BRER2015-0019LICENSED 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 and effect.
Lice Class: C39 License No.: 774482
Date: ,3 _ / Contractor: lNj�
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.).
(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 contractor(s) licensed pursuant to
the Contractors' State License Law.).
( I 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
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: _
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 sh II forthwith
comply with those provisions.
63-3- Applican't:
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 3106 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 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 information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this ci to teLl��g mentioned property for inspection purposes.
Dat `i _ /SSignature (Applicant or Agen :
N
78-495 CALLE TAMPICCI-
T D
VOICE (760).777-7125
`
FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253
COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 2/24/2015
Application Number: BRER2015-0019
Owner:
Property Address: 80122 HERMITAGE
THOMAS BRADSHAW
APN: 762230034
1990 MANDEVILLE CANYON R
Application Description: PGA WEST RES II HOA REROOF
LOS ANGELES, CA 92253
Property Zoning:
Application Valuation: $4,500.00
d
a
4 N
Applicant:
_o
Contractor:S�
WILLIAMS ROOFING
WILLIAMS ROOFING
p� S
P O BOX 391841
P O BOX 391841
0
ANZA, CA 92539
ANZA, CA 92539
z
(760)399-9394
rr-1 g
Llc. No.: 774482
—�–�
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 and effect.
Lice Class: C39 License No.: 774482
Date: ,3 _ / Contractor: lNj�
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.).
(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 contractor(s) licensed pursuant to
the Contractors' State License Law.).
( I 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
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: _
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 sh II forthwith
comply with those provisions.
63-3- Applican't:
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 3106 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 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 information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this ci to teLl��g mentioned property for inspection purposes.
Dat `i _ /SSignature (Applicant or Agen :
N
Prescriptive Certificate of Comp(lance: Residential Reroof CF-iR-ALT-ReRoc
Prolnes 612253
Climate Zone
Permit ti
u
ROOFING PRODUCTS (COOL ROOFS) §151(f)12
IWhen the area of exterior roof surface to be replaced exceeds 50% of the existing root area, or 1,000 ft`, whichever /s less, the nel,
roofing arse must meet the roofing product "Cool Roof" requirements of 5152(b)1H1, 152(b)1H/l, or 152(b)1HIll.
Check applicable alternative or exception below it the roof alteration is exempt from the roofing product Cool Roof" requirements:
❑ Cool roofs not required in Climates Zones 1-12,14, and 18 with a low sloped roof pitch (less or 2:12 pitch),
❑ Cod roofs no required in Climates Zones 1-9, and 18 with a steep -sloped roofs (greater pitch than 2:12) and product weightless than 5/Ib/l
Alternatives to §152(b)1 HI and §152(b)Hli, Steep -slope roof (pitch > 2:12)
❑ ' Insulation with a thermal resistance of at least Q85 heft-OF/Btu or at least a 314 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(})10; or
❑ In climate zones 10, 12 and 13, with 1112 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(92; or
❑ Building has no ducts in the attic; or
❑ In climate zones 10, 11, 13 and 14, R-3 or greater root deck Insulation above vented attic.
Exception to §152(b)1 Hili, 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/tt2 are exempt from the Cool Roof criteria.
NOTE: If any one of the alternatives or exception is checked the Aged Solar Reflectance and Thermal Emittance requirements for rooting
products in §118(1) are not applicable. Do not fill table below.
NATE: When a Cool Root Is required, the installing contractor shall complete and submit the CF -6R -ENV -01 for final inspection.
Declaration Statement
Roof Slope
Product Weight
Product
Aged Solar
Thermal
S
CRRC Product ID Number'
s 2:12 > 2:12
< 51b/ftz z 51b/f>z
Type'
Reflectance"Emitta
ce
SRI
❑
❑
❑°
.13
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 10 Number can be obtained from the Cool Roof Rating Council's Rat Product Oirectory at www.coolroofs.g=roductslsearch.ohQ
2. Indicate the type of product is being used for the roof top, 1, e. single -ply roof, asphalt roof, metal root, 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(p•.w - 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 httvyAvww.gnerov.ca.gQv/title24/ and enter the resulting value in the SRI Column above and attach
acopy of the SRI- Worksheet to the CF- I R.
To apply Liquid Field Applied Coatings, the coating must be applied across the entire roof surface and meet the dry mil thickness or covers
recommended by the coatings manufacturer and meet minimum performance requirements listed in §118(1)4. Select the applicable coating:
❑ Aluminum -Pigmented Asphalt Roof Coating ❑ Cement -Based Roof Coating ❑ Other
NATE: When a Cool Root Is required, the installing contractor shall complete and submit the CF -6R -ENV -01 for final inspection.
Declaration Statement
• I certity 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, Part!
1 and 8 of the California COO of Regulations.
Name:
Signature:
Compa'
D
Addrepo.
p.
License:
City/
Phone%( ,_
For assistance or questions regarding the Energy Standards, contact the Energy Hotline at. 1-800-772.3300.
'��...,��.�::FINANCiALiNP.ciRmAT.ION
E:,•>, .:. .�:.! �i 9.r 'ax , P4� ,}. .yP k.'£ t3 i. x ? (T..y -i f7C5
3;z„hACCO�UNTk.�E QTY PAID `DATE:
` .. YfeyDESCRIPTIONk b AMOUNT+ PAID
BSAS SB1473 FEE
101-0000-20306 0
$1.00 $0.00
t � ;
7 PAID BYE F k
,.E.. �t21.5 ._ n� .d':'�.ati �;�rF's�F f �, 4x5p"y� I{uE`'�r7F; �S � b ':,�i:: .•.,.: �s�r�;ir � '�'k` 4�
', iMETHOD, RECEIPTt# CIiEGK #E,E r
CLTD BY
r>
.. '3S ..
f- g
.,...e..,.....t.Fs.3...F.a'a....si8s as.e .cin,s..am....s e'�ri�n'f5.., ✓.�3Y.s...:`a--3;`�E...°�a,. ..i ..L.i ..i
Total,Paid forBUILDING STANDARDS ADMINISTRATION BSA $1.00 $0.00
.F X !'C ,l;.:.f„l
Er DESCRIPTION-
C'
ACCOUNT
:=
QTYAMOUNT,p
SY+ E:> 3
s by. S
92K '° .'.S
PAID
.
1. ''
PAIDfDATE'
3e,*m^u ax�..
.d. !'`.csw,
._......
v ,4-_�:.rt�+F.2;3.. -. ...
�%.6.:
RE -ROOF - FIRST 2,000 SF
101-0000-42404
0 :
$49.311
$0.00
a4...��
PAID BY
METHOD
Y,'&`✓7#LaX�'�a{ Y.x<�''/�, �F
#
C??4.� s, ,i n'' -
CHECK #
'C. .
CLTD BY
ksx �f
u c�,
RECEIPT
4b''
��.,..> TIONDESCRIP'
NIM `
z PAID
PAID DATE'
,.
.�i.0a�0,0g
xAMOUNT a
y`,:,' :<
RE -ROOF - FIRST 2,000 SF PC
101-0000-42600
0
$98.62
$0.00
:PAID BY g
'i4K �""* Yom' ' yv5i'�s e:�.a'd 'T •vV-T
- E
'x # f E:.
CLTD BY
aCHECK
Total Paid forRE-ROOF: $147.93 $0.00
• 00
Description: PGA WEST RES II HOA REROOF
CONDITIONS
NAMETYPE
Type: RE -ROOF
Subtype:
Status: APPROVED
Applied: 2/24/2015 MFA
Approved: 2/24/2015 MFA
Parcel No: 762230034 Site Address: 80122 HERMITAGE LA QUINTA,CA 92253
Subdivision: 28118
Block:
Lot:2
Issued:
Lot Sq Ft: 0
Building Sq Ft: 0
Zoning:
Finaled:
Valuation: $4,500.00
Occupancy Type:
Construction Type:
Expired:
No. Buildings: 0
No. Stories: 0
No. Unites: 0
OWNER
Details: REROOF NEW FOAM ON ALL FLAT DECKS ONLY 1050 SF 2013 CALIFORNIA ENERGY CODE.
LOS ANGELES
CHRONOLOGY
CONDITIONS
NAMETYPE
NAME ADDRESSI_:
CONTACTS
CITY '.
STATE
ZIP -
PHONE; :
FAX EMAIL
APPLICANT
WILLIAMS ROOFING P O BOX 391841
ANZA
CA
92539
CONTRACTOR
WILLIAMS ROOFING P O BOX 391841
ANZA
CA
92539
OWNER
THOMAS BRADSHAW 1990 MANDEVILLE
CANYON RD
LOS ANGELES
CA
92253
Printed: Tuesday, February 24, 2015 9:47:34 AM 1 of 2
LfLf SYSTEMS
PARENT PROJECTS
BOND INFORMATION
Printed: Tuesday, February 24, 2015 9:47:34 AM 2 of 2 Cm
srsrenns.
CgY�
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK #
METHOD
PAID BY
RE -ROOF - FIRST 2,000
101-0000-42404
0
$49.31
$0.00
SF
RE -ROOF - FIRST 2,000
101-0000-42600
0
$98.62
$0.00
SF PC
Total Paid for RE -ROOF: $147.93 $0.00
TOTALS:0•
PARENT PROJECTS
BOND INFORMATION
Printed: Tuesday, February 24, 2015 9:47:34 AM 2 of 2 Cm
srsrenns.
A
tsI" f
City of La Quinta
Building 8r 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:MA
Wf!S-t
RC-2wrier's
Name: PG 'Ves-r S --IL bA
A. P. Number:
Address:
��y��,,� pp
Legal Description: 5 FF t-�1rTt v t F-eR-OQ�
Contractor:IM i
City, ST, Zip:
elephone:� 4—� �j— �j Dr5 : `I2SI��eT/I�.Giyi; I
Address:
Project Description: J r F ' Z
J�3
City. ST, Zip:
Telephone: 7h( �3C C1_ 3G��1
State Lic. # : City Lic.:
Arch„ Engr., Designer:
Address:
Cit)', ST, Zip:
Telephone.
State Lic.#:
Name of Contact Person: j
Construction Type: Occupancy:
Project t} pe (circle one): New Add'n Alter Repair Demo
Sq. Ft.:1655() # Stories: # Units:
r Telephone M of Contact Person: -
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
q
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 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted,
Mechanical
Grading plan
2"Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
II.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