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10-1265 (RR)Q P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number. ':YO 000-01265 Property Address: 54250 AVENIDA VALLEJO APN: 774 -245 -001 - Application description: ` RE -ROOF Property Zoning: COVE RESIDENTIAL Application valuation: 5000 Tiht 4 4 Q" Applicant: Architect or Engineers: ----------------- : LICENSED CONTRACTOR'S DECLARATION BUILDING & SAFETY DEPARTMENT BUILDING PERMIT 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 any applicant 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.). 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.). - - ( ) I am exempt under Sec. , B.&P.C. for this reason D Dater! / O t� Owner: t, t lit +.�:� �1 . �4-C�i °PQM 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 ISec. 3097, Civ. C.). Lender's Name: Lender's Address: LQPERMIT Owner: BECERRA ADOLFO 54-260 AVENIDA LA QUINTA; CA (580)768-1534 Contractor: Owner VOICE, (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 11/18/10 & CHRISTINE VALLEJO 92253 ----------------------------------------------—- 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 for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier - - - - - - - - - - - - - - - - - - - - - -- Policy Number certify that, in the performance of the work for which this permit is issued, I shall not employ any '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 Labor Code, I shall forthwith comply with those provisions. Date: � I" l y(j�Applicar t: 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, 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 this county to enter upon the above-mentioned property for inspection purposes. _Date:_ _/ G Signature -(Applicant or Aget)a i1J1.c�- Application Number . . . . . 10-00001265 Permit.RE-ROOF Additional desc . Permit Fee . . 30.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . 0 Expiration Date 5/17/11 Qty Unit Charge Per Extension ~ BASE FEE 30.00 Special Notes and Comments w . RE -ROOF BUILDING HAS AT LEAST R-30 CEILING.INSULATION CLASS_ A MATERIAL '30 YEAR APPROVED'PER A.J. ------------------------------ 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 . - .. _ ' . .^ .• . P.O. Box 1504 Q LA UINTA, CALIFORNIA 92247-1504 78-495 CACLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT (7'60) 777-70.12 PROPERTY O'WNER'S PACKAGE FAX (760) 777-7011 Disclosures & Forms for Owner -Builders Applying for Construction Permits MUNTt NQTICE TO FRUER'ru OWNER Dear Property Owner: An. application for a building permit has been submitted in your name listing. yourself as the builder Of. the :property improvements specified at We are .providing you with an Owner -Builder Acknowledgment and, Information -Verification Form to make you awar3e:of your responsibilities and possible risk you may incur by having this- permit -issued mi your name as the Owner -Builder. We will not issue a building -permit until you,4ave read, ftW aled your understanding of each'pi ovWon, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute thi&notice unless you, the property owner, obtain the prior approval of the permitting authority. 0 V KWWS Af1940 E1)G W EM AKDI MRi)�CA')<'ION-©E ODIC At MREC'FONS. Read and initial eachstatement below wsignYy you understand or- Ver•({y this information. 'l. 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 rnatecial pers6 iift-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. 1. am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers 'on my. property - (3_3 2. roperty. X32. 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. 3. I understand as an "Owner -Builder" I'am the responsible.party of mrd on the permit. I understand that I msy protect myself from potential, financial riskby hiring a licensed Contractor and Having the permit filed in his or her name instead of tY own. da4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers cn permits and contracts. C J. I understand if I employ or otherwise engage any persons-, other than California licensed Contractors, and the total valae of my construction is at least five hundred dollars ($500), including labor and materials, 1 may be considered an "employ&' under state and federal law. C6. [..understand if I am considered an "employer" under state and federal law, I mustregister with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and' contribute to unemployment . compensation for each "employee:" I also understand my fiilure to abide by these laws may subject me to serious financial risk. �7. 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 isperfomed under contract with a,licensed general building Contractor. �8. I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal. i'rljuries sustained by any subsequent owner(s) that result from any latent construction defects in the worlananship or materials. 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 (CSLU) at 1- 800-321-CSLB (2752) or www.cs[b.ca.gov for more information about licensed contractors. �lQ. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the party legally and financially resp risible for. proused construction activity at the following address: C�11. I agree that, as the party legally and financially responsible for this proposed construction activity,.1 will abide by all applicable laws and requirements that govern Owner -Builders as well as employers. 12.1 agree to notify the issuer of this form immediately of any additions; deletions, or, chgnges 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. toss . . 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 t©: understand that -if an unlicensed 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 permit as Owner -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 issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing; the.permit. Nate: A copy of tine property owner's dkiver.'s.ltcwrtsei faun notadvadony or other verification acceptable to the agency is required to be presented when the permit is inued to verify the property owner's signature. Signature of property ownck_f'/6e_/lid 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 BFKA ,F Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following Person(s) 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 perjurythat 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 Signaturt rVLy�,�i `_) / y ,�V�e Date: / / _ �� ',�y / 6 Prescriptive Certificate of Compliance: Residential Reroof Project Address. SSI \60 o �. �, IL rwvnivv rrwuut; 15 (COOL ROOFS) 5151(012 CF -1 R-ALT-ReRoof Climate Zone Permit # /5 - - - -- - •- 1-1 uurrace to ve replaced exceeds 50% of the existing roof area, or 1,000 ff, whichever Is less, the new roofing area must meet the roofing product "Cool Roof" requirements of §152(b)1H1, 152(b)1H11, or 152(b)1H1l1. 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 weight less than 5Ab/ft2. Alternatives to §152(b)1 Hi and §152(b)Hli, Steep -slope roof (pitch > 2:12) 0 Insulation with a thermal resistance of at least 0.85 hr•ft2•"FBtu or at least a 314 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(010; or ❑ In climate zones 10, 12 and 13, with 1 112 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(1)2; or ❑ Building has no ducts in the attic; or ❑ In climate zones 10, 11, 13 and 14,11-3 or greater roof deck insulation above vented attic. Exception to §152(b)1 Hili, Low -slope roof (pltch 5 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 products in §118(1) are not applicable. Do not fill table below. Roof Slope Prod CRRC Product ID Number' s 2:12 > 2:12 < 51bi m�m n7ol Note: !f no CRRC- 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 www.coolroofs.o►o%roducts/seamh ply Indicate the type of product is being used for the roof top, i.e. single -ply roof, asphalt If the Aged Reflectance is not available in the Cool Roof Rating COunCI s Rated Product Directof metal ry then use the Initial Reflectance value from the same directory and use the equation (0.2+0.7(p,,f, — 0.2) to obtain a calculated aged value. Wirer p is 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 kitty:/M ww.enernv ca nov/ti 024/ and enter the resulting value in the SRI Column above and affach 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(1)4. Select the applicable coaling: 0 Aluminum -Pigmented Asphalt Roof Coating ❑ Cement -Based Roof Coating ❑ Other NOTE When a Cool Roof rs required, the installing contractor shall complete and submit the CF -6R -ENV -01 for final inspection. Declaration Statement • 1 certify under penalty of peri'ury, under the laws of the State of California, the information provided on this form is accurate and complete. • I certify that the energy features and performance specifications identified on this Certificate of Compliance conform to the requirements of Title 24 Part: 1 and 6 of the California Code of Regulations. Name:,. ( - ' Signature _ Company: Date: .ss �o/C> License: City/State/Zip: Phone: For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300. uct Weight ft, 5lb/ft2 Product T Z Aged Solar Reflectance3A Thermal 'Emittance SRI Bin # City of La Quinta Building 8r Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Penntt # \1-19 Project Address: --d,(o Owner's Name: c) - A. P. Number: Address: SLI. --a. b-© U Legal Description:rn, °- ��,��, Contractor:% City, ST, Zip: Telephone:O Project Description: Address: / i City, ST, Zip: / / i:,•' ; Awa; S$. �:. Telephone: f State Lie. # : ;City Lie. #; Arch., Engr., Designer: Address: ` City., ST, Zip: Telephone: State Lie. # \ �i>:�.?•. airy: L.'4}l. > ;:.:x� .;A.•;w;::;�. Construction Type: cu anc y YP P Y� Project type (circle one): New Add'n AlterRepair Demo Name of Contact Person:Sq. Ft.; �61 0 b #Stories: # Units: Telephone # of Contact Person: Estimated Value of Project -$'Coo APPLICANT: DO NOT WRITE BELOW THIS LINE N Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called- Contact Person Plan Check Balance. Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 20° Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- ''d 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