BRER2016-010378-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application Description
Property Zoning:
Application Valuation:
c&�t 4 4 Q"
DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
BRER2016-0103
Owner:
55730 RIVIERA
PGA RESIDENTIAL ASSOCIATION
775242012
54320 SOUTHERN HILLS
PGA WEST HOA / POLYURETHANE FOAM ROOF
LA QUINTA, CA 92253
$2,140.00
Applicant:
B R S ROOFING INC
777 SOUTH LUGO AVE
SANBERNARDINO, CA 92408
D
Contractor:
o
B R S ROOFING INC
777 SOUTH LUGO AVE
CITY OF LA QUINTA SAN BERNARDINO, ZA 92408
DESIGN AND DEVELOPMENT DE"RTMEN9o9)ssa s5o5
LIc: No.: 907600
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 Clas : C3 License No.: 907600
c
Date:' �04/Contractor: �
n _
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, 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 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 Name:
Lender's
Date: 11/9/2016
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of tie 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
ofthe Work for which this permit is issued. -
I have and will maintain workers' compensation insurance, as required by
S t ion 3700 of the Labor Code, for the performance of the work for which this permit
is issued. My workers' compensation insurance zarrier and policy number are:
Carrier: STATE COMPENSATION INSURANCE FUND Policy Number: 9141962
I certify that in the performance of tF a work for which this permit is issued, I
shall not employ any person in any manner so a: 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 3770 of the Labor Code, I shall forthwith
comply with hos provisions.
Date: Applicant-
��-..
WARN NG: FAILURE TO SECURE WORK CON NSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,00Q. 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 perform 2d under or pursuant to any permit
issued as a result of this application the owne and the applicant, each agrees to, and
shall defend, indemnify and hold harmless the =ity 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 cancel ation.
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 n the
above-mentioned property for inspection purposes.
r "—
Date: Signature (Applicantor Agent):
f•
Date: ,11/9/2016
Application Number:
BRER2016-0103
Owner:
Property Address:
55730 RIVIERA
PGA RESIDENTIAL ASSOCIATION
APN:
775242012
54320 SOUTHERN HILLS
Application Description:
PGA WEST HOA / POLYURETHANE FOAM ROOF
LA QUINTA, CA 92253
Property Zoning:
Application Valuation:.
$2,140.00
Applicant:
Contractor:
B R S ROOFING INC
8 S ROOFING INC
777 SOUTH LUGO AVE
777 SOUTH LUGO AVE
SAN BERNARDINO, CA 92408
SAN BERNARDINO, CA 92408
(909)884-8505
Llc. No... 907600
Detail: REROOF WITH POLYURETAHNE FOAM - LA POLLA COATINGS[CRRC: 0770-0002) 2013 CALIFORNIA ENERGY CODE.
iFINANCIAL INFORMATION,.
DESCRIPTION
ACCOUNT • Q1'
AMOUNT
BSAS SB1473 FEE
101-0000-20306C
$1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA:
$1.00.
DESCRIPTION
ACCOUNT
Q1Y
AMOUNT
RE -ROOF - FIRST 2,000 SF
101-0000-42404
0
$51.68
Total Paid for RE -ROOF:
..$51.68
Bin ##
Permit #
,--.{
Project Address: '
City of La Quin to
Building 8t• Safety Division
78-495 Caffe Tampico
U Quinta, CA 92253 - (760) 777-701,2
Building Permit Application and Tracking Sheet
P /� �V D Owner's Name:
,%
A. P. Number: l e6
�
Address: . i.
Legal Description:
City, ST, Zip: fit.
Contractor: t
or:
Telephone:
Address:
9�47/
Project Description: Q ep
1 11
City_ ST, Zip: C_ d,' f
ne•
TeleP ho .
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State Lie. # lao 6 '
City Lie.
Arch.,:Engr., Designer:
Address:
City, ST, Zip:
Telephone -
NX.
ecu an.
Occupancy:
n t" O
Co trot ton T e:
s Y P
Lie. ,.
i #
State a
Project ect 0P (circle one): Add'n A1tJr Repair. t Demo
0
Name of Contact Person:
Sq. Ft.:
# Stories:
# Units: ,
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rcc'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cafes.
Reviewed, ready for corrections
Plan Clieck Deposit '
Truss Calcs.
Called Contact Person
Plan Check Balanc--.
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Revicw, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.T.
I-I.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
7r9 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,
l
Total Permit Fees
STATE OF CALIFORNIA r
RESIDENTIAL ALTERATIONS
CEC-CFIR-ALT-01-E Revised 06114 CALIFORNIA ENERGY COMMISSION ai
CERTIFICATE OF COMPLIANCE
CFIR-ALT-01-E
Prescriptive Residential Alterations (Page 1 of 4)
Date Prepared:
A. GENERAL INFORMATION
01
02
01 Project Name:
03 Project Location:
05 CA City: `
02
Cal 04
06
Date Prepared: ao- .'6 ; iv
Building Front Orientation (deg or cardinal):
Number of Alie edkDwelling Units: r
07 Zip Code:
08
Fuel Type:
09 Climate Zone: `
10
Total C'OrOl toned Floor-,AEeb (ft2)i
STATE OF CALIFORNIA
RESIDENTIAL ALTERATIONS s
CEC-CFIR-ALT-01-E Revised 06/14)CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CF1R-ALT-01-E
Prescriptive Residential Alterations , (Pape 4 of 4)
Project Name: 'PC—/ J¢ b/l.r-I �'f I Date Preoared: ////a -7-/ '91)14
DOCUMENTATION AUTHOR'S DECLARATION STATEMENT
1. 1 certify that this Certificate of Compliance documentation is accurate and complete. k?
Documentation Author Name:
Documentation Author Signature: W -
IV Company:Signature
V 041441,
Date:
Address:
CEA/ HERS Certification Ide tifutionf(if pplicable):
City/State/Zip:
1 `
Phone: _i' ,/►j
"A'71'001-`
' (�
RESPONSIBL PERSON'S DECLARATION STATEMENT,.:t
I certify the following under penalty of perjury, under the laws of the State of California: � is f" i , `�
1. The information provided on this Certificate of Compliance is true and correct.
system
2. I am eligible under Division 3 of the Business and Professions Code to accept responsilimity,for the building,. es'lg ?o design identified on this Certificate of Compliance (responsible
designer).
3. That the energy features and
performance specifications, materials, component ,hand manufactur��yd•,��evit'ee for the building design or system design identified on this Certificate of
Y
Compliance
conform to.the requirements of Title 24, Part 1 and Part 6 q the >ai fornia Code of`Regfilafions.
4. The building design features or system design features identified thl Co}npliance
on rtificate of are consiste,n� . It the information provided on other applicable compliance documents,
worksheets, calculations, plans and specifications submitted to thMe oicement agen`c ford pprovaI with Ing
is. buil permit application.
S. I will ensure that a registered copy of this Certificate of CompllannE hall be madeailablt with the buildi rmit(s) Issued for the building, and made available to the enforcement agency
for all applicable inspections. I understand that a regist9r,.ed copy of this Certifcd"te bf Compliance is requirei to be included with the documentation the builder provides to the building
owner at occupancy.
Responsible Designer
ame:
f9
�Respbnsible Designer Signature:
G7laVf'4
Company yti )�
Date Signed:
t.mants.
V
Address:��5 `? -y} 4P"�`'fit:
license:
f
City/State/Zip:' jJnry <• " quarX "-
�"z•4°. i / 1
V-21
Phone:
'a• 717
For assistance &14 estions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300.
Registration Number: Registration Date/Time: HERS Provider:
CA Building Energy Efficiency Standards - 2013 Residential Compliance June 2014