BRER2017-006678-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7125
;u FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Application Number: BRER2017-0066 Owner:
Property Address: 53680 AVENIDA CORTEZ OBEIDA HERNANDEZ
APN: 774102009 53680 AVENIDA CORTEZ
Application Description: HERNANDEZ / RE -ROOF ENTIRE DWELLING WITH SHINGLES LA QUINTA, CA 92253
Property Zoning:
Application Valuation: $1,600.00
Applicant: Contractor:
OBEIDA HERNANDEZ OWNER BUILDER
53680 AVENIDA CORTEZ JUN '3 0 2017
LA QUINTA, CA 92253
CITY OF LA QUINTA
DESIGN AND DEVELOPMENT DEPARTMENT uc.. No.:
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..
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).:
as owner of the property, or my employees with wages as their sole
mpensation, 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.).
V1, as owner of the property, am exclusively contra cting,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.).
71 am exempt under Sec. . B.&P.C. for this
reason
Date:y a _��_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:
Date: 6/30/2017
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:
Carr er,:1 Policy Number: _
rily�tertify that in the performance of the work for which this permit is issued, I
shalt 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 shall forthwith
comply with those provisions.
pplicant Cl,
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 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 city to enter upon the above-
mentioned property for inspection purposes.
Date: 6/30/2017
Application Number: BRER2017-0066 Owner:
Property Address: 53680 AVENIDA CORTEZ OBEIDA HERNANDEZ
APN: 774102009 53680 AVENIDA CORTEZ
Application Description: HERNANDEZ / RE -ROOF ENTIRE DWELLING WITH SHINGLES LA QUINTA, CA 92253
Property Zoning:
Application Valuation: $1,600.00
Applicant: Contractor:
OBEIDA HERNANDEZ OWNER BUILDER
53680 AVENIDA CORTEZ
LA QUI NTA, CA 92253
Llc. No.:
--------------------------------------•--------=--------7------------------------------------
Detail: RE -ROOF ENTIRE DWELLING WITH COOL ROOF SHINGLES (CRRC # 0676-0098) 2016 CALIFORNIA ENERGY CODE.
t
FINANCIAL INFORMAT10N
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 -FIRST 2,000 SF
101-0000-42404
0
$51.68
DESCRIPTION
ACCOUNT
CITY
AMOUNT
RE -ROOF - FIRST 2,000 SF PC
101-0000-42600
0
$103.36
Total Paid for RE -ROOF: $155.04
DESCRIPTION
ACCOUNT
CITY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
Bin # `
Qty .of Ld u%nta
Building &' Safety Div1sion
78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
00 6A Building Permit Application and Tracking Sheet
Permit #
Q&2._P-Z 17_
'Project WE 5-3 b530 ft - I X TE
'Own—er's Name: _ I
A. P. Number:
CAddress_ _ 6 O 4E. J,. C 2 Z -@ -2-
Legal
Legal Description:
(City; ST; Zip:
Contractor:/ z /-
OW �% C� �C
Telephone: _ S _
Address:
Project Description: _
City, ST, Zip:
- - - - --- -
Telephone:
-State -00 # : City Lie. #t
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:-
P one:'
Construction on Ty P e: Occupancy:
Project type (circle one New Add' nAlter Repair Dem
State Lic. #•
Name ofContact Person_`
tome of --- -- -
�Sq: Ft.: 0
_
�# Stones:
#Units:
Telephone #'of Contact Person: -•- - -
Estimated -Value of Project.
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 Cales.
Called Contact Person
Plan Check Balance
Tide 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
S.M.I.
H.O.A: Approval
Plans resubmitted
Grading
IN HOUSE:-
3"' 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
P.D. 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
IMPORTANT!. 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 properly
improvements specified at C Z (�) r¢UE,� f (p� �1�„ITE Z
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:
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
DIRECTIONS: Read and initial each statement below to signs you understand or verify this information.
♦l(tl. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder"
�buiiding permit that erroneously implies that the property owner is providing his or her own labor and material personally. I as
an Owner -Builder, maybe 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 insurance coverage for injuries to workers
on my property.
,2. 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
myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my
own.
I unde
permits and contracts. rstand Contractors are required by law to be licensed and bonded in California and to list their license numbers on
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" understate 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.
. I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for.any
financialor personal injuries'sustained by any subsequent owner(s) that result from any latent construction defects' in the
workmanship or materials.
9rl derstand 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 (CSLB) at 1-
800-321-CSLB (2752) or www.cs1b.ca.gov.for more information about licensed contractors.
Caa1'O__t�m 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:
au Ili agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all
applicable laws and requirements that govern -Owner -Builders as mell as employers.
12. agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I
nave 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 maybe unable to assist -you with any financial loss
you may sustain as a result of a complaint. Your only -reriiedy`against unlicensed Contractors maybe in civil court. It is also
important for you to understand that if an unlicensed 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 workers'
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 issuing the permit. Note:, A copy of the property 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.
Sigriatxr� of-property�o�wn r te, — O(, ate — 3
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 I understand is my personal responsibility, I hereby authorize
the following person(s) to act'as my agent(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):
Project Location or Address:
. Name of Authorized Agent:
Address of Authorized Agent:
Tel No
I declare under 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 owners signature.
Property Owner's Signature: Date:
• ':'—STATE OFCALIFORNIA
.. Prescriptive Residential Alterations That Do Not Require HERS Field Verification
rffl
sh
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 1 of 3
Project Name: n&E TA MAX AMAI^C Z— .
Date Prepared: G /,T0/ 17
This compliance document is only applicable to simple alterations that do not
with a HERS Provider Data Registry.
for compliance. When HERS verification is required, a CFIR-ALT-01 shall
Alterations to Space Conditioning Systems that are exempt from HERS verification requirements may use the CFIR-ALT-OS and CF2R- ALT -05 Compliance Documents. Possible exemptions from duct
leakage testing include:'Iess than 40 ft of ducts were added or replaced; or the existing duct system was insulated with asbestos or the existing ductsystem was previously tested and passed by a
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 a 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 a 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.
Temporary labels shall not be removed before verification by the building Inspector.
A. General Information
Ol
Project Name:
/n r—�
02
Date Prepared:
n� t-7
G .s
613491
03
Project Location:
S-7660 UE NP /I � " �-
(vv �Y
04
Building Front Orientation (deg or cardinal):
OS
CA City:
vR I
"^�
06
Number of Altered Dwelling Units:
07
Zip Code:
2 r
.08
Fuel Type:
09
Climate Zone:
SO
Total Conditioned Floor Area (ft):
11 .
Building Type:
12
Slab Area (ft)
13
Project Scope (Select all that apply):
❑ B. Insulation ❑ D. & E. Fenestration/Glazing - ADD ❑ G. Space Conditioning System (Heating, Cooling, Duct system) ❑ Lighting
❑✓ C. Roof Replacement ❑ 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 r
CEC-CFIR-ALT-057E Revised 04116 CALIFORNIA ENERGY. COMMISSIONEWS�
CERTIFICATE OF COMPLIANCE CFIR-ALT-05-E
Prescriptive Residential Alterations That Do Not Require HERS Field Verification Page 2 of 3
Project Name: Date Prepared:
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
Method of
Compliance
Roof Pitch
Exception
(CRRCProduct
mber ,
Product
Type
R -value
Deck
Insulation
Initial Solar
Reflectance
Aged Solar
Reflectance
Thermal
Emittance
SRI
(Optional) '
Aged SolarThermal
Reflectance
Emittance -
SRI
(Optional)
SRS
s
0676-690'
hcs
qX
20 .
' AO .
: 75r
� 6
CJ
Add.Ro''
LeletMeR�ow;
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 April 2016
r
' "STATE OF CALIFORNIA
Prescriptive Residential Alterations That Do Not Require HERS Field Verification a'r
CEC-CFIR-ALT-05-E (Revised 04/16) CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CF1R-ALT-05-E
Prescriptive Reside ntial.Alterations That Do Not Require HERS Field Verification Page 3 of 3'
Project Name: Date Prepared:
DOCUMENTATION AUTHOR'S DECLARATION STATEMENT
1. 1 certify that this Certificate of Compliance documentation is accurate and complete.
Docurpentation Author Name:
Documentation Author Signature:
tN
Company:
Signature Date: '
//
441 e4
Address:
CEA/ HERS Certification Identification (if applicable):
City/State/Zip:
Phone:
RESPONSIBLE PERSON'S DECLARATION STATEMENT
I certify the following under penalty of perjury, under the laws of the State of California:
1. The information provided on thii 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:
? -z-
Company:
Date Signed:
Address:
License:
City/State/Zip:
Phone:
dam: "C/ /a.
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