10-0605 (RR)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
10-00000605
Property Address:
54411 AVENIDA VELASCO
APN:
774-251-019-8 -000000-
Application description:
RE -ROOF
Property Zoning:
COVE RESIDENTIAL
Application valuation:
.7500
Tiht .4 4 Qu&4
Applicant: Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
--------------------------------------------------
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: 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
ny, applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500)•:
1) 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 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project ISec.
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 contractors) licensed
pursuant to the Contractors' State License Law.).
( 1 I am exempt under Sec. , BAP.C. for this reason
Date: b caner:
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:
BRIAN JOHNSON
54411 AVENIDA VELASCO
LA QUINTA, CA 92253
Contractor:
Owner
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 7/07/10
-----------------------------------------------
WORKER'S COMPENSATION DECLARATION
I 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 Policy Number
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 be a subject to the workers' compensation laws of California,
and agree that, if I should beco s bject to the workers' compensation provisions of Section
�\0 of the Labor Co , I h fo with comply with those provisions.
licant:
WARNING: FAILURE TO SECU WO KERS' 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 of rmation is correct. I agree to comply with all
city and county ordinances and state laws relating to building c ns uction, and hereby authorize representatives
of this Cou tyy Tenter upon the above-mentioned property or n action purposes.
te: t7 Sign re (Applicant or Agent):
Application Number . . . . . 10-00000605
Permit
RE -ROOF
Additional desc .
Permit Fee . . .
. 30.00
Plan Check Fee
.00
Issue Date
Valuation . . .
. 0
Expiration Date
1/03/11
Qty Unit Charge Per
Extension
BASE
FEE
30.00
----------------------------------------------------------------------------
Special Notes and
Comments
RE -ROOF WITH COOL
ROOF APPROVED
MATERIALS - FAGLELITE MALIBU TILE. 2007
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
rx - M
"t.
r i
P.O. BOX 1504
LA QUINTA, CALIFORNIA 92247-1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT -
PROPERTY OWNER'S PACKAGE
(76,0) 777-7012
FAX (760) 777-7011
Disclosures & Forms for Owner-Banders Applying for Construction Permits
MOOTAN-11 NOME TO PROREM
Dear Panperty Owner.
An- application for a building permit has been submitted m your name listing yourself as the build" of the rogarty
improvanmts specified at L ACc- O
We are pruviding you with an Owner -Builder Acknowledgment and lnf6imaWn Veci€iEatM Form to make yvu amine of your
reVens6ildm and possible risk you may inenr by Wing this permit issued in your name as the
Ownes-Builder. We will not issue a Wading permit; untie you have read, inid" your understanding of each PrOvision,
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 -
ON 8
uthority.
Oz's AteQ!wCE0 f AM -MMMAMN OF 1 MW*A- iN
fliA"Et' ONS: Read and wand e=h statement below to. signify you undwstand or veriVy dais informa"n.
isf1. 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 Pmenal#Y. I, 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 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.
1'_�T2. I understand building permits are not required to be signed by property owners unless they are responsible for the
construction and are not Miring a licensed Contractor to assume this responsibility -
_%T -3. 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 name instead of my
own.
;—Ir 4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on
perrruts and contracts.
S1_ 5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total vale,
of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer
nunder state and federal law.
�\ 6. I understand if I am considered an "employee' under state and federal taw, I must register with the state and feder
government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployme
compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious fmanci
risk
�7. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family resident
structures cannot legally build them with the intent to offer them for sale, unless all work is performed bylicen'
subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is perforn
under contract with a licensed general building Contractor.
8. 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. houries sustained. by any subsequent owner(s) that result from any latent construction defects in the
workmanship or materials.
�9- I understand I may obtain more information regarding my obligations as an "employee' from the hAM4 at RO'4enuo
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 (CSI.B`) at 1-
800-321-CSLB (2752) or www.csib.ca.gov for more information about licensed contractors.
10. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the
pay legally and financially responsible for proposed construction activity at the following address:
i L I agree that, as the party legally and Otnamially responsible for this proposed construction activity, I will abide by all
applicable lows and requirements that govern Owner -Builders as well as employers.
t12. 1 agree to notify the issuer of this form immediately of any additions; deteQiorrs, or chi to �Y infarcmaticuft I
fiave 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 twonse,. Eire Contractors' State License Board may be unable to. MOM you with any financial loss
you may sustain as a result of a complaint Your only remedy against unlicensed Contractors may loo in;civil cwmt It is also
important far You to bndastand that -if anualkans6d.ConmtctororempWyceof that individual os firm is uy V" voile w0d[ing
on your property, you may be !told liable for dalmages. If you obtain a permit as Owner -Builder. and wish to hire Contractors,
You will be vespowMt for vend ing vAnta or not those Contractors are proponly licensed and the status (If their vvo&C&
conpenswon instutnme ooverage.
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 ismittr .ft.pti€tsdt. Note: A copy. of Ntc p vVenV ow#w s dhivw.VAb&� fetvu koftdMdM4 or
other verification acceptable: to lfre Wil' is eesgr&ed to be presented when the pemdt is iwwd to v the properly
owner's signature. .
Signature of property owner Date: 7 / Q
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 ACTON PROPERTY OWNRTZ'S RER&LF
Excluding the Notice to Property Owner, the exec otion of which I understand is my personal responsibility, I hely authorize
the following persons) to act as my ageot(s) toapply 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 OF 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 abo,
information and certify its accuracy. Note. A copy of the owner's driver's license, forth notarization, or other ver0cation
acceptable to the agency is requiredlo be presented when the permit is issued to verify the property owner's signature..
Property Owner's Signature: Date:
Prescrip
Project Ad
Certificate of Compliance: Residential Reroof
L k�S C o
I ROOFING PRODUCTS (COOL ROOFS) §151012
Climate Zone
CF -1 R-ALT-ReRoof
'ermit #
When the area of exterior roof surface to be replaced exceeds 50% of the existing roof area, or 1,000 fe,whichever is less, the new
roofing area must meet the roofing product "Cool Roof" requirements of §152(b)l Hi, 152(b)1Hii, or 152(b)MY.
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/Ib/ft2
Alternatives to §152(b)l Hi and §152(b)Hii, Steep -slope roof (pitch > 2:12)
❑ Insulation with a thermal resistance of at least 0.85 hr•f?-*FBtu 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 11112 of free ventilation area of attic ventilation for every 150 ft2 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
❑ Building has at least R-30 ceiling insulation; or
❑ Building has radiant barrier in the attic meeting the requirements of §151(1)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)1 Hili, Low -slope roof ( pitch 5 2:14
❑ 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 criteria.
❑ Roof constructions that have thermal mass over the roof membrane with at least 25 Ib/ft2 are exempt from the Cool Roof criteria.
NOTE: If any one of the alternatives or exception is checked the Aged Solar Reflectance and Thermal Emittance requirements for roofing
products in §118(1) are not applicable. Do not fill table below.
Roof Slope
CRRC Product ID Number < 2:12 > 2:12
Product Weight Pr
< 51b/ft2 z 5lb/ft2 T
Al
11
C
Dduct Aged Solar Thermal
eZ Reflectance"' Emittance
(r
❑4
L . L� 3
13
SRI
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.coolmofs.oru/products/search oho
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(po,;f„ — 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 htty://www.energv
acopy of the SRI- Worksheet to the CF -1 R. ca govRitle24/and enter the resulting value in the SRI Column above and attach
To apply Liquid Field Applied Coatings, the coating must be applied across the entire roof surface and meet the dry mil thickness or coverag
,ecommended 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
NOTE: When a Cool Roof is required, the installing contractor shall complete and submit the CF -6R -ENV -01 for final inspection.
Declaration Statement
• 1 certify under penalty of perjury, under the laws of the State of California, the information provided on this form is accurate and complete.
• 1 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 Reaulatinnc ,v
Nam
N'No'Z
Company:
F !ss: �;-q % )
City/State/Zip: L,
,6 {-`r" S daJ
I-
\( I
\t, v. 7V- 'C (� 9z2
gnature:
Date:
License:
Phone:
For assistance or questions regarding the Energy Standards, contact the Energy Hotline
3 -71 3 WO
1-800-772-3300.
Bin #
City of La Quinta
Bul'Iding &r Safety Division
Permit # O
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Project Address:
Owner's Name:
lr,Address:
A. P. Number:
'1f L 0 I
Legal Description:
City, ST, Zip: —7 /k- (2 tA 12
ti <:?`
Telephone: ".
Contractor:
1 ( �&_
Address: 1p4 to
Project Description:
City, ST, Zip: w ,1„-7,or
L' A g ZZ T
Telephon ,^s;>:y„a
State Lie. # :
City Lie. a:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
Construction T (� ,�,�
1 ` • :o -r Type: ` ccupancy:
State LIC. #:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.:#Stories: # Units:
Telephone # of Contact Person:
Estimated Value of Project: 50c�
APPLICANT: DO NOT WRITE BELOW THIS LINE
# Submittal Req'd
Rec'd TRACKING PERMIT FEES
Plan Stu
Plan Check submitted Item Amount
Structural Caics.
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 plan
2" Review, ready for correctionsrssue Electrical
Subcontactor List
Called Contact Person Plumbing
Grant Deed
Plans picked up S.M.I.
H.O.A. Approval
Plans resubmitted Grading
IN HOUSE:-
3'4 Review, ready for correctionstiissue Developer Impact Fee
Planning Approval
Called Contact Person A.1.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees