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11-0994 (RR)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 ceitit' 4 4 Q" - BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Application Number: 11-00000994 - Property Address: `78480 -CALLS REMO APN: 646-182-004- - - Application description: RE -ROOF Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 6990 Applicant: .) Architect or Engineer: �t k 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: C39 _ - LicenseNo.: 44,71139_ 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 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.). (_) 1, 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 Owner: TRAVIS -SIEGEL 78480 CALLE REMO LA QUINTA, CA 92253 Contractor: DESERT VALLEY CONSTR & ROOF 594 W. 7TH STREET SAN JACINTO, CA 92583 (951)654-1980 Lic. No.: 447139 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 9/14/11 — U -P 4 2011 f� .� -0 F: It. Dui u VA 1 --------------------------------------� 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 PREF CONTR INS Policy Number FC32241 _ I 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 La rIIII rthwith ith those /ovisions. 'Date: Iyl/ scant 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 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 relatingttbuild* construction, and hereby authorize representatives bf this county to enter upon the above-mentionede for inspec ' purposes. Date:?/"y nature (Applicant or Agen Application Number . . . . . 11-00000994 Permit . . . RE -ROOF Additional desc . Permit Fee 30.00 Plan Check Fee .00 Issue Date Valuation . . . . 0 Expiration Date 3/12/12 Qty Unit Charge Per Extension BASE FEE 30.00 ---------------------------------------.---------------------------=--------- Special Notes.and Comments REMOVE SHAKES THEN APPLY 30 YEAR SHASTA .WHITE FIBERGLASS SHINGLES. 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 LQPERMIT INSTALLATION CERTIFICATE CF -6R -ENV -01 Envelope — Insulation; Roofing; Fenestration (Page 2 oU3) Site Address: p Enforcement Agency: Permit Number: OO C,4�a A"o I Description of Roofing Products CRRC Product ID Manufacturer Manufacturer/Brand Name (GROUP LIKE RODUCTS Product Roof Roof Product Initial Solar Aged Solar Thermal Number' info do Brand/Model Type Area Sloe Weight' Reflectance Reflectance' Emittance (V50_00/3 2 V t4AQ a 3,200 y/t'a vQyo o G , v� 9� 3 ❑3 4 ❑3 5 ❑3 1. The CRRC Product ID Number can be obtained from the Cool Roof Rating Council's Rated Product Directory at ww. coolroofs. org/products/search. php 2. The weight in lbs per square feet of the roofing product being installed 3. Check box if the Aged Reflectance is a calculated value using the equation below, footnote 4. 4. 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 directory and use the equation (0.2+0.7( i„i,ipt — 0.2) to obtain a calculated aged value. ✓OCHECK APPLICABLE BOX BELOW IF EXEMPT FROM THE ROOFING PRODUCT "COOL ROOF” REQUIREMENT.' ❑ The roof area covered by building integrated photovoltaic panels and building integrated solar thermal panels are exempt from the above Cool Roof criteria. ❑ Roof constructions that have thermal mass over the roof membrane with a weight of at least 25 Ib/fI2 is exempted from the above Cool Roof criteria. To apply Liquid Field Applied Coatings, the coating must be applied with a minimum dry mil thickness of 20 mils across the entire roof surface and meet minimum performance re uirements listed inI18 03 and Table 118-C. Select the applicable coatin ❑ Aluminum -Pigmented Asphalt Roof Coating ❑ Cement -Based Roof Coating ❑ Other ✓ ❑ CRRC-l. Label Attached to CF -611 (Note if no CRRC-1 label is available. this compliance method cannot be used and another method is required to meet compliance). FENESTRATION/GLAZING Item Manufacturer/Brand Name (GROUP LIKE RODUCTS Product U- factor Product SHGC' # of Panes NFRC Certified' Z Total Quantity of Like Product (Optional) Area ft Add. Exterior Shading Dev. or Overhang Comments/ Location/ Special Features I 2 3 4 5 6 7. 3. 1. Use values from a fenestration product's NFRC Certified Label. For fenestration products ivithout an NFRC label, use the default values from Section 116, Table 116-A and 116-B of the 2008 Energy Efficiency Standards. 2. NFRC Label Certificates shall not be removed until the building inspector has verified the aIflciency. Enter Yes or No. ❑ § 1 16(a) 1: Doors and windows between conditioned and unconditioned spaces designed to limit air leakage. ❑ § 1 16(a)2 and 3: Actual fenestration products installed are equivalent to or have a lower U -factor and/or a lower SHGC than that specified on the Certificate of Compliance (Form CF - IR). ❑ § 1 16(a)4: Fenestration products (except field -fabricated windows) have a label listing the certified U -Factor, certified Solar Heat Gain Coefficient (SHGC), and infiltration that meets the requirements of §10-111(a) ❑ § 117: Exterior doors and windows weather-stripped; all joints and penetrations caulked and sealed. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF -6R -ENV -01 Envelo e — Insulation; Roofing; Fenestration (Page 3 of 3) Site Address; /0�� Enforcement Agency: Permit Number: DECLARATION STATEMENT I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. • I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized representative of the person responsible for construction (responsible person). • I certify that the installed features, materials, components, or manufactured devices identified on this certificate (the installation) conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the enforcement agency. • 1 reviewed a copy of the Certificate of Compliance (CF- I R) form approved by the enforcement agency that identifies the specific requirements for the installation. 1 certify that the requirements detailed on the CF -I R that apply to the installation have been. met. • I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or 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 signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the building owner at occupancy. Co mny Name: In `t i Subcontractor or General Contractor or Builder/Owner) Responsibl Person's Name• Respons' le erson's Sig�a�tu-re: CSLB License: Date Signed: Position With Company (Title): 2008 Residential Compliance Forms August 2009 Bin # City. of La Quetta Building & Safety Division. P.O. Box 1504, 78-495 Calle.Tampico ; La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # qa1 Project Address: �' ��(j Owner's Name: A. P. Number: Address: Legal Description: City, ST, Zip: Contractor: Telephone: ` :v,:N."�;- 5.;. qC Address: �i J � 7/7171 Project Description: -� City, ST, Zip: gats Ci` Telephone: 7 5��9,J20 :rfi,'•ii'�":'.n:ri,!:�,y..:;,-::2?i'Gi! >;h::.'Y+'.' City Lic. #: u/J State Lic. / / %# : 13 Arch., Engr., Designer: Address: City, ST, Zip: Telephone: State Lic. #: ;. ,?�� J . : " ` `: r.:.>`., -s ..;�;�wv ..:- -��.:<:�••<.:<.:�>i�; s.:--.. ' s " �" Construction T an Type: Occupancy: Project type (circle one): New Add'n Alter Repair Demo Name of Contact Person: Sq. Ft:�a00j # Stories: # Units: Telephone # of Contact Person: Estimated Value of Project: K APPLICANT: DO NOT WRITE BELOW THIS UNE # Submittal Req'd Rec'd TRACIUNG PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cala. Reviewed, ready for corrections Plan Check Deposit Truss Cala. Called Contact Person Plan Check Balance Title 24 Cala. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading pian 2'! Review, ready for corrections/'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:- Review, ready for correctionsrrssue Developer Impact Fee Planning ApprovalCalled Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fea Total Permit Fees