand that I may protect myself from potential financial"visit by - a licensed Cm&gctm_=draving the. permit filed in his or her name instead of my own. ✓ 4. I understand Contractors•are required by taw to be licensed and bonded in California and to list their ticepse numbers on permits and contracts. ✓ 5. I understand if I employ or otherwise engage any persons; other than Califmiia. 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. ✓6. I understand if I am considered an "em;Aoyq".: oder; state ande. Weral law, I must register with .the state and feden government, withhold payroll taxes,:'provide woi ows' compensation ri� disability. insurance, and contnituhe to to compensation for each "employee." I also understand 'my failure to abide by these laws may subject me to serious f nanci: risk 7. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family resident structures cannot .legally build diem with' the..intent to offer them for sale, unless all worts is performed by tieens subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is perform under contract with a licensed general building Contractor. 8. I understand as an Owner -Builder if I sell.the - . for which this tis issu I ma be held Liable for any financial or Pt?Y Pew Y Pte. 6y any subsequent owuer(s) 'that result from any latent construction defects in the workmanship or materials. f9. I understand I may obtain more information regarding .my obligations; as an :`employee" from the Roveme Service, the.Uoited States Small Business Adminutation, the'California De¢actu►ent:of )3enefit Paymetyta, and the California Division of Industrial Accidents. I -also understand kmay coniact,the .California Contractors' State License Board (CUB) at 1- 800-321-CSLB (2752) or www.cslb.ca.gov for more information about Wensed contractors: 10. I am aware of and consent to an,Owner-Bailde building permit applied for in my Dame, and' understand that I am the party tegalY and fnanc' p posed constm.ction activity at the following address: tatlY respo�ns�te .for . ro . -2-7 OC7 IL��J9J l y�A 'iZl.Ji� 10 f�'A I. agrue that, as the party, legally and fwaacnal1 re-ble for this proposed.00nstruction activity. -1 will abide by all applicable taws and reqthat goveta Oaitrec=builders as well as employees. � 12. I agree to notify the issuer of this form immediately ouany adamon: kfim, of c6aoge8.to tliy of the infannadw 1 have provided on this form: Licensed -.contractors are'negulated by laws:designed'to-'protect:the public. If you eentract with sosaoom who.dops not have .dW'CoMaCW fcaState LicenseBoard ®ay be .table st'jron with any Ions You may sustain: as a result°o£ a cowlaint Your only temedy agarnst unlicensed Coutr ctors'roay be in.civil coWL h is: �o ibWoctm nt for Yon t u .t6 if im Ali oaosed'Centractor oa,e ; ym of .t d in&if tiai`or &m is i while vw ng on Your ProP�Y: You; Y Ctd r ` if, you .obWR, permit as Owatr Builder and wish to moo: Cogs, Y %r v00Pfi i�' or 4M' thou Q=Facpi. na: are . f t d and &e Mt" of wO&W compansM6016 bourse oovenW. Beforea building'permit can bey, tis;form mast be completed and ed-bY the . owner a" returned to FroFY the agency responsible for isat al>t At prti ; awise 's,ditr '� fay rh or Othel Vq pA._ e0. tkQis . t0 be ented'.Wiefr Ia iaswetf 60. 9J . owner's signaame. Signmum of property owner L< Dater. 12, Note: Ae following Authorization Form '.is'regtured io be completed by, the property owner only when designating an agent of the property, owner to appiy fora constru�tion permit for. the Owner -Builder. AU'HOItIZA'TIiON�1 O iNT 1`O ACT ON PtO�LR'�'Y O�'K[�El'S MHA�I F.xciuding.the Notice to Prope ty.Owner, th,..:CIXOc; t oa of *hien Lunderstaad is.my..pers:omal Vewduk&ility, . keretiy authorize the foIIottring pegs} -to act as'my.ag�s)-to apply for, sign, cad file the doe uneats necessary.0 obi anOwner-Builder Fermit.for Scope of Construction Project (or Description of.Work): Project Location or Address: Name of Authorized Agent:... Tel No Address of Authorized Agent: I declare under nal .. pe ty of peryury that.1 the property owner for the address listed above and I personally filled out the abo, information and certify its sextrrac ole A cwpy of [he a»nrer,s driver's license, form irotarrzalion; or other verf/ieation. . acceptable: to the agency rs--- ed`to be prieceirted when die permit is issnced to verify the property owner's signature.. Property Owner's Sig6ature: Date: Bin # City of La. Qunta Buifding'8t Safety Division ! . P.O. Box Box .1504; .78-495 Calle Tampico La Quints, CA 92253 - (760) 777-7012 B010ing'Permh-Application and Tracking Sheet Permit # U I Project Address: 5Z100 Av 1. :,,Owner's Name: G tis A. P. Number: - �c� Z �" Address: -5 O Legal Description: — G ' L:rIZI" City,`ST, Zip. svizA o Contractor:p Tele hone•.;., . A.,• ( Address: �, �jL- ©g Project Description. Z• City, ST, Zip: 7p. � t� .S. i., ,_ .. Z.4' 010 L-ES IZE 1�- L ACS_ Tele hone: �j 73 _Z {�1 ; c1 W ks., ' >'^, . '13 r- State.Lic. # : %ik City Lic:'#: 0 • Arch., Engr., Designer: 'O/A . AT QP7H J ESTt_L Address: City., ST, Zip: Telephone: ' : ,' •A:sy. Construction Type: r (2- Occupancy: ' Project type (circle"one): New Add'ii Alte Repair Demo State Lic. #:y Name of Contact Person: l� 'Sq: Ft : `(� S Z # Stories: # Units: Telephone # of..Contact•Person: Estimated Value of Project: � 2S APPLICANT: DO NOT',WRITE. BELpW: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 Title 24 Calcs. Pians picked up" Construction Flood plain plan Plans.resubmitted r Mechanical Grading plan 2"" Review, ready for correi:tions/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed pians picked up S.M.I. H.O.A. Approval T4ns'resubmitteId Grading IN HOUSE: 7id Review, ready for corrections/issue Deyeloper Impact Fee Planning Approval Called Contact.Person Pub. Wks. Appr Date of permit Issueq School Fees Total Termit Fees 1ptive Certificate of Compliance: Address: 740 AyEo(D A 117v3 lD, ..1 ROOFING PRODUCTS (COOL ROOFS) §151012 CF -1 R-ALT-R@ROOfI t# When the area of exterior roof surface to be replaced exceeds 50% of the existing roof area, or 1,000 fe, whichever Is less, the new roofing area must meet the roofing product. "Cool Roof, requirements of §152(b)1HI, 152(4)1Hii, of 152(b)1Hlil. Check applicable altemative or exception below if the roof alteration is exempt from the roofing product "Cool Roof requirements:: ❑ Cool roofs not required in Climates Zones 1-12,14, and 16 with. a low sloped roof pitch (less or 2:12 pitch). ❑ Cool roofs r o required in Climates Zones 1-9, and 16 with a steep -sloped roofs (greater pitch than 2:12) and product weightless than 5Ab/ft2. Alternatives to §152(b)1 HI and §152(b)HII, Stee"lope roof (pitch > 2:12) ❑ Insulation with a thermal resistance of at least 0.85 hr•ft2-°F/Btu or at least a:3/4 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(f)10; or ❑ In climate zones 10, 12 and 13, with 1 ft2 of free ventilation area of attic ventilation for every 150 f12 of attic floor area and where at least 30 percent of the free ventilation area is within 2 feet vertical distance of the roof i d e -or Rf Building has at least R-30'ceiling insulation; or 9 IW OF LA QUI NTA ❑ Building has radiant barrier in the attic meeting the requirements of §151(f)2; or BUILDING & SAFETY DEPT. ❑ Building has no ducts in the attic; or n P P R OW E❑ In climate zones 10, 11, 13 and 14, R-3 or greater roof deck insulation above vented attic. d'i i Exception to §152(b)1HIIl, Low -slope roof (pitch:5 2:12) FOR CONSTRUCTION ❑ Building has no ducts in the attic. Other Exceptions DAT L11?• O BY ❑ 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 Iblfl2 are exempt from the Cool Roof criteria. NOTE: if any one of the alternatives or exception is checked the Aged Solar Reflectance and Thermal Emittance requirements for roofing products in §118(1) are not applicable. Do not rill table below. Roof Slope Product Weight Product Aged Solar Thermal CRRC Product ID Number 5 2:12 > 2:12 < 51b/ft2 2 51b/ft2 Type2 Reflectance3A Emittance SRI 'a ❑ ❑ ❑ 04. ❑ 13 13 ❑ ❑4 Note: If no CRRC-1 label is available, this compliance method cannot be used, use the Performance Approach to show compliance, 1. The CRRC Product /D Number can be obtained from the Cool Roof Rating Councirs Rated Product Directory at www coo/roofs orv/ar+oducts/cQarch rho ?. Indicate the type of product is being used for the roof top, 1. e. single -ply roof, 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 Reflectance value from the same directory and use the equation (0. 2+0.7(pkw — 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. i. Calculate the SRI value by using the SRI- Worksheet at hffpAAVWW.en@roy Ca aov/title24/and enter. acopy of the SRI- Worksheet to.the CF -IR. 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 coverage eeommended 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 TOTE: When a Cool Roof is required, the installing contractor shall complete and submit the CF -6R -ENV -01 for final inspection. Declaration Statement. • 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 identified on this Certificate of Compliance conform to the requirements of Title 24, Parts 1 and 6 of the California Code of Regulations. Name: �. Signature :Ss: For assistance or questions 224:� /'-"/7-2- License: 2/Z.z License: Qt - Phone: the Energy Standards, contact the Energy Hotline at: 1-800-772-3300.