10-1035 (RR)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 10-00001035
Property Address: 51725 AVENIDA DIAZ
APN: 773-114-012-4 -000000-
Application description: RE -ROOF
Property Zoning: COVE RESIDENTIAL
Application valuation: 4500
ll::::� 4-144A4l
Applicant: Architect or Engineer:
0)1_11*' SIR
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
---------------------------------------------------
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
ay
ypplicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars 155001.:
1 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 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, 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 La
l _ 1 I am exempt under Sec. ,. B.&P.C. for i reason
ate: ner:
CO STRUCTION LENDINGAGENCY
I hereby affirm under penalty of perjury that ere 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:
LQPE"I IT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner: A
BRIAN JOHNSON
9:_en 51725 AVENIDA DIAZ
LA QUINTA, CA 92253 -------------------
Contractor:
Owner
X2
------------------
WORKER'S COMPENSATION DECLARATION
10/04/10
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
I 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 bere subject to the workers' compensation laws of California,
and agree that, if I should b o subject to the workers' compensation provisions of Section
of the bor Co I orthwith comply with those provisions.
ate:,,3700
pplicant:
WARNING: AILURE TO SECUR ORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO C MINAL 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 const tion, and hereby authorize representatives
of this county to ter upon t 'above-mentioned property or s tion purposes.
Date: ature (Applicant or Agent):
Application Number . . . . .. 10-00001035
Permit RE -ROOF
Additional desc .
Permit Fee . . . . 30.00
Plan Check Fee
.00
Issue Date . . . .
Valuation . . .
. 0
Expiration Date 4/02/11
Qty' Unit Charge Per
Extension
BASE
FEE
30.00
-------------- --------------------------------------------------------------
Special Notes and Comments
RE -ROOF WITH COMP SHINGLES. PER
APPLICANT R-30 INSULATION TO BE
INSTALLED AT PRE -ROOF INSPECTION.
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 1.00
.00 .00
1.00
Grand Total 31.00
.00 .00
31.00
LQPERMIT
WW Me# =
/ I
P.O. BOX 1504
LA QUINTA, CALIFORNIA 92247-1504
78-495 CALLS TAMPtco
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
PROPERTY O'WNER'S PACKAGE
(760) 777-7012
FAX (760) 777-7011
Disclosures & Forms for Owner -Builders Applying for Construction Peruilts
fRALIM -1 MQTICE Tf2 >�Rcxl� Tir at�VN1�R
Dear Property Owner:
Art. application for a building permit has been submitted in your name listing yourself as the builder of the .Property
-improvements specified at 1�' 1 7 ZS Aw ap, , b A- `ham i rA =Z
We are providing you with an Owner -Builder A4knoWlezdgmentand In€ennatien verifieationForm to make you aware.of your
eespensibilities and possible risk you may incur by having dais permit issmd. in your name as the
Owner -Builder. We w14 not issue a building permit until yowhave read, initialled your understate of eaeh`provision,
signed, and returned this form to us at our ofRcial address indicated. An agent of the ownff cannot execute thismatice
unless you, the property owner, obtain the prior approval of the permitting authority.
ops ACEMWLEQGl e A �ia MATIdP 0.V
DHWCIWNS Read and w aial each statement &6� tw'signify you waiwsWn&or vW* this information.
I understand a frequent practice of unlicensed persons is. to have the property owner obtain an "Owner -Builder"
building permit that' roneously implies that the property owner is providing his. or her own labor and material persouaft' - I, 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 o€ the limits of my insurance -coverage for injuries to workers
'on my property-
j5� 2. 1 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" P am the respgnsible.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 my
own.
4. I understand Contractors are required by law to be licensed and -bonded in California and to list their license numbers on
permits and contracts.
S. I 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 ($500), including labor and materials, I may be considered an "employee:'
under state and federal law.
'9__ 6. 1. understand if I am considered an --employee' under state and federal law, I must register 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 failure 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 resideutia
structures cannot .legally build them with the .intent to offer them for sale, unless all work is performed by licens"
subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performe,
under contract with a licensed general building Contractor.
A k 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. 4uries sustaked by any subsequent owner(s) that result from any latent construction defects in the
workmanship or materials.
9. I understand I may obtain more information regarding my obligations as an "employer" from the Internal ROWMI :
S MIce, the United States Small Business Administration, the California Department of Benefit Payments, and the Ealiforflia
Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSM at 1-
800-321-CSLB (2752) or www.cslb.ca gov for more information about licensed contractors.
I_Z10. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the
pay legally and financially responsible for proposed construction activity at the following address:
1 L I agree that,, as the party legally and firtaucially responsible for this proposed coq truction activity, .I will abide by all
applicable l•iws 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, os.ch m any of the informs I
ave provided on this form. Licensed contractors are lated b laws designed to protect the public. If you contract with
someone who does not have a liwaser @re Contractors' SSttate License Board may be unae to asst you with any firimm#1 loss
YOU may sustain as a result of a complaint. Your only remedy agaigst unlicensed Contractors may be in;civil court: It is. also
.tant for• you to. understand tl a if arf ansed udiaContraptor or employee of that in&vidual or firm is injured while wig
'Na
on your property, you may be hdd liable for damages. If you obtain' a permit as Owner -Builder and wish to hire ContEeetors,
you .will be responsrblo for verging whdba or not those Cortractors are prgmdy geensed and the status of their wovkers'
compensation insurance ooverW.
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 issaft Omptr"anit Note: A copy of ilta property owg0r s 4J*ec:'slkn5cr form notaAdotrAm or
other verification acceptable to the agcney . required to be presented when dw pFm a is issued to verify the Vroperty
owner's signature. .
,r
Signature of property owner Date.
LT _20#�
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 fox a construction permit for the Owner -Builder.
AUTHORIZATION OF AUNT TO ACT ON PROPERTY OWNER'S
Excluding the Notice to Property Owner, the gaecAtion of which I understand is my personal responsibility, I hereby authorize
the following petson(s} to act as my agent(s) toeapply for, sign, and file the documents necessary to 06.tnin an Owns -Builder
Permit for iny project.
Scope of Construction Project (or Description of Work):
Project Location or Address. S 1 i2S
Name of Authorized Agent: Tel No
Address of Authorized Agent:
I declare under penalty of perjury that I
information and certify its accuracy. Nc
acceptable to the agency is required' p
Property Owner's Signature:
to property owner for the address listed above and I personally filled out the above
copy of the owner's driver's license, form notarization, or other verification
ur.hted when the permit is issued to verify the property owner's signature..
Date:
,rescri tive Certificate of Compliance: Residential Reroof CF-IR-ALT-ReRooi
roject Address: Climate Zone Permit 9
Sf "7--2-.1Z-,k1 t=om 1 /5 /4_- /03
ROOFING PRODUCTS (COOL ROOFS) §151(1)12
When the area of exterior roof surface to be replaced exceeds 50% of the existing roof area, or 1,000 ff, whichever is less, the new
rooting area must meet the roofing product "Cool Roof requirements of §152(b)iHi, 152(b)1Hil, or 152(b)1Hlli-
applicable alternative or exception below If the roof alteration is exempt from the roofing product
❑ 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 Utan 5llbM
Alternatives to §152(b)1 HI and §152(b)Htl, Steep -slope roof (pitch > 2:12)
❑ Insulation with a themtal.resistance of at least 0.85 hr-ftz "FiBtu or at least a 314 inch air -space is added to the roof deck over an attic; or
❑ Existing duds in the attic are insulated and sealed according to §151(f)10; or
❑ Intimate zones 10, 12 and 13, with 1 f12 of free ventilation area of attic ventilation for every 150 ft2 of attic Boor area, and
where at least 30 percent of the free ventilation area is within 2 feet vertical distance of the roof ridge; or
,E Building has at least R-30 veiling 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
❑ Intimate zones 10,11,13 and 14, R-3 or greater roof deck insulation above vented attic.
Exception to §152(b)l Hill, Low -slope roof ( pitch 5 2:12)
❑ Building has no duds in the attic.
Other Exceptions
O Roofing area is covered by buldatg integrated; photovoltaic panels and solar thennai panels are exempt from the Cod Roof criteria.
❑ . Roof constructions that have thermal mass over the roof membrane with at least 25 IbM are exempt from the Cod Roof ctiteiia.
140re., If any one of the alternatives or exception Is checked the Aged Solar Reflectance and
products in §116(1) are not applicable. Do not tiff table below.
requirements for roofing
NO When a Cool Roof is required, the installing contractor shall complete and submit the CF,6R-ENV-01 for final inspection.
Declaration Statement
Roof Slope
Product Weight
Product Aged Solar Thermal
S
CRRC Product ID Number'
s 2:12 > 2:12
< 5lb/ft 2 5WT
2 Refiectance"' Emittanoe SRI
Signat
❑
❑
❑
❑
❑•
Date: �l
�T
p :ss:
a
❑
❑
❑
❑°
Note: If no CRRC-1 label is available, this compliance method cannot be used, use the Performance Approach to show compliance,
i. The CRRC Product ID Number can be obtained from Me Cool Roof Raft Counc rs Rated Pmduct Directory at www coolroofs orob�eam oho
2. Indicate the type of product is being used for the roof top, i.e. shVfae ply roof, asphaft roof, metal roof, etc.
3. If the Aged Reflectance is not available in the Cool Roof Rating Councr's Rated Product Directory then use the Initial Reflectance value from the same .
directory and use the equation (0.2+0.7(pw — 0.2) to obtain a calculated aged value. Where p is the Initial Solar Reflectance.
box ff the Aged Reflectance is a calculated value using the equaWn above.
lculate the SRI value by using the SRI- Worksheet at hp dNrww er►erov ca.00yA tle24f and enter the resulting value In the SRI t,olumn above and aftec
Leck
opyofthe SRI- Worlksheetto the CF -1R.
pply Liquid Field Applied Coatings, the coating must be applied across the entire roof surface and meet the dry mil thickness or covr
mmended by the coatings manufacturer and meet minimum performance requirements listed in §11804. Select the applicable coating
LAturninum-Pigmented Asphalt Roof Coating ❑ Cement -Based Roof Coating ❑ Other
NO When a Cool Roof is required, the installing contractor shall complete and submit the CF,6R-ENV-01 for final inspection.
Declaration Statement
• I 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 Cert
Compliance conform to the requirements of Title 24.1
1 and 6 of the California Code of Regulations.
Na 7� Flin
Signat
Company:
Date: �l
�T
p :ss:
License.
City/State/Zip:
Phone:
For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300.
Bin #
City of La Quetta
Building &r Safety Division i•Q
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: S 2 A4.3,4 a. t wk'Z
Owner's Name: c) Hp -,9J h1
A. P. Number:
Address: ,� � '7.2 U L r1 { iA 1)t w
Legal Description:
City, ST, Zip: t A Q� �(A-
Contractor: 0W e" tom--
Address: S
Telephone: f..
Project Description:
City, ST, Zip:
.
Telephone:k
^ :r
^�..,
State Lie. #:
City Lie. #:
Arch., Engr., Designer.
Address:
City., ST, Zip:
Telephone:
Y
sri;.• s .r;s ,r,::%
Construction Type: Occupancy:
ProJect type circle one) New Add'n Alter Repair DemoState
Lie. #:
Name of Contact Person: VtN
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
N
Submittal
Req'd
Recd
TRACING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cales.
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
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN 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