BRER2019-0020UDR VOICE (760) 777-7125
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 3/5/2019
Permit Type/Subtype: RE -ROOF/ Owner:
Application Number: BRER2019-0020 JEFFREYJ. HOLL
Property Address: 51611 AVENIDA MARTINEZ 51611 AVENIDA MARTINEZ
APN: 773141006 LA QUINTA, CA 92253
Application Description: HOLL/ REROOF ENTIRE DWELLING WITH NEW ASPHALT SHINGLES
Property Zoning:
Application Valuation: $3,500.00
Applicant: Contractor:
JEFFREYJ. HOLL D Zk,OWNER BUILDER
51611 AVENIDA MARTINEZ 51611 AVENIDA MARTINEZ
LA QUINTA, CA 92253 MAR 0 2019 D
LA QUINTA, CA 92253
CITY OF LA QUINTA Llc. No.::CONV:140528101254105753
DESIGN & DEVELOPMENT DEPARTMENT
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 Professions Code,
and my License is in full force and effect.
License Class: License No.::CONV:140528101254105753
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, priorto 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
rasowner of the property, or my employees with wages as their sole
nsation, MIT do the work, and the structure is not intended or offered for sale.
044, Business and Professions Cade: 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
she did not build or improve for the purpose of sale.).
j 1, as owner of the property, am exclusively contracting with licensed contractors
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
e tractors' State License Law,).
} I am exemmppt under Sec. . B.&P.C. for this reason
Date: i Owner:
CONSTRUCTI ?ENDING 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
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 IssufJ My workers' compensation Insurance carrier and policy number are:
Carri r Poiicy Number: _
1 certify that in the performance of the work for which this permit Is issued, I
sh I AOL employ any person in any manner so as to become subject to the workers'
co pensation laws of California, and agree that, if I should become subject to the
workers' compensation provisions of SectionAO of the Labor Code, I shall forthwith
comply with those provisions. �� )
iDate: s / ApplicanPS'COMPENSATION
WARNING: FAILURE TO SECURE WORK 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: MotSignature (Applicant or Agent):
Date: 3/5/2019
Application Number:
BRER2019-0020
Property Address:
51611 AVENIDA MARTINEZ
APN:
773141006
Application Description
HOLL/ REROOF ENTIRE DWELLING WITH NEW ASPHALTSHINGLES
Property Zoning:
Application Valuation:
$3,500.00
Applicant:
JEFFREY J. HOLL
51611 AVENIDA MARTINEZ
LA QUINTA, CA 92253
Owner:
JEFFREY J. HOLL
51611 AVENIDA MARTINEZ
LA QUINTA, CA 92253
Contractor:
OWNER BUILDER
51611 AVENIDA MARTINEZ
LA QUINTA, CA 92253
Llc. No.::CONV:140528101254105753
Detail: REROOF WITH ASPHALT TILE AT SLOPED AREAS OWENS CORNING COOL ROOF [CRRC: 0890-0009] 2016 CALIFORNIA ENERGY CODE.
DESCRIPTION
ACCOUNT CITY
AMOUNT
BSAS SB1473 FEE
101-0000-20306 0
$1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA:
$1.00
DESCRIPTION
ACCOUNT
CITY
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
Bin #
Permit #
City of La Quinta
Building 8r Safety Division
_ 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Project Address: I/ �
i Owner's Name: ,�&A, �itl R • , GL�.
A. P. Number: r�
- - - 7 1 � �y1- o D !D
_
dress:
Ad---J9s90 .t�j�lo�s S,7,46-e'T
Legal Description:
City, ST, Zip: 44AW , qAy"w
Telephone: fT' ;k.
Contractor:
Address:
Project Description: I-rew
City, ST, Zip:
Telephone:
State Lie. # :
City Lie. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
Construction Type:�JO� Occupancy:
State Lie. #:
Project type (circle one): New Add'n Alter cpair Demo
'Sq. Ft.: OD # Stories: / # Units: /
Name of Contact Person: �%a�j/ 1J
Telephone # of Contact Person: 2Z/7a17— 72A le
Estimated Value of Project: 3 Soo. D O
APPLICANT: DO NOT WRITE BELOW THIS LINE
N
Submittal
Req'd
Reed
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Plan Check Deposit
Amount
Structural Calcs.
Truss Cales,
Reviewed, ready for corrections
Called Contact Person
Plan Check Balance
Title 24 Cales.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2nd Review, ready for corrections/issue
Electrical
SubcontactorList
Called Contact Person
Plumbing
Grant Deed
i
Plans picked up
S.M.I.
Grading
Developer Impact Fee
A.I.P.P,
II.O.A. Approval
Plans resubmitted
Review, ready for correctlonsrssue
IN HOUSE:-
Planning Approval
Called Contact Person
Pub, Wks. Appr
Date of permit issue
School Fees,
Total Permit Fees
P.O. BOX 1504 � - --� - �— --- R- - -- —
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
IMPORTANT1 NOTICE TO PROPERTY OWNER
Dear Property Owner:
An application for a building ermit has been submitted in your name listing yourself as the builder of the property
improvements specified at S%7Z ACE /�, -;fie-c-i . Qq j Z-�,fa
We are providing you with an Owner-Buildcr Acknowlcdgmc+,t and Infosmalon 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 A("KNOWI,E I)(;MI:N'r AND VERIFICATION OIL INFORMATION
17IR C.'l ON,S: Read and initial each statement IvIosv to signify you understand or verify this information.
1. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder"
wild inb permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as
an Owner-Buildcr, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person
and his or her ernployees while working on my property. My homeowner's insurance may not provide coverage for those
injuries. 1 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. 1 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 bylaw to be licensed and bonded in California and to list their license numbers on
permits and contracts.
5, I understand if I employ or otherwise engage any persons, other than California Iicensed 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" under state: and federal law, I must rcgistcr with the state and federal
government, withhold payroll taxes, provide workers' conTvnsalivn disability insurance, and contribute to unemployment
compensation far 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 tliem 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 thus permit is issued, I may be held liable for any
tancial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defocus in the
workmanship or materials.
'.). 1 understand I may otttain more information regarding my obligations as an "employer" fiomr the Internal Revenue
Service, the United States Small Business Achninistrntion, 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.csib.co.gov for more information about licensed contractors.
10.1 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the
arty legally and financially responsible for proposed construction activity at the following address:
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 asmell as employers.
12.1 agree to notify the issuer of this form immediately ofany a,1,iiIions, deletions, or climPI % to any of the information
ave provided on this form. Licensed contractors are regulated by lases designed to protect thr 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 furn 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 issuft the permit. Note: A copy of the property owner's driver's license, form notarizadiorr, or
other verification acceptable t th agenc�T¢ r�uired to be presented when the permit is issued to verify the property
owner'.v signature. � J
Signature of property awn Date:
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.
AIITIIOfWATION OF AGENTTO A('T ON PROPERTY OWNER'S REHAI
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
Pemut 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 owner s signature.
Proporty Owner's Signature. Date:
STATE OF CALIFORNIA
i
RESIDENTIAL ALTERATIONS
_ A I
CALIFORNIA ENERGY COMMISSION
p E: =�F t R ALT-0t-E : = a , .sc 7 = : : -
CF(Page
CERTIFICATE OF COMPLIANCE
of
(rage 1 of 4]
Prescriptive Residential Alterations
Project Name: Gt� Q
i Date Prepared:
A. GENERAL INFORMATION
Ol E Project Name: Q 102
03 1 Project Location r n►i fie % A) E Z o4
Date Prepared:
Buiiding Front Orientation (deg or cardlnall: 1
06
Number of Altered Dwelling Un lm:
05 CA
07 1 Zip Cade: 08
Fuel Type:
09 Climate Zone: 10
Total Corurdioned Floor Area (ft2):
12
Stab. Area [ftZ)
au type
1Po
1C-
B. ULATION DETAILS (Section 150.2(b)1)
01 02 05 06 07
08 N 10
11
Proposed
Required
:Frame
Appendix.1
Frame m"' -
ReferencFrame
Cavity InsulationTa ID Assembly Type Tv (inches) R-value R-value U-factor Table Cell Comments
t
C. ROOF REPLACEMENT (Prescriptive Alteration, Section 150.2(b)iH)
01 02 03 04 05 06 i 07
08 09 10 11
12 13
Pro osed 19Ainimum Re aired
R-value
Method of Roof CRRC Product ID Deck Initial Solar
Aged Solar Thermal SRI Aged Solar
The SRI
al)
Compliance Pitch Exception Number Product Type Insulation Reflectance
Reflectance Emittance I tOPtional) cta
'.
{e
OWAFAts QOP.wus� Z f
. 2 / I
�F
NOTES
• Roof area covered by building integrated photovoltaic panels and solar thermal panels are exempt from the above Cool Roof requirements- 1 f
f
�cc f �j7 iTLk-4
• Uquid field applied coatings must comply with installation criteria from section 110.8(i)4_
2:�2
�S
o\J�
Registration Number: Registration Date/Time: HERS Provider:
June 2014
CA Building Energy Efficiency Standards - 2013 Residential Compliance
STATE OF CALIFORNIA
RESIDENTIAL ALTERATIONS
CEC•CF 1Rv;L7-01-E,Rensec M,.4i
CERTIFICATE OF COMPLIANCE
Prescriptive Residential Alterations
Project Name:
DOCUMENTATION AUTHOR'S DECI
1. I certify that this Certificate of
Company.
documentation is accurate and
L
Date Prepared:
M.
Signature Dat �
c.G /1/3 S
CW HERS CRfication Identification Iif appiicabie]:
MR-ALT 01-E
(Page 4 of 4)
;[ I Phone. 7-17- 773 &
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
j designer).
3. That the energy features and performance specifications, materials, components, and manufactured devices fbr 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.
S. 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.
Responsible Designer Name: Responsible Designer Signature:
r.ompany .
Address:
Date Signed:
License:
Phone:
For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300.
Registration Number: Registration Date/Time:
CA Building Energy Efficiency Standards - 2013 Residential Compliance
HERS Provider
June 2014