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12-0872 (RR)'P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application description: Property Zoning: Application valuation: I • Applicant: Is 12-0000087'24 52-62'5 AVENII5AJJVALLEJO 773-292x017-5 -000000- RE-RO6F COVE RESIDENTIAL 4000 Architect or Engineer: BUILDING & SAFETY'DEPARTMENT BUILDING PERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 8/03/12 Owner- ALI VOSSUGHY 52625 AVENIDA VALLEJO LA QUINTA, CA 92253 Contractor: D 1 Owner D - ----- - - - - - - - - - - - - - - - - - - --- fi� J 2012 ` n1 - c IJ�QuItA N c%V o �!Gt D F1 N. -- LICENSED CONTRACTOR'SDECLARATION 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: • 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' compensat' surance, as r ired.by Section 3700 of the Labor - .. - - - - Code, for the performance of the w or which this per t is issued. My workers' compensation OWNER -BUILDER DECLARATION r insurance carrier and policy nu r are: t 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 . I certify tliat, in the perfor nc of the work for ich 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 mann so a o become sub' t 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 houl ecome subje 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 La r Cod , I shall fort ith co h 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 thanfiive 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 owne rty who builds or improves thereon, -� and who does the work himself or herself through r her own a ployees, provided that the improvements are not intended or offered �®r e. If, however, a building or improvement is sold within _ one year of completion, the owner -build have the burden f proving that he or she did not build or improve for the purpose of sale.). (_ 1 I, as owner of the property, am excI ely contract with Ii nsed contractors to construct the, project (Sec. 7044; Business and Professio Code: The ractor State License Law does not apply to an owner of property who builds or impr es thereon, d ho c tracts for the projects with a contractors) licensed ' pursuant to the Contract. 'State Licen W.I. - I—) I am exempt under Sec. B.&P. r t ' son ate: - 0 ner: 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 ' ei I2 Ica t: . WARN T R WF N HALL G L ERS' COMPENSATION COVERAGE IS UNLAWFUL, AND S . SUBJECT AN EMPLOYER TO RIMINAL 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 def emn and hold harmless the City of La Quinta, its officers, agents and employees for, ct.or omission elated to the work being performed under or following issuance of this per ' 2. Any permit issued as a result of this application co null and voi if.work is not commenced within 180 days from date of issuance of su per , or cessatio of work for 180 days will subject permit to cancellation. 1 certify'that I have read this application and state that a ab a informatio is correct. I agree to comply with all ' city and county ordinances and state laws relating to ildi constructi , and hereby authorize representatives of this my enter upon thbove-mentioned pr art for inspect - purposes. te0.42— ature (Applicant or Agent) ' Application Number . . . . . 12-00000872 Permit RE -ROOF Additional desc . Permit Fee . . . . 30.00 Plan Check Fee .00' Issue Date Valuation 0 Expiration Date 1/30/13 Qty. Unit Charge Per Extension BASE FEE 30.00 ----- Special Notes and ------- Comments RE -ROOF WITH CRRC APPROVED SHINGLES (OWENS-CORNING SHASTA WHITE)2010-.CODES. --------- Other Fees ------------ ,. . . BLDG SIDS 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 Prescriptive Certificate of 2 Residential Reroof L.C. 9,��z ROOFING PRODUCTS (COOL ROOFS) §151012 F, ••roust una area w emnor roof surface to be IlaplaCed exceeds 503/ of the existing roof area, or 1,000 W, whichever Is less, the new roofing area must most the roofingproduct "Cool Roof" requirements of 152(b)1Hi,152(b)l Hii, or 152(b)1Hi11. Check applicablealternative or exception below If the roof alteration !s exempt from the roofing product 'Cool Roof requirements:: O Cool roofs act required In ClirrateS Zones 1-12,14. and 16 with, a low sloped roof pitch gess or 2:12 pitch). O Cool roofs D9required in Climates Zones 1-9, and 16 with a steel) -sloped 2:12) roofs (greater pitch than 2:12) and product weigh less than 5/lb/ft Alternatives to §t S2(b)1 Hi and §152(b)Hu, Steep -610119 roof (pitch > ❑ Insutation with a thermal resistan08 of at feast 0.85 hrfe..Flatu or at least a 3/4 inch air -space is added to the roof deck over an attic; or ❑ Existing duds in the attic are insulated and seated accord nto §151(f)10 or ❑ In climate zones 10, 12 and 13, with 1 ft2 of free ventilation anew 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 feast R-30 ceirmg insulation; or ❑ Building has radiant banter in the attic meeting the requirements of §151(t)2; or ❑ Building has no duds in the attic; or O in climate zones 10, 11,13 and 14,.R-3 or greater roof deck insulation above vented attic. Exception to §152(b)1Hill, Low-Wope roof (pitch S 2:12) ❑ Building has no duds in the attic. Other Exceptions . ❑ Roofing area Is covered by building Integrated; photovoltaic panels and solar thermal panels are exempt from the Coot Roof criteria. O Roof constructions that have thermal maks over the roof membrane with at least 25 IbW are VO : if anyone of the alternatives ore exempt from .the Coot Roof cxiteaia. x�epnon � ��� � �r Re roe and 7irermal roe requirements fbr troducts In § 118(0 are not roofing applicable. Do not fill table below. CRRC Product I Number' Roof Slope S 2.12' > 2:1 L W Product Weight < SlbW a 5ib/ft Product T Aged Solar Reflectance' 4 Thermal EmftWwe SRI 1:3113Ifi c340.2 ❑ ❑ ❑4 Note: if no CRRC-1 label Is available, this compliance method cannot be used, use the Performance Approach to show comp/lance, 1: The CRRC Product-, Number can be obtained from fire CoolRoof g C WWWS Rated Product Dftctory w at ww 000f[oofs.maM02M fflk j ,, nr,n 2. Jndicate the type of product k be/rrg used for the roof top, L e. single -0y rpof, , . i. If the ,aged Reflectance is not avepable in the Cad Roof Rat/ng CoUIW.s espAsft roof metal roof, atcRated Product directory and use the equation (0.2+0.7(py,�N — 0.2) to obtain a caladated aged valueObectory then use the lnNal Reflectance value fiom the same t: Check box TP the Aged Reflectanc. Where p is the lnftial Solar Reflectance. e /s a caloAsted value using ft equation above. i Calculate the SRI value by using the SRI- Worksheet at lzttpJhvww enemy CS. aoopy of the SRI- Worksheet to the CF. -1R. and enter.t/re resulting value in the SRI Column above and attach ro apply Liquid Field Applied Coatings, the coating must be applied across the entire roof surface. and meet the dry mff thickness or coven 'ecommended by the coatings manufacturer and meet minimum Performance requirements listed in §118(1)4. Select the applicable coating: 7 Aluminum -Pigmented Asphalt Roof Coating ❑ Cement -Based Roof Coating When a Cool Roof IS required, the fistalGng connector shall complete and submit the Declaration Statement • 1 certify under penalty of perjury, under the laws of the State of California, the informatton dad • 1 certify that the energy features and -performance speciftcatlons Identified on this cat of Co 1 and 6 of the California Code of Regulations. Name: A. I / P ❑ Other SR -ENV -0f for final insnedinn on this " is accurate and complete. to the requirements of Title 24, Par u/3/i 2 Phone:, -I P For ass/stance or questions regarding the Energy Standards, contact the Energy HodinTe at: 1-800-772-3300. IV moo® I r P.O. BOX 1504 LA QuINTA; CALIFORNIA 92247-1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING &c SAFETY DEPAR'T'MENT PROPERTY ORNER'S PACKAGE (760) 777-7012 FAX (760) 777-7011 Disclosures & Forms' for Owner-Bui tiers Applying for Construction Permits kWORMT! NORCE TO PROPERTY OWNER Dear Property Owner. Arr. application for a building permit has been sub 4t in your na listing yourself as the builder of the .property improvements specified at 57.&26 . Vide are providing you with an Owner -Builder Acknowledgmentand-Information Ve catronForm to make you aware:of your responsibilities and possible risk you may incur by having this.permit. issued in your name as the Owner -Builder. We will not issue a building. -permit until yoa•110ve read, initialed 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. Read and initial each statement Waw- 10 3ign#yyou understand or verify this information. eii%' 1. 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 pers6nalo.1, 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 (Fr7��'- 2. I understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility.. �rI understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect rom potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my r4jAriderstand Contractors are required by law to be licensed and bonded in California and to list theirlicense numbers on ad contracts. 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 least five hundred dollars ($500), including labor and materials, I may be considered an "employer" Zerrte and federal law. 6. I understand if I am considered an "employer" under state and federal law, I must register with the state and federal ov mment, withhold payroll taxes, provide woikers' compensation disability insurance, and' contribute to unemployment ce tion for each "employee." 1 also understan d my failure to abide by these laws may subject me to serious financial ls . V7. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential structures cannot .legally build them with the .intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. 8. 1 understand as an Owner -Builder if I sell the property for which this permit is issued, I maybe held liable for any financial or personal. injuries sussamed by any subsequent owner(s) that result from any latent construction defects. in the r hip or materials. nderstand I may obtain more information regarding my obligations as an "employer" from the Internal Revenuee 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 MSI..B) at I - 8 0- -CSLB (2752) or www.csib.ca.gov for more information about licensed contractors. 10. 1 am aware of and consent to an.Owner-Builder building permit applied for in my name, and understand that I am the party legally andfinancially nsMe for pro nstruction activity at the following address: .. _r. 735 - - ....... 11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all cable litws and requirements that govern Owner -Builders as well as employers. 12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to -any of the information 1 ave 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 license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in;civil court. It is- also important for you to understand that if an uidicensed.Contractor or employee of that individual or firm is injured while working on your property; you may be held liable for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. _ Before a building permit can be issued, this the agency responsible for issue: the perm other verification acceptable to the owner's signature. , Signature of property rm must be completed and signed by the property owner and returned to Note: A copy of the property owner's dkivea'shkafteifarm notar-iutdot : or required to be presented when the permit is issued to verify the property Date: O 3 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 OWNER'S_ BEHALF Excluding.the Notice to Property Owner, the execution of which 1 understand is my personal responsibility I hereby authorize the following person(s) to act as. my agents) 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: Tel No Address of Authorized Agent: I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note: A copy of the owner's driver's license, form notarization, or other verification acceptable to the agency is required to be presented when the permit is issued to verify the property owner's signature-. Property Owner's Signature: Date: Bin.# C(�/ Of Ldp Qurnta Building til Safety Division P.O. Box 1504,78-495 Calle Tampico La.Quinta, CA 92253-(760) 777-7012 Building Permit Application and Tracking Sheet Permit # ^ ` v Project Address: `j� Z� t/'� a.;, L' �,�. Owner's Name:. A/; A. P. Number. Address: Legal Description: City, ST, Zip:MIN Contractor. Telephone: Address: Project Description: City, ST, Zip: --WIN ;:: �r.,� . Telephone: 1 . I ✓i< State Lie. # : City Lie.. #: Arch, Engr., Designer Address: City, ST, Zip: Telephone:. State Lic. #:�' � �`�''�" %a�`r ,r Name of Contact Person: Construction Type:. Occupancy: Project type (circle one): New Add'n Alter Repair Demo Sq. Ft. -11W # Stories: t # Units: I Telephone # of Contact Person: Estimated Value of Project APPLICANT: DO NOT WRITE BELOW THIS UNE # Submittal Rcq'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted Its Amount Structural Cafes. Reviewed, ready for corrections Plan Check Deposit... Truss Calcs. Called Contact Person Plan Check Balance Title 24 Calc§. Pians picked up Construction- onstructionFlood Floodplain plan Plans resubmitted.' Mecharilcai Grading plan 2ad Review, ready for corr"tionsfissue Electrical Subcontaetor List Called Contact Person Plumbing Grant Deed Plans picked up S,I MOA: Approval. Plans resubmitted Grading IM HOUSE-, '^' 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