BRER2016-007278-495 CALLE-TAMPICO
LA QUINTA, CALIFORNIA 92253
DESIGN & DEVELOPMENT DEPARTMENT
- BUILDING PERMIT
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/1/2016
Application Number:
BRER2016-0072
Owner:
Property Address:
79940 MERION
AMARJIT SINGH
APN:
762110028
9507 BRIAR CIR
Application Description:
TILE RESET
BLOOMINGTON, MN 92253
Property Zoning: ,
Application Valuation:
$32,700.00
Applicant: Contractor:
WILLIAMS ROOFING WILLIAMS ROOFING
P-0 BOX 391841 P 0 BOX 391841
ANZA, CA 92539 ANZA, CA 92539
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:
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 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 Name:
Lender's Address:
(760)399-9394
LIC. No.: 774482
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 worker's'
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: STATE COMPENSATION INSURANCE FUND Policy Number: 1890178
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):
Date: 8/1/2016
Application Number:
BRER2016-0072
Owner:
Property Address:
79940 MERTON
AMARJIT SINGH
APN:
762110028
9507 BRIAR CIR
Application Description:
TILE RESET
BLOOMINGTON, MN 92253
Property Zoning:
Application Valuation:
$32,700.00
Applicant:
Contractor:
WILLIAMS ROOFING
WILLIAMS ROOFING
P O BOX 391841
P 0 BOX 391841
ANZA, CA 92539
ANZA, CA 92539.1 „
(760)399-9394
---------------
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tic. No.: 774482
Detail
-
i
i
. r
r
DESCRIPTION
. ACCOUNT I QTY I _AMOUNT
BSAS SB1473 FEE 101-0000-20306 0 $2.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $2.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
Credit Card Fee
101-0000-43505
0
$4.32
Total Paid for Credit Card Fee: $4.32
DESCRIPTION
ACCOUNT.
QTY
AMOUNT
R&ROOF - EA ADDITIONAL 1,000 SF
101-0000-42404 1
0
$46.40
DESCRIPTION
ACCOUNT
QTY
AMOUNT
RE -ROOF - FIRST 2,000 SF
101-0000-42404
0
$49.31
DESCRIPTION
ACCOUNT
QTY
AMOUNT
RE -ROOF - FIRST 2,000 SF PC
101-0000-42600
0
$98.62
Description: TILE RESET
Type: RE -ROOF (WEB)
Subtype:
Status: ISSUED
Applied: 7/6/2016 ECON
Approved: 7/8/2016 MFA -
Parcel No: 762110028 Site Address: 79940 MERION LA QUINTA,CA 92253
Subdivision: TR 28410-2
Block:
Lot: 61
Issued: 7/8/2016 ECON
Lot Sq Ft: 0
Building Sq Ft' 0
Zoning: .
Finaled:
Valuation: $32,700.00
Occupancy Type:
Construction Type:
Expired: 1/7/2017 crw
No. Buildings: 0'
No. Stories: 0
No: Unites: 0
Details:
2.
0
RUNULG
a
FINANCIAL
` •.•
Printed: Monday, August 01, 2016 4:30:38 PM 1 of 3
SYSTEMS
V
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CLTD.
DESCRIPTION
ACCOUNT.
QTY
..AMOUNT
PAID.:.PAID
DATE
RECEIPT #
CHECK #
METHOD
PAID BY .
-.
.
BY
201607082
BSAS SB1473 FEE
101-0000-20306
0
$2.00
$2.00
7/8/16
WEB909
356522430
CREDIT
STEVEN D WILLIAMS
ECON.
2
Total Paid for BUILDING STANDARDS ADMINISTRATION $2,00 $2.00
BSA:
201607082
Credit Card Fee
101-0000-43505
0
$4.32
$4.32
7/8/16
WEB909
356522430
CREDIT
STEVEN D WILLIAMS
ECON
2
Total Paid for Credit Card Fee: $4.32 $4.32
201607082
RE-ROOF - EA
101-0000-42404
0
$46.40
$46.40
7/8/16
WEB909
356522430
CREDIT
STEVEN D WILLIAMS
ECON
ADDITIONAL-1,000 SF
2
201607082
RE-ROOF - FIRST 2,000
101-0000-42404
0
$49.31
$49.31
7/8/16
WEB909
356522430
CREDIT
STEVEN D WILLIAMS
ECON
SF
2
201607082
RE-ROOF - FIRST 2,000
101-0000-42600
0
$98.62
$98.62
7/8/16
WEB909
356522430
CREDIT
STEVEN D WILLIAMS
ECON
SF PC
2,;:
Total Paid for RE-ROOF: $194.33 $194.33
�.
Printed: Mdnday, August 01, 2016 4:30:38 PM 2 of 3 -
SYSTCMS
PARENT PROE�T$ , „