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BRER2018-018278-495 CALLE TAMPICO �4 LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT BUILDING PERMIT Permit Type/Subtype: RE -ROOF/ Application Number: BRER2018-0182 Property Address: 54105 AVE NIDA MENDOZA APN: 774222017 Application Description: PETTIBONE / 1200SF REROOF Property Zoning: Application Valuation: $4,000.00 Applicant: D PHILLIP PETTIBONE 7 54105 AVENIDA MENDOZA OEC 47 2018 LA QUINTA, CA 92253 ?�}4��M+����� ':R3tr• "9Qirri:�rrn4„�il�+rrr 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 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 worN 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 did not build or improve for the purpose of sale.). S 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:1Owner:'PIEILtor$ [ 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 Na Lender's VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 12/7/2018 Owner: PHILLIP PETTIBONE 54105 AVENIDA MENDOZA LA QUINTA, CA 92253 Contractor: OWNER BUILDER Llc. No.: 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: _ that in the performance of the work for which this permit is issued, I sWertify loy 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. Imo: ��10d' IF 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 ins pectiq n wposes. ,Elate:. a1 Signature (Agpllcant or Agen Date: 12/7/2018 Application Number: BRER2018-0182 Property Address: 54105 AVENIDA MENDOZA APN: 774222017 Application Description- PETTIBONE / 1200SF REROOF Property Zoning: Application Valuation: $4,000.00 Applicant: PHILLIP PETTIBONE 54105 AVENIDA MENDOZA LA QUINTA, CA 92253 Owner: PHILLIP PETTIBONE 54105 AVENIDA MENDOZA LA QUINTA, CA 92253 Contractor: OWNER BUILDER Llc. No.: Detail: REROOF ENTIRE ROOF WITH OWNES CORNING DESERTTAN SHINGLES [CRRC: N/A]APPLICANT WILL PASS ENERGY REQUIREMENTS WITH THE R38 INSULATION. INSPECTOR MUST VERIFY R38 INSULATION. OWENS CORNING PRINTOUT SHOWS THAT SHINGLES ARE SUTABLE FOR THIS AREA. 2016 CALIFORNIA ENERGY CODE. DESCRIPTION I ACCOUNT I CITY AMOUNT BSAS SB1473 FEE 1101-0000-20306 1 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 $54.43 DESCRIPTION ACCOUNT CITY AMOUNT RE -ROOF - FIRST 2,000 SF PC 101-0000-42600 0 $108.87 Total Paid for RE -ROOF: $163.30 DESCRIPTION ACCOUNT CITY AMOUNT TECHNOLOGY ENHANCEMENT FEE 502-0000-43611 0 $5.00 Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00 ta axikrev - GEM fd,,1 *-SER-F — PERMIT #�- PLAN LOCATION: Project Address: S�{- 1Ob J %J%DA Project Description: Pool, Remodel, Add't, Elect, Plumb, Mech APN #: 7 7 I&ZaD I T - $ Rz R00C n-Ass, t' A SH 1171� Lfl"� Ol,.ctia- i P I'D 03 OJM54 Applicant Name: j ttel eat)1. Cam^ foa(V 1�638 6,,J'lj&,U3ULfMpw Address: { -IOb cwt rJQ-" 046C wvlN� A21 A t4t%p> xx2- P&P iFD46-& ? *ii- City, ST, Zip: I -A cA. —lam;-3 JV,w1Ji1 C1;& falOr J�ZDW a'jV +--V►RT jb e4TeN Telephone: 7Gf7 (a&of3 y S Email: N(o1U��- Valuation of Project $ Alb Contractor Name: A%O1VC New SFD Construction: Address. Conditioned Space I AOa SF. ''fir• r City, St, Zip Garage ao� Sf Telephone: Patio/Porch a 8 SF Email: Fire Sprinklers N1 SF State Lic: City Bus Lic: Arch/Eng Name: t4 Construction Type: F0,6A" Occupancy: Fos- Address:, Grading: S'TKV �,y,p City, St, Zip Telephone: Bedrooms: 3 Stories: # Units: I Email: State Lic: City Bus Lic: Property Owner's Name: New Commercial / Tenant Improvements: Address: S' 0`j R ��19 Total Building SF City, ST, Zip wTA.(7. Construction Type: Occupancy: Telephone: 7(00 &048' 4(q[ ' Email: NONE 78495 CALLE TAMPICO LA QU I NTA, CA 92253 760-777-7000 OFFICE USE ONLY # Submittal Req'd Rec'd Plan Sets Structural Calcs Truss Calcs Title 24 Calcs Soils Report Grading Plan (PM10) Landscape Plan Subcontractor List Grant Deed HOA Approval School Fees Burrtec Debris Plan Planning approval Public Works approval Fire approval City Business License STATE OF CALIFORNIA Prescriptive Residential Alterations That Do Not Require HERS Field Verification CEC-CF1 R-ALT-054 (Revised CA/t6 CERTIFICATE OF COMPLIANCE Prescriptive Residential Alterations That Do Not Require HERS Field Verification I'mima Name: — _ _ This compliance document is only a, with a HERS Provider Data Registry. to simple alterations that do not require compliance. Wien HERS MA ENERGY COMMISSiON CF111-ALT-05-E is required, a CFIR-ALT- 01 shall first be Page 1 of 3 Alterations to Space Conditioning Systems that are exempt from HERS verification requirements may use the CF1R-ALT-05 and CF2R-ALT-05 Compliance Documents. Possible exemptions from duct leakage testing include: less than 40 ft of ducts were added or rep?aced,• 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 nnr exemptfrom 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.S 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 /Q(07 (a� o1 01 Project Name: ` ��•i 1i 1 �apjc . (� �s �I G L� —I� 02 Date Prepared 03 Project Location; 04 Building Front Orientation (deg or cardinal): E 4S T J i f L ] O 05 07 CA City: Zip Code: N f 1 06 08 Number of Altered Dwelling Units- Fuel Type: 09 Climate Zone: 10 Total Conditioned Floor Area 2 Slab Area (ft) 11 Building Type: _ f~ r 12 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 CEC-GFIR-ALT-05-E Revised 04116RaN CERTIFICATE OF COMPLIANCE H! CALIFORNIA ENERGY COMMISSID • Prescriptive Residential Alterations That Do Not Require HERS Field Verification CF1R-ALT-OS-EPage 3 of 3 Pmpec Name: Date Pr�pared:' �' DOCUMENTATION AUTHOR'S DECLARATION STATEMENT I. I certify that this Certificate of Compliance documentation is accurate and complete. Documentation author Name: Documentation Author Signatu :ompany: Signature Date: Address' I IMt S� A�Ntpf1 CEN HERS Certification [den tlfcation 0f app - •• )"4 -0%)'Ns"', 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 this 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 buflding deslgn features or system design features identified on this Certificate of Compliance are consistent with the information provided on other applicable compliance document=•, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with this building permit application. 5. i 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. Company: /V/o'/-. Z 04 License: �N- f 06' A-VC4,1 Wvq JAc—:;PP&z,4 �- p' Phone: i 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 �� a h 660wood Oakridge®Shingles are designed to provide long-lasting performance and striking beauty. In addition to a wide range of inviting, popular colors, they also offer a Limited Lifetime Warranty"* (for as long as you own your home), a 110/130-MPHff Wind Resistance Limited Warranty" and an Algae Resistance Limited Warranty" available on a regional basis. Amber' Not available in Service Areas 1, 2, 3, 4, 5, 6, 7, B. 9, 11, 13 Antique Silver' Not available in Service Areas 1, 2, 4, 5, 6, 7, 6, 9, 10, 11,12,13 Teak' Sierra Gray" Not available in Service Not available in Service Areas Areas 1, 3 2, 3, 6, B, 11 Williamsburg Gray' Chateau Green' Not available in Service Areas Not available in Service Areas 1, 3, 4, 5, 7, 6, 9, 10, 1, 2, 3, 6, 8, 12, 13, 14 11,12,13,14. r r,' i 1 Beachwood Sand' Shasta White' Not available in Service Areas Not available in Service Areas 1, 2, 4, 5, 6, 7, 8, 9, 10, 2,3,6,8. 11, 12, 13, 14 ARCHITECTURAL Product Attributes Warranty Length" Limited Lifetime" (for as long as you own your home) Wind Resistance Limited Warranty' 110/ 130 MPH" Algan 11-1st-on a-lobte to I- shown ,n what Algae Resistance Limited Warranty" 10 Years TruPROtection-" Non -Prorated Limited Warranty' 10 Years Colors availability varies by Service Area, Aged Cedar' Black Walnut' Flagstone' Not available in Service Areas Not available in Service Areas Not available in Service Areas 2, 3, 6, B. 1, 2,3,4.5,6,7, B, 9, 10, 11, 14. 2, 3, 6, B. Peppermill Gray' Sand Castle' Woodland Path' Not available in Service Area Not available in Service Areas Not available in Service Areas 2,3,6,8, 2, 3, 6, 8,12, 13. 1, 2, 3, 4, 5, 6, 7,6, 9,10,11, 14. Twilight Black' Not available in Service Areas 2, 3, 6, B, 1 2, 13. Oakridgel Shingles Product Specifications Nominal Size 13'rn" x 393/6" Exposure 55,11 w Shingles per Square 64 Bundles per Square 3 Coverage per Square 98,4 sq. ft. Oyster Shell' Not available in Service Areas 1, 2, 3, 4, 5, 6, 7,6, 9, 10, 11, 12, 13, Applicable Standards and Codes ASTM D228 ASTM D3018 (Type 1) ASTM D3462 ASTM D3161 (Class F Wind Resistance) ASTM D7158 (Class H Wind Resistance) ASTM E108/UL 790 (Class A Fire Resistance) Florida Product Approval§ ICC-ES AC438" Miami -Dade County Product Approval§§ UL ER2453-01 " Shasta White color meets ENERGY STAR' requirements for initial solar reflectance of 0.25 and 3-year aged solar reflectance of 0.1 5; 2013 California Building Energy Efficiency Standards, Title 24, Part 6 requirements; rated by the Cool Roof Rating Council (CRRC). tt 110 MPH is standard with 4-nail application 130 MPH is applicable only with 6-nail application and Owens Corning' Starter Shingle product application in eaves and rakes in accordance with installation instructions. § Applicable only in Service Area 3, §§ Applies far all areas that recognize Miami -Dade Product Control Section. #t Available in Algae Resistance in Service Area 13 (see map), # International Code Council Evaluation Services Acceptance Criteria for Alternative Asphalt Shingles. ## Underwriters Laboratories Evaluation Service Evaluation Report. T-vf 4 4 Q" P.O. Box 1504 LA QUINTA, CALIFORNIA 92247-1504 7$-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 property improvements specified at t] 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 signify you understand or verify this information. /L. 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. I, 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 insurance coverage for injuries to workers on my property. 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. /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 4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. V 5. 1 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. _V/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 - .� 7. 1 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. 8. I 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 sustained by any subsequent owner(s) that result from any latent construction defects in the wor anship or materials. 9. 1 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 (CSLB) at 1- 800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. ►' 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 .i 11. I 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 well as employers. ✓ 12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have 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 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 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. Signature of property owner Date: Z 6 '16 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: -! tl(S PiyFOw Name of Authorized Agent: eq i l_ �d, ;���,�_ Tel No %(�O l,Sc - `1< %_ Address of Authorized Agent: 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 require', to 6esented when the permit is issued to verify the property owner's signature. Property Owner's Signatur Date: 0:? t