10-1215 (RR)a
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property_ Address:
APN:
Application description
- Property Zoning:
Application valuation:
Applicant:
Al
10-00001215
54283 AVENIDA RUBIO
774-234-016-4 -000000-
RE-ROOF
COVE RESIDENTIAL
8980
Ta!t 4 44ur«rw
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT .
Owner:
MARILYN JANE SMITH
54-283 AVENIDA RUBIO
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Contractor:
DIVERSIFIED ROOFING SRVC, I
72877 DINAH SHORE DR, STE #03!
RANCHO MIRAGE, CA 92270
(760)407-9639
Lic. No.: 947919
Date: 11/08/10
NOV p 2010
E DEQ -- _.._
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LICENSED CONTRACTOR'S DECLARATION
-
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WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
_ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: C39 License No.: 947919
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
,actor:
issued.
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
OWNER -BUILDER DECLARATION
insurance carrier and policy number are: _
I hereby affirm under penalty of peryury th I am exempt from the Contractor's State License Law for the
Carrier COMPANION PROP Policy Number CPCA10644
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to
_ I certify that, in the performance of the work for which this permitisissued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
person in any manner so as to become subject to the workers' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
and agree that, if I should become subject to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
3700 of the Labor Code, I shall forthwith comply with those provisions.
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)•:
D icant:
(_ I 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
100,
WARNING: FAILURE TO SECUlacRS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
SUBJECT AN EMPLOYER TO CRIMINAL EN1 ES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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 Address:
LQPERMIT
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
ofthis county to enter upon the above-mentioned property for inspection purposes.
ete:
aS' ature (Applicant or Agent): • �`
Application Number . . . .
Permit RE -ROOF
Additional desc . .
Permit Fee . . . . 30.00
Issue Date . . . .
Expiration'Date . . 5/07/11
10-00001215
Plan Check Fee . . .00
Valuation . . . . 0
Qty Unit Charge Per
Extension
BASE FEE
30.00
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Special Notes and Comments
TEAR OFF ROCK ROOF INSTALL NEW
21X8'
FASCIA AND 1"X6" STARTER BOARD
INSTALL
NEW OWENS-CORNING 30 YEAR SHASTA WHITE.
SHINGLES. 2007 CODES.
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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
Of
t Address:
V a?
fo
lance: Res
ROOFING PRODUCTS (COOL ROOFS) §151(fl!2
When the area of eirterfor roof surface to be replaced
rooting area must meet the roofing product "Fool -Rom
;heck applicable alternative or ezceotion trainw if iha m
z.r3 E /5
the existing roof area, or 1,000
of §152(b)1 H1,152(b I U11. or 1
exempt from the
R -ALT
whichever Is less, the new
b)1H1U.
Roof requirements:,
O Cool roofs nM required In Crunates Zones 1-1.2, 14, and 16 with. a low sloped roof pitch Qess.or 2:12 pitch).
D Cool roofs ng required in CBmates Zones 1-9, and 16 with a steep -sloped roofs (greater pitch than 2:12) and product weight less than.5Ab/f?.
Alternatives to §152(b)1HI and §152(b)Hil, Steep lope roof ditch > Z:12J
❑ Insulation with -a thermal resistance of at least 0.85 lu'FBtu or at least a 314 inch air --space is added to the roof deck over an attic;: or
D Existing duets in tfie attic are insulated and seated according to §151(Q10; or .
❑ in climate 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 dstance of the roof ridge; or
D Building has at least R•30'ceiting insulation; or
D Building has radiant barrier tn.the attic meeting the requirements of §151(f)2; or
D 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.attle.
Exception to'§152(b)1HiIi, Low4lope roof (pitch S 2:12)..
t7 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 root membrane with at4TEi If . 2516lit2 are exempt from -the Cool Roof criteria:
Nany one of the alternatives or exception /s checked a aged olar Reflectance and T her.mal Emlttance requirements ror roofing
products in §118(1) are not applicable. Do not fill table below.
Roof SlopeProduct Weight- Product Aged Solar Thermal
CRRC Product ID Number S 2:12 > 2:12 < Sib/ft� a R*Ik 2 I -r.,.;.2 oeae..a�..ea< c..u..,..,,. �,,,5
Note. N no CRRC71 label Is available, this compliance method cannot be used, use the Performance Approachto show compliance,
F. The CRRC Product iD Number can be obtained from the Roof Rating: Council's Rated Product Directory at
t. Indkete the We of product is being used for the root top;1.e. single,,* roof;
asphalt roof, metal root, etc.
Il the Aged Reflectance is not aiWable in the Cool Roof Rating Counof's .Rated Product Directory then use the Initis! Reffedence value tom the same
directory and use the equation (0.2+0.7(phw 0.2) "to obtain a calculated aged value:• . Mare p.4 thelnitlal Solar Reflectance.
�.
Check box d the Aged Reflectance is a calcEdated value Using the equation above.
Calculate the SRI value by using the SRI- Wbrksheet'at htty //lvww one ooff24/and enterthe resulting value in the SRI Column aboveand attach
acopy of the -SR& Worksheetto time CF -1R
`o apply Uquld Field Applied Coatings, .the coating must be applied across the entlre roof suilace and meet the dry rail thickness or coverage
eoommended by the coatings manufacturer and meet. minimum performance requirements listed in §118(1)4. Select the applicable coating:
7 Aluminum -Pigmented Asphalt Roof Coating 13 Cement -Based Roof Coating 0t)ther ._4SDA.rl>C' S%J 6
! When a Coo! Roof is required, the installing contractor shall complete and submJt the CF -6R -EN V-01 for final Inspection.
Declaration Statement
• 1 certify under'' enally of perjury, undefthe laws of the State of California, the information provided on this form is accurate and complete.
• I certify that the energy'features and performance specifications identified on this Certificate of Com liance conform to the
1 and 6 of the Calitomia Code of R ulations. P requirements of Tdle 24. Parts
Name:
Signature
P ,ss:
Z^ License:
S 7 7 /.vay sftoaP D,e SrE /03 9y79/9
CdyiStatelLp�% Phone:
For assistance or questions regarding �
��—T
the Energy Standards, contact the Energy Hotline at: 1-800.777-3300.
Bin #
Permit #
Projoct Address: s• y _ Z b
A. P. Number:
Legal Description:
Contractor.NQS
Address: 7 Z_ 97-)
DI
City. ST. Zip: ,&. j � V
TelcOwne: %`C — Y07_ 9,0
--------------
Staeelia � � 9y7 9/9
Arch., EW.. Designer;
Ad*=:
City, ST, Zip:
Telephone:
State Lig tk:
Name otComtect Pemr,:
Telephoaq B of Contact Pam.
M Submstttal Re
Plan Seh
Structural Coles,
Thu Cates.
Tide 24 Cales.
Flood plain plan
Grading plan
Subeontaetor List
Grant Deed
H.O.A. Approval
IN HOUSE: -
Planning Approval
Pub. Wks. Appr
Sekow Fees
City of La Quinta
BuMfing & Safety D11drlon
P.O. Box 1504, 78-495 Cage Tampko
La Qulnta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
v e . �,td • Owner's Nanw. /,4/e [. ,t .,,& SwI
Address: Sy- tit . a.Bi o
CitY. ST, Zip: a �w�.�7lit ��► , �j'Z ZS3
T�
{ Q/1 STS, i?rgiocxDosctiptiart: !� Odic
Lie N. X0.7 u1 (�. C . 3U 5AAS%4- AW
iiii
mrd �.NG,I
Construction Type: Ocy:
Project type (ctrde one): Now Add'n Aida Repair 'Demo
Sq. FL: Z3 o G Storim: d units:
' n b0
Estimated Value of Project8 `7 Q
APPLICANT: DO NOT WRITE BMOW THIS LM
Rec'd
Plan Ckeek
Reviewed.
Called Con
Plans pi
Plana respb
2`! Review,
Called Om
Plana picked
Plana reambm
3'4 Review,
Called Con
Date of
1MACKING
r
tact
ekod
tad
Permit
PERMIT FEES
submitted
Items Anoaat
mdT for cor reetions
Plan Ckedr Deposit
----
Pisa Ckedc Balance.
ap
Cos:trseHon
taitted
Mechanical
for correcdonsflssae
EleeGrteal
Person
Plambing
up
S.M.L
ltted
Gradlog
ready for eorreetionne
s/tas
Developer Impact Fee
tact Person
A.I.P.P.
Issue
Total Permit Fees