11-1051 (RR)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
1.1-OOOOrO.51 ^�
Property Address:
529-0 AVENIDA DIAZ
APN:
773-312-013-14 -000000-
Application description:
RE -ROOF
Property Zoning:
COVE RESIDENTIAL
Application valuation:
2300
Tit!t 4 4 4"
Applicant: Architect or Engineer:
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
a�y pplicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
( tx) I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
7� 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 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 exe t under Sec. B.&P.C. fort s reaso
44
12 r
Date: ` ner:
CONSTRUCTION LENDING AGENCY
I hereby affirm unddr 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
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/28/11
Owner:
GYULA BODROGI
52990 AVENIDA DIAZ
LA QUINTA, CA 92253
-------------------rs
contractor:Owner
CVV
--------------------------�p°�-C-- --
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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 whip this permit is issued, I shall not employ any
person in any manner so as to became subject t he workers' compensation laws of California,
11�_j7l_j
ree that, if I should beco subject to t workers' compensation provisions of Section
of the L r Code, I s forthwith co pl with those provisions
vete: plicant:
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 in ormation is, rrect.
I agree to comply with all
city and county ordinances and state laws relating to building co uction, an reby authorize resentatives
of this u to r upon the above-mentioned property for i ection pur s.
tw nature (Applicant or Agent):
C 1
Application Number . . . . . 11-00001051
Permit . .
. RE -ROOF
Additional desc .
Permit Fee . . .
. 30.00 Plan Check Fee
.00
Issue Date . . .
. Valuation
0
Expiration Date
3/26/12
Qty. Unit Charge Per
Extension
BASE FEE
30.00
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Special Notes and
Comments
INSTALL NEW LAYER
OF.SHINGLES
(OWENS-CORNING DESERT TAN) OVER EXISTING
ROOF. R-30 INSULATION TO BE IN PLACE AT
FINAL INSPECTION.
2010 CODES.
----------------------------------------------------------------------------
Other Fees
BLDG STDS ADMIN (S B1473)
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 Compliance: Residential Reroof CF -1 R-ALT-ReRoof
D A 2-
��+ QVfAi7'X VU3
ROOFING PRODUCTS (COOL ROOFS) §151012
When the area of exterfor roof surface 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 Roof' requirements of §152(b)1 Hl, 152(b)1 HII, or 152(b)1 HILI.
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 5AbW.
Alternatives to §152(b)1 HI and §152(b)HII, Steep -slope roof (pitch > 2:12)
❑ Insulation with a thermal resistance of at least 0.85 heft •°FBtu or at least a3/4 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(f)%, or
❑ In climate zones 10, 12 and 13, with 1 ft2 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
juilding has at least R-30 ceiling insulation; or
❑ Building has radiant barrier in the attic meeting the requirements of §151(02; or
❑ Building has no duds 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 Hili, Low -slope roof ( pitch 5 2:12)
O 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 Cool Roof kriteria.
❑ Roof constructions that have thermal mass over the roof membrane with at least 25 IbAM are exempt from the Cool Roof criteria.
MOTE: If any one of the alternatives or exception is checked
products in §118(i) are not applicable. Do.not rill table below.
and
NOTE: 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.
• I certify that the energy features and performance specifications identified on this Certificate of Compliance conform to the requirements of Title 24, Parts
1 and 6 of the California Code of Regulations.
Name: l VA Signature:
/1
Company: Date:
. 2 P//
/ Z
P. :ss: License:
CitylState2ip:C l y 0 Co �c y ( j Phone: (�5 6 _ j.2_2_J 4
For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300.
Roof Slope
Product Weight Product Aged Solar Thermal 5
1 4
CRRC Product ID Number'
s 2:12 > 2:12
< 51bW 2 516W TypW Reflectance E.mittance SRI
❑
❑
❑ ❑ ❑4
❑
❑
❑ ❑ ❑4
Note: If no CRRC-1 label is available, this compliance method cannot be used, use the Performance Approach to show compliance,
1. The CRRC Product ID Number can be obtained from the Cool Roof Rating Council's Rated Product Directory at wwff cookW s o=roductstNamh.nhD
2. Indicate the type of product is being used for the roof top, Ia. sing!e-ply roof, asphalt roof, metal roof, etc.
3. 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(phw — 0.2) to obtain a calculated aged value. Where 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 htta:1Avww.enemv,ca.00v4lde241 and enter the resulting value in the SRI Column above and attach
acopy of the SRI- Worksheet to the CF -1 R.
o apply Liquid Field Applied Coatings, the coating must be applied across the entire roof surface and meet the dry mil thickness or coverag
ecommended by the coatings manufacturer and meet minimum performance requirements listed in §118(1)4. Select the applicable coating:
1(3 Aluminum -Pigmented Asphalt Roof Coating ❑ Cement -Based Roof Coating ❑ Other
NOTE: 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.
• I certify that the energy features and performance specifications identified on this Certificate of Compliance conform to the requirements of Title 24, Parts
1 and 6 of the California Code of Regulations.
Name: l VA Signature:
/1
Company: Date:
. 2 P//
/ Z
P. :ss: License:
CitylState2ip:C l y 0 Co �c y ( j Phone: (�5 6 _ j.2_2_J 4
For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300.
P.O. BOX 1504
LA QUINTA, CALIFORNIA 92247-1504 BUILDING & SAFETY DEPARTMENT
78-495 CALLS TAMPICO (760) 777-7012
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011
PROPERTY OWNER'S PACKAGE
Disclosures & Forms for Owner-Bullders Applying for Construction Permits
I WORTA r KOT%CE TO >PRQPEIi,TX OWNER
Dear Property Owner:
An. application for a building permit has been submitted in your name listing youcseif as the builder of the property
impmvements specified at
We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to make you aware of your
responsibilities and possible risk you may incur by baving 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 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.
OAR'S &9QMM%EDGNW_M AND VERIFICATION OF RWORMTEMN
DIRECTIONS: Read and initial each statement below to signify you understand or verify dtis information.
X-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 personally. 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 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 'propetty 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 record on the permit. I understand that I may protect
yself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my
own.
M4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on
its and contracts.
�5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value
of niy construction is at least five hundred dollars ($500), including labor.and materials, I may be considered an "employer
under state and federal law.
)6. I understand if I am considered an "employer" under state and federal law, I must register with the state and feden
government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemploymei
compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious fimmci
risk.
)7. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family resident
structures cannot .legally build them with the intent to offer them for sale, unless all work is performed by tic CIL;
subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is perform
under contract with a licensed general building Contractor.
1-8. 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 iWuries sustained by any subsequent owner(s) that result from any latent construction defects. in the
woriananship or materials.
9. I understand I may obtain more information regarding my obligations as an "employee' 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 (CSILB) 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
legally and financially responsible for proposed construction activity at the following address:
I. 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.
12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or chimes 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-uWxx sed 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 revonsibble for verilYm whether or not those Contractors are ptopcxly 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. Now A copy of the property owner's driver'r..tliaeexi form notar han, or
other verification acceptable to the agency is required -to be presented when the permit is issued to verify the property
owner's signature.
Signature of property owner Date: ��- /` �oi�
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 UE[&LF
Excluding the Notice to Property Owner, the execution of which I understandis 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 Authorised Agent: i✓O S �� E 2 Q /`r 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 felled out the abo
information and certify its accuracy. Note: A copy of the owners driver' icense, form notarization, or other verification
acceptable to the agency is required to be pr
ruented when th ilt ' issued to verify the property owner's signature.
Property Owner's Signature: Date:
air.#
City of: La Quints
BuIldtng a; Safety Divfsion
P.O. Box 1504,76-495 Calle Tampip
La.Quinta, CA 92253 -:(760) 777-7012
Building Permit Application and Tracking Sheet
Perinit # t
5
Project Address:
Owner's Name:.
A. P. Number.
Address: J 2 0 V Y/h z
Legal Description:
Contractor.
City, ST, Zip: Z 4
Telephone:;/
Address:
Project Descr iption:
City, ST, Zip:
C /
l N 5 !-4 L L / N /VL- W %^ FA .
Telephone:
A
OF s N / N &L•F-S o v) F -x rs T/N
State Lic. # :
City Lia M
ft• y zit
Arch., Engr., Designer.
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person:
Construction Type:. Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: % ROO # Stories: S/ jU (rd
Telephone # of Contact Person: Estimated Value of Project -+-21 300 -00
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Plan Sets
Req'd
Recd
TRACMG PERMIT FEES
Plan Check submitted Item Amount
Structural Cala.
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
2" Review, ready for correctionsrmue Electrical
Subcontactor List
Called Contact Person Plumbing
Grant Deed
Plans picked up S.M.L
H.O.A. Approval
Plans resubmitted Grading
IN ROUSE:-
''' Review; ready for correctionsAssue Developer Impact Fee
Planning Approval.
Called Contact Person
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees