13-1320 (RR)kit
t 4-�'
.,P.O. BOX 1504 � ^' /� � � VOICE (760) 777-7012
78-495 C'ALLE TAMPICO -�+ - FAX (760) 777-701.1
QUINTA, CALIFORNIA -92253 „BUILDING &SAFETY -DEPARTMENT - INSPECTIONS (760) 777-7153
'y , ; ,... 1 • L ' BUILDING 'PERMIT' . "
h `. • F Date' 10/15/13
Appflbation'Number: 13-00001320... _. Owner:
• 'Property Address: .5139O �AVENIDA VILLA, ' ANGELA ZEPEDA t-
APN:L 773-103-002-12 -00000.0=• 83487 PUERTO ESCONDIDO
Application description:' RE -ROOF K r COACHELLA, 'CA -92236,. 6
t a•Yo
Property Zoning: COVE RESIDENTIAL (760) 702-9912 D q
Application valuation 7000 - - 1�q'tp.ci Zol�
~ '•? - Cont aC10f:` OGT
_ Applicant: Architect or Engineer:. Owner OF LAQUINTA -
;. - CITY CE DEPT.
FINA . - - - LICENSED CONTRACTOR'S DECLARATION - WORKER'S COMPENSATION DECLARATION • • ,.
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with ,S - 'I hereby affirm under penalty of perjury one of the following declarations:' ,i - -
Section 7000) of Division 3'of the Business and Professionals Code, and my License is in full force and effect. ' - ' I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided -
License Class: " License No.:, y for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued..,
Date: Contractor: •� 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.
OWNER -BUILDER DECLARATION - - ' • _ •M+ insurance carrier and policy number are: -
y
• I hereby affirm under penalty of perjury that Lam exempt from the Contractor's State License Law for the •., ' " � " Carrier - - - - - = - - - - - - - - - - - - - - - - -Policy Number -
- . following reason (Sec. 7031 :5, Business and Professions Code: Any city or county that requires a permit to i ��_s^`I-certify that, in the performance of the work.for. which this permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the - person in any manner so as to become subject to the workers' compensation laws of California, _
- - permit to file a signed statement that -he or she is licensed pursuant to the provisions of the Contractor's State "s• - - and agree that, if I should become subject to the workers' compensation provisions of Section
'License Law (Chapter 9 (commencing with Section 7000) of Division.3 of the Business and Professions Code) or , y ' •� ` _' 3700 of the Labor C de, all forthwith comply 'th rhos provisions. '
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by - ,R • r
• an fa plicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: -Date (Applicant
a w µ
;II'
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 - - .WARNING: FAILURE TO SECU R S' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL -
o Contractors' State License Law does not apply to an owner of property who builds or improves thereon, �s - - -SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
••!• and who does the work himself or herself through his or her own employees, provided that the ,.DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IW—, - r
-. - improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. "� L
. one year of. completion, the owner -builder will have the burden of proving that he or she did not build or - - _ +� '- a b: _a• -
/ improve for the purpose of sale.). - - �, - • - APPLICANT ACKNOWLEDGEMENT -
fl. Y I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the "
7044, Business and Professions Code: The Contractors' State License Law does riot apply to an owner of s conditions and restrictions set forth on this application. ,
• property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed ^ - 1 . Each person upon whose behalf this application is made, each person at whose request and for -
r , 7pursuant to the Contractors' State license Law.). _ - - - whose benefit work is performed under or pursuant to any permit issued as a result of this application
1 �» am exempt under Sec. _ B. .C. for this reason "- the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City r
_ _ - of La Quinta, its officers, agents and employees for any actor omission related to the work being - - -
',performed under or following issuance ' this permit. • - L '
SDate '�.OWner �- i 2.• Any permit issued as a result of thisapplicationbecomes null and void if work is not commenced •^- -
•^'` e 'within .180 days from date of issuance of such permit, or cessation of work for 180 days Will subject
C STRUCTION LENDING AGENCY ` ^ "�, permit to cancellation. - = ' • '
hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the 1 • • I certify that I have read this application and state that the above information is correct. I agree to comply with all
work for which this permit is issued (Sec. 3097, Civ: C.). - - - - -city and county ordinances and state laws -relating to building cons uction, and hereby authorize representatives r<• •�
r - - - - of this county to enter u on the above-memioned property fe ins ec ionpurposes,2 - . _
ti Lender's Name ^ a-`' - r' - - + • +
'L Date i 0.".l S_. IS ature (Applicant or Agent)' -'r
Lender's Address: - ^r+: "� n b
t'l:- .. (r a '- .� a .T' '- w -. � 'ti� -'.L J, . _ - J •� -t. • F � q,a .� � ._ ��,
P 'LQPERMIT ,i •- ; } 1 .. ^, < • _ . -. -� , r i.
Y 1 4
=Application Number .. . . . . 13=00001320
t7 Permit., _ RE -ROOF
Additional desc .
."Permit Fee. . ,48•.62
Plan Check
Fee..
.00
Issue Date
Valuation
0.
s - Expiration Date 4/13/14
. Qty Unit Charge Per
Extension
1.00 48.6200 LS MISC RE
-ROOF, 1ST 2000
SF
48.62
----------------------------------------------------------------------------
Special Notes and Comments
REROOF WITH SAME SHINGLES - [CRRC:
0676-00331 2010 .CALIFORNIA ENERGY
CODE.
Other Fees PLAN CHECK, RE -ROOF
97.24
Fee.summary Charged
Paid Credited
Due'
Permit Fee Total 48.62
.00
.00
48.62 1
Plan Check Total_ .00
.00
.00
.00
Other Fee Total 97.24
.00
00
97.24
Grand Total 145.86
.00 -
.00
145.86
_ LQPERMIT, - - _ _
_
- - •. _ _ -
�3J U
Prescriptive Certificate o Com fiance: Residential Reroof CF-IR-ALT-ReRoof
s
Project Address: __tr.
Climate one
Permit # =
1-��
Thermal
Emittance
SRI
ROOFING PRODUCTS (COOL ROOFS) §151(1)12
When the area of exterior roof surface to be replaced exceeds 50.1- of the existing roof area; or 1,000 F, whichever is less, the new
roofing area must meet the roofing product "Cool Roof" requirements of §152(b)1Hf, 152(b)1Hii, or 152(b)1Hiii.
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 5/Ib/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•ft2•°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(010; 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 .
❑ Building 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 ducts 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)1Hiii, Low -slope roof ( pitch 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.
TOTE: If any one of the alternatives or exception is checked the Aged Solar Reflectance and Thermal Emittance rebuirements for mnfinn
p,uuucrs in 9 i r afr/ are nor applicable uo not till table below.
�A
CRRC Product ID Number
Roof Slope
<- 2:12 > 2:12
Product Weight
< 5lb/ft2 >- 5lb/ft2
Product
Type 2
Aged Solar
Reflectance 3,4
Thermal
Emittance
SRI
06. C
❑
Addr ss' 2 �i h
(, License:
❑ :
El
o4
❑
❑
❑
❑
o4
0.2--)
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 /D Number can be obtained from the Cool Roof Rating Council's Rated Product Directory at www.coo/roofs ora/nroductslsearch vhn
2. Indicate the type of product is being used for the roof top, i.e. single -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(pwtw - 0.2) to obtain a calculated aged value. Where p is the Initial Solar Reflectance.
4. Check box if the Aged Reflectance is a calculated value using the equation above.
5. Calculate the SRI value by using the SRI- Worksheet at httpYAvww.energy.ca.gov/Ntle241 and enter the resulting value in the SRI Column above and attach
atopy of the SRI- Worksheet to the CF -1 R.
To apply Liquid Field Applied Coatings, the coating must be applied across the entire roof surface and meet the dry mil thickness or coverage
recommended by the coatings manufacturer and meet minimum performance requirements listed in §118(i)4. Select the applicable coating:
❑ Aluminum -Pigmented Asphalt Roof Coating ❑ Cement -Based Roof Coating ❑ Other
..v. a.. —flu" a vvw nwI w fuqurrtu, uie rnscanrng coniracior snau complete and submit the CF -6R -ENV -01 for final inspection.
Declaration Statement
• 1 certify under penalty of perjury, under the laws of the State of Calif omia, the information provided on this form is accurate and complete.
• 1 certify that the energy features and performance specifications identified on this Certificate of Compliance conform to the requirements of Title 24, Parts
I and 6 of the California Code of Regulations.
Nab � �
Signature:
O
Company: Date:
Addr ss' 2 �i h
(, License:
Cit /State ip: Phon .
Z'-3 r ��
t -or assistance or que.1tions regarding the Energy Standards, contact the Energy Hotline at: 11800-772-3300.
P.O. Box 1504
LA_QUINTA, CALIFORNIA 92247-1504 BUILDING & SAFETY DEPARTMENT
78-495 CALLE TAMPICo (760) 777=7012
LA QUINTA, CALIFORNIA 92253 FAX (760),777-7011.
PROPERTY OWNER'S PACKAGE
II IY YID -.
Disclosures & Forms for Owner -Builders Applying for Construction Permits
IMPORTANT! NOTICE TO PROPERTY OWNER
Dear Property Owner.
An application for 'a building permit has been subm� tted in our name listing yogrself as the builder of the property
improvements specified at �) S� 9 At/n s . Vt /,t= (n QuLii� 6q 9a a 53
We are providing you with an Owner -Builder Ackaowledgment'and information Verification Form to make you aware of your
responsib•tlities 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 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.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF -INFORMATION
DIRECTIONS: Read and initial each statement below to signify you understand or'verify this information.
0a1. I understand a frcquent 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:
a2. 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 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
aZ?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.
P-5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value
omy construction is at least five hundred dollars ($500), including labor and materials, I maybe considered an "employer"
under state and federal law.
46. I understand if I am considered an "employer" under state and federal law, I roust 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.
rstand under California Contractors' State License Law, an Owner -Builder who builds single-family residential
kle;�deannot legally build, them with the intent to offer them for sale, unless all work is Pe y
performed b - 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 -Builder if I sell the property for which this permit is issued, I may be held liable for any
nancial or personal injuries sustained 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 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 legally and financially responsible for proposed construction activity at the following address:
0511. 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 govem Owner -Builders as well as employers.
115 2. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I
ave 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 anunlicensed Contractor or employee of that individual or firm is injured while working
on your property, you may be held liable. am
for dages. If you obtain a permit as Owner -Builder and wish to hire Contractors,
you will be,responsible for verifying whether or not those Contractors are properly 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. Note: A copy of the property 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. 2
Signature of property owner Date:lolly
h�,
Note: The following Authorization Form is required to be completed by the property owner only when designating
an agety of the property owner to apply for a construction permit for the Owner -Builder.
AUTHORIZATION OF AGENT TO ACTON 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 person(s) to act as my agent(s) to apply for, sign, and file the docum is necessary to obtain an Owner -Builder
Permit for my project.
Scope of Construction Project (or Descriptionof Work): j
Project Location orAddress: _f5 �"(� �(v�ii�(,lLi _ I ,�I I' :.1� �� r;� t : -�a�
Name of Authorized Agent:
Address of Authorized Age
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 drivers license, form notarization, orother verification
acceptable to the agency is required to e p s ted hen the permit is issued to verify the properly
a er'sIsignature.
�(�Property Owner's Signature: Date: V.
/13
Din #
City of La .Quinta
BWiding et 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: S —! A w n irki V,
Owner's Name: 01 nnej L-
A. P. Number: — 1 C) a) — Q O a
Address: nC� lUl
Legal Description:
Contractor.
City, ST, Zip:��_DCZ L
170J-9qlD
Project Description:
z:6-�
Address:
City, ST, Zip:
Telephone:
��� ✓�• •h: , .a ,,.;/-;
..!• :ESslfAy: J -�hii,.+>%<!(.X"o s uw�.�wi
City Lic. #:
State,Lic. # :
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone: y �� •�< SyY '�
p Construction Type: Occupancy.
State Lic. #: :.::y� •v::.a �9g„;,;n Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: Sq. FL: ,?� # Stories: , # Units:
Telephone # of Contact Person: Estimated Value of Project: 001)
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING"
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Coles.
Reviewed, ready for corrections
Pian Check Deposit
Truss Coles.
Called Contact Person
Plan Check Balance
Title 24 Cala.
Plans pleked up
Construction
Flood plain pian
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