BRER2017-0050-78-495 CALLE TAM PICO D VOICE (760) 777-7125
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
FAX (760) 777-7011
ONS (760) 777-7153
BUILDING PERMIT
Date: 5/22/2017
Application Number: BRER2017-0050 Owner: .
Property Address: 51412 AVENIDA MENDOZA JOSE OLIVOS
APN: 773102011 51412 AVENIDA MENDOZA
Application Description: OLIVOS / RE -ROOF ENTIRE DWELLING WITH EURETHANE FOAM LA QUINTA, CA 92253
Property Zoning:
Application Valuation: $6,000.00
Applicant: Contractor:
URETHANE FOAM CONSULTING AND SERVICES URETHANE FOAM CONSULTING AND SERVICES
P 0 BOX 638 MAY 2i 2 2Q�] P 0 BOX 638
THOUSAND PALMS, CA 92276 THOUSAND PALMS, CA 92276
CITY OF LA QUINTA (760)345-0622
DESIGN AND DEVELOPMENT DEPARTMENT LIc. No.: 736420
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: C39 License No.: 736420 /
Dater Nftntractor-
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 ),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 intehded'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, 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 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
Lender's Address:
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
1 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 thor which this permit is issued.
iFV16ve 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: CALIFORNIA INSURANCE COMPANY Policy Number: 4684855701
_ 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, shall forthwith
comply with those provisions.
Date: a� p 4 _-'t
4�
WARNING: FAILURE TO SECURE ORKERS' 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 ciky to enter upon the above-
mentioned property for inspection purposes. S
Date: 5/22/2017
Application Number: BRER2017-0050 Owner:
Property Address: 51412 AVENIDA MENDOZA JOSE OLIVOS
APN: 773102011 51412 AVENIDA MENDOZA
Application Description: OLIVOS / RE -ROOF ENTIRE DWELLING WITH EURETHANE FOAM LA QUINTA, CA 92253
Property Zoning:
Application Valuation: $6,000.00
Applicant: Contractor:
URETHANE FOAM CONSULTING AND SERVICES URETHANE FOAM CONSULTING AND SERVICES
P 0 BOX 638 P'O BOX 638
THOUSAND PALMS, CA 92276 THOUSAND PALMS, CA 92276
(760)345-0622
Llc. No.: 736420
--------------------------------------------------------------------------------------------
Detail: REROOF.ENTIRE DWELLING WITH URETHANE FOAM AND COATINGS [CRRC: 0620 0022] 2016 CALIFORNIA ENERGY CODE.
FINANCIAL INFORMATION
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
ACCOUNTQTY
AMOUNT
RE -ROOF - FIRST 2,000 SF PC
101-0000-42600
0
$103.36
Total Paid for RE -ROOF: $155.04
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
Bin.#
City 0f La Quin
Building &r Safety Division
78-495 Calle Tampico.
La Quinta, CA 92253 - (760) 777-7012
Building Permit.Application, and Tracking Sheet
Permit #
Project Address: �' L11 Ue �, �D Z
u'ne�,c r ame:
0
A. P. Number:
Address:.
Legal Description:
sC I L4
Co Tzacgr
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vh e
e on .
Mmi=
Address: 6 L
bio ect DeSCtlption:
'elephone: o_ 3 _ d
S a
N� ry
,.City 0&060
Arch., Engr., Designer:
64
Address:
City., ST, Zip:
Telephone: .
Construction coon TY e: anc
occupancy:
P u Y:
Project a circle one):. New Aad'n'
� type ( ) , e Add n Alter Repair Demo
State Lic. #:
:::• r:#::;:::::::<:::.'>.'::»
::::::............D .................,::::.::
Name of Contact-p son:'
--�—I�Na
Sq. Ft : ,l
#Stories:
#Units:
Telephone # of Contact Person: . —�I
Estimated Value of Project; o U , 00
APPLICANT: DO NOT WRITE BELOW THIS.LINE
#
Submittal
Req'd
Recd
TRACKING
r 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 Calcs.
Plans picked up
Construction
Flood plain plan
Plans.resubmitted
Mechanical
Grading plan '
tad 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:-
'"' 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
STATE OF CALIFORNIA
Prescriptive Residential Alterations That Do Not Require HERS Field Verification
CEC-CF1 R -ALT -05-E (Revised 04/16) CALIFORNIA ENERGY COMMISSION t
CERTIFICATE OF COMPLIANCE CF1R-ALT-05-E
Prescriptive Residential Alterations That Do Not Require HERS Field Verification Page 1 of 3
Pro ect tne: � Date Prepared:
This compliance document is only applicable to simple alterations that do not require HERS verification for compliance. When HERS verification is required, a CFIR-ALT- 01 shall first be registered
with a HERS Provider Data Registry.
Alterations to Space Conditioning Systems that are exempt from HERS verification requirements may use the CFIR-ALT-05 and CF2R-ALT-05 Compliance Documents. Possible exemptions from duct
leakage testing include: less than 40 ft of ducts were added or replaced, • or the existing duct system was insulated with asbestos; or the existing duct system was previously tested and passed by a
HERS Rater. If space conditioning systems are altered and are not exempt from HERS verification, then a CF1R-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.
Genera Informat0vh
01
Project Name:
1 oS
OU
02
Date Prepared:
03
Project Location:_
/� �e
04
Building Front Orientation (deg or cardinal):
05
CA City:
06
Number of Altered Dwelling Units:
07
Zip Code:
08
Fuel Type:
09
Climate Zone:10
Total Conditioned Floor Area (ft):
11
Building Type:
+�S / /
12
Sk*4eeaM)
O }1
V
'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
7-2
CEC-CFIR-ALT-05-E Revised 04/16 CALIFORNIA ENERGY COMMISSION_`��
CERTIFICATE OF COMPLIANCE CFIR-ALT-05-E
Prescriptive Residential Alterations That Do Not Require HERS Field Verification _ Page 2 of 3
Date Prepared: I
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
CRRC Product
ID NyyummbQe�r
Product
Type
R -value
Deck
Insulation
Initial Solar
Reflectance
Aged Solar
Thermal
Emittance
SRI
(Opti
Aged Solar
Reflectance
Thermal
Emittance
SRI
(Optional)
Reflectance
"q 0
Cal)
Add Row.
Delete•Row
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(1)4.
Q
CA Building Energy Efficiency Standards - 2016 Residential Compliance
April 2016
STATE OF CALIFORNIA
Prescriptive Residential Alterations That Do Not Require HERS Field Verification
CEC-CFIR-ALT-05-E Revised 04/16 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CF111-ALT-05-E
Prescriptive Residential Alterations That Do Not Require HERS Field Verification Page 3 of 3
Prolect Name: I Date Prepared:
(AOCUMENTATION'AUTHOR'S'DEC ARATION STATEMENT
1. 1 certify that this Certificate of Compliance documentation is accurate and complete. .
DocumentationAuthor Name:
Document on Author Signal re:
;�;Company:
Si re Date:
Address:
S6 L
CEA/ HERS Certification Identification (if ap licable):
City/St to/Zip:
7 Lens 9,a- -7
Phone:
3 61"
RESPONSIBLE PERS SNO DECLAR'ATI�NSTA' TEMENT
I certify the following un er penalty, ofperjury, under the laws of the State of California:
1. The information provided on this Certificate of Compliance is true and correct.
2. 1 am eligible under Division 3 of the Business and Professions Code to accept responsibility ftir 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 applicablecompliance 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: � 1
S'T lAr-k- 4�0
Responsib=Ignature.
/-j
Company:
Date Si ed:
-0a - �2 v,l
Address:
SS^� 16 e SaL
License:
3(� a
City/State/Zip:
s a22
Phone:
26to Sys- Q��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