10-1266 (RR)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 10-00001266
Property Address: 51485 CALLE GUATAMALA
APN: 770-162-006-90 -28470
Application description: RE -ROOF
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 5000
Td�v 4 4 Q"
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 1 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 a is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
any a cant fora permit subjects the applicant to a civil penalty of not more than five hundred dollars 1$500).:
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 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 contractorls) licensed
pursuant to the Contractors' State License Law.).
( 1 I am exempt under Sec. , B.&P.C. for this reason
Date: G J I 1 If 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:
LQPERMIT
Owner:
WILLIAMS GRANT
51485 CALLE GUATAMALA
LA QUINTA, CA 53
_._.----IID).-.n
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 11/18/10
Contractor:
Owner
_o7 pulh
/'C'.try- i , ��, 0!
-------------------------- ---- ;--..- - - - - --
WORKER'S COMPENSATION DECCL'AR 176AL1
I hereby affirm under penalty of perjury one of thefollowing 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 become subject to the workers' compensation laws of California,
and agree that, if I should become subject to the workers' compensation provisions of Section
3700 of the Labor Code, I�shaa forwithcomply with those provisions.
Date: 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 ($100,000). 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 abo information i orr 1 agree to comply with all
city and county ordinances and state laws relating to buildin nstruction, y authorize representatives
of this county to enter upon the above-mentioned property ins a ion es.
Date: 44S 4 0 Signature (Applicant or Agent): _
Application Number . . . . . 10-00001266
Permit . .
. RE -ROOF
Additional desc .
Permit Fee . . .
. 30.00
Plan Check Fee
.00
Issue Date
Valuation . . .
. 0
Expiration Date
5/17/11
Qty Unit Charge
Per
Extension
BASE FEE
30.00
----------------------------------------------------------------------------
Special Notes and
Comments
RE- ROOF PERMIT SHASTA WHITE (CRRC#
0890-002) APPROVED
PER A.J.
----------------------------------------------------------------------------
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
P.O. Box 1504
LA QUINTA, CALIFORNIA 92247-1504
78-495 CAI;LE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
PROPERTY OVMER' S PACKAGE
(760) 777-70.12
FAX (760) 777-7011
Disclosures, & Forms, for Owner-Bullders Applying for Construction Permits
I.IFM_TA V NOTICE TO V IPER OWNER
.. Dear Property Owner:
-An. application for a building permit has been sqbj tted your {game listirig yourself as the builder of the .property
-improvements specified at �) '- C j Q. LrI,y��
•Vk1e are Providing you with an Owner -Builder Acknowledgment and Information-Verification.Form to make you awne.of your
eesonsibilities and possible risk -you may incur by having this -permit -issued m your name as the
Owner -Builder. We will not issue a building permit until yowhave read, initiated 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 Mice
unless you, the property owner, obtain the prior approval of the permitting authority.
OVA'S ACI{NRwLEDGMNT AND NE> CATION OF MKORRI UATT#3N
i3&ECUONS. head and initial eachstatement befow-to signer you understandervddit this information.
�. 1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "owner-Bumee,
building permit that erroneously implies that the property owner is providing his. or her own labor and material person &y. 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 insurancemay 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 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
yself from potential financial risk by hiring a licensed Contractor and having the permit fled in his or her name instead of my
own.
4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on
permits and contracts.
4 5. 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 "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 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 residential
structures cannot .legally build them with the .intent. to offer them for sale, unless all work is performed by 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.
akz 6\4 "
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_ 4.uries sustained by any subsequent owner(s) that result from any latent construction defects in the
workmanship or materials.
k
I understand I may obtain more information regarding my obligations as an "employer" from the Internal. Rtvmue
e, 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.csib.ca.gov for more information about licensed contractors.
t10. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the
y- legally' and financially responsible . for proposed construction activity at the following address:
1 1. I agree that, as the party legally and fjnaucially responsible for this proposed.construction activity,.i will abide by all .
applicable laws and requirements that govern Owner -Builders as well as employers.
l2. I agree to notify the issuer of this. form immediately of any additions; deletions, or chAnW 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 finaneial. loss .
you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in'civit court- It is, also
important for your to understand that if air unlicensed Contractor or employee of that individual or firm is injured while worming
on your property; you may be held liable for damages. If you obtain'a permit as Owner -Builder and wish to We Contractors,
You will be .responsible for verifying whether or not those Contractors are properly licensed and the status of their wo&ers'
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 issultug; tLs..M.ni t. llfote: A copy of dw property owner's didver.'sll wtsei farm nota*atbn9 or
other verification acceptable too the agency is required to be presented when the permit is issued to verify the property
owner's signature. '
Signature of property ownerEV Date: N o `i
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 BEHALF
Excluding.the Notice to Property Owner, the execution of which 1 understand is my personal responsibility, I hereby authorize
the following person(s) to act as my ageat(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): 9
Project Location or Address. 5- 1 L+ 9,S/ l °`� r e "U -t 4a `,- 0- l
Name of Authorized Agent: 6 ��. W l 1 ^ 0. �`^ �' Tel
Address of Authorized Agent:
I declare under penalty of perjurythat 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 driver's license, form notarization, or other verification
acceptableto the agency is requi d to a presented when the permit is issued to verify the property o er's signature. .
Property Owner's Signature: Date:
of Coni
rojectAddress: S-/qos—Ca
1 r
W
ROOFING PRODUCTS (COOL ROOFS) 5151012
-Reroof -- -- -
- CF RR=ACT -ReRoof
Climate Zone Permit #
When the area of exterior roof surface to be replaced exceeds M of the exMng roof area, or 1,000 ft, whichever Is less, the new
.roofing area must meet the roofing product "Cool Roof" requirements of §152(b)1 Hl, 152(b)l Hii, or 152(b)MIN.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, anis 16 with a low sloped roof pitch (less or 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 511
W.
Alternatives to §152(b)1Ht and §152(b)Hlt, Steep -slope roof._(pitch > 2:12)
❑ insulation with a thermal resistance of at least 0.85 fir-fe-T/13tu 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
❑ 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(f)2; or
❑ Building has no duds in the attic; or
❑ In climate zones 10,11,13 and 14,11-3 or greater roof deck insulation above vented attic.
Exception to §152(b)l Hill, Low -slope roof ( pitch 5 2:12)
❑ Building has no ducts in the attic.
Other Exceptions
❑ Roofing area is covered by building integrated ovoltaic_panels-and solar thermal panels are. exempt from the Coot Roof ait�ia.
❑ . Roof constructions that have thertnal mass over the roof membrane with at least 25 Un"are exempt from the Cool Roof criteria..
NOTE., If any one of the altematives or exception is checked the Aged Solar Reflectance and
products in §118(i) are not applicable. Do not fill table below.
for mooing
NOTE: when a k;ool KOOr is requlreo,. the Installing contractor snail complete.and submit the ut--6K-trvv-vi for final ulaverufurl.
Declaration Statement
• I certify under penalty of perjury, under the laws of the State of Calffomia, 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
1 and 6 of the California Code of Regulations.
Name:A Signatu -
Comoanv: Date:
P :ss: 5 1 -t 0-f CQ i (• c�
License:
' c;ttyi5tateiup:L, A � ^�. t� t'ttone2k b .�
For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300.
Roof Slope
Product Weight
Product I Aged Solar Thermal
S
CRRC Product ID Number'
s 2:12 > 2:1
< NMI? i 5lblflz
Type? ReftedancW'4. Emittance SRI
O
❑
❑
❑
❑4
❑
❑
❑
0
❑4
Note. If no CRRC-1 label is available, this compliance method cannot be used, useVw Pezfimnance Approach to show compliance,
1. The CRRC Product ID Number can be obtained from the Cool Roof Rating Council's Rated Product Directory at www.coohaofs•ordnroducrs/search.aho
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 ReBectence is not available in the Cool Roof Rating Couna's Rated Product Directory then use the Initial Reflectance value from the same
directory and use the equation (0.2+0.7(phm - 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 hffDY_Ai".enemv.ca.poY4Ve24l and enter the restating value in ft SRI Column above and attach
acopyof the SRI- Worksheet to the CF -1R.
To apply Liquid FIeld.Applied-Coatings ,the coating must be applied across_the_enfki� _=f surface and meet -the dry mil thickness or oovera4
by-the-coatings-manufadurer and meet minimum performance requirements listed in §118()4. Select the applicable coating:
rcommended
E3 Aluminum -Pigmented Asphalt Roof Coating ❑ Cement -Based Roof Coating E3 Other
NOTE: when a k;ool KOOr is requlreo,. the Installing contractor snail complete.and submit the ut--6K-trvv-vi for final ulaverufurl.
Declaration Statement
• I certify under penalty of perjury, under the laws of the State of Calffomia, 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
1 and 6 of the California Code of Regulations.
Name:A Signatu -
Comoanv: Date:
P :ss: 5 1 -t 0-f CQ i (• c�
License:
' c;ttyi5tateiup:L, A � ^�. t� t'ttone2k b .�
For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300.
Bin #
Oty of La Quinta
Building 8L 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: , GN ,�
Owner's Name: Q —&1
A. P. Number:
Address: 6-1 ey e G
Legal Description:
City, ST, Zip:
Contractor:
Address:
y2�' r<z
telephone:
Project Description: Re-
CCity,
City,ST, Zip:BF
ZFi
Telephone:
mw
State Lie. # :
City Lie. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:.y�x
x
c N; 'ti..
Construction Type: Occupancy:
State Lie. #:
Project type (circle one): New Add'n Alter CRe!R Re!'Demo
Name of Contact Person:
Sq. Ft.: f/opQ
I # Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project: O
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
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 Check Balance.
Title 24 Cales.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
Zed 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:-
3'd Review, ready for correcdons/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