12-0756 (RR)-1 .
P.O.. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
�0 00756
521`4 0 �AVENIDA—JUAREZ
773-211-007-16 -000000-
RE-ROOF
COVE RESIDENTIAL
4100
Tit(t44Q"
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
CARMELITA COPPINS
52140 AVENIDA JUAREZ
LA QUINTA, CA 92253
Contractor:
Owner
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
N/
Date: 7/10/12
4
D 2012
uOfi4 0i.�.._
------------------------------------------------------------------------------------------------_
LICENSED CONTRACTOR'S DECLARATION
- 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: License No.:
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
Date: Contractor:
_ 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 workerscompensation
OWNER -BUILDER DECLARATION
insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
Carrier Policy Number
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to
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 V t 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 Lab ode, 1 sh fort wit t omply with those provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
�,0
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
ate: � �,y cant:
-
(_ 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and -
LVERAGE
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code:. The
WARNING: FAIL RE TO SECURE WORKERS' COM ENSATION 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
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.l.
( 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.).
(_ 1 I am exempt under Sec. , B.&P.C. for this reason
Date: I o ' l %Zner:!e _
( CONSTRUCTION LENDING IGIENCY
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.I.
Lender's Name: 2
Lender's Address: r �`
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.
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 this county to enter upon the above-mentioned pr y for inspec n p po 0
ate: t -1Q �$rgnature (Applicant or Agent):
LQPERMIT
Application Number . . . 12-00000756
Permit . . . RE -ROOF
Additional desc .
Permit Fee . . . . 30.00
Plan Check Fee
.00
Issue Date . . . .
Valuation
0
Expiration Date 1/06/13
Qty Unit Charge Per
Extension
BASE
FEE
30.00
----------------------------------------------------------------------------
Special Notes and Comments
RE -ROOF WITH SHASTA WHITE 30 YR.
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
Prescriptive Certificate of Compliance: Residential Reroof
Project Address:
6z
140 -PV �N�— CS LAA-�•G—Z �2� 3 Climate Zone
1,d4-- cru l N'i� , CA -
ROOFING PRODUCTS (COOL ROOFS) 6151(012
When the area of exterior roof surface to be replaced exceeds 50% of the existing roof area, or 1000
rooting area must most the roofing product "Cool Roof" requirements of 15
Check applicable alternative or exception below if the roof alteration is exempt frothle iroofing p11
.roduct rCk
F-1 R-ALT-ReRoof
, whichever is less, the new
b)1H111.
O Cool roofs W required in Climates Zones 1-12, 14, and 16 with a low sloped roof pitch gess or 2:12 pitch).
O Cool roofs= required in Climates Zones 1-9, and 16 with a steep -sloped roofs (greater pitch than 2:12) and product weight less than 5/1b/ft2.
Alt Ives to §152(b)1 Hi and §152(b)Hil, Steep -610138 roof (pitch > 2:12)
C� Insulation with a thermal resistance of at least 0.85 hr•ftz•°FBtu or at least a 3/4 inch air -space is added to the roof deck over an attic; or
O Existing duds in the attic are insulated and sealed according to §15i (t)10; 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 'kee ventilation area is within 2 feet vertical distance of the roof ridge; or
O Building has at least R-30 oeAing insulation; or
❑ Building has radiant barrier in the attic meeting the requirements of §151(f)2; or
O Building has no duds in the attic; or
O In climate zones 10, 11, 13 and 14,-R-3 or greater roof deck insulation above vented attic.
Exception to §152(b)1 Hill, Low -slope roof (pltch 5 2:12)
O 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 criteria.
O Roof constructions that have thermal mass over the roof membrane with at least 25 IbM are exempt from the Cool Roof criteria.
LOM.- If any one of the alternatives or exception is checked—65e Aged Solar Re eciance and Thermal Emittance requirements for rooting
roducts in §118(1) are not applicable. Do not rill table below.
CRRC
Note: If no CRRC-1 label
Roof Slope
S 2:12 > 2:1;
❑ ❑
13 1-13
Product Weight
51bR z 51111
Product
Type2
Aged Solar
Reflectance3'4
Thermal
E.mittance
SRIS
:03
❑
❑4
❑
❑
❑4
this compliance method cannot be used, use the Performance Approach to show compliance,
• • i ate h • pe o1 p duct i b car► De obtained hoof the Cool Roof Rating Councils Rated Product Directory at w�rw. 000/roofs.oro%rodudsica ►ch oho
Indicate the 4'Pe of product 1s beteg used for the root top, I.e. single�ply roof, asphalt roof, metal roof, etc.
If the Aged Reflectance is not available in the Cool Roof Rating Cmm&s Rated Product Directory then use the Initial Reflectance value from the same
directory and use the equation (0.2+0.7(Pl m _ 0.2) to obtain a calculated aged value. Where p is the Initial Sonar Reflectance.
Check box If the Aged Reflectance is a calculated value using the
equation above.
Calculate the SRI value by using the SRI_ Worksheet at htto/hvww enemy ca
eoopy of the SRI- Worksheet to the Cf•1 R. oovRitle24/ and enter the resulting value in the SRI Column above and attach
apply Liquid Field Applied Coatings, the coating must be applied across the entire roof surface and meet the dry mil thickness or coverag
commended 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
When a Coo/ Roof is required, the Installing contractor shall complete and submit the CF -6R -ENV -01 for final inspection.
)eclaration 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.
• I 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.
Signature:
:ss:
License:
Phone:
For assistance or questions regarding the Energy Standards, contact the Energy . rgy Hotline at: 1-800-772-3300.
It
OVA
P.O. Box 1504
LA QUINTA, CALIFORNIA 92247-1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
PROPERTY OWNER'S PACKAGE
(760) 777-7012
FAX (760) 777-7011
Disclosures & Forms for Owner -Builders Applying for Construction Permits
-
1W NOTICI±, TO PROPERTY OWNER
Dear Property Owner.
Tri. application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified at
We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to make you awam of your
responsibilities and possible risk you may incur by having this.permit•issued in your name as the
Owner -Builder. We will not issue a budding -permit until you,4ave read, initialed yourunderstanding of ea&provfsion,
signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice
unless you, the property owner, obtain the prior approval of the permitting authority.
oV R'S ACXOGMENT AMI➢ V)u) CATION OTf DWOI AT)EON
DIRE(ITIOIYS. Read and initial each: staternmr below'ta signify you understand or verify this information.
L I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder"
building. permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as
an Ownr-Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person
and his or her employees while working on my property. My homeowner's insurance may.not provide coverage for those
injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers
on my. property.
02.1 understand building permits are not required to be signed by property owners unless they are responsible for the
construction and are not hiring a licensed Contractor to assume this responsibility.
I understand as an "Owner -Builder" I am the responsible espo party of record on the permit. I understand that I may protect
mYselffrom potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my
own.
D4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers ori
p,,�e,,� nits and contracts.
M)5. I understand if I employ or otherwise engage any persons, other than California 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 "employee' under state and federal law, I must register with the state and federal
government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment
compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial
risk.
U7. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential
structures cannot .legally build them with the .intent to offer them for sale, unless all work is performed by licensed
subcontractors and the number of structures does not exceed four' within any calendar year, or all of the work is performed
under contract with a licensed general building Contractor.
j
I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any
financial or personal- i otos susftaed by any subsequent owner(s) that result from any latent construction defects in the
worlananship or materials.
I9. I understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue
Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California
Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLS) at 1-
800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors.
(VI 0- I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the
party legally and financially responsible . for proposed construction activity at the following address:
e974l-IU C -►J lD p�- . �1�I A�2 6Z , -W (Qi til t -fnN: _. CA °I'LL ...-
W-1 L I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all
applicable laws and requirements that govern Owner -:guilders as well as employers.
0V12.1 agree to notify the issuer of this form immediately of any additions; deletions, or changes to any of the information I
have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with
someone who does not have a license, the Contractors'. State License Board may be unable to assist you with any financial loss
you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in'civil court. It is also
important for you to, understand that if an unikensed.Contractor or employee of that individual or firm is injured while worlang
on your property; you may be held liable for damages. If-you.obtain a permit as Owner -Builder and wish to hire Contractors,
you will be responsible for verifying whether or not those Contractors are properly licensed and the status of ftir woficers'
compensation insurance coverage.
Before a building permit can be issued, this form must be completed and signed by the property owner and returned to
the agency responsible for issuing, the. permit Note: A,copy of the property owner's dkiver,'sIkensef form not6QUadon-, or
other verification acceptable to the agency is.required to be presented when the permit is issued to verify the property
owner's signature.
Signature of property owner ► t,0 Date: 1 ' ' Iy
Note: The following Authorization Form is required to be completed by the property owner only when designating
an agent of the property owner to apply for a construction permit for the Owner -Builder.
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the Notice to Property Owner, the exewtion of which I understand is my personal responsibility, I hereby authorize
the following person(s) to act asmy agents) to apply for, sign, and file the documents necessary to obtain ati Owner -Builder
Permit for my project.
Scope of Construction Project (or Description of Work):
Project Location' or Address:
Name of Authorized Agent:
Address of Authorized Agent:
Tel No
I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above
information and certify its accuracy. Note: A copy of the owner's driver's license, form notarization, or other verification
acceptable to the agency is required* to be presented when the permit is issued to verify the property owner's signature.
Property Owner's Signature: Date:
tsin rr
9
Permit #
}C Project Address:
A. P. Number:
[Legal Description:
ontractor: )W E) `
# I Submittal
•
Plan Sets
Structural Calcs.
Truss Calcs.
Title 24 Calcs.
Flood plain plan
Grading plan
Subcontactor List
Grant Deed
H.O.A. Approval
IN HOUSE: -
Planning Approval
Pub. Wks. Appr
School Fees
Address:
e :
Type:
P
City, ST, Zip:
Telephone:
State Lic. #
# Stories:
Arch., Engr., Designer:
Address:
t
l`"/ '.
City, ST, Zip:
i;
Telephone:
State Lic. #:
Rec'd
Name of Contact Person:
Telephone # of Contact Person:
# I Submittal
•
Plan Sets
Structural Calcs.
Truss Calcs.
Title 24 Calcs.
Flood plain plan
Grading plan
Subcontactor List
Grant Deed
H.O.A. Approval
IN HOUSE: -
Planning Approval
Pub. Wks. Appr
School Fees
Total Permit Fees
e :
Type:
P
OOcc P
nc :�ctrcleo
a
uO
rConstruction
neNew Alter Repair Demo
# Stories:
# Units:
ValueEstimated of Project:
t
l`"/ '.
i;
APPLICANT: DO NOT WRITE BELOW THIS LINE
'd
Rec'd
TRACKING
PER1tIT FEES
Plan Check submitted
Item
Amount
Reviewed, ready for corrections
Plan Check Deposit
Called Contact Person
Plan Check Balance
Plans picked up
Construction
Plans resubmitted
Mechanical
2n' Review, ready for corrections/issue
Electrical
Called Contact Person
Plumbing
Plans picked up
SAI 1
Plans resubmitted
Grading
"'" Review, ready for corrections/issue
Developer Impact Fee
Called Contact Person
A 1 P P
Date of permit issue
Total Permit Fees