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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'