BRER2014-1033LICENSED 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 Professions Code,
and my License is in full force andeffect.
License Class: License No.:.LIC_010477
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.).
(_) 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
Date:
Owner:
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 Na
Lender's Add
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of tie following declarations:
_ 1 have and will maintain a certificate of consent to self -insure for workers'
co7603700
, as provided for by Section 3700 of the Labor Code, for the performance
of r which this permit is issued.
ave and will maintain workers' compensation insurance, as required by
Seof the Labor Code, for the perforrrance 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 t6 a work for which this permit is issued, I
shall not employ any person in any manner so a; 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 37JO,�f fh Labor Code, I shall forthwith
comply with t se provisions. /
Applicant: ,
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 ($100,00C). 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 Building Official 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 perform ?d under or pursuant to any permit
issued as a result of this application , the owne •, and the applicant, each agrees to, and
shall defend, indemnify and hold harmless the --ity of La Quinta, its officers, agents, and
employees for any act or omission related to tl-e 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 cancel ation.
I certify that I have read this application and st ste that the above information is correct.
I agree to comply with all city and county ordinances ands s relating to building
construction, and hereby authorize representaeives of s city to ter on the abo -
yet,ned roperty f r inspection purposes.!r�v Signature(Applicant:o gent)��
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,
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78-495 CALLE TAMPICO
D U 4 Qum&
VOICE (760) 777-7125
LA QUINTA, CALIFORNIA 92253
FAX (760) 777-7011
COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 11/6/2014
Application Number: BRER2014-1033
Owner:
Property Address: 79875 WESTWARD HO DR
DAVID GRAU
APN: 600050009
29875 WESTWARD DR
Application Description: REROOF WITH GAF ARTIC WHITE SHINGLE CRRC: [CRRC 0676-0089]
LA QUINTA, CA 92253
0
Property Zoning:
Application Valuation: $6,100.00
Z c, Z
'
M� D
Applicant:
;Contractor:
PALM SPRINGS CARRIAGES
PALM SPRINGS CARRIAGES
m p
0 OUTSIDE CITY LIMITS
0 OUTSIDE CITY LIMITS
o z No .
LA QUINTA, CA 92253
LA QUINTA, CA 92253
n n :F,.
(760)364-4430
z t�
Llc. No.: :LIC -0104772
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 Professions Code,
and my License is in full force andeffect.
License Class: License No.:.LIC_010477
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.).
(_) 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
Date:
Owner:
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 Na
Lender's Add
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of tie following declarations:
_ 1 have and will maintain a certificate of consent to self -insure for workers'
co7603700
, as provided for by Section 3700 of the Labor Code, for the performance
of r which this permit is issued.
ave and will maintain workers' compensation insurance, as required by
Seof the Labor Code, for the perforrrance 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 t6 a work for which this permit is issued, I
shall not employ any person in any manner so a; 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 37JO,�f fh Labor Code, I shall forthwith
comply with t se provisions. /
Applicant: ,
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 ($100,00C). 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 Building Official 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 perform ?d under or pursuant to any permit
issued as a result of this application , the owne •, and the applicant, each agrees to, and
shall defend, indemnify and hold harmless the --ity of La Quinta, its officers, agents, and
employees for any act or omission related to tl-e 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 cancel ation.
I certify that I have read this application and st ste that the above information is correct.
I agree to comply with all city and county ordinances ands s relating to building
construction, and hereby authorize representaeives of s city to ter on the abo -
yet,ned roperty f r inspection purposes.!r�v Signature(Applicant:o gent)��
i
1
FINANCIAL .• /•
DESCRIPTION' .
•ACCOUNT QTY t
AMOUNT t PAID < : DATE
,�
s'
; rPAID
BSAS SB1473 FEE
101-0000-20306 0,
$1.00
$0.00
'hPAID BY '+ f � _'
METHOD :. �} ,, RECEIPT # `-CHECK # ''}_" ,CLTD' BY
y
f.
Total Paid forBUILDING STANDARDS ADMINISTRATION BSA $1.00
$0.00
DESCRIPTION
S•
�.
~ AMOUNT
�''
t"` PAID
PAID"`DATE
_ _ s..
z.
,.
c.-
r.- _
RE -ROOF - EA ADDITIONAL 1,000 SF
101-0000-42404,
0
$23.20
$0.00
s
-PAID BY
Y
'�METHOD" . _
�'�
�. /
RECEIPJ"#
CHECK# -
° CCTD BY'
-
r W
-
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�,.. '-' DESCRIPTION FF, 4 '. z
' ACCOUNT t ;..
QTY
"AMOUNT.µ 3
-" PAID � F�
PAID DATE
t"'
,
RE -ROOF - FIRST 2,000 SF
101-0000-42404
0
$49.31
$0.00
PAID BYRECEIP",T*#
'CHECK # _
CCTD.BY.
3.
w
Y h =y � DESCRIPT,ION µ',Vi f ;' u
fsk--:'A000UNTI ' "`
"'QTY
4 : "AMOUNT n:
wi : PAID - "
PAID DATE
.. # .y
RE -ROOF - FIRST 2,000 SF PC
101-0000-42600
0
$98.62
$0.00
METHOD x
r, '•RECEIPT #
`CHECK #
4CLTD BY'•
,
Total Paid forRE-ROOF: $171.13
$0.00
TOTALS:•
••
1
-
'�OF'['N� s^ .. ..�#.� a�i^-'.;�.�Ci. .SXR'.+•�2�3 .f. � 3'7'�yy�+. K +_':"�a��.,`� U' - �� .. x.�.,.. ��Ily
Description: REROOF WITH GAF ARTIC WHITE SHINGLE CRRC: [CRRC 0676-0089]
Type: RE -ROOF
Subtype: Status: APPROVED
Applied: 11/6/2014 SKH
Approved: 11/6/2014 SKH
Parcel No: 600050009 Site Address: 79875 WESTWARD HO DR LA QUINTA,CA 92253
Subdivision: TR 2190
Block: Lot: 9
Issued:
Lot Sq Ft: 0
Building Sq Ft: 0 - Zoning:
Finaled:
Valuation: $6,100.00
Occupancy Type: Construction Type:
Expired:
No. Buildings: 0
No. Stories: 0 No. Unites: 0
Details: REROOF WITH LIGHT -WEIGHT -GAF ARTIC WHITE SHINGLE- CALIFORNIA MISSION BLEND COLOR [CRRC: 0676-0089] 2013 CALIFORNIA
ENERGY CODE
F
� J Appnes to Approves ..►„ r� � �.,
ADDITIONAL
y
CONDITIONS
Printed: Thursday, November 06, 2014 2:18:52 PM
1of2 _
SYSTEMS
. ,
'
PARENT PROJECTS
REVIEWS
—, '
.
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-
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.
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_
BOND INFORMATION
ATTACHMENTS
` .
Printed: Thursday, November 06, 2014 2:18:52 PwZ ofZ � ' .
' CBmwW,ore^
. .
-
di -
RE -ROOF - EA
101-0000-42404
0
$23.20
$0.00
ADDITIONAL 1,000 SF
RE -ROOF - FIRST 2,000
101-0000-42404
0
$49.31
$0.0b
SF
RE -ROOF - FIRST 2,;;TF
101-0000-42600
0
$98.62
$0.00
SF PC
Total Paid for RE -ROOF: $171.13 $0.00
TOTALS: $172.13 $0.00
. ,
'
PARENT PROJECTS
REVIEWS
—, '
.
�
-
`
^
. . ' . .
.
.
_
BOND INFORMATION
ATTACHMENTS
` .
Printed: Thursday, November 06, 2014 2:18:52 PwZ ofZ � ' .
' CBmwW,ore^
. .
-
#
city. Of .%d Qu%��d.
Bulklipg 8t Safety Division
P.O. Box 1504,78-495 Calle Tampico
La.Quinta, CA 92253 -:(760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: / O W C J /L' Owner's Name:.
A. P. Number. Address: .
Legal Description: • . City, ST, Zip:
,q
Contractor. /oQ ✓ , U Telephon UU
6/7o
Address:( Project Description:
City, ST, Zip: ' . v e Q
Telephone U6�2
76
State Lie. # : ` tf City Lie. #: Q
Arch, Engr., Designer i y4
�✓
Address: `�
City., ST, Zip:
Telephone:.
Y Construction Typ Occupancy:
State Lie. #: `W�... � y,�`�,. Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:Sq. Ft : #Stories: #Units:
Telephone # of Contact Person: Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd'Ree'd
TRACENG
PERMIT FEES
Plan Sets
PIan Cheek submitted
Item
Amount
Stmdural Cales•
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Calcs•
Called Contact Person
Plan Check Balance
Title 24 Cales.
Plans picked up
Construction
Flood plain plan
Plans resubmitted.'.
Mechanical
Grading plan
2i4 Review, ready for correctionstissue
Electrical
Subeontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.L
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'"' Review; ready for correctiouslissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
STATE OF CALIFORNIA
RESIDENTIAL ALTERATIONS
CEC-CF1 R -ALT -01-E (Revised 06114)
CERTIFICATE OF COMPLIANCE
Prescriptive Residential Alterations,
Proiect Name:
Date P
CALIFORNIA ENERGY COMMISSION =
CF 1 R -ALT -01-E
(Paee 1 of 41
A. GENERAL INFORMATION
01
02
01
Project Name:
02
Date Prepared:.
03
Project Location: 0
e 04
Building Front,O ieniation(deg or cardinal):
05
CA City: (2% 4
06
Number of Al`ter`ed Dwelling Units: #�\
07
Zip Code:
08
Fuel Type:qzs"P�'
T G'
Climate Zone:
10
To tal,Qondifio'ned Floor A�ea'((t2):>
i09
11
Building Type
12
SIab�Area-(ft2) +A`v
13
Project Scope: I
I _
((' ..
B. BUILDING INSULATION DETAILS (Section 150.2(b)1) (C -A
01
02
03
04
05
06 1 08, Jf'j 1L'
10"
11
Tag/ID
Assembly Type
Frame
Type
Frame
Depth
(inches)
Frame
Spacing
(inches)
oPropo ed t.%#
Required
I Comments
O 4O`rpendixJA4
J►,Continuous "` Reference
Cavity Insulation
R -value R -value Of'j > Ll-, or Table. Cell
LI -Factor
T G'
v or '4;� P "�' . ,
NOTES
• Roof area covered by b i dilintegrated p bo o
tjaic-p:neIs and solar thermal panels are exempt from the above Cool Roof requirements.
• Liquid field applletJ"'cuallrigs iiiuil LorI'Iply will>riri3tallation criteria from 6ectien 110.2(i)4.
"i� )� .1'e`:i v
C. ROOF REPLACEMENT (Prescriptive Alteration, Se ti n'150.2(b)1H) �`'' `.�
01
02
03
04 05\
06
{f('6,71P 08 09 10 11 12 13
Method of
Compliance
Roof
Pith
Exception
o
CRRC443 D
kNumber „ /� oduct Tye
R -value
Deck
sula i n
Proposed Minimum Required
NInitial Solar Aged Solar Thermal . SRI Aged Solar Thermal SRI
Reflectanc —Reflectance, Emiftanc " (Optional) Reflectance Emittance (Optional)
1
/�
`6V7 :[ - Gx-,S°I 'Iw`ti ti aA
T G'
NOTES
• Roof area covered by b i dilintegrated p bo o
tjaic-p:neIs and solar thermal panels are exempt from the above Cool Roof requirements.
• Liquid field applletJ"'cuallrigs iiiuil LorI'Iply will>riri3tallation criteria from 6ectien 110.2(i)4.
Registration Number: Registration Date/Time: HERS Provider:
CA Building Energy Efficiency Standards - 2013 Residential Compliance June 2014
STATE OF CALIFORNIA
RESIDENTIAL ALTERATIONS
CEC-CFIR-ALT-01-E Revised 06/14 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CFIR-ALT-01-E
Prescriptive Residential Alterations (Page"4 of 4)
Project Name: Date Prepared:
DOCUMENTATION AUTHOR'S DECLARATION STATEMENT
1. 1 certify that, this Certificate 9KC-6-rlipliance docume n is accurate an complete. - • . �i �`
Documentation Author Name:. ��
Documentation Author Signature:
Company:
Signature Date:
Address
CEA/ HERS Certification Ideiitification'Nif applicable):
City/ v Y/ � l/ Z !i V (
V ✓
Phone: •� _ � .
RESPONSIBLE PERSON'S DECLARATION STATEMENT
I certify the following under penalty of perjury, under the laws of the State of California: t
1. The information on this Certificate Compliance is true '►
provided of and correct.
2. I am eligible under Division 3 of the Business and Professions Code to accept respo�nslblll10
tyafor the building de�s+� or system design identified on this Certificate of Compliance (responsible
designer).
3. That the energy features and performance specifications, materials, components, and manufacturdd''de5ices�for the building design or system design identified on this Certificate of
�W-A 4W
Compliance conform to the requirements of Title 24, Part 1 and Part 6 of the Calitornia Code of(Regulations. ,�,
4. The building design features features are with
or system design identified on tt i C,eertificate of Compliance consistent lie information provided on other applicable compliarice documents,'
worksheets, calculations, plans and specifications submitted to the enforcement agency' o� approval with his building permit application:
,5: ;1 will ensure that a registered copy of this Certificate of Compliance shall be made.available with the building permits) issued for the buildirig, and made available to the enforcement agency
for all applicable inspections. I understand that a regiissteredtopAof this CCertifiica,of Compliance is r��ec to be included with the documentation the builder provides to the building
owner at occupancy. aLi �4r ,l
Responsible Designer Name:
C
fRislib`vsible Designer Signature:
@�
Company . ' ` �• �. .. " ,
Dite Signed:
Address:
'6T
License:
City/State/Zip: °! ~*'
Phone:
For assistance or -questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772=3300.
Registration Number: Registration Date_ /Time: HERS Provider:
CA Building Energy Efficiency Standards - 2013 Residential Compliance - June 2014 '