12-1333 (RR)Applicant:
Architect or Engineer:
^�VOICE (760) 777-7012 55>
FAX (760) 777-7011
•BUILDING & SAFETYDEPARTM ENT I INSPECTIONS (760) 777-7153
BUILDING` PERMIT
Date: • 11/09/12
Owner:
ULTRA INVESTMENTS 1
D /
y 1233 VIA PRESA
SAN CLEMENTE, CA 92672 r
Contractor:
!• KELLEY •CUSTOM BUILDING&"F
42801 PLEASANT HILL PL.
HEMET, CA 92544
(951)796-7099
Lic. No.: 899674
' LI
NOV 10 ?Old
a OF(AQUTArrA
E aEPT
-
---------------------------------------------
-LICENSED CONTRACTOR'S DECLARATION •
P:O. BOX 1504
r
- 78-495 CALLE TAMPICO
I hereby affirm under penalty of perjury one of the following declarations:
LA QUINTA, CALIFORNIA 92253
Application Number:r�
�T2=00001 3—
Property Address: ��51735'P.VENIDA
VALLEJO
APN:
773-131-026-12 -000000- '
Application description:
RE -ROOF r
Property Zoning:' 1
COVE RESIDENTIAL
Application valuation:
6500
Applicant:
Architect or Engineer:
^�VOICE (760) 777-7012 55>
FAX (760) 777-7011
•BUILDING & SAFETYDEPARTM ENT I INSPECTIONS (760) 777-7153
BUILDING` PERMIT
Date: • 11/09/12
Owner:
ULTRA INVESTMENTS 1
D /
y 1233 VIA PRESA
SAN CLEMENTE, CA 92672 r
Contractor:
!• KELLEY •CUSTOM BUILDING&"F
42801 PLEASANT HILL PL.
HEMET, CA 92544
(951)796-7099
Lic. No.: 899674
' LI
NOV 10 ?Old
a OF(AQUTArrA
E aEPT
-
LQPERMIT -
---------------------------------------------
-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: _B Licens 899674
for by Section 3700 of the Labor Code, for the performance of the work for which this permitris -
issued. f
/Date:. j_/ Z ontractor:
j+ '
_ I have and will maintain workers' compensation insurance, as required by Section 3700 of theLabor
-Code, for the performance of the work.for which this permit is issued. My workers' compensation
- OWNER- ER DECLARATION
insurance carrier and policy number are:
I hereby affirm under penalty of that 1 am exempt from the Contractor's State License Law for the
Carrier EXEMPT - Policy Number EXEMPT - -
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to
1 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 subject 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 Labor Code comply with those provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
A `/�thwith
any applicant for a'permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
Date:�-
- (_ 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
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE 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 orherself through his or her own employees, provided that the -
I DOLLARS ($100,000). IN ADDITION�TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
-CODE,
- _ improvements are not intended or offered for sale. •If, however, the building or improvement is sold within
- _
SECTION 3706 OF THE LABOR INTEREST, AND ATTORNEY'S. FEE S.
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.).
APPLICANT ACKNOWLEDGEMENT,.
(_) -1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
IMPORTANT. Application is hereby made to the Director of Building and Safety for a permit subject to the
- 7 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
conditions and restrictions set forth on this application. -.
property who builds or improves- thereon, "and who contracts for the projects with a contractor(s) licensed
1 : Each person upon whose behalf this application is made, each person at whose request and for
pursuant to the Contractors' State License Law.).
whose benefit 'work is performed under or pursuant to any permit issued'as a result of this application,
(_ 1 I am exempt under Sec. , B.&P.C. for this reason "
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.
Date: Owner:
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
' CONSTRUCTION LENDING AGENCY " -
•• . permit to cancellation.
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
I certify that I have read this application and state that the above information is correct. I agree to comply with.all
work for which this permit is issued (Sec. 3097; Civ. C.). - -
city and county ordinances and state laws relating to -building const tion, and hereby authorize, representatives
' -
of this county to enter up the above-mentioned'propert�je Pon purposes.
• Lender's Name;��0
L / Z
//`f
Date:ignature (Applicant or Agen0:
Lender's Address:
LQPERMIT -
14
•, , Application „Number ,. '. 12-00001333
4J. Permit RE -ROOF,
•
Additional desc rt
_
- - Permit Fee- 4 30"00' Plan Check Fee
00
Issue Date . Valuation . . .
'. ,i 0 '
�.• Expiration Date .. 5/08/13
Qty 3 Unity Charge, Per, r f
. Extension
BASE FEE
•' =•
-----Special 'Notes and `Comments-------------------, -�---- - - - -
-`--_---. - - - - -- .;
F
' REMOVE=EXISTING TILE, REPAIR EXISTING,
REPLACE WITH'ORIGINAL.TILE..ADDITIONAL
-., 'TRADES PER ATTACHED CONTRACT. 2010 • '
` CODES. • a
--------------------------------------------------=-----------.---------`---
..
` Other,Fees BLDG STDS�ADMIN (SB1473)
1,00
,•�
*Charged
` Fee summary _ Paid Credited
------------=---------------------.------------
Due' `
-----
Permit Fee -Total .30.00 .00 .00 •'
_
30.00 t
- Plan Check Total .00 .00..00
_ .00
.,
T Other Fee Total 1.00 00 :00
1:00 ,
Grand Total- 31.00 .00 1.00
3'1.00•
Ir
41
+
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4
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LQPERMIT - a •.� '� - .. .+ • ' •
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Prescriptive Certificate of Compliance: Residential Re roof CF -1 R-ALT-ReRoof
Project Address:
rr
Climate Zone
Permit #
AVE efo
Thermal
Emittance
SRI
ROOFING PRODUCTS (COOL ROOFS) §151(012
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)1Hi, 152(b)1Hii, or 152(b)1HM.
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 (lessor 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 weightless than 5/Ib/ft2.
Alternatives to §152(b)1 Hi and §152(b)Hii, Steep -slope roof (pitch > 2:12)
❑ Insulation with a thermal resistance of at least 0.85 hr-ft2•`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(f)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 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(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)l Hiii, 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 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
V -.Y • ,civ a,� "V 0NN11La,nc. uu nvt nn eaule oerow.
CRRC Product ID Number'
Roof Slope
< 2:12 > 2:12
Product Weight
< 5lb/ft2 >- 5lb/ft2
Product
Type 2
Aged Solar
Reflectance3,4
Thermal
Emittance
SRI
C14:2e V,)
51
❑
❑
❑
❑4
❑
❑
❑
❑
❑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 vho
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„w„ — 0.2) to obtain a calculated aged value. Where p is the Initial Solar Reflectance.
4. Check box if the Ager/ Reflectance is a calculated value using the equation above.
5. Calculate the SRI value by using the SRI- Worksheet at httvJ/www.eneray.ca.gov/tit/e24/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
ecommended 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• Wh C I R
Ulf a o0 oof is required, the tnstalung 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 Regulations.
Name:
-Prylc.�ir c
Signat
Company: r<� U vU � e:
Address:
a Sto^) ` �` License: ��
City/State/Zip: Phone:
�-4--e �f �� `��-��i L( 17S-1 ;L C11
For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300.
Ultra Investment 949-443-4202 p.2
A-NC3819/T-3850^3-partwrboNes9 contractorsproposa! -
L V �IA�i. Page Y Ot pages
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PROPOSAL SLM AnTE0 JOB NAM81.108N
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SI / ( /VT e.. DATE DATE OF RAMS
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,0,0 hereby submit zowf atiom and estimates for.
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e propose hereby to furnish eieterial and Wxr - odmplete in accdrdappe wdh the above sb a cifii atians for the•surri ef:
[Any OD
ith payments m be made asTallorvs .'
' Dol�rs
,pcey,be rl"Lu gnwh a rag; and Wigbdcoma'&AoftchargeW and above the oafM, al 8greemerto wrrb enr upon stma.
cidmcm• a detDY9 OCPOntl Dur CDn4aL - .
this proposal wn 5y es it nai acCaDtgd within - • . days-
. � �cte�tante �i
The above plicas, apetifieatidns and Condl@one are sdtisfac ftn and arg 7ro�o�ac[
htareby amepted. You are authorized io do the Klark ea specified.
Payments wM be made as outlined above.
DILW ofA=Pmnce �-- ' Sigrea>ura
MS8D7D/T 9f900F1'1 ,
Y
r
P.O. Box -1504 .
LA QUINTA; CALIFORNIA 92247-.1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING dt SAFETY DEPARTMENT
PROPERTY OWNER'S PACKAGE
(760) 777-7012
FAX (760) 777-7011
Dhelosares do Forms for Owner-BuRders Appl jig for Constmetion Permits
eRQrrpnqry Qin
Dow Pnperty owns
An. enfication for a building permit has been d in yew twee listing poussdf as the -lint-Wer of the .ProPeny
ioAso emeew specif"d at
We We'"019 311180 Owner -Builder Aclma0adgment-and la6otmetien vafeat =F=m to erim yoou arraxe of your
eque ililmand punible ri>ou may iW by bvin Gtisp0=k-Wftgd'iD yournun 0 dw
Oertaa"8udder. We *0 net Isstee a bdAdl a "MR und, yet leave re* WElWati y6aF of eack vrWA1 1011, :
sighed, and returned ttiis form to as at our otlleial address indteated. An agent of the owner cannot execlude dais notice
unless you, the property owner, obtain the prior approval of the permitting authority.
siVdfyyou widerstandvrs+wo this irrformati
�. I understand a kequent practice of unlicensed persons is to have the property owner obtain an '1 vw r-Bui W
building pernut that erroneously implies that the property owner is providing hag or her own labor and material personally. I. as
an Owner -Builder, may be held liable and subject to serious financial risk for. any iajur sustained by an unlicensed person
sad his or her employees while working on my property. My homeownces, insurance may not provide coverage for tlwme
injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance -coverage for injuries to workers
on say P"*Mky-
OhL2. 1 understand building permits are not raprired to be signed by property owners unless they are respore We for the
construction and are not hiring a licensed Contractor to assume this respoust'bilitg.
3. I understand as an "Owner -Builder' f am the rt*t Alt.p uty of record on We permit. I understand that I may plowet
myself'6toet potential financial risk by hiring a licensed Contractor and having the permit filed in his or her nme iast+eed of my
own.
4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on
'permits and contracts. .
�5-1 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 (5500), including labor and materials, i may be considered an "employer"
�un/d�e�r state and federal law.
C/' "6. I understand if I am considered an "employee" under state sad federal law, I mug wgistw whir the smte and federe
government, withhold payroll taxes, provide workers' compensation disability inswanc c, and eontn'bute to uhetnploymea
compensation far each "employee." 1 also understand my faihue to abide by these laws may subject me to mriobs finencir
risk.
7. 1 understand under California Contractors' State License I.aw, an Owner -Builder who builds single-family residenti
structure's cannot .legally build them with the intent'to. offer them for We. unless all weTk is performed by licem
subcontractors and the number of structures does not exceed four within any calendar year. or all of the work is perform
under contract with a licensed general building Contractor.
Y'
GAJ 8. 1 understand a's an Owner -Builder if I sell the property for wbich this permit is issued, I may be held liable for any
financial or pasooal. boadas sundned by any subsopent owmrf s) dig result from any latent construction defects in the
workmanship or materials.
ZN 9. I understand I may obtain more information regarding my obligations as an "employer" trove *0
Servioe, the United States Small Business Administration, the California DepaAmcat of Beaefit Payments. and tba California
Division of Industrial Accidents. I also understand I tray contact the California Contractors' State License Board (CSM at 1-
6800- 21-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors.
l0. I am aware of and consent to an Owner -Builder build' 't lied for in my name, and understand that 1 am the
m8l�ti applied
party legally and financially mWmsMc foil propomd construction activity at tbt following address:
CJlJit. 1,851M that, as thepatty lepIly.aod Umcially msponsible for this proposed conctructioo activity, i will abide by all
�ap�p[ 61e taws and mgitimments that govern 0we-1huldess as well at employers.
agree to notify the issue: of this foma immediately of any adder; des, of c"mgat tw4mY' af &a I
have provided on this form. Licensed contractors are mplated by laws designed to protect,the public. If you centract with
mm one who does not have a beense, the <voMnMoW State LA=w Dowd may be tenable q-atbt yam with -say tlaan siert loss
you may sustain as a result of a complaint Your only remedy against unlicensed Contractors may be Iwo" oourL it is, abo
id all for you 40 Mwersmd then -ti' an naboom ceffi acter or emloyee ortut bdividw a &m is i*" T'We waldeg
on your property; you may be Mid Ii" lbrdu3WL if you obahm- a pmM it as Owner-Bvilda and vA& w bbe Co ttaMM,
your wig be mgwud' ria for vettfyft wbdbw air not chose Coattratxore we pmpedy Ibe="a and an of edw wedmw
end.
Before a building pendt can be is esed, this form mast be completed and signed by the prepeM 010aec sad rettuned to
the agency segmdble for . 0MNap: A Cqw of *Ve+�'s %� 110 A I Or
Other vedfica4a Mm"He to a m is�.r4wred to be pras fid whsn as ptrM& (6 irk era. wero Se p�rly
owxcr's signature.
S*D*M of prq*ny o
Note: Tirefollowing Audwrization Form is required to be completed by the proper. ty owner only w1wn designating
an agent of the property owner to apply fox a construction permit for the 4t vex -wilder.
Excluding the Notice to Property Owner, the www ien of which I ;=it=is my personal cesponas�sility, I anwerowner authorize
the following penwo(s) to act as my agengs) to a@pIy for; sign, and file the docunaet�ts racewmq to qWa n -Builder
Persrit for my project.
Scope of Construetion Project (or Description of Work):
Project Location or Address:
Name of p►uthorized Agent:
Address of Authorized Agent:
Tel No
I declare ender penalty of perjurythat 1 am the property owner for the address listed above and I personally filled out the abort
information and certify its accuracy. : A copy of the owner's driver's License, form notarization, or other ver*orion
aoerptable to the agency is to a ed -hex tie permit is issried to verify the property owner's siaranture.
P Owner's Si Date: '
Property !�
Ultra Investment
949-443-4202 p.1
City of 1� Quina
Ptlrink #
P.O. Box 1504,76-49S Gtfe Tampico
..1
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