12-1382 (RR)P.O. BOX .1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253'
•4 ��Af�I1l1�
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number:
1---12-00001382--;
Property Address:
- 77370 CALLE^SINALOA
APN:
773-122-010-7 -000000-
Application description: RE -ROOF �.
Property Zoning: .
COVE RESIDENTIAL
Application valuation:
1700
Applicant: Architect or Engineer:
LICENSED CONTRACTOR'S DECLARATION
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 ISec. 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 sheds 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 plicant fora permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: -
( 1, 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 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' • 1 I am exempt under Sec. B.&P.C. for this reason
+ ,Date:..' % � ner.
• ONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that ere 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:
~DEJARNATT VEVA
C/O PHILIP WARREN CON
30512 107TH AVE SE
AUBURN, WA 98092
Contractor:
Owner
I—
VOICE (760) 777-7012
S�pNNED FAX (760) 777-7011
SPECTIONS (760) 777-7153
Date: 11/27/12
NOV 2 7 2012
CITY OF LA QUINTA
FINANCE DEBT.
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
_ I have and will maintain a certificate ofconsent 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
T person in any manner so as to become subject to the workers' compensation laws of California,
and agree that, if I should become subject to the workers' compensation provisions of Section
3700 of the abor Code, I hall forthwith comply with those provisions.
te: '
Z pplicant:
WARNING: FAILURE TO SECURE ORKER COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS 1$100,0001. 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 cessation of work for 180 days will subject
permit to cancellation. '
I 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 t " county to enter upon a above-mentioned property fo inspection purposes.
ate: nature (Applicant or Agent): '
LQP6R1111T
Application Number . . . . . 12-00001382
Permit RE -ROOF
Additional desc .
Permit Fee . . . . 30.00
Plan Check
Fee
.00
Issue Date ..
Valuation
. . .
. 0
Expiration Date 5/26/13
Qty Unit Charge Per
Extension
BASE
'-------------------------7-----------------------------------------------7'
FEE
30.00
Special Notes and'Comments
STRIP ROOF TO PLYWOOD, NAIL 1 LAYER #28
BASE FELT, INSTALL TORCH ON ROOF
SYSTEM
(GAF) 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
A. r
P.O. Boirr 1504
LA QUINjiA, CALIFORNIA 92247-1504 BUILDING & SAFETY DEPARTMENT
78-495 GtALLE TAMPICO (760) 777-7012
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011
'
PRO
�R'I'Y OWNER'SPCG
k
Disclosures &
Dear Prvperty Owner.
An. application for a building pem,,
impmvemcnts specified at 7.2 "- 31,
We are providing you with an Owner
fesponsMities and pomble risk. -you
Owww-Buitdcr_ We will not issue a
signed, and returned this form to
unless you, the property owner, obtat
Read and bririal
for Owner-J,3ullders Applying for Construction Permits
has been subr{iiittod in your name listing youndf as the builder of the paoperty
0 C1a \k e. Lo, C?L-v.i k- ri i_L5 I
3uilder Aclmowiedgment•and Infotmatien VerTkationForm to make "swami of your
iay incur by haviag do permit • iss and m yoer name as the
►uilding,.permit until ywA--ave read, WidaW yetis anderstandiug of each prevision,
s at our official` address indicated. An agent of the owner cannot execate this notice
the prior approval of the permitting authority_
sfgrrlfy you ander3tand or verify dais mfarnmtion.
1. 1 understand a frequent pral"Aim 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_ 1, as
an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an WA'MnsW person'
and his or her employees while worlicing on MY property.'My homeowner's insurance may not provide coverage for those
injuries. I am willfully acting as an 01wner-Builder and' am aware of the limits of my insu:i-ame coverage for injuries to workers
on my property- { f
[F 2. 1 understand building permi . are not required to be signed by property owners unless they are responsible for the
construction and are not hiring a licezised Contractor to assume this responsibility_
I
j�At3. I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand prat 1 array protect
myself'from potential financial risk by hiring a licensed Contractor and Luring the permit filed in his or her name instead of my
own. l
{
a-4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on
permits and contracts.
Citi 5.1 understand if 1 employ or otherwise engage any persons, other than California licensed Contractors, and the total value
of my construction is at feast five hundred dollars ($500), including labor and materials, I may be considered an "employee'
under state and federal law.
Cl. 6. 1 understand if 1 am consideired an "employer" under state and federal taw, I must register with the state and federal
government, withhold payroll taxest provide workers' compensation disability im mane, and contribute to unemployment
compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financialrisk.
L7. 1 understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential
structures cannot legally build thein with the intent to offer them for sale, unless all work is performed by Licensed
subcouttactors and the number of structures does not exceed four within any calendar year, or all of the work is performer
under contract with a liwnsed generarl building Contractor.
[�8. 1 understand as an Owner -Builder if I sell the property for which this pertrut is issued, I may be held liable for any
financial or personal. injuries atssaiot'ed by any subsequent owner(s) that result from any latent construction defects in the
workmanship or materials f
C4C 9. I understand I may obtain more information regarding my obligations as an "employee" from the intesai Rgv>rnue
Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California
Division of Industrial Accidents. I also understand 1 lnay contact the California Contractors' State License Board (CMB) at 1-
800-321-CSLB (2752) or www.cslb.Eea gov for more information about licenced contractors.
k
C -P am aware I aaware of and consent o an Owner -Builder building permit applied for in my Dame, and understand that 1 am the
part' legally and financially responsible for proposed construction activity at the following address:
7'7-.310 Ca -.UQ S'.`I.,Q;�oC� .1�-A":,:
Cie ILI
agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all
em
applicable laws and requirents Cheat govern Uwiier-Builders as well as employers.
rJi 12.1 agree to notify the issuer of this form immediately of any additions; deletions, or changes to any of the Information l
haveprovided on this form. Licensed contractors are regulated by laws designed to protect the public_ If you contract with
someone who does not have a tieenise, the Contractors' State Uceme Board may be unable to asst you with any 6naneial loss
you may sustain as a result of a ccomplaint Your only remedy against unlicensed Contractors may be im'civ.7 ootut It is also
important for you to. understand th2Iit if an ualicensed Contractor or employee of that individual or is injured while v ng
on your property, you may be k dud ruble for damage& if you obtain• a permit as Owner -Builder and wish to hire COntsactors,
you will be respimsMe for verifying wltetltea or not those Camractom are pwpedy titer aud'the status of trioti wenicers'
COI OU iMUM0e boverag6. f
Before a building permit can be issued, this formmust be completed and signed by the property owner and returned to
the agency responsible for . &e.per nit_ Mete: A copy of the propesty owner's dSever's ftensvi fam n� or
other venifrcadon acceptable to the agency is required to be presented when the permit is icsrre m � y per'
owner's signature.
Signature of property owner �� ��� Date:
i .
Nate: ire following Authonzli tion Form is required to be completed by the property owner only when designating
an agent of the property owned to apply for a construction permit for the Owner -Builder.
AUM0gg6:fF <ON OE AGENT 't O AC'T ON P OPER'TY ®"Wb MU" -'r
Excluding the Notice to Property Owner, the execs ition of which I understand is my personal responsibility,
I hereby authorize
-the following person(s) to act as my agents) toapp' ly for, sign, and file the documents necessary to obtain an Owner -Builder
Permit for my project. I
Scope of Construction Project (6r Description of Work):
Project Location or Address: 10-3-70 tye \cc,
Name of Authorized Agent: Tel No
i
Address of Authorized Agent:; t
I declare under penalty, of perjtiuy that I am the property owner for the address listed above and I personally filled out the above
information and -certify its accuuaey. Note:A copy of the owner's driver's license, form notarization, or other verification
acceptable to the agency is required to be presi? ited when the permit is issued to verify the property owner's signature.
f l �zE / L
Property Owner's Signature: , /x L ��%�'` Date: )
Cool Roof Rating Council
Rated Products Directory: Search Results 1 new search I I ex ort I
(last updated 20 Nov 201218:04 CST )
Showing Search Results for:
Company: Tropical Roofing Products Corp.
Page 1 of 1
P_ioduc_e Tape_ Field-_Aoolled
Coating, Fector�i or Field Applied_ Coati__ _____•_____ ___ _ �_
Note
Manufacturer
CRRC
Prod. ID
Brand
Solar Reflect. Therm Emit SRI®
PAW PtodureS Slooe about
Model CaWaory IM f 3 yr tnit 3 yr Application Ratings
Information
(sorted +)
0656-0001
Tropical
Tropical
#921 Re-
Bright
Field-
0.84
0.74
0.88
0.89
105
91
Low/Steep
Roofing
Asphalt
Flex
White ,
Applied
'
Products
Coating
Corp.
George
Buckhold
-
(954-983H
LH
I
3434)
0656.0002
Tropical
Tropical
#911
Bright
Field-
0.86
0.69
0.88
0.91
108
85
Low/Steep
Roofing
Asphalt
Etemalastic
White
Applied
Products
Coaling
Corp.
George
Buckhold
(954-983-
3434)
0656-0003
Tropical
Tropi
#901
Bright
Field-
0.88
0.76
0.88
0.89
11194
Low/Steep
Roofing
Asph t
Standard
White
Applied
Products
Coating
Corp.
George
Buckhold
1(954-983-
HLUL-1
13434),
-----
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10/10 39dd sio(INd 908 OM8 8066ZZE09LT ZS:LO ZLOZ/LZ/11
Binfl
City ®1 La Quanta
Building 8L Safety Division
P.O. Box 1504, •78-495 Calie Tampico
LA.Quinta, CA 92253 -:(760) 777-7012
Building Penin t'Application' and Tracking Sheet
permit #
1%
Project Address: Cr Owner's Name:. �,... � ip, -c-i t^ s
A. P. Number. '. Address: sir 7') -3 %i a (iia hG �Cfi
Legal Description: City, ST, Zip: Ccs. 9 - Lq�A 3
0.
Contractor. Telephone: V,— ��7 2 '
V,— •tAct'a ; :s':
" 3 i 3 S x n
Address: Project Description:
city, ST, Zip:
Telephone: _ ��<t . i.� �% (a ! fe e
State Lic. 4: Cary Lic. K; f n Q O79)
Arch., Engr., Designer: lyf
Address:
City, ST, Zip:
Telephone:
'' 3 Construction Type:. Occupancy:
• :y Project type (circle one): New Add'n " Auer Repair Demo
State Lic. #:,.
Name of Contact Person`. N Sq. Ft:ti o�
#Stories: # Units:
Telephone # of Contact Person:
Estimated Value of Project 7,9. C- U
fit°PLICANT:
DO NOT WRITE BELOW THIS LINE
TRACKING PERIUrr FEES -
Submittal
Req'd
. Reed
Plan Sets
Plan Cherksubmitted t,:" item Amount
Structural Gales.
Reviewed, ready for corrections Plan Check Deposit" .
Truss Cates!
Called Contact Person Pian Check Balance
Tide 24 Calms.
- I?
Plans picked up ` Construction -
Flood plain I plan
� Plans resubmitted Mechari[cal
Grading plan
2'r Review, ready for correetionsfissue Electrical
Subeontactor List
Called Contact Person Plumbing
E
Grant Deed
Ytans picked up SALL
ILO.A. Approval
Pians resubmitted Grading
M HOUSE`
Review; ready for correctionsfissue Developer Impact Fee
Ptanoing Approval
Called Contact Person
Pub. Wks. fpr '
4 Date of permit Issue
School Fees
�� {
Total Permit Fees