BRER2016-0084LICENSED 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 offBusiProfessions Code,
and my License is in full force and effect.
License Cl as C39 Li/cense No.: 868171
Date: Zi E+ Contractor:"
OWNER -BUIL
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.).
(_J 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.).
(__j ].am exempt under Sec. B.&P.C. for this reason
Date: Owner:
I
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
Lender's
WORKER'S COMPENSATICIN DECLARATION .
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certificate cf. consent to self -insure for workers'
compensation, as provided for by Section 3700 cf the Labor Code, for the performance
of the work for which this permit is issued.
_1.tin�l have and will maintain workers' compensation insurance, as required by
Section 3700 of the Labor Code, for the perform:,nce of the work for which this permit
is issued. My workers' compensation insurance carrier and policy number are:
Carrier: CALIFORNIA INSURANCE COMPANY Polity Number: 4684631401
I certify that in the performance of th 2 work for which this permit is issued, I
shall not employ any person in any manner so asto become subject to the workers'
compensation laws of California, and agree that, iif I should become subject to the
workers' compensation provisions of Section 37CO of bor Code, I shall forthwith
comply with ose pr visions.
Date: �Z, (o Applicant:
WARNING: FAILURE TO SECURE WORKERS' COM IENSATION COVERAGE IS UNLAWFUL, .
AND SHALL SUBJECT AN EMPLOYER TO CRIMINA_ PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,000) IN ADDITION TO THE'COST OF
COMPENSATION, DAMAGES AS PROVIDED FOR ILI SECTION 3706 OF THE LABOR CODE,
INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWI EDGEMENT
IMPORTANT: Application is hereby made to the Building Official for a permit subject to
the conditions and restrictions set forth on this application.
1. Each person upon whose behalf this applica-ion is made, each person at whose.
request and for whose benefit work is performec 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 thework being performed under or
following issuance of this permit.
2. Any permit issued as a result of this applicat-on 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 cancellailion.
I certify that I have read this application and state that the above information is torr
I.agree to comply with all city and county ordinances and.state laws relating to bui ' g
construction, and hereby authorise representatives of this ci�re
above-mentio property for inspection purposes.
Date: �7 77
% �6 Signature (Applicant on Agent):
Ct N�tI1�Cl/i
VOICE (760) 777-7125
78-495 CALLE TAMPICO
0 D
.
FAX
FAX (760) 777-7011 �
LA QUINTA, CALIFORNIA 92253
DESIGN & DEVELOPMENT DEPARTMENT
(760) 777-7153
BUILDING PERMIT
nDate: 9/12/2016
Application Number: BRER2016-0084
Owner:
Property Address: 78575 SAGEBRUSH AVE
EDWARD SAVAGE
APN: 646311007
78575 SAGEBRUSH
Application Description: SAVAGE / REROOF WITH FOAM SYSTEM
LA QUINTA, CA 92253 p c?
Property Zoning:
rC-0
Application Valuation: $11,000.00
O
Applicant:
Z � �
Contractor: ti — s
FOAMBOND CORPORATION
FOAMBOND CORPORATIO►�Vu o
25.5 N EL CIELO RD STE 140-656
255 N EL CIELO RD STE 14656
PALM SPRINGS, CA 92262
PALM SPRINGS, CA 92262 f
Z
(866)404-5440 ~
Llc. No.: 868171 _
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 offBusiProfessions Code,
and my License is in full force and effect.
License Cl as C39 Li/cense No.: 868171
Date: Zi E+ Contractor:"
OWNER -BUIL
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.).
(_J 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.).
(__j ].am exempt under Sec. B.&P.C. for this reason
Date: Owner:
I
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
Lender's
WORKER'S COMPENSATICIN DECLARATION .
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certificate cf. consent to self -insure for workers'
compensation, as provided for by Section 3700 cf the Labor Code, for the performance
of the work for which this permit is issued.
_1.tin�l have and will maintain workers' compensation insurance, as required by
Section 3700 of the Labor Code, for the perform:,nce of the work for which this permit
is issued. My workers' compensation insurance carrier and policy number are:
Carrier: CALIFORNIA INSURANCE COMPANY Polity Number: 4684631401
I certify that in the performance of th 2 work for which this permit is issued, I
shall not employ any person in any manner so asto become subject to the workers'
compensation laws of California, and agree that, iif I should become subject to the
workers' compensation provisions of Section 37CO of bor Code, I shall forthwith
comply with ose pr visions.
Date: �Z, (o Applicant:
WARNING: FAILURE TO SECURE WORKERS' COM IENSATION COVERAGE IS UNLAWFUL, .
AND SHALL SUBJECT AN EMPLOYER TO CRIMINA_ PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,000) IN ADDITION TO THE'COST OF
COMPENSATION, DAMAGES AS PROVIDED FOR ILI SECTION 3706 OF THE LABOR CODE,
INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWI EDGEMENT
IMPORTANT: Application is hereby made to the Building Official for a permit subject to
the conditions and restrictions set forth on this application.
1. Each person upon whose behalf this applica-ion is made, each person at whose.
request and for whose benefit work is performec 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 thework being performed under or
following issuance of this permit.
2. Any permit issued as a result of this applicat-on 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 cancellailion.
I certify that I have read this application and state that the above information is torr
I.agree to comply with all city and county ordinances and.state laws relating to bui ' g
construction, and hereby authorise representatives of this ci�re
above-mentio property for inspection purposes.
Date: �7 77
% �6 Signature (Applicant on Agent):
Date: 9/12/2016
Application Number: BRER2016-0084 -
Owner:
Property Address: 78575 SAGEBRUSH AVE
EDWARD SAVAGE
APN: 646311007
78575 SAGEBRUSH
Application. Description: SAVAGE / REROOF WITH FOAM SYSTEM
LA QUINTA, CA 92253
Property Zoning:
Application Valuation: $11,000.00
Applicant:
Contractor:
FOAMBOND CORPORATION
FOAMBOND CORPORATION
255 N EL CIELO RD STE 140-656
255 N EL CIELO RD STE 140-656
PALM SPRINGS, CA 92262
PALM SPRINGS, CA 92262
(866)404-5440
Llc. No.: 868171
Detail: REMOVE EXISTING CAP SHEET ROOF, INSTALL POLYURETHEAN FOAM ROOF SYSTEM WITH COATINGS AND GRANEL=S [CRRC: 0790-0001] 2013
CALIFORNIA ENERGY CODE.
FI <NCIAL] N FORMATION,
DESCRIPTION ACCOUNT QTY AMOUNT
BSAS SB1473 FEE 101-0000-20306 '0 $1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION .3SA: $1.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
RE -ROOF - EA ADDITIONAL 1,000 SF
101-0000-42404
0
$11.60.
DESCRIPTION
ACCOUNT
CTY
AMOUNT
RE -ROOF - FIRST 21000 SF
101-0000-42404
D
$49.31
DESCRIPTION
ACCOUNT
CTY
AMOUNT
RE -ROOF - FIRST 2,000 SF PC
101-0000-42600
D
$98.62
Total Paid for RE -ROOF: $159.53
1
Bin 1i � ,
Pty of La Qu«nta
Building 81: Safety Division
Permit u 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-701,2
Building Permit Application and Tracking Sheet .
Project Address:, g�� S� r ✓ 2 'Owner's Name: S4 Y G
A. P. Number.
Address: / Y 5-7T
Legal Description:
City, ST, Zip:
�r
oria
C ct r:
o O � w
a O
Telephone:
P
Address: 5-:
v
Project Description:
JjLop_ .gk t'S
City_ ST; Zip: ✓in
—
Cod
Ca J7. S<�c, ✓OQ ?� 6
Tele hone: n ¢ L
P o v O / o -
� w U t�-
e D r
State Lic: # : 6 V -71,City
Lie. #:
/
�;.�.� Caa-FI 1
Arch., Engr., Designer: -
r le -
Address:
City, ST, Zip:
Telephone:
............ .....................
ecu
a1cY o
Cn iructi n Type: e: O
ic.,.
Repairair
Ject tYPe circle one : New Add'n A.ter
Demo
Name of Contact Person:
Sq. Ft.: r•?92,42
# Storiies:
# Units:
Telephone # of Contact Person: v
Estimated Value of Project: (� vv Q .
APPLICANT: DO NOT WRITE BELOW THIS LINE
to
Submittal
Req'd
Rcc'd
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 Bilan_e.
Tile 24 Calcs.
Plans picked up
Construction •"
Flood plain plan
Plans resubmitted
T4echanical
Grading plan
2"' Review, ready for corrections/issue
Electrical
Subcontact'or List
Called Contact Person '
Plumbing
Grant Decd
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted '
Grading
INHOUSE:-
Review, ready for corrections/issue
Developer. ImpackFee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fccs,
Total Permit Fees
A. GENERAL INFORMATION
-
02 t
01
Project Name:02
05
_ Date Prepared: 3_
.03'.,
Project Location: • ,S ; °J ca e:' —'S k
04
Building Front Orientation (deg or cardinal):
05
CA City: tai '41
Frame
Spacing
. (inches)
Number of Alte dDwelling Units:
07-
- �,
Zip Coder
08
Fuel TYpe :.�
09
Climate Zone:30
Table, Cell'
TotahConditionid Floor Area (ft2) -
11 -
Building Type'
12
51'abArea (ft2) -
13
Project Scope: 2R r Lam/w "e r
Pitch
Exception
Won. k
B. BUILDING INSULATION DETAILS (Section 150.2(6)1) _
01
02 t
03
`04
05
_ 06 `" "; 07 - 08 09
10
11
Tag/ID,'
- -
Assembly Type -
Frame
Type
Frame
Depth
(inches)
Frame
Spacing
. (inches)
P oposed
Required
r a'
;
Comments
•Continuous
Cavity. 10insulation
R value, R 4alue Ufactor
KIP p
Reference
U -Factor
Table, Cell'
'
CR�R:,C�Pduct ID
Deck
Initial'Solar Aged Solar Thermal SRI
Cp kp
Al I
Pitch
Exception
Number
,Pr„oduc Type _
Insulation
l Reflectance Reflectance Emittance (Optional)
Reflectance Emittance (Optional)
-> r.
W W
C. ROOF REPLACEMENT (Prescriptive Alteration, SecAti`on�
0.2(b)1H) V-
-
01
07
03
04
05,
' 06
07 08 • 09 - 10
11 12 . 13'
� •
->
R -value
Proposed
Minimum Required
Method of ''.
Roof .
'
CR�R:,C�Pduct ID
Deck
Initial'Solar Aged Solar Thermal SRI
Aged Solar . 'Thermal SRI
Compliance
Pitch
Exception
Number
,Pr„oduc Type _
Insulation
l Reflectance Reflectance Emittance (Optional)
Reflectance Emittance (Optional)
I
. _..
NOTES
• Roof by buildingtjntegrated thermal are exempt from the above Cool Roof require_ merits
:
area covered photovoltaic panels and solar panels
t
Liquid field' applied,coa&, s% must comply w thsins allation criteria from section 110.8(i)4: ' ”
- \� - '- d , , � f w,� �. -i:.Y' � �Y. I '1• - 1 , a + Fes. 4 ,,�., � _ .. _ •
Registration Number:. "` Registration-Date/Timei <HERS Provider:
CA Building Energy Efficiency Standards 2013 Residential Compliance ; June 2014
DOCUMENTATION AUTHOR'S DECLARATION STATEMENT '
1. I certify that this Certificate of Compliance documentationis accurate and complete.
Documentation Author Name: /
Documentation Author SignaturE�
Company: V
Signature Date`.
Address:
CEA/ HERS Certification Iden"tifica4ion (if applicable) r "'
City/State/Zip: - -
Phone: ,
RESPONSIBLE PERSON'S DECLA TION STATEM NT
I certify the following under.penalty of perjury, under the laws of the State of California: }
1. is
The information.provided on this'Certificate of Compliance true and correct..
2., I. am eligible under Division 3 of the Business and Professions Code to accept responsiblhty for the building'desig�n or system design identified on this Certificate of Compliance (responsible
designer):
3: ,That the energy features -and performance specifications, materials, components, and manufactured evices for the building design or system design identified on this Certificate of
.Na-�
fornia
Compliance conform to the requirements of Title 24, Part 1 and Part b of the Ca Code of Regulations.
4. Certificate plianc are on documents,
The building design features or system design features identified on this of Co cons isten with&tthi information provided other applicable compliance .�
proval his building
worksheets, calculations, plans and'specifications submitted to the nfo cement.agency.'fo with. permit application.
a>shall bl"e with g p agency
5. I.will ensure that,a registered copy of this Certificate of Complian be made�avai. the bulldi r�mit(s) issued for the building, and made available to the enforcement
for all applicable inspections. I understand that a registeered op�y�- this.Certificate f C mpliance'is.required'to be included with the documentation the builder provides to the building
owner at occupancy.
Responsible Designer Name; fo
Responsible Designer Signature;
Company:.. V Y
Qi ��
Date Signed: ,
Da 'G Q& D u v'r^
Address: -
License:
�
� _
City/State/Zi �
�
�Phnnp,-,,
.. /