BRER2016-005978-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: BRER2016-0059
Property Address:
80432 RIVIERA
APN:
762200030
Application Description:
ROOF TILE RESET
Property Zoning:
ANZA; CA 92539...-...._ .:..... --- ._.. _ ......_ ....
Application Valuation:
$36,000.00
4Vauilirw
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
KARIBROTHERTON
1201 3RD AVE STE 3400
SEATTLE, WA 92253
Date: . 7/12/2016
Applicant:
Contractor:
WILLIAMS ROOFING
WILLIAMS ROOFING
P 0 BOX 391841
P O BOX 391841
ANZA, CA 92539
ANZA; CA 92539...-...._ .:..... --- ._.. _ ......_ ....
(760)399-9394
LIc. No.: 774482
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.: 774482
Date:
Contractor:
OWN ER -BU ILDER'DECLARATI ON
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).:
(_J 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 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
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: _
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, I shall forthwith
comply with those provisions.
Date:
Applicant:
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 inspection purposes.
Date: Signature (Applicant or Agent):
i
FINANCIAL INFORMATION
g .:. DESCRIPTIONACCOUNT„
F= "QTY AMOUNT 'i t
z PAID
PAID DATE`
BSAS SB1473 FEE
101-0000-20306 0 $2.00
$2.00
6/14/16
„...
PAID BY �,�TMETHOD
�`' rRECEIPT#`
CHECK#'
CLTDBY."i
Sheri L Williams
CREDIT WEB870
201606 5751103713
ECON
Total Paid.for BUILDING STANDARDS ADMINISTRATION BSA: $2.00 $2.00
ACCOUNT �•
!-`;PAID..,
#PAID DATE
Credit Card Fee
101-0000-43505
0
$4.57
$4.57
6/14/16
PAID BYw
; r METHOD p{> t-
, RECEIPTf#
'W' CHECK #a.
CLTD BY
Sheri L Williams
CREDIT
WEB870
20160654 51103713
ECON
Total Paid for Credit Card Fee: $4.57 $4.57
DESCRIPTION",",
ACCOUNTf �4
QTY
AMOUNT
PMD
PAID
_
RE -ROOF - EA ADDITIONAL 1,000 SF
101-0000=42404
0
$58.00
$58.00
6/14/16
s .�+ " PAID. BY g ":::; &r
METHOD
'RECEIPT #
CHECK #,
CLTD BY"
;*
Sheri L Williams
CREDIT
WEB870
2016065475 103713
ECON
° �,e,w DESCRIPTION s
ACCOUNT.a ° {_
QTY
KAMOUNT'
"PAID
;PAID DATE
_�
RE -ROOF - FIRST 2,000 SF
101-0000-42464
0
$49.31
$49.31
6/14/16
PAID BY $ -
� _ METHOD ` _q
RECEIPT #
' � ,CHECK # 4
CLTD1BY i
a
A��
#
Sheri L Williams
CREDIT
WEB870
201606551103713
ECON
`DESCRIPTION `'` �.
; : s` ACCOUNT'. -'.QTY
AMOUNT,;,:
7., PAID
PAID DATE
RE -ROOF - FIRST 2,000 SF PC .
101-0000-42600
0
$98.62
$98.62
6/14/16
PAID. Y " t
METHOD 't
RECEIPT # <,}
:. CHECK # t »
r= CLTD BY
m
.-
Sheri L Williams
CREDIT
WEB870
2016061421103713
ECON
575
Total Paid for RE -ROOF: $205.93 $205.93
------- ---`}
Permit Details PERMIT NUMBER
City of La Quinta BRERd24OR0059
Description: ROOF TILE RESET
CONDITIONS
=s
Type: RE -ROOF (WEB)
Subtype: Status: ISSUED
Applied: 6/10/2016 EC;ON
Approved: 6/14/2016`S.KH
Parcel No: 762200030 Site Address: 80432 RIVIERA LA QUINTA,CA 92253
Subdivision: TR 28603-2
Block: Lot: 3
Issued: 6/14/2016 ECON
Lot Sq Ft: 0
Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $36,000.00
Occupancy Type: Construction Type:
Expired: 12/12/2016 crw
No. Buildings: 0
No. Stories: 0 No. Unites: 0
WILLIAMS ROOFING
Details:
ANZA
CA
CHANGE UNDERLAYMENT. 2013 CALIFORNIA BUILDING.CODES.
(
FINANCIAL INFORMATION
Printed:. Tuesday, July 12, 2016 1:19:57 PM 1 of 3 r1r
SYSTEMS
DESCRIPTION
777
ACCOUNT
77—,!,
,
17
t "
P AID.'
PAID DATE'
�74, 7
RECEIPT #
nMETHOD
PAID BY,
CLTD.
.,
�4.AIVIOUNT',-
BY
20160qU42
BSAS SB1473 FEE
101-0000-20306
0
$2.00
$2.60
6/14/16
WEB870
1103713S7
CREDIT
Sheri L Williams
ECON
5
Total Paid for BUILDING STANDARDS ADMINISTRATION
$2.00 $2.00
BSA:
201606142
Credit Card Fee
101-0000-43505
0
$4.57
$4.57
6/14/16
WEB870
110371357
CREDIT
Sheri L Williams
ECON
5
Total Paid for Credit Card Fee: $4.57 $4.57
201606142
RE -ROOF'- EA
.101-0000-42404
.$58.00
$58.00
6/14/16
WEB870
110371357
CREDIT
Sheri L Williams
ECON
ADDITIONAL 1,000 SF
.0
5
201606142
RE -ROOF - FIRST 2,000
101-0000-42404
0
$49.31
$49.31
6/14/16
WEB870
110371357
CREDIT
Sheri L Williams
ECON
SF
5
201606142
RE -ROOF - FIRST 2,000
101-0000-42600
0
$98.62
$98.62-
6/14/16
WEB870.
110371357
CREDIT
Sheri L Williams
ECON
SF PC
Total Paid for RE -ROOF: $205.93 $205.93
TOTALS: $212.50 $212.50
-SEQID INSPECTIONLTYPE< INSPECTOR -SCbb6,[COM0LETO - RESULT idwkkg7, NOTES'..
DATE DATE
Printed: Tuesday, July 12, 2016 1:19:57 PM 2 of 3 CRWIMEMS
PRE -ROOF
JFU
6/15/2016 1
6/15/2016 1
APPROVED
PARENT PROJECTS
eTRAKiT Inspection
Request
6/14/2016 2:16 PM WILLIAMS ROOFING
Morning appointment if possible. Thank
You.
Contact Name: WILLIAMS ROOFING
Site Address: 80432 RIVIERA
Phone:7603999394
e -Mail:
WILLIAMSROOFING2000@YAHOO.COM
Printed: Tuesday, July 12, 2016 1:19:57 PM 3 of 3
SYSTEMS