BRER2020-004078-495 CALLE TAMPICO D �P Q"
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Permit Type/Subtype: RE -ROOF/
Application Number: BRER2020-0040
Property Address: 51460 CALLE QUITO
APN: 770172008
Application Description: MARTIN / TILE REROOF
Property Zoning:
Application Valuation: $20,000.00
Applicant: D
DOUGLAS MARTIN
51460 CALLE QUITO FEB 14 2020
LA QUINTA, CA 92253
CITY OF LA QUINTA
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.:
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
s Ws the applicant to a civil penalty of not more than five hundred dollars ($500).:
F, 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
o e 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 contra or(s) licensed pursuant to the
Clw1practors'State License Law.).
I am exempt under Sec. . B.&P.C. fo this reason
Date: & Owner: , :�,�
CONSTRUCTION LEN NG 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 N
Lender's Address:
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 2/18/2020
Owner:
DOUGLAS MARTIN
51460 CALLE QUITO
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:
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:_
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 at, if I should become subject to the
workers' compensation provisions of Section 1 1700 of the Labor Code, I shall forthwith
comply wit P
tth se provisions.
y
Date: O Applicant:
WARNING: FAILURE TO SECURE WORKERS' C MPENSATION 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
fend, 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 ofthis 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 hat the above information is correct.
I agree to comply with all city and county ordlnan 'a
and state laws relating to building
construction, and hereby authorize representjorAg
of th" city to enter upon the above -
mention pr erty for inspection purposes.
Date? 19?-V Signature (Applicantnt):
Date: 2,"18/2020
Application Number:
Property Address:
APN:
Application Description:
Property Zoning:
Application Valuation:
Applicant:
DOUGLAS MARTIN
51460 CALLE QUITO
LA QUINTA, CA 92253
BRER2020-0040
51460 CALLE QUITO
770172008
MARTIN / TILE REROOF
$20,000.00
Owner:
DOUGLAS MARTIN
51460 CALLE QUITO
LA QUINTA, CA 92253
Contractor:
OWNER BUILDER
Llc. No.:
Detail: REMOVE EXISITNG ROOF TILE AND REROOF WITH NEW CLAY TILE AT SLOPED AREAS [CARC 0942-0160] 2019 CALIFORNIA ENERGY CODE.
PERMIT #
Project Address: ,�� 6 Q C,hL4,4 J aI V
APN #:
Applicant Name:
Address: �j %.
City, ST, Zip: Lk, Luw—L co"
Telephone: V S
Email: ice,.,.. — — _ _-I—
SlWa,sTck� o Cow4
Contractor Name:
Address:
City, St, Zip
Telephone:
Email:
State Lie: City Bus Lie:
PLAN LOCATION:
Project Description: Pool, Remodel, Add't, Elect, Plumb, Mech
4,M00ti, 4,t151)1-6 STAM'qA+!% y)1vt4q-1_
to r i ° ! Ad 0 o h-w
Valuation of Project $ 21t 00 Q
New SFD Construction:
Conditioned Space SF
Garage SF
Patio/Porch SF
Fire Sprinklers SF
Arch/Eng Name:
Construction Type: Occupancy:
Address:
Grading:
City, St, Zip
Telephone:
Bedrooms;
Stories:
# Units:
Email:
State Lie: City Bus Lie:
Property Owner's Name:
New Commercial / Tenant Improvements:
Address:
Total Building p SF
City, ST, Zip
Construction Type: Occupancy:
Telephone:
Email:
/64y5 CALLL IAMPICU
LA QUINTA, CA 92253
760-777-7000
T a
4ht 4 4 a"
P.O. 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
CMPURTANT! NOTICE TO PROPERTY OWNER
Dear Property Owner:
An application for a building permit has been submittFq in your n e li$ti ourself as the builder of the property
improvements specified at
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 verb this information.
�l 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.
_J.�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.
V3. 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.
_IxI 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.
_\XI 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. 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.
Ai8. I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any
nli ncial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the
workmanship 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
part ally and �anc y resp ibl r props d co ctioa activity the following address:
�1 1. 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.
\�Z12. 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 '.v required to be presented when the permit is issued to verify the property
owner's signature. }
Signature of property owner 14. 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.
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: J `''[ tc� ' 2
Name of Authorized Agent: 1 �,ek A CrA jCTel No L3+ J I
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 aecur Note: A copy of[ e owner's driver's license, form notarization, or other verification
acceptable to the agency is regi re to be pr c!s ntcd ku en the pe it is issued to verify the roper }rrowner's signature.
Property Owner's Signature: C _ Date: W
STATE OF CALIFORNIA
Prescriptive Residential Alterations That Do Not Require HERS Field Verification
CEC-CFtR-ALT-05-E (Revised 01120)
CERTIFICATE OF COMPLIANCE
Prescriptive Residential Alterations T hat Do Not Require HERS Field Verification
a.ajea Nam : 0' f M N
In+s compliance document is only applicable to
with a HERS Provider Data Registry.
that do not require HERS
compliance. When
ENERGY
MMISSION
CF 1 R-ALT-05-E
Page 1 of 3
'on is required, a CF1R-ALT-01 shall first be
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 nat 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 greater 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 CF1R-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
01 Project Name:
03 Project Location
05 CA City:
07 Zip Code:
09 1 Climate Zone
C2.I1V—' C
S l �i o 1%
it
LA Qgrr'Ar
q vZS3
11 I Building Type: Q L h pf-
13 Project Scope (Select all that apply):
02 Date Prepared: 7—Z rp( tA)?jt%
04 Building Front Orientation (deg or cardinal):
06 Number of Altered Dwelling Units:
08 Fuel Type:
10 Total Conditioned Floor Area
12 Slab Area (ft)
❑ 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 - 2019 Residential Compliance January 2020
STATE OF CALIFORNIA
Prescriptive Residential Alterations That Do Not Require HERS Field Verification CALIFORNIA ENERGY COMMISSION
CEC-CFIR-ALT-05-E (Revised 01120) CF1R-ALT-05-E
CERTIFICATE OF COMPLIANCE
Prescriptive Residential Alterations That Do Not Require HERS Field Verification Page 2 of 3
Prvjeci Name: Date ?enared +�
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
R-value
Method of CRRC Product Product Deck
Initial Solar
Aged Solar Thermal SRI
Aged Solar Thermal SRI
Emittance (Optional)
Compliance Roof Pitch Exception ID Number) Type Insulation
Reflectance
Reflectance Emittance (Optional)
Reflectance
pp
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(i)4.
CA Building Energy Efficiency Standards - 2019 Residential Compliance January 2020
STATE 6F CALIFORNIA
Prescriptive Residential Alterations That Do Not Require HERS Field Verification
GEC-CF1 R-ALT-05-E (Revised 01120)
CERTIFICATE OF COMPLIANCE
Prescriptive Residential
Irolect Name:
rations That Do Not Require HERS Field Verification
ENERGY
MISSION
F 1 R-ALT-05-E
Page 3 of 3
DOCUMENTATION AUTHOR'S DECLARATION STATEMENT
1. 1 certify that this Certifi ate of Compliance documentation is accurate and complete.
Documentation Author Name: Documentation Author Signature:
Company: signatur@ Date:
Address: n �Q / O / 7 CW HERS Certificatfoh Identi ation (if app5cable):
City/StateMp: VA ` Phone:
M
•✓1�'Y�%� CA-{ one: 0 152�1 1
TS
RESPONSIBLE PERSON'S DECLARATION STATEMENT l a
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 buiddIng 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 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 his Certificate of Compliance is required to a included with the documentation the builder provides to the building
owner at occupancy.
Responsible Designer5,WI. Respons761e Designer '
Company: —
Date Signed: '4
Address: `
Po
Go /` V1 I License:
Ckty/5tatellip: , ^ _ —
M '{/rl WS �22.� Phana � S1-ar, -tl � It
For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300.
'CA Building Energy Efficiency Standards - 2019 Residential Compliance January 2020