12-1419 (RR)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 12-00001419
Property Address: 78315 CRESTVIEW TER
APN: 643-193-018-32 -2117 -
Application description: RE -ROOF
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 3000
Applicant:
(r� aF 4 Q"
Architect or Engineer:
A/4-
------------------
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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: License No.:
Date: Contractor:
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).:
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 I, as owner of the property, am exclusively contracting with ' ensed contractors to construct the project (Sec.
7044, Business and Professions Code: The Contr rs'S ate License Law does not apply to an owner of
property who builds or improves thereon, and pfro contra s for the projects with a contractor(s) licensed
pursuant to the Contractors' State License 1.
(_ 1 I am exempt under Sec. , B.&P.C. r thi on�� f
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: tA
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 12/10/12
Owner: D
COX ROBERT G Q
78315 CRESTVIEW TERRACE
LA QUINTA, CA 92253
----------------------- -- --f'n
�020��
C1T OF �q QUTA1
Contractor: FINlyq�jCE DEF��'T.�
Owner
-----------------------------------------------
WORKER'S COMPENSATION DECLARATION
hereby affirm under penalty of perjury one of the following declarations:
1 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 Poli Number
I certify that, in the performance of a work for ich this permit is issued, I shall not employ any
person in any manner so as to ecome su ' t to.the workers' compensation laws of California,
and agree that, if I should b o t to a worke compensation provisions of Section
3700 of the or Co all fort ith c ly w' those provisions.
ate: �r7 pplicant: /
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 15100,0001. 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 cessat work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the above infor ation is rect. I agree to comply with all
city and county ordinances and state laws relating to building cons c ' reby uthor'I epresentatives
of this county to enter upon t above-mentioned property for i ctio pur es.
ature (Applicant or Agent):
Application Number . . . . . 12-00001419
Permit . . . RE -ROOF
Additional desc : .
Permit.Fee . . . . 30.00 Plan Check
Fee
.00
Issue Date . . . . Valuation
. . .
. 0
Expiration Date 6/08/13
Qty Unit Charge Per
Extension
BASE FEE
30.00
---------------------------------------------------------
Special Notes and Comments
--------------=----'
INSTALL NEW ROOF COVERING WITH
TIMBERLINE 30 YEAR SHINGLES. R-30
INSULATION TO BE VERIFIED AT INSPECTION.
2010 CODES.
------------------------------------------------------------7---------------
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 ,
#
QW 0if 4 Quihtd
BWI*g &r Safety Division
P.O. Box 1504,76-495 Calle Tampico
14.Quinta, CA 92253 -:(760) 777-7012
Building Permit Application and Tracking Sheet
VK
Permit #
Project Address: - 64 F1 T tl/ eGJ IP
Owner's Name:.
A. P. Number.
Address: .'f 3 �s �� CSS �� � 71e2 ,
Legal Description:
Contractor. % �
0
City, ST, Zip: J —A C`9 ZZ S
Address:
Project Description: A-N -57-4,L4—
T 4L4—
City, ST, Zip:
City,
Telephone:
�;;C tt`• " r
SSC/ l�.L t✓ . E: !� v
State Lic. #: City Lic. #:
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone: "
State Lic. #: lF. • .
Name of Contact Person:
Construction Type:. 5 Occupancy:
Project type (circle one): New Add'n Alt Repa'u Demo
Sq. Ft.: ) L16 d # Stories:
# Units: f
Telephone # of Contact Person:Estimated
Value of Project 3 Q o Q
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
'Rec'd
TRACKING PERMIT FEES
Plan Sets
Plan Check submitted
Item Amount
Structural Coles.
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Calcs.
Called Contact Person
Plan Check Balance"
Title 24 Calm
Pians picked up
Construction
Flood plain plan
Plans resubmitted." .
Mechanical
Grading plan
2'i Review, ready for correctionstissue
Electrical
Subeontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
SIMI.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE-,
''d Review; ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees "
Total Permit Fees
2061 Aldergrove Ave. (760) 839 - 3200 Lic. # 888804
Escondido, CA 92090 (760) 839 - 3859 FAX fed.id#20-5576054
Job
SFR 78315 Crestview Ter IN
Customer Address
COX02
INVOICE
4057871
Phase
SFR 78315 Crestview Ter - Blow
Robert Cox
Attn: Accounts Payable
78315 Crestview Terrace Job Address
La Quinta, CA 92253 78315 Crestview Ter
La Quinta, CA 92253
Contact Phone: ( Contact Fax:
Date: 09/11/2012 Job: 2337321 -2B PO #: Sales Rep: Cliff J Fleming
Work Area
Blow Attic Area
NOTES:
$560.00 : Contract Amount
$180.00 - Change Order 01: Attic Blow R Value Change
$740.00 - Revised Contract
$740.00 - 100% Completed to Date
$740.00 - Less Payments Recd to Date
$ 0.00 - Amount Due (MR)
***Rebate Information***
Attl Area: R-30 1,400sgft
Manufacturer: Owens Corning
Install Date: 7/20/12
Please Pay This Amount 4
Base Price $
Option Price
740.00
0.00
E mVa W-15,'.ta
Retainage
Job Deposit
Payments/Adjustments
Received
0.00
0.00
740.00
Current Due $
-
TERMS: Net 10 Days, PLEASE REMIT PAYMENT TO: 600 South Vincent Avenue; Azusa, CA 91702
ivl.l•�.
Prescriptive Certificate of Compliance: Residential Reroof CF -1 R-ALT-ReRoof
Project Address:
7- 3 5 aI�s U
Climate Zone
s
Permit #
ROOFING PRODUCTS (COOL ROOFS) §151(1)12 1
When the area of exterior roof surface to be replaced exceeds 50% of the existing roof area, or 1,000fttf , --whichever is less, the new
roofing area must meet the roofing product "Cool Roof" requirements of§152(b)1Hi, 152(b)1Hil, or 152(b)1Hiii.
Check applicable alternative or exception below if the roof alteration is exempt from the roofing product "Cool Roof" requirements::
❑ Cool roofs not required in Climates Zones 1-12,14, and 16 with a low sloped roof pitch (less or 2:12 pitch).
❑ Cool roofs not required in Climates Zones 1-9, and 16 with a steep -sloped roofs (greater pitch than 2:12) and product weight less than 5/IbJftz.
Alternatives to §152(b)1Hi and §152(b)Hii, Steep -slope roof (pitch> 2:12)
❑ Insulation with a thermal resistance of at least 0.85 hr-ftz•`F/Btu or at least a 3/4 inch air -space is added to the roof deck over an attic; or
❑ Existing ducts in the attic are insulated and sealed according to §151(010; or
❑ In climate zones 10,12 and 13, with 1 le of free ventilation area of attic ventilation for every 150 ftp of attic floor area, and
/where at least 30 percent of the free ventilation area is within 2 feet vertical distance of the roof ridge; or .
Ad 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)1Hill, Low -slope roof (pitch <_ 2:12)
❑ 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 kriteria.
❑ Roof constructions that have thermal mass over the roof membrane with at least 25 Ibtft2 are exempt from the Cool Roof criteria.
NOTE. If any one of the alternatives or exception is checked the Aoed Solar Reflectance and Thermal Emittance requirements for roofing
products in §118(1) an- not applicable. Do not fill table below.
NOTE. When a Cool Roof is required, the installing contractor shall complete and submit the CF -6R -ENV -01 for final inspection.
Declaration Statement
Roof Slope
Product Weight
Product
Aged Solar
Thermal
CRRC Product ID Number'
<- 2:12 > 2:12
< 5lb/ftz z 51bfftZ
Type2
Reflectance3'4
Emittance
SRIS
❑
❑
❑
❑
❑4
11
11
11
11❑4
Note: if no CRRC-1 label is available, this compliance method cannot be used, use the Performance Approach to show compliance,
1. The CRRC Product ID Number can be obtained from the Cool Roof Rating Council's Rated Product Directory at www.coolroofs.ora/nroducts/search.nhp
2. Indicate the type of product is being used for the roof top, i.e. single -ply roof, asphalt roof, metal roof, etc.
3. 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 same
directory and use the equation (0.2+0.7(pk" — 0.2) to obtain a calculated aged value. Where p is the Initial Solar Reflectance.
4. Check box if the Aged Reflectance is a calculated value using the equation above.
5. Calculate the SRI value by using the SRI- Worksheet at httoJAvww.enmv.ca.gov/6de24/ and enter the resulting value in the SRI Column above and attach
acopy of the SRI- Worksheet to the CF -1 R.
To apply Liquid Field Applied Coatings, the coating must be applied across the entire roof surface and meet the dry mil thickness or coverage
recommended by the coatings manufacturer and meet minimum performance requirements listed in §118(i)4. Select the applicable coating:
❑ Aluminum -Pigmented Asphalt Roof Coating ❑ Cement -Based Roof Coating ❑ Other
NOTE. When a Cool Roof is required, the installing 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 Califomia, the information pr ded on this accurate and complete.
Iis
I certify that the energy features and performance specifications identified on this Certifi a e of Compliancform to the requirements of Title 24, Parts
1 and 6 of the California Code of Regulations.
Name:
Signature.
Company: Date:
Address: License:
City/St�jefzip: Phone:
n v, 7(Q O' -7-2
A/7
For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300.
IF
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-Ballders Applying for Construction Permits
MWMT INTI KUTtCE 19 PROPERTY OWNER
Dear Pnaperty Owner.
An. application for a building paTnit has atbeakW w your name listing younelf as the builder of the property
impro.anews spoeifmd at __79'-3/S- C k ES 77/ / = Gt7 TPS. _ C'� 5�z 2 S 3
We am providing you with an Owner -Builder Ad..WVt..d Information V=Txafim Form to make you awm of your
r+ bilabes and possible tisk you may incur by (raving thispamit•itcsnmd in your name as the
O nw-BuiWer. We TO not issvee a baildlag permit astll y4mbave read, mad your ander%ftading of each prevision,
signed, and returned this form to us at our otilcial address indicated. An agent of the owner c u]Ot execute this notice
unless you, the property owner, obtain the prior approval of the permitting authority.
9 'S -AND YERMCATiON O'TNFRANAMN
Dfft& TfM: Read aftd luteal each srarantrsrtbzl? w to mgmfy you w derAw d or very dyes mtrjormanon.
Lt. 1 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 materia} petsonaltjr.l, as
an Owner -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 insuiaace 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 sny property -
1 understand building permits are not requited 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 party of record on the permit. I understand that I may protect
Myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her nine insteed of my
Owren.
i^ I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers of
permits and contracts.
/ �_ understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total Vail
of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employe
under state and federal law.
&4_1 understand if I am considered an "employer" under state and foderal law, I must register with the state and fede
government, withhold payroll taxes, provide woikm' compensation disability insurance, and contnbutc to uaetnploym
compensation for each "employee." I also understand my failure to.abide by these laws may subject me to serious finan
risk.
A�il'understand under California Contractors' State License Law, an Owner -Builder who builds single-family resides
structures cannot legally build them with the intent to offer them for sale, unless all work is performed by lice
subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is petfol
under contract with a licensed general building Contractor.
r
I understand as an Owner -Builder if I sell the property for which this permit is issued, 1 may be held liable for any
financial or personal_ itoucies msuined by any subsequent owners) that resuh from any latent construction defects. in the
workmanship or materials.
understand I may obtain more information regarding my obligations as an "employer" from the id Revenua
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 (CSIA at 1
800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors.
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:
� that, as the party legally and finaacially responsible for this proposed construction activity, I will abide by all
applicable laws and requireamertts that govern Owner -Builders as well as employers.
agree to notify the issuer of this form immediately of any additions; deletions, or chsogcs to any of the inforrmation I
have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If yon contract with
somoone who does not have a Beene, the Contractors' State License Board may be unable to assist you with any finanoW loss
you may sustain as a result of a complaint Your only remedy against unlicensed Contractors may bo M'civd court- It is also
important for you to. understand thim if an u nkcassd Contractor or employee of that individaral or film is iejarod while wwkmg
on your property. you may be. hdd Haile for damages. If you obtain a permit as Owner -Bander sad wit to bare Contrsetors,
you wdl be responsible for verifying wieihes or not those Contractors are pcopedy he cwtd and the status of tiseir workers'
oortion insurance coverage.
Before a building permit can be issued, this fo be completed and signed by the property owner and returned to
the agency responsible for issuim.dw. Neta: copy of ske pr+vperu V owners 'pk+"i fwm n6ft*26*R� Or
other verification aseeptaLic to die cB tv is c presented when due perarit is issrttd to rrerify du crtJ'
prvp
owner's signature. ,i
Signature of property owner
Date ) Z —/472el-2—
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 0"-- RI'S BkH6J F
Excluding the Notice to Property Owner, the execution of which I understand is my personal mWoMbilrty, I heraby authorize
die following penx*s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an 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:
I declare under penalty of perjury that I am th rc
information and certify its accuracy. Note: copy
acceptable to the agency is required to pTTo
Tel No
owner for the address listed above and I personally filled out the abi
owner's driver's license, form notarization, or other verification
en,ffie permit is issued to verify the property owner's signature.
Property Owner's Signature: V1-41/ 00, 11` _ Date: /2 --ld'