10-0148 (RR)P.O. BOX 1504.
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 10-00000148' ?
Property Address: 52165 AVENIDA HERRERA
APN: 773-223-019-8 -000000-
Application description: 'RE -ROOF
Property Zoning: COVE RESIDENTIAL
Application valuation: 1800
Applicant:
Architector 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 70001 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 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 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project ISec.
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 La1.
I—) I am exempt under Sec. , B.&P.(ftor tf is reason
Date: 4IT�` Owner:
CONSTRUVION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a cons ruction lending agency for the performance of the
-work for which this permit is issued ISec. 3097, Civ. C.). �.
Lender's Name: _
Lender's Address:
LQPERMIT
Owner:
LUIS GARCIA
52165 AVENIDA H
LA QUINTA, CA 9
Contractor: �` v
Owner
--------------
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/01/10
WORKER'S COM ENS ION DECLARATION
I hereby affirm under penalty of perjury one of the followin 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 inany manner so as be me subject to the workers' compensation laws of California,
and agree that, if 1 should b c m ubject to the workers' compensation provisions of Section
3700 of the Labor Code, I tall f hwith comply with those provisions.
Date: Applicant:
WARNING: FAILURE TO SECURE WORK RS' C M NSATION 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 ab v i formation is correct. 1 agree to comply with all
city and county ordinances and state laws relating to b 'Idin c ruction, and hereby authorize representatives
of this c un ltlo enter upon the above-mentioned prope i ct on purposes.
* Date: \ Signature (Applicant or Agent): I/
- -"r
Application Number . . . . . 10-00000148
Permit . . . RE -ROOF
Additional desc .
Permit Fee .. . . . 30.00
Plan Check Fee
.00
Issue Date . . . .
Valuation . . .
. 0
Expiration Date 8/28/10
Qty Unit Charge Per
Extension
BASE FEE
30.00
----------------------------------------------------------------------------
Special Notes and Comments
REROOF'(SHAKEWOOD - ASPHALT SHINGLE)
***R30 INSULATION EXEMPTION FROM COOL
ROOF REQUIREMENT*** CODE CASE: 10-0890
[MM] 2007 BUILDING/2008 ENERGY.
March 1, 2010 10:38:26 AM AORTEGA
----------------------------------------------------------------------------
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
Bin #
City of La Quinta
Btdfdang & Safety Div
P.O. Box 1504, 78-495 Calle Tampko
La Quanta, CA 92253 - (760) 777-7012 1`•
Building Permit Application and Tracking Sheet
Permit #
0- ONS
Project Address:
Owner's Name: tu'k S & A (-(, I Gk,
A. P. Number: .�
Address: 5Z1 5 A\P- k, Ilef ei-0-
Legal Description:
Contractor:
City, ST, zip:
Telephone: Telephone:
Project Description: —Y -o .
Address:
City, ST, Zip:
Wesos- Erni iWStlttM 4mi 'K
Telephone:
City Lie. #:
State Lic. #
'
Arch., Engr., Designer: )JA
�E • � � p t+lnr,,
Address:
City, ST, Zip: �--
Telephone: Construction Type: Occupancy:
State Lic. #: �- Project type (circle one): New Add'n Alter Repair Demo
m
Nae of Contact Person: Sq. Ft.: —# Stories: A # Units:
Telephone # of Contact Person:Estimated Value of Project: 0k,.1r.1G2..
APPLICANT: DO NOT WRITE BELOW THIS LIME
N
Submittal
Plan Seo
Req'd
Rec'd
11LACMG PERMIT FEES
Plan Check submitted I0wo Item Amount
Structural Cales.
Reviewed, ready for corrections Plan Check Deposit
Truss Cala.
Called Contact Person Plan Check Balance.
Title 24 Cala.
Pians picked up ( Construction
Flood plain pian
Plana resubmitted ' Mechanical
Grading plan
2`! Review, ready for correctionslissue Electrical
Subeontsetor List
Called Contact Person Plumbing
Grant Deed
Plans picked up S.M.L
H.O.A. Approval
Plana resubmitted Grading
IN HOUSE:-
''' Review, ready for correctioas/issue
/ Developer impact Fee
Planning Approval
Called Contact Person A.LP.P.
Pub. Wks. APpr
Date of permit Issue 3
�O
School Fees
Total Permit Fees 4
Prescriptive Certificate of Compliance: Residential Reroof CFA R-ALT-ReRoof
Project Address:
fti- s "404
Climate Zone
15
Permit # '
lip- ct ya
I ROOFING PRODUCTS (COOL ROOFS) §151(012 1
When the area of exterior roof surface to be replaced exceeds 50% of the existing roof area, or 1,000 ff; whichever is less, the new
roofing area must meet the roofing product "Cool Roof' requirements of §152(b)Mi, 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 54b/ft2.
Alternatives to §152(b)1 Hi and §152(b)Hii, Steep -slope roof (pitch > 2:12)
❑ Insulation with a thermal resistance of at least 0.85 heft-*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 am
❑ In climate zones 10, 12 and 13, with 1 ft2 of free ventilation area of attic ventilation for every
where at least 30 percent of the free ventilation area is within 2 feet vertical distance of the oof09W OF LA QUI NTA
Building has at least R-30 ceiling insulation; or BUILDING & SAFETY DEPT.
❑ Building has radiant barrier in the attic meeting the requirements of §151(f)2; or APPROVED
❑ Building has no duds in the attic; or
❑ In climate zones 10, 11, 13 and 14,.R-3 or greater roof deck insulation above vented attic. FOR CONSTRUCTION
Exception to §152(b)1 Hili, Low -slope roof ( pitch 5 2:12)
❑ Building has no duds in the attic. DATP4111VIO BY
Q:�
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 Ibiit2 are exempt from the Cool Roof criteria.
NOTE: If anv one of the alternatives or exception is checked the Aaed Snlar Reflectance and Thermal Emittance reauirements for roofrna
products in §118(1) are not applicable. Do not fill table below.
NOTE: When a Cool Roof 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
g ,�)V
,
For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300.
P.O. Box 1504
LA QUINTA, CALIFORNIA 92247-1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
PROPERTY OWNER'S PACKAGE
(760) 777-7012
FAX (760) 777-7011
Disclosures & forms for Owner -Builders Applying for Construction Permits
I.1100AZ E NOTICE TO PROPERTY OWNER
Dear Property Owner.
An. application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified at
We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to make you aware of your
responsibilities 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.
OV R'S ACKNOWLEDGMENT AND VERIFIMCATWN OF N
DfRECTIONS: Read and initial each statement below to signify you understand or verify this information.
L�) - 1. I understand a frequent 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- 1, 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 insurince coverage for injuries to workers
on my party.
Lit - 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.
1,6_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.
1, 6_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.
L-6-15. 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.
l,C _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.
t, _7. 1 understand under California Contractors' State License Law, an Owner -Builder who builds single-family residentia
structures cannot .legally build them with the intent to offer them for sale, unless all work is performed by license(
subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is perfomme,
under contract with a licensed general building Contractor.
�t'f • 8. 1 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. injuries susfiamed, by any subsequent owner(s) that result from any latent construction defects in the
workmanship or materials.
L//��
, 1,1,_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 (CS -LB) at 1-
800-321-CSLB (2752) or www.csib.ca.gov for more information about licensed contractors.
L-6 • 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:
L G` i I. I agree that, as the party legally and financially responsible for this proposed construction activity, 1 will abide by all
applicable laws and requirements that govern Owner -Builders as well as employers.
�. L'1 •
12. 1 agree to notify the issuer of this form immediately of any additions; deletions, or c.ha_nges.to any of the information I
have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you c=ontract 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 an utdicensed Contractor or employee of that individual or firm is injured while working
on your property, you may be held, liable for damages. 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 woticers'
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 issaiug; tlre.perndt; Note: A copy of the property owner's driver's Reense% form n0tarizativn; or
other verification acceptable to the cyred to be presented when the permit is issued to verify the property
owner's signature.
Signature of property owner Date: 3 1 1 ( O
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 _BEE ALF
Excluding the Notice to Property Owner, the execution of which l understand is my personal responsibility, I hereby authorize
the following person(s) to act as. my agents) 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):
Project Location or Address:
Name of Authorized Agent:
Address of Authorized Agent:
Tel No
I declare tinder 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 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.
Property Owner's Signature: Date: