12-1141 (RR)P.O. BOX 1504
78-495 CALLE TAMPIC0
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
x`12 -00001141y-
52565 AVENIDA VALLEJO
773-292-014-2 -000000-
RE-ROOF `
COVE RESIDENTIAL
1300
c:e,lu4t, 4�
f�!'itiGv
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner: �J�AE�Jl MITCHELL SAVAGE52565 AVENIDA V LA QUINTA, CA 922
Architect or Engineer:
Contractor:
Owner
-ted �T
VOICE (76011\7 2
FAX (760) 777-7011
:T \WS (760) 777-7153
1p 21 It" ' v
9/27/12
---------------------------------
--- - - - - - - - --- - - - - — — — — — — — — — — — — — — — — — — — — — — — — — — — — — I — — — — — — — — — — — — — ----- — — — — — — — — --- — — — --- — — — — — — — — —
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 perjuryone 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: License No.: for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
Date: Contractor: _ - _ 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
�o OWNER -BUILDER DECLARATION insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier Policy Number
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to 1/I 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 beco subject to the workers' compensation laws of California,
permit to file a signedstatementthat he or she is licensed, pursuant to the, provisions of the Contractor's State and agree that, if I sh Id b 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 C e, I shalt orthwith 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
any pplicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars IS5001.:- ate: pplicant: -
11 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 WARNI G: FA RE 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 MPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or.her own employees, provided that the - DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. - - 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 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
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 contractors) 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 undei Sec. , B.&P.C. for thisr on - 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.
ate: caner: 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 abAinrmtion 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 bui ingn, and hereby authorize representatives
oft ' county to ent r upon the above-mentioned prope fopurposes.
Lender's Name:
ate: nature (Applicant or Agent):.
Lender's Address:
LQPERMIT
LQPERMIT
Application Number . . . . . 12-00001141
Permit . . . RE -ROOF
Additional desc .
Permit Fee . . . . 30.00 Plan Check
Fee
.00'
Issue Date . . . . Valuation
. .
- 0
Expiration Date 3/26/13
Qty Unit Charge. Per
Extension
BASE FEE
30.00
Special Notes.and Comments
TEAR OFF EXISTING ROOFING, REPAIR DAMAGE
.TO FASCIA & RE -ROOF WITH CRRC APPROVED
PRODUCT. 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
LQPERMIT
Sep -11. 2012 6:01PM McAfee and Taft 918 599 9317
rnl/. From; 761IM1111 Page: 215 Date: 9110/21125:36:13 PM
17
No. 7254 ' P..2
Aa
P -O- BOX 1504
LA Q1U114TA, CALIFORNIA 92247-1504. BUILDING & SAFETY DEPARTMENT
79-495 CALLE TAMPICO (760) 777-7012
LA QVINTA, CAI.IpOANIA 97.253 FAX (760) 777-7011
ER-OPERTY OWNER'S PACKAGE
Disclosures & dorms for; Owner-BuRders Applying.for Construction Permits
-1 F. W=
Dear property Owner
An. Wllctttion for a buildia
ubt la In ue U&ft youtwf tho builder of the property
i:eaerors specilled ate fo 1/ d,a ,Crt es Cif-
W'D U* ptovift you with Ari Owner-Buildtr Adtaowbod '
reegwasxblllde'saad gmertt-sad infotinatlon Verification Form to make yen awaie of year
pwalvle dek-you may is Aw by MUM tads permit issued is yovr:Izalne as the
Owrsw- tfllder. Wi wM not 6tte a. bulldirig*ermlt %litu yW.l%tve read:, lohkW yottr.underabusding of eac4t ptovleion,
aligned, and'rct}trned chis form to 4A at our clods! address Indicated, Axt agent of the OWM cannot enoauto ".notice
Wan you, the property owper, obtain the prior approval of the pertnitting authority,
bridal nark arate'rraW blow tb SIVI %YOU Undffstarrd of Wary thk Wonnpalon.
I tutd"Vmd a ONuenl practice of itnllecosed persons is to have the property owner obtain an "OwnerBalidee,
B petuilt that etxotxeously impllct: that the proptzty owner is providing his or hero" labor end matt" personattq. I, as
Ownct •Bulldcr, racy be held liable end subjegt to 6crious fiap dal risk for any injuries. 4otairted by itn xulumaaod person
and his or bei cegployees while wotlong on hey 1,mpmt, My h6meowner's insurance may not provide coverage for those
es, I ub wftlly acting as an Owner'n d' er awl am aware of the limits of toy lamiance-COveme for iNudes to workers
Vey pro".
l tmdetstand building Permits aro not tegttM to be signed by property owners unless they are responsible for the
otlolt
,:and
aot biting a Wnnsod Contractor to Wurna this respoaaibiility,
i rmat ,attd as an 41Owner-8uildcc" I aux tfte mo onslble party of record on the permit. i understand tktat I mw protect
lyse! frdm potesitlal financial risk by hung % liq,=I)d Cottttaotor and having thy p;0nii Thad to his or het name mate of my
I understand Contractors are Mqutred by low to be liecnsod aad bonded in California, artd to list their license numbers on
and contracts,
I tuiderstand if l employ or otherwise extgege any persons, other than California licensed Oantractots, end the't'otal ochre
-coastntet(t tt is At least five hundred dollars ($500), Inoluding labor and ttiatetntls, l -may be considered an "tMoloyce,
stato and federal law,
undersf ad if I am oonside� an "Lmptvy ' ubtdcr state andlrodoral law, I uwet megt+er with the state and federal
Int, withhold payroll taxes, provide woikucs' compensation disahnity ursunUm, and contribute' to unemployment
Ilton for each "employee." I also uaderstand my failure to abide by those laws may subject me to serious Iiasnolel
[ undorstend under Califot'nia Contractors' State License Law, an Owner -Builder who builds slagle-family rasidenda
stru 5Annot legally build thew with th4 jut ' to offer theta for saUe, urticas all work is performed by l'ctostt
stibO6tutors and the number of structures does oat exceed four within any caleadar year, or all of the we* is porforma
uadeF contract with a licensed gencrn) building Contractor. .
Sep. 11. 2012 6:01PM McAfee and Taft 918 599 931.7 No, 7254 P. 3
From: 7M41402 Page: 415 bate: Oil V2012 5:36:13 PM
1 8. I understand as an Owner-Bulldar If 1 sell the Property fvr which thtt permit is`issucd• 1 may be. held liable for„ any
M natal or, potsonol. lgltttim s<tstnined by any subsequent owntu(s) that result from any latent conslniction .defects In the
W
Amr"V
tanship or motcriats,
I undersiard [ may obtain more information regarding my oblignlions as Ra "employer" &ora the in1� od IioNt ito
o, the UttUed States Sadall Business A.draiahvmdot4 the Callfornia beparwaortt of tloneflt Payments, and the California
Division of InduS' hiAl Accidents. I also understand 1 may contact the (aAufonda Contractors' State License DORM (tiLi� at l .
8 • -321-CSLB (2132) or wwtvcstb.ea.gov for ritoro information about licensed contraitots.
0. I ato aware of and consent to an Owncr-Buildct building. permit applied for in ray mato, and undcfstand that Lam the
p legally Aad fnarmlelly responsible fol proposed consuucGon activity at the following address:
W 11.1 sgrcc that, as thc'pwly legally and Anenci�lly rcxponslbto for this prorosed tonstwetion activity, t wilt W& by At
a tcabfd lAm and requlri m to that gown Owner -Builders a -s wail :to croptoru's.
ntom
2:1 agree to.nolify the ttsucr of tlrls &tu1 immediately of any additions; deletions, o(006m to Any of the inforrttailoa t .
rovided on US farm. Licensed contractors aro r�ulated by laws daslgntid to protect the pubilo. If you contract with
"who door not have a llaotud, the Coou'aet"rs' State I.,iccm Tioard may be usable to assist yvti with any 6tnanCist loss
you toay sgatain as a result of a complaint. Your only remedy against unliveneod Contractota may be is civil court- it is also
imporwt. for you t'4.wWw. nj�gp�,j land thxt-if&huContractor or wVloycc otthert individtol br ftin is lgjucod White Working .
on Your: property; you may be held• liablo (qr damages. If you vbtaln a pert#it as, 0wnes`0uiid' mad wish to hits Coa tutors,
You will bo rospoesrbte for vcd*iag wbeam,or not dw" C fie aetora ace p'raperty licensed and rho suttuin•of their workwe
aompewti9nitsstttettea106y tego.
Before x building porattt can be icaued, !Ws tarot must be completed and signet by( he property owner and irtturtzW to
rho agency rtaponsible for lasuln� Mq.'ptr�titit-N ii copy of the propetp�otvner's driver•-r**rt'wo f" twlsnloeAbr4 or,
other acrificddolc rteco�fAbld tv the ireii to be presutted when tlro pcfmu is lsstteti to Va'r* fire preperto
bWRer :c signanrrp. i
Signaturoc(Prepcmown ( .. _ G,/\ Y 2
Date:
N61c: rhC followlhg Authorization Fonu is regrelred to be t:otnpleted by the properly owner only when des!Vwtfng
do ogeitt of the property owner to apply for a conslrirctlon pertnit for the Owner -Builder, ,
IXtDWZA.T[ON A c TO AC[' qN FRO)'lmik OVi!NI;a'S C
exeludin$ the Notice to Proudly Ow(er, the exQeptien of which ). undorslattd to my personrl m4p6ssibiiity, L beibby authorize -
the'followipg potaon(s) to act as my V 01(9) to apply for, 'sien, and Rio lite documents necessary to obtain an Owtteriiuildcr
format Pot toy Project. -
Seope of Const uctiou Project (or Ae irrr►//puna
rrQjet:l lAeatiVR br Addross: ��%(O� y b A oat, k*
Noma a[atttftt►ruod Ag9at; v4 KGt R -fit Tel No05`% /3,3
Addrosa
of Authorized Agent:IT
I decldre under Poualty of POdury that.I ain the Pmperty owner for'thio address listed above and f porsonkily Riled out tbo abov<
lnforinadon entti(y d C4 iia accuracy. N9 fir; A y ofrhe owner's driver's license, form nolarfzatlon, or 011ier var((icatlon
acmptable ro the agency qui d Q0 h:rf en thepermif tr issued to verify the property owner's signature -
Pro" O%vner',t Sign
ignature_PropertyOtivner'cSign..�
�L' Date: I �'
•rrr..aLU Ur mom glance: Residential Reroof
l CF -1 R-ALT-ReRoof
Z -S— (e 4 + / 6 I Climate Zone J Penmlt 5
rwv�uw r-rwuV6lb (GOAL ROOFS) §151M12
uti-- AL - -
•-..wr Mw mvo Vr uxierrorroo',
roofing area must meet the ra
Check applicable alternative or
Ice to be replaced exceeds
Product "Cool Root" reaul
Mon below If the roof alterati
% of the ex<sting roof area, or 1,000
rents of §152(b)1141, 152(b)1H11, or 1
is exam f
Wchever Is less. the new
Hill.
-
1' rom the roofing product Cow Koor requirements:, .
O Cool roofs W required to Climates Zones 1-12,14, and 16 with a low stoped roof pitch (less or 2:12 pitch).
❑ Cool roofs = required to Climates Zones 1-9, and 16 with a steep -sloped roofs (greater pitch than 2:12) and product weight less than 5MW.
Alternatives to §152(b)1 Hi and52(b)I�il
§ 1 , Stee (pP•elope roof itch > 2:12)
O Insulation with a thermal resistance of at least 0.85 hr fe.*FiBW or at least a 3/4 inch air -space,❑ Existing ducts in the attk are Insulated and sealed is added to the roof deck over an attic; or
O In climate zones 10, 12 and 13, with 1 ft2 of free to §151(f)10' or
where at least 30 ventilation area of attic ventilation for every 150112 of attic floor area, and
P" cent of the free ventilation area is within 2 feet vertical distance of the roof ridge; or
O Building has at least R-30 caging insulation; or
❑ Building has radiant barter In the attlo meeting the requinaments of §151(f)2; or
O 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 Hiil, Low*Glope roof ( pitch S 2:12)
❑ Building has no ducts in the attic
Other Exceptions
❑ Roofing area is covered by building tntegrat84 photovoltaic panels and scar thermal pains are
O Roof exempt from the Cod Roof airetia.
y toad have therms! mass over the roof membrene wlttn at least 25 b V are
s !f any one of Nre aftemativ�es or exr�on is c►ne<aked lige exempt fromtheCod Roof criterta.
products in § 118(1) are not applkable. Do not tip table below. Soar and Thermal requhemerrts for roofing
CRRC Product Ip NumberrRoof Slope
s 2:12 > 2:1
O�� ❑
MW
2
Product Weight
< 5ib/ft t 516V
Product
Types
Aged Solar
Refledanoe''4
Thermal
Ertlittaunoe
SRIS
❑
❑
❑4
Note: K no CRRG 1 label /s available, ttNs oovrlplJanoe method ca►urot be used, use lige Perfonnanoe
. The CRRC Product ID Number can be Appvoac�n to show ca»pliartce,
Indicate the type otpoducf b ° from the Cod Roof Rafting Coun a Rated Plvdud Otrectory at "W Q00MM&
d the � used for the roof top,1. e. slrlple ply roc% asphalt roof, metal roof, etc.
a�ReI" the tTeda►rce is not evaBebie !n the Cod Roof Re ft Cound'i; Rated Product Dbedbry then use the inlbial Reflectance value nom the same
Check box n the WIA00n (0.2+0. Tia,,,,,. - 0.2) to obtain a CGlladated aged value. Where p is the ht W Solar Refledance.
Aged Reflectence is a cakxlated vahre uctrp the epr�on above.
Cafadate the SRI value by usft the SRI- Worksheet at
a00tny of the SRI- Worksheet to the CF -1R end enter the resulting value in the SRI Column above and attach
o apply Uquid Field Applied CoathW, the coating must be applied across the entire roof surface and meet the dry mil thickness or covers
commended by the coatings manuladurer and meet minimum ped mance
_ requirements fisted in §118(i}4. Select the anolicabie c�nAlinn•
Aluminum -Pigmented Asphalt Roof Coating
When a Cool Roof 1s required, the installing
ration Statement
❑ Cement -Based Roof Coating ❑ Other
complete and submit
for
1 certify under penalhr of perjury, under the taws of that the ene ' the State of California, the intonation provided on this form is accurate and complete.
MY features and.perkmance 1 and 6 of She California Code of � s o� ^ad on this Certftate of CONAence conform to the
requlremerfts of Tolle 24 P
Name:
Company:
(2 �- license:
-zIl
Phone:
For assistance or questions regarding the Energy Standards, contact the Energy koffine at: 1-800-772-3300.
art:
Sep -11, 2012 6:01PM '--McAfee.and Taft 918 599 93*17
From: 7608641402 Page: 315 Date: 911=012 $1613 PM
No. 7254 P. 4
W7
Qty or La Qfjiht.,'a
RullOw ar Safety Dfv(dM
pmt B
P.O, Pox (504,-7e-495 Offe TaMpka
4.QuM06 CA 9W3 - -(760) 777V012
Building
PerrWC. Applicadon* and Traddng Sheet
Civ
A- P,'Number,
Addresr
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Address;
!to)* Desodpdoa!
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Addr=
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