11-1340 (RR)P.O. BOX 1504
WORKER'S COMPENSATION DECLARATION
787495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
11=0.000134-0
Property Address:51250
AVENIDA RAMIREZ
APN:
773-062-011-12 -000000-
Application description:
RE -ROOF
Property Zoning:
COVE RESIDENTIAL "
Application valuation:
8105
Tay/ 4 4 Q"
Applicant: Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
GLAZNER JIM.
51250 AVENIDA RAMIREZ
LA QUINTA, CA 92253
E �D
Contractor:.
WESTERN PACIFIC ROOFING' O
3462 LA CAMPANA WAY � I
PALM SPRINGS, CA 922621
(760)416-5877
Lic. No.: 235717
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 12/19/11
L J, 20 1,11,
1
CITY A Zy6pl-rA I
LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
I,heretiy 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: B -C39 License No.:.' 235717
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
DateContractor:: / �/ [/V '
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
OWNER -BUILDER DECLARATION
insurance carrier and policy number are:
1 hereby affirm under. penalty of perjury that I am exempt from the Contractor's State License Law for the
Carrier COMPANION PROPT Policy. Number '_ CPCA13668 ,
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 permit is issued, 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 co ply with t se provisions.
that.he she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
.or
"any -applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500)•:
!1rDate:r/.z _�4- /(�sA,pplicant
(_ 1 I, as owner of the property,, or my employees with wages as their sole compensation, will do the work, and
- ;."�" '
the structure isnot intended or offered for sale (Sec._ 7044, Business and'Professions Code: The
WARNING: FAILURE'TO'SECURE WORKERS] 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 PENALTIES 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
_
improveinents are not.iritended 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.).APPLICANT
ACKNOWLEDGEMENT .
(_ 1 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the .
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
conditions and restrictions set forth on this application. '
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
1.. Each "person upon whose behalf this application is made, each person at whose request and for
pursuant to the Contractors' State License Law.)•
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
I—) I am exempt under Sec. , B.&P.C. for this reason
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
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
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 h eby authorize representatives
of this county to enter upon the above-mentioned property for inspection purpost;
Date:
Ll
LQPERMIT
Application Number . . . . . 11-00001340
Permit . . . RE -ROOF
Additional desc . .
Permit Fee . . . . 30.00
Plan Check Fee
.00
Issue Date . . . .
Valuation . . .
. 0
Expiration Date 6/16/12
Qty Unit Charge Per
Extension
BASE FEE
30.00
----------------------------------------------------------------------------
Special Notes and Comments
INSTALLATION OF POLYUERTHANE FOAM ROOF
SYSTEM. PER 2010 CODES.
----------------------------------------------------------------------------
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
'-Project Add n*
'ING PRODUCTS (COOL ROOFS) §151(i}92
the area of exterior i»of surface to be'r+eplaced'exceeds 509
i area must meet the roofing product "Cool Root" ulrem
of the existing roof area, or 1,000 ; whichever is Fess, the new
nts f 15
o § 2(6)1171, 152(b)1HI1, or 152(b)1HIII.
Check applicable alternative or.exception below if the roof alteration is exemptfrom the rooting product "Cool Roof" requirements-.
O Cool roofs [a required in Cyanates Zones 1-12,14, and 16 with a low sloped roof pitch (less or 2:12 pitch).
O Cool roofs rte# required in Climates Zones 1-9, and 16 with a steep -sloped roofs (greater pitch than 2:12) and product weight less than 5IIb/HZ.
Altematives to §152(b)1Hi and §152(b)Hli, Steep -slope roof (pitch > 2:12)
❑ Insulation with a thermal resistance of at least 0.85 heft *°F1Btu or at least a 3/4 inch air -space is added to the roof deck over an attic; or
O Existing ducts in the attic are insulated and seated according to §151(f)10; or
'0 In climate zones 10, 12 and 13, with 1 ft2 of free ventilation area of attic ventilation for every 150 ffi of attic Hoon 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 ducts 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)1Hii1; Low -slope roof ( pitch S 2.12)
❑ Building has no duds in the attic.
Other Exceptions
O Roofing area is covered by building integrated; photovoltaic panels and solar thermal panels are exempt from the Cool Roof aitena.
O Roof constructions that have thermal mass over the: roof membrane with at least 25 bV are exempt from the Cool Roof criteria.
FO If any one of the altemat, s or exception is checked Aged Solar Re nce and Thermal Emfttance requirements for roofing
1rvduds in § 118(1) are not applicable. Do not fill table below.
Roof Slope Pn
CRRC Product IQ Number 5 2:12 > 2:12 < 51
;I�f-oo a
133�11331 ❑
dud. Weight
Slblft�
. Product
2
Aged SolanThermal
T
ReHectances'a
Emittance SRIS
❑
��+,�
❑`
.7(
3 �p
E3❑a
Note: If no CRRC-
odud I label is available, this compliance method cannot be used, use the Performance Approach to show compliance,
i. The CRRC Product ID Number can be obtained from the Cool Roof Ratbrg Couna7's Rated product Directory at tvtvw coo/roofs on1/orpdarxs/saand, „tip
2. Indicate the Type of product is being used for the roof top. i.e. single -ply roof asphalt roof metal root, etc.
t. 1/the Aged Reflederroe is not available in the Cool Roof Rating Councils Rated Product Directory then use the Initial Refledance value bpm the same
directory and use the equation (0.2+0.7(pj„f, — 0.2) to obtain a calculated aged value. Where p Is tire Initial Solar Reffedenee.
1. Check box ff the Aged Reflectance is a calculated value using the equatron above.
i. Calculate the SRI value heel to t the SRI- Worksheet at hltn /M�ww.enerov oov/tkle2 i and enter.the resulting value in the SRI Column above and attach
aoopy of tl►e SRI- Worksheet to the CF -IR.
Fo apply Liquid Field Applied Coatings, the coating must be applied across the entire roof surface and meet the dry aril thickness or covers
eoommended by the coatings manufacturer and meet minimum performance r uiremerrts listed in§118(1)4.Sated the
applicable coating:
7 Aluminum -Pigmented Asphalt Roof Coating 17 Cement -Based Roof Coating ❑ Other
TOLE: When a Cool Roof Is required, the InStellin9 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 oomptete.
• 1 certii)r.that the energy features and performance specifications identified on this Certificate of Compliance conform to the requirements of Title 24, Part
1 and 6 of the California Code of Regulations
knk1c
P. :ss:3Y�z �
City/StateJZip:
For assistance or vuest�
l<`
_P'
17_/01 /it
License: r
z3S7t �
"(S ZZ Phone:
740-1/6 — X77
Jing the Energy Standards, contact the Energy Hotline at: 1-800-772-3300.
Bin1.�ty
,dla Quints
Building 8t Safety Division
P.O.'Box 1504, 78-495.Calle Tampico
La Quints, Ck92253 - (760),777-70,12
Building Permit Application and Tracking Sheet
Permit #
�O.
Project Address: sl Z , f C'L
Owners Name: I r / nG✓
A. P. Number:
Address:
Legal Description:
Contractor. 1
W eS C/►� c.� c -�� :....
t:;City; ST, Zip:
Telephone:
Address: .
a
Projecc;Uescription:.
rr?� /,'���
City, ST, Zip: a lM S CAr-. �l .2 zG Z
N 'fit., ikA aK 40 n I
Telephone: ?Gp_y& 5-777
State Lic. # : L,3 f7 J %
City Li c. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
nstruction Type: Occupancy
•Proje&type (circle one): New 1 Add'n Alter Repair Demo
State Lic:
Name of Contact Person: 0 ell,
C
Sq. Ft:: ZZ J
# Stories:
#Units:
Telephone # of Contact Person: 740 �S7Y — Zq Q3Estimates"Value
of Project: g/o�
APPLICANT: DO NOT WRITE BELOW THIS LINE
N
Submittal
Req'd
Recd
TRACKING;
PERMIT FEES
Plan Sets
Pian Check submitted
Item Amount
Structural Calls.
Reviewed, ready for corrections
Plan Cheek Deposit
Truss Cales.
Caned Contact Person
Plan Check Balance
Title 24 Calcs.
Pians picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2°° Review, ready for correctioris/issue
Electrical
Subcontactor List
Called Contact •Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'..'�.Revicw, ready for correctiouMissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I:P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees