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10-0567 (RR)_ P.O. BOX 1504 VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Application Number: 10-00000567 Owner: k4-15t�bN25 6/25/10 Property Address: 53959 AVENIDA VALLEJO UNITED ASSOC. GENE (�1APN: 774-162-020-9 -000000- 16033 BOLSA CHICA # 2010Application description: RE -ROOF HUNTINGTON BEACH, Property Zoning: COVE RESIDENTIAL-----------------------0WISFt"UINTA Application valuation: 4000 FINANCE DEPT. Contractor: Applicant: Architect or Engineer: Owner --------------------------------- 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 a5lyfipplicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: () 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.). (_ ) I, as owner of the property, am xclusively contrpi's'roelapon with licensed contractors to construct the project (Sec. 7044, Business and Profess s Code: The ctors' State License Law does not apply to an owner of property who builds or. impr v thereon, ancontr is for the projects with a contractor(s) licensed pursuant to the Contractors' t to License LaI am exempt under Seca B.&P.C. for Date: 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.)• —7 iV Lender's Name: /h^ Lender's Address: r LQPEM11T WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: _ I 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 f r which this permit is issued. My workers' compensation insurance carrier and policy number an Carrier Policy 4u bar I certify that, in the p rmance of the w rk or whi h this permit is issued, I shall not employ any person in any mane so as to become su ject to he workers' compensation laws of California, and agree that, if 1 1 Auld become subi to the orkers' compensation provisions of Section 3700 of the Labor de, I shall forthw compl with those provisions. e: (� licant: WARNING:. FAILURE TO SECURE WORKERS' 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, i emnify and hold harmless the City of La Quinta, its officers, agents and employees for any act or mi ion related to the work being performed under or following issuance of” .'s permit. 2. Any permit issued as a result of this app u n becomes null d vo if work is not commenced within 180 days from date of issuance t1d permit, or ces ation f wo for 180 days will subject permit to cancellation. I certify that I have read this application and state thove informati, i is rrect. I agree to comply with all city and county ordinances and state laws relating to construction, nd1tereby uthorize representatives of tth/is,�rctbun[y toXuponeabove-mentioned prr inspection p poses. aD te:V 6a'l (Applicant or Agent): 4 " Application Number . . . . . 10-00000567 Permit . . . RE -ROOF Additional desc . Permit Fee 30.00, Plan Check Fee .00 Issue Date . . . . ..Valuation . . . . 0 Expiration Date 12/22/10 Qty Unit Charge Per Extension BASE FEE 30.00 ---------------------------------------------------------------------------- Special Notes and Comments RE-ROOF;WITH COOL ROOF APPROVED PRODUCT - - OWENS-CORNING DURATION PREMIUM: 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 1Ao .00 .00 1.00 Grand Total 31.00 .00 .00 31.00 d LQPERMIT Bin # Now City of La Quinta Btdlding 8T Safety Duron P.O. Box 1504, 78-495 Calle Tampico La Qirinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # Protect Address: S ��N.0 i` To A P. Number. Legal Description: owner's Name: [/yi f2: -p •/fC(4,7_ -Cq Address: I& 33 $"LSA- C (&- lAl W /Ot{—I 5/ CitY, ST, Zip: YL^4( f„J h cad Q a f t( Contractor: Telephone: f 0 ;? SVY -7 YG 3 Project Description: CG C Address: City, ST, Zip: Telephone: State Lic. # City Lie. i!: Arra., Engr., Designer Address: City., ST, Zip: Telephone: State Lia #: Name of Contact Pelson: Construction Type: OcwPanaY: W44 Project type (circle one): New Add'n Alter Repair. Demo Sq. FL: # Stories: #Units: Telephone # of Contact Person: Estimated Value of Project 06 C) APPLICANT: DO NOT WRITE BELOW THIS UNE # Submittal Req'd Recd TRACKIIVG PERMiT FEES Plan Set Plan Cheek submitted Item Amount Structural Caics. Reviewed, ready for corrections Plan Check Deposit Truss Cala. Called Contact Person Plan Check Balance. Title 24 Cales. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2" Review, ready. for corrections/issue Electrical Subcoutaetor Ust Called Conts et Person Plumbing Grant Deed Plans picked up SALL H.O.A. Approval Plans resubmitted Grading 1N HOUSE:- Review, ready for correctiouafLune Developer Impact Fie Planning Approval Called Contact Person A.LP.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees P.O. Box. 1504 LA QUINTA, CALIFORNIA 92247-1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT PROPERTY OWNER'S PACKAGE (760) 777-7012 FAX (760) 777-7011 Disclosures & Forms for Owner -Builders Applying for Construction Permits .OTAM7 NOTICE TO PROPERTY OWNER Dear Property Owner. Ari. application .for a building Permit has been submitted inyour name.listing yourself as the builder of the .property improvements specified at S J g v¢ lo(yl okq V A L L L•`J' p We are .providing you with an Owner -Builder i4cknowIedgment and Information Verification Form to make you aware 0 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 you•have read, initialed your understanding of each'pravision, 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. OVRMWS A!QRj WI EDGWNT AND-VE1IIFICATION OF MORNAMN DIREUTONS: Read and initial each. statement below to signify you understand or'ver, ify this information. 1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder' bur ding permit that erroneously implies that the property owner is providing his. or her own labor and material- personally. I, as an Owner -Builder, may be held liable and subject to serious. financial risk for any injuries sustained by an unlicensed perso-a 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. 2. I understand building permits are not required to be signed by property owners unless they are responsible for the co truction and are not hiring a licensed Contractor toassume this responsibility.. . 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 ray own. (f4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers: on permits and contracts. . jE55. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total vElue of my construction is at least five hundred dollars' ($500), including labor and materials, I may be considered an "emplo-er" under state and federal law. IF6. 1. understand if I am considered an "employer" under state and federal law, I must register with the state and fecerat government, withhold payroll taxes,- provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee:" I also understand my failure to abide by these laws may subject me to serious financial risk. L7. 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. I understand as an Owner- uilder if I sell the property for which this pen is issued, I may be held liable for any financial or personal. injuries sustained. by any subsequent owner(s) that result from any latent construction defects in the worlananship or materials. 9. I understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue 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 (CSLB) at 1- 800-321-CSLB (2752) or www.cslb.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 party le ally and financially responsible . for proposed construction activity at the following address: 3 S 7 1 4 lin,I19 tq V af_t t F U - 11. I agree that, as the party legally and financially responsible for this proposed construction activity, .I will abide by all applicable laws and requirements that govern Owner -Builders as well as employers. _�r_l2. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have 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 -unlicensed Contractor or employee of that individual or firth is injured while working on your property; you may be held liable for damages. If you obtain a permit asOwner-Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are property licensed and the status of their workers' compensation insurance coverage. Before a building permit can be the agency responsible for ' other verification acceptabl .to owner's signature. Signature of property owner issi red, this form must be completed and signed by the property owner and returned to 4 mit. Note: A co. o the property owner's dr'iver's lkensef orae notartzatl'on; or b: p�' FY f P PAY f the alrq is required to be presented when the permit is issued to verify the property Us Date: 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 I understand is my personal responsibility, I hereby authorize the following persons), to act as my agent(s) 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: 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 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 bepresented when the permit is issued to verify the property owner's signature.. Property Owner's Signature: Date: TRUST CERTIFICATION CHICAGO TITLE COMPANY RE: Order No. 985104960 - .S32 Escrow No. 985104960 - S42 Trust Agreement/ Declaration dated made under the laws of the State of by Lawrence E French [name of settlor(s) person(s) who created the Trust] The undersigned, Silvermoon Entities, Inc. A California Corporation [Trustee] for the settlor(s) certify(ies) to you that: 1. The above Trust instrument has not been revoked and is in full force and effect. 2. The name(s) of the Trustee(s) now qualified to act under the Trust instrument and who are the only Trustee(s) qualified to act is/ are: LawrenceE French 3. The powers of the Trustee(s) are contained in the attached copy of a portion of the trust instrument. 4. The Trust is irrevocable . X revocable and the person(s) holding the power to revoke is/ are: Lawrence E French 5. If there is more than one Trustee, the Trustee(s) may exercise the .powers set forth in paragraph 3 above by all/ less than all their signatures. (Attach excerpt from Trust showing such provisions.) 6. The Trust identification number is: Social Security number Employee Identification number 42-1742787 7. Title to the Trust assets should be taken as: UNITED ASSOCIATES GENERAL TRUST #1774162019, DATED MAY 05, 2010 8. The above referenced Trust instrument has not been amended, modified or supplemented; except as follows: IN THE EVENT THAT THIS CERTIFICATION IS BEING USED IN A TRANSACTION IN AN OU OF $500,000.00 OR LESS THE ATTACHMENTS CALLED FOR IN ITEMS 3 AND 5 ABOVE ARE NOT REQUIRED. IF THE T ACTION CEED $500 00.00, THEN THIS CERTIFICATION MUST BE NOTARIZED. • . Dated: 05/24/2010 STATE OF CALIFORNIA SS COUNTY OF On before me, personally appear who pro v o me on the basis ot satisfactory evl en—c o e e person(s) whose name(s) is/ are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s), acted, executed the instrument. " I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. . WITNESS my hand and official seal. (This area for official notarial seal) 140TARY'S SIGNATURE TC2 —12/03/ 07 AA Prescriptive Certificate of Co 'ance: Residential Reroof Project Address: rcvvrrrrrU. VKUDUCTS (COOL ROOFS) §151(1)12 1AA.,......,.. _ CF -1 R-ALT-ReRoof Permit # _...._ _.... ,,, ".r 1w,,sur surrace 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 Roor requirements of §152(b)1Hi, 152(b)1Hil, or 152(b)1H11i. Check applicable alterative 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/lb/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(1)10; or ❑ In climate zones 10, 12 and 13, with 1 ft2 of free ventilation area of attic ventilation for every 150112 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 uilding 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 14i R-3 or greater roof deck insulation above vented attic. Exception to §152(b)1 Hili, Low -slope roof ( pitch 5 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. ❑ Roof constructions that have thermal mass over the roof membrane with at least 25 Ib/fl2 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(i) are not applicable. Do not fill table below. Roof Slope Product Weight Product Aged Solar Thermal CRRC Product ID Number s 2:12 > 2:12 . < 51b/ft2 Z 5lb/ft2 T 2 Refledance''4. Emittance SRI 5 10-0 4 3T❑❑ 13 11 V Note: If no CRRC-1 label is available, this compliance method cannot be used, use the Performance Approach to show compliance, The CRRC Product ID Number can be obtained from the Cool Roof Rating Council's Rated Product Directory at wwwcoolmofs ombroduct�seardr or►o Indicate the type of product is being used for the roof top, i.e. single ply roof, asphalt roof, metal roof, etc. 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(p,,, - 0.2) to obtain a calculated aged value. Whera pis the Initial Solar Reflectance. Check box if the Aged Reflectance is a calculated value using the equation above. Calculate the SRI value by using the SRI- Worksheet at httnJ/www.enerov ca aovAN624/and enter the resulting value in the SRIColumn above and attach acopy of the SRI- Worksheet to the CF -1R. o apply Liquid Field Applied Coatings, the coating must be applied across the entire roof surface and meet the dry mil thickness or Covera. :commended by the coatings manufacturer and meet minimum performance requirements listed in §118()4. Select the applicable coating: IL3 Aluminum -Pigmented Asphalt Roof Coating ❑'Cement -Based Roof Coating 13 other NOTE When a Cool Roof rs required, the installing contractor shall complete and submit the CF -6R -ENV -1 Y�V�q�q{XVII V{q lCrrrC.rr� _ , • 1 certify under penalty of perjury, under the laws of the State of Californ a, thip infc • I certify that the energy features and performance specifications identififiedthis 1 and 6 of the California Code of R ulations. Name: _ _ for final inspection. on this form is accurate and complete. conform to the requirements of Tdle 23, Part. viusr Company: _ el1-t/ 14VV,-J 6A/r('r(Ff (d 0 Date: OGv9/v FIWt. 3oL.S� Ct'�r�� �Gt%�/S�� License: Dl Ci2v/Statef7in- �' tfcfV-t v(17, -J Oet-(, eo �a tSt/C� Phone:. 7/Y 6a,,' ,S__?5 � For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300.