BRER2017-0077LICENSED 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 B iness and Professions Code,
and my License is in full force and effect.
License Class- C39 License No.:821891
Date: / -7 Contractor: z
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).:
(_) 1, 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 Name:
Lender's Address:
(760)329-8500
Lic. No.; 821891
WORKER'S COMPENSATUON 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'
co *io3700
tion, as provided for by Section 3700 of the Labor Code, for the performance
ofrk for'which this permit is issued.
I have and will maintain workers' compensation insurance, as required by
Se of the Labor Code, for the' perfornance of the work for which this permit
is issued. My workers' compensation insurance carrier and policy number are:
Carrier: STATE COMPENSATION INSURANCE FUND Polity Number: 9150060
_ I certify that in the performance of ire 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 s egome subject to the
workers' compensation provisions of Section 3' o e Lab r Code, I shall forthwith
comply with those rovisions.
Date:' �� 7 Applicant)
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMIMAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FORIN 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 appliotion 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 owne4 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 tF= 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 ing to building
construction, and hereby authorize representaives of this c' t nter Pon the
above-mentio d pr erty for inspection purposes.
Date: Signature (Applicant or Age
TAUP a'""""�
VOICE (760) 777-7125
78-495 CALLE TAMP.ICO
D
FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253
DESIGN & DEVELOPMENT DEPARTMENT
INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 8/14/2017
Application Number: BRER2017-0077
Owner:
Property Address: 51910 AVENIDA VILLA
DAVID ALTENBER A r;
APN: 773183007
51910 AVENIDA VILLA --
Application Description: ALTENBERN / REROOF ENTIRE
DWELLING WITH FOAM
LA QUINTA, CA 9253 z
Property Zoning:
�? C
Application Valuation: $11,450.00
J d!
Applicant:
Contractor: c t N
PEAK ROOF MANAGEMENT INC
PEAK ROOF MANAGEMENT INC o
P O BOX 580368
P 0 BOX 580368
NORTH PALM SPRINGS, CA92258 0368
NORTH PALM SPfaNGS, CA 92258-0368s .
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 B iness and Professions Code,
and my License is in full force and effect.
License Class- C39 License No.:821891
Date: / -7 Contractor: z
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).:
(_) 1, 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 Name:
Lender's Address:
(760)329-8500
Lic. No.; 821891
WORKER'S COMPENSATUON 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'
co *io3700
tion, as provided for by Section 3700 of the Labor Code, for the performance
ofrk for'which this permit is issued.
I have and will maintain workers' compensation insurance, as required by
Se of the Labor Code, for the' perfornance of the work for which this permit
is issued. My workers' compensation insurance carrier and policy number are:
Carrier: STATE COMPENSATION INSURANCE FUND Polity Number: 9150060
_ I certify that in the performance of ire 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 s egome subject to the
workers' compensation provisions of Section 3' o e Lab r Code, I shall forthwith
comply with those rovisions.
Date:' �� 7 Applicant)
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMIMAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FORIN 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 appliotion 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 owne4 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 tF= 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 ing to building
construction, and hereby authorize representaives of this c' t nter Pon the
above-mentio d pr erty for inspection purposes.
Date: Signature (Applicant or Age
Date: 8/14/2017 ^
Application,Number: .BREP2017-0077
Owner:
Property Address: 51910 AVENIDA VILLA
DAVID ALTENBERN A
APN: 773183007
51910 AVENIDA VILLA
Application Description: ALTENBERN / REROOF ENTIRE DWELLING WITH FOAM
LA QUINTA, CA 9253
Property Zoning:
Application Valuation: $11,450.00
Applicant:.
Contractor:
PEAK ROOF MANAGEMENT INC. '
PEAK ROOF MANAGEMENT INC
P O BOX 580368
P.0 BOX 580368
NORTH PALM SPRINGS, CA 92258-0368
NORTH PALM SPF:INGS, CA 92258-0368
(760)329-8500
Llc. No.: 821891
Detail: REROOF FLAT ROOF WITH FOAM [CRRC: 0620-0022] 2016 CALIFORNIA ENERGY CODE.'
O•
:'r• 'DESCRIPTION ACCOUNT QTY AMOUNT :.
BSAS SB1473 FEE 101-0000-20306
0 $1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
RE -ROOF - EA ADDITIONAL 1,000 SF
101-0000-42404
0
$12.16 .
DESCRIPTION
ACCOUNT ' _
-QTY
AMOUNT
RE -ROOF - FIRST 2,000 SF
101-0000-42404
.0
$51.68
DESCRIPTION
ACCOUNT
QTY
AMOUNT
RE -ROOF - FIRST 2,000 SF PC
101-0000-42600
0
$103.36
Total Paid for RE -ROOF: $167.20
DESCRIPTION
iACCOUNT
'QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00 .
STATE OF CALIFORNIA
Prescriptive, Residential Alterations That Do. Not Require HERS Field Verification
CEC-CF1 R -ALT -05-E Revised 04/16 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CFIR-ALT-05-E
Prescriptive Residential Alterations That Do Not Require HERS Field Verification Page.1 of 3
Project Name: Date Prepared:
This compliance document is only applicable to simple alterations that do not require HERS verification for compliance. When HERS verification is required, a CFSR-ALT- 01 shall first be registered
with a HERS Provider Data Registry.
Alterations to Space Conditioning Systems that are exempt from HERS verification requirements may use the CFIR-ALT-05 and CF2R- ALT -05 Compliance Documents. Possible exemptions from duct
leakage testing include: less than 40 ft of ducts, were added or replaced. or the existing dart syctPm wns inrrrintPrl with-f-beEter or tha existing duct system wos prcviously tested wrd pulsed by u
HERS Rater. If space conditioning systems are altered and are'not exempt from HERS verification, then a CFIR-ALT=02 must be completed and registered with a HERS Provider Data Registry.
Alterations that utilize close Cell Spray Polyurethane Foam (ccSPF) with a density of 1.5 to less than 2.5 pounds per cubic foot having an R -value other than 5.8 per inch,. or Open Cell Spray
Polyurethane Foam (ocSPF) with o density of 0.4 to less than 1.5 pounds per cubic foot having an R -value of 3.6 per inch, shall complete and register a CFIR-ALT-01 with o.HERS Provider Data
Registry.
If more than one person has responsibility for installation of the items on this certificate, each person shall prepare and sign a certificate applicable to the portion of construction for which they are
responsible. Alternatively, the person with chief responsibility for construction shall prepare and sign this certificate for the entire construction. All applicable Mandatory Measures shall be met_
Temporarylabels shall not be removed before verification by the building inspector.
A. General Information
01
Project Name:ji&L
- /
'V�
02
Date Prepared:
03
Project Location:
,
04
Building Front Orientation (deg or cardinal):
Y�
OS
CA City:
06
Number of Altered Dwelling Units:
07
Zip Code:
08
Fuel Type:
09
Climate Zone:
10
Total Conditioned Floor Area
11Building
Type:
12
Slab Area (ftZ)
�NGLtG S
13
Project Scope (Select all that apply):
Fl. B. Insulation
D. & E. Fenestration/Glazing - ADD
Q G. Space Conditioning System. (Heating, Cooling, Duct system),
Q Lighting
Q✓ C. Roof Replacement F D. & F. Fenestration/Glazing - REPLACE H. Water Heating System .. Include Mandatory Measures?
CA Building Energy Efficiency Standards - 2016 Residential Compliance
April 2016
STATE OF CALIFORNIA
Prescriptive Residential Alterations That Do Not Require HERS Field Verification
I - FAMIM16-t
CEC-CFIR-ALT-05-E (Revised 04/16) CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CF1R-ALT-05-E
Prescriptive Residential Alterations That Do Not Require HERS Field Verification Page 2 of 3
Project Name: Da[e Prepared: Zt/ 7
C. Roof Replacement (Prescriptive Alteration, Section 150.2(b)1H)
01
02
03
04
05
06
07
08 09 10
11
12
13
Proposed
Minimum Required
R -value
Method of
CRRC Product
Product
Deck
Initial Solar
Aged Solar
Thermal
SRI
Aged Solar
Thermal
SRI
Compliance
Roof Pitch
Exception
ID Number
Type
Insulation
Reflectance
Reflectance
Emittance
(Optional)
Reflectance,
Emittance
(Optional)
:- Add AoW
Delete Row'
NOTES:
• Roof area covered by building integrated photovoltaic panels and solar thermal panels are exempt from the above Cool Roof requirements.
• Liquid field applied coatings must comply with installation criteria from Section 110.8(i)4.
CA Building Energy Efficiency Standards - 2016 Residential Compliance I -N April 2016
01
STATE OF CALIFORNIA
Prescriptive Residential Alterations That Do Not Require HERS Field Verification
CEC-CFIR-ALT-05-E Revised 04116 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CF1R-ALT-05-E
Prescriptive Residential Alterations That Do Not Require HERS Field Verification Page 3 of 3
Project Name: �4�le - Date Prepared •' /
DOCUMENTATION AUTHOR'S DECLARATION STATEMENT
1. 1 certify that this Certificate of Compliance documentation is accurate and complete.
Documentation Aut Na e: 1
Documentation Auth r Sign ur
Company:
Sienabirrnate-
Address:
CEA/ HERS Certification dentifica on (if applicable):
-
City/State/Zip:
Phone:
RESPONSIBLE PERSON'S DECLARATION STA EMENT
I certify the following under penalty of perjury, under the laws of the State of California:
1.. The information provided on this Certificate of Compliance is true and correct.
2. 1 am eligible under Division 3 of the Business and Professions Code to accept responsibility for the building design or system design identified'on this Certificate of Compliance (responsible
designer).
3. That the energy features and performance specifications, materials, components, and manufactured devices for the building design or system design identified on this Certificate,of
Compliance conform to the requirements of Title 24, Part 1 and Part 6 of the California Code of Regulations.
4. The building design features or system design features identified on this Certificate of Compliance are consistent with the information provided on other applicable compliance documents,
worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with this building permit application.
5. 1 will ensure that a registered copy of this Certificate of Compliance shall be made available with the building permit(s) issued for the building, and made available to the enforcement agency
for all applicable inspections. I understand that a registered copy of this Certificate of Compliance is required to be included with the documentation the builder provides to the building
owner at occupancy. .
Responsible Designer Name:
Responsible Designer Signature:
.l1Gd
d�
Company:
Date Signed'
Address:
License:
City/State/Zip:
Phone:
For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300.
CA Building Energy Efficiency Standards - 2016 Residential Compliance April 2016
Bin#
t ,'�
♦ . City of La.Quinta
r
Building & Safety Division
, -
, 78-495 Calle Tampico
Permit#
La Quinta, CA 92253 -- (760) 7774012
�
Building Permit Application and Tracking Sheet
Project Address:
er'.s Name:
A? . umber
' .
�dress: r D Al % L�
Ial Description:
(QityT,
Zip: ^
;
@o�actor:
it
Telephone Dlid
8 01M
Address: if
,� (Koje
ct Description: '
Ctyf.-,ST; Zip:/V
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TyeIephone:
tate Lic..#: /
City Lie #:
Arch, Engr., Designer:
Address
}
City, ST, Zip:
Telephone: r
Construction Type:
Proj. Type I New Add'n
Occupancy:
Alter Repair Demo
State Lie. #:.
Janie of Contact:Ay�
SqF=tom' yDd
#Stories
# Units:
�- Iepho a of Contact:
`Esti�at`ed,Val
of Ps ' Ga77
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Y
APPLICANT: DO NOT WRITE BELOW THis UNE
#
Submittal
Req'd '
Rec'd .
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 Ch=k Balance:
-
Title 24 Calcs
Plans Picked Up
Construion:
Flood Plain Plan `,
Plans Resubmitted,
Mechanical:
;
Grading Plan
2nd Rev, Ready for corrections /
Electrics:
Subcontractor List
Called Contact Person
Plumbing:
Grant Deed ,
Plans Picked Up `
S.M.I.
HOA Approval
Plans Resubmitted t
Grading
IN-HOUSE
3rd Rev, Ready for corrections /
1t41
Developer Impact Fee
Planning Approval
Called Contact Person `f
A.I.P,P.
r
Pub. Wks. Apps
Date of permit issue';
A
School Fees
Total Permit Fees
,
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, -
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