11-1281 (RR)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
11-00001281
Property Address:
52630 AVENIDA HERRERA
APN:
773-294-007-17 -000000-
Application description:
RE -ROOF
Property Zoning:
COVE RESIDENTIAL
Application valuation:
3500
T,&t 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 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)•:
j) 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 _ 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 thereo and who contra s for the projects with a contractor(s) licensed
pursuant to the Contractors' State Lice s Law.)•
(_) I am exempt under Sec. , B.&P. . or this ea on
Date:Ot -O Owner. t
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: to
LQPERMIT
Owner:
ED CABRITA
52630 AVENIDA HERRERA
LA QUINTA, CA 92253
Contractor:
Owner
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 11/29/11
----------------------------------------------—
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
certify that, in the perform a of the workle
hich this permit is issued,.I shall not employ any
person in any manner so Dec a suot workers' compensation laws of California,
and agree that, if I should a ome su ject w kers' compensation provisions of Section
3700 of the Labor Code, I all f ith those provisions.
ate: Qv 1�,A066cartt:
WARNING: FAdURECURE 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, indemnity 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 work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that t hove i mati is co ect. I agree to comply with all
city and county ordinances and state laws relating to bui g con tr do d he by authorize representatives
of this county to enter upon the above-mentioned propert for in a ion pose .
atm e: `` Signature pplicant or Agent): o
Application Number . . . .
Permit . . RE -ROOF
Additional desc . .
Permit Fee . . . . 30.00
Issue Date . . . .
Expiration Date . . 5/27/12
11-00001281
Plan Check Fee .00
Valuation 0
Qty Unit Charge Per
Extension
BASE FEE
30.00
----------------------------------------------------------------------------
Special Notes and Comments
RE -ROOF WITH DUROID SHINGLES.
R-30
INSULATION TO BE VERIFIED AT
INSPECTION.
2010 CODES.
---------------------------------------------7------------------------------
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
' Project
Climate Zon
.CF-. RALT=ReRoof:
•. a
ROOFING PRODUCTS (COOL ROOFS) §151(012
When the area of exterior roof surface to be replaced exceeds SM of the existing roof area, or 1,000 fe, whichever Is less, the new
roofing area must most the rooting product "Coot Roof"requirements of §152(b)1Hi, 152(b)1Hi1, or 152(b)1H111. .
Check applicable alternative or exception below if the roof alteration is exempt from the roofing product "Cool Roof requirements::
❑ Coop roofs not required in Climates Zones 1-12,14, and 16 with a low sloped roof pitch (fess 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 511btf?
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 heft .°F/Btu or at least a 314 inch air-spaoe is added to the roof deck over an attic; or
❑ Existing ducts in the attic are insulated and seated 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 f12 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 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)1 Hill, Low -slope roof ( pitch 5 2:12)
❑ Building has no duds 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.
O Roof constructions that have therrnal mass over the roof membrane with at least 25 IbM are exempt from the Coot Roof criteria. .
NO if any one of the. altemabives or exception is checked the Aged Solar Reflectance and Thermal Emittance requirements for roofing
products in § 118(i) are not applicable. Do not rill table below.
NO When a cool Koor is required, the installing contractor shall complete and submit the CF -6R -ENV -01 for tinat inspection.
Declaration Statement
Roof Slope
Product Weight
Product
Aged Solar Thermal
CRRC Product ID Number'
S 2:12 > 2:12
< 5lbW Z 516/ft2
T 2
Reflectance" Emittance SRI
P. :ss: License:
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 ID Number can be obtained from the Coot Roof Rating Council's Rated Product Directory at www coolroofs OnybnDdycWseerch.oho
2. indicate the type of product is being used for the roof top, to. 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(pjw — 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 htfa:Aivww.enernv.ca•oovrtitle24/ and enter the resulting value in the SRI Column above and attach
acopy of the SRI- Worksheet to the CF -IR.
To apply Liquid Fleld.Applied Coatings, the coating must be applied across the entire roof surface and meet the dry ml thickness or coverag
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
NO When a cool Koor is required, the installing contractor shall complete and submit the CF -6R -ENV -01 for tinat inspection.
Declaration Statement
• I certify 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 Certificat f comp ' ce to the requirements of Title 24, Parts
rnff,n
rand 6 of the California Code of Regulations.
Name:
Signature:
6
Company: Date:
N 2�1
P. :ss: License:
CitylStatelZip: Phone:
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 OWNEW S PACKAGE
(760) 777-7012
FAX (760) 777-7011
Disclosures & Forms for Owner-Bailders Applying for Construction Pelrmits
°.� TANTI MQTICE To �ItC�gSI�1"l� OWNB.II
Dear Property Owner.
An. application for a building permit has been submitted m your name listing yourxdf as the build" of the property
imnents specified at
We are ptviding you with an Owner -Builder Acknowledgment and. in ematkm `texifieution Forth to wakt YW avrana of Yaw
des and possible nsk you may intern by having this permit, issued_ its your naw as the
Owner -Builder. We w% not issue a bUlldjag.µermit Until yw4mve: read, initialed your uftdt sdWg of esti► 4►c'svWon,
signed, and returned this form to us at our official address indicated. An agent of the owner cwt tae mile 63ts_nottee
unless you, the property owner, obtain the prior approval of the permitting authority.
Read arm iYrittial earA statearent &CI#W eb signify you wdd¢rstc nd or very dia utfon"aErvrr.
L1 I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Buik W
ding permit that erroneously implies that the property owner is providing his or her own tabor and material pmmtmafiy. I, as
an Owner -Builder, may be held liable and subject to serious financial risk for any injVjies sustained by an unliaased petsoc
and his or her employees while working on my prey. My homeowner's insivaacc may Got plovtdo coverage for dmm
injuries. l am willfully acting as an Owner -Builder and am aware of the limits of my inb MWc-covMge for injuries to workaex
MY,7:d
-
tand building permits are not required to be signed by property owners unless they are respom*k for th
constructand ars not hiring a licensed Contractor to assume this tvvoustbility.
1 I understand as an "Owner -Builder" I am the responsible party of record on the permit- I understand tfsat I may prole
myself from potential financial risk by hiring a licensed Contractor and having the permit fled in his or her name; instead of in
4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers
uts and contracts.
JL5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total v
of my construction is at least five hundred dollars (5500), including labor and materials, I may be considered an "empl6
Rmder state and federal law.
6. l understand if I am considered an "employer" under state and Mend law, I must register with the state and fe
government, withhold payroll taxes, provide workers' compensation disability in,uranoc, and contribute to MWVlol
compensation for each "employee." I also understand my failure to abide by these laws may subject me to sen°us fm
risk-
7.-1 understand under California Contractors' State License Law, an Owner -Builder who builds single-family resin
strictures cannot legally build them with the intent to offer them for sale, unless all worts is performed by li
subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is per
under contract with a licensed general building Contractor.
8. Lundehland'as an Owner -$wilder: if•I sell the propeity.fbt which this permit is issued,' Lmay, be held liable for•.any: "
anciil or personal. ijnries sus4alnod by any subsequent' owaet(s) •that result from any latent `construction defects in. the
Ferwc
nship or materiels.. .
understand d may obtain -more information regarding.. my obligations as au "employer". from►,d&. L*%val'Revenuer:
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 (CSM at 1-.
800-321-CSLB (2752) or www.cslb.ca gov for more information about licensed contractor's. .
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 CSPI sible for proposed constriction activity. 'at the following address:
agree that, as the party legally and finamially responsible for this proposed construction activity, h will abide by all
table laws and requireatents that govern Ow'nex-Builders as well as employers.
12. 1 agree to notify the issuer of this form immediately of any additions; deletions, or cls tQ �y of the infarmati<m 1
lav vided on this form.. licensed contractors are regulated by taws designed to protect the public. If you contract with
someone who does not have a license, Eire Contractors' State Lioense Board WAY be unable to assist You with any 8naneid toss
you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be invivil nowt. It is also
important for you to u nderstttnd dM if sur ualioeasod Centreaor or eaVloyte of that individual or film is injured while woddag
on your Property, you may be Add l for damagm if you obtain a permit as Ovi -Builder and wixh to him Cont0etots,
you wdl be rho for vedfjiog or not those Counactom are properly fieensed and the status of 6166 wo&CW
mon instuance ooverago.
Before a building permit cora be issued, this form mast be completed and signed by the property owner sad returned to
the agency responsible for Und ft &* #w=tL Nota: A copy of Eta p vp" *wow's 6irev-s &Omwf fgm rS
� o,
other verification ac,eptaW to is to be presented when Eke pts is i� to v rfy p vpe
owner's sigxaftwe.
Signature of property owner Date:
W
Note: The following Authorization Form is required to be completed by the property owner only when designatin
an agent of the property owner to apply for a construction permit for the Owner -Builder.
AU MRIZ.,AUM OF AGENT TO ACT ON rROKUTY OkW n0V 1 BFA&L, F
Excluding.the Notice to Property Owner, the execution of which I understand is my persbud bility, I hereby author'
the followi% peraon(s) to act as my ag aKs) to apply for, sign, and file the documents neeessafy to obtain an Owner-Builde
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 under penalty of perjury that l am the property owner for the address listed above and I personally filled out the
information and oaRify its accuracy. Note: A copy of the owner's driver's license, form notarization, or other ver*,atio
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:
Bin#
City of -L a Quinta..
Building &r 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:JEr� Q��QA
Owner's Name:
A. P. Number:
Address: p
Legal Description:
City, ST, Zip:
Contractor: � -
3,•.;,: >�� :� y.:. } . y
Address:
Project Descriptions
City, ST, Zip:
w�2:0 t S t -a jai. tE�s'
Telephone:
MERINO
State Lic. # :
State
City Lic. #:
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
:„�l'^*:sqq`'�-,.`•"-'.�.J} :.i�;:�q.,y`-}_'<,hk"��X;4`o ,c ;
.
;t'•','cr%xs__~'��fi'*,:
Construction Type: Occupancy:
State Lic. #:
Project type (circle one): New Add'n Alter Repair
Demo
Name of Contact Person:
Sq. Ft.: kLV00
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project: 150(7
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Recd
TRACKING PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cales.
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
2"' Review, ready for correctionsli sue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
1rd 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