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BRER2014-100978-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 T4tr 4 4 Q" COMMUNITY DEVELOPMENT DEPARTMENT BUILDING PERMIT Application Number: BRER2014-1009 Property Address: 78271 HIGHWAY 111. APN: 604050061 Application Description: REPLACE TILE ON FASCIA ONLY Property Zoning: issued. My workers' compensation insurance carrier and policy number are: Application Valuation: $24,246.00 Applicant: _ _ I certify that in the performance of the work for which this permit is issued, I CENTIMARK CORPORATION 12 GRANDVIEW CIRCLE city or county that requires a permit to construct, alter, improve, demolish, or repair any ATTN: ERIC B EFAW structure, prior to its issuance, also requires the applicant for the permit to file a signed CANONSBURG, PA 15317-8533 I uL P19 2014 COMMUNIryDEV LFPMGONTA gTMENT VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Owner: HARSCH INV REALTY 1121 SW SALMON ST 4TH FL PORTLAND, OR 92253 Contractor: CENTIMARK CORPORATION 12 GRANDVIEW CIRCLE ATTN: ERIC B EFAW CANONSBURG, PA 15317-8533 (724)514-8765 Llc. No.: 497859 Date: 9/19/2014 LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 1 hereby affirm under penalty of perjury one of the following declarations (commencing with Section 7000) of Division 3 of the Business and Professions Code, and _ 1 have and will maintain a certificate of consent to self -insure for workers' my License is in full force and effect. • compensation, as provided for by Section 3700 of the Labor Code, for the performance of License Class: C39, D06 License No.: 497859 the work for which this permit is issued. ^ (Dae CI Cont" racfor: �l 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: OWNER -BUILDER DECLARATION Carrier:. Policy Number: I hereby affirm under penalty of perjury that I am exempt from the Contractor's State _ _ I certify that in the performance of the work for which this permit is issued, I License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any shall not employ any person in any manner so as to become subject to the workers' city or county that requires a permit to construct, alter, improve, demolish, or repair any compensation laws of California, and agree that, if I should become subject to the structure, prior to its issuance, also requires the applicant for the permit to file a signed workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith statement that he or she is licensed pursuant to the provisions of the Contractor's State comply with those provisions. License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business 4 �� _ , �t�u..12i- and Professions Code) or that he or she is exempt therefrom and the basis for the alleged DG ) App' licant: 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).: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, (_J I, as owner of the property, or my employees with wages as their sole AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE compensation, will do the work, and the structure is not intended or offered for sale. HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, apply to an owner of property who builds or improves thereon, and who does the work INTEREST, AND ATTORNEY'S FEES. 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 APPLICANT ACKNOWLEDGEMENT within one year of completion, the owner -builder will have the burden of proving that he IMPORTANT:Application is hereby made to the Building Official for a permit subject to or she did not build or improve for the purpose of sale.). the conditions and restrictions set forth on this application. (_) I, as owner of the property, am exclusively contracting with licensed contractors to 1. Each person upon whose behalf this application is made, each person at whose construct the project. (Sec. 7044, Business and Professions Code: The Contractors' State request and for whose benefit work is performed under or pursuant to any permit issued License Law does not apply to an owner of property who builds or improves thereon, and as a result of this application , the owner, and the applicant, each agrees to, and shall who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and State License Law.). employees for any act or omission related to the work being performed under or' (_) I am exempt under Sec. : B.&P.C. for this reason 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 Date: Owner: for 180 days will subject permit to cancellation. 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: 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. Pic Date:�-q IQ 1 Sig nature-(ApplicantorAgent): �� r DESCRIPTION l •• FINANCIAL ACCOUNT l, QTY AMOUNT PAID PAID DATE BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid forBUILDING STANDARDS ADMINISTRATION BSA: $1.00 $0.00 DESCRIPTION ACCOUNT QTY' AMOUNT PAID PAID DATE RE -ROOF - FIRST 2,000 SF 101-0000-42404 0 $49.31 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RE -ROOF - FIRST 2,000 SF PC 101-0000-42600 0 $98.62 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid for RE -ROOF: TOTALS:00 $147.93 $0.00 Permit Number: BRER2014-1009 Applied: 9/19/2014 Issued: Status: APPROVED Parent Permit: Parent Project: Approved: 9/19/2014 Finaled: Description: REPLACE TILE ON FASCIA ONLY Site Address: 78271 HIGHWAY 111 City, State Zip Code: LA QUINTA, CA 92253 Applicant: CENTIMARK CORPORATION Owner: HARSCH INV REALTY Contractor: CENTIMARK CORPORATION Details: RE -ROOF - TEAR OFF EXISTING TILE PORTION ONLY AND REPLACE 54 SQUARES (2) 40# LINER AND BORAL MISSION - 2 PIECE CLAY TILE ALONG FASCIA NEAR ROOFLINE ONLY, [CRRC 0942-0129]. 2013 CALIFORNIA BUILDING CODES. LIST OF REVIEWS RETURNED SENT DATE ' ` DATE DUE DATE TYPE. CONTACT STATUS REMARKS i N Printed: Friday, 19 September, 2014 1 of 1 Bin # City of La Quinta Building &r Safety Division P.O. Box 1504, 78-495 Calle Tampico. La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # / Project Address: -7&..,4•7 ( t U W' lI l - Owner's Name: G2 i A. P. Number: Address: 7,% 4 0 I Legal Description: City, ST, Zip: I_C,% CA 4 ZZS •3 •lr'I'?:�!<j� Contractor: CeV%kmC,' Co -vv. Telephone: '?�.vSi'�:Y::i}inji}'w :i�+i:4. Address: 70. ova Project Description: City, ST, Zip: CX_ CA G Z 8to7 5Ai 'T;_ �. Telephone: ->1�-7yy-(,gty ' Zn s all �, � Ler,4 30w—\ State Lic. # : 14 tk e)$S S City Lie. #;Z 1.3 '— f�ii5s' • ece_ _l1; � 1Zcot Arch., Engr., Designer: i0r) L'Q1QC Ogcl2- 0l2q Address: City., ST, Zip: -cxs cz_ OP, av; lainl Dnl Telephone: Construction Type: Occupancy: State Lie. #: Project type (circle one): New Add'n Alter Repair Demo Name of Contact Person: S Sq. Ft.: t eJI # Siories: #Units: Telephone # of Contact Person: 2'9 j Estimated Value of Project: '� �� '(! (� , APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rec'd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cates. Reviewed, ready for corrections Plan Cluck Deposit Truss Cates. Called Contact Person Plan Check Balance Title 24 Cales. Plans picked up Construction ' Flood plain plan Plans resubmitted Mechanical Grading plan 2pd Review, ready for corrcctionsfissue Electrical Subcontactor List Called Contact Person Plumbing Grant Decd Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN IiOUSE:- 3" Review, ready for correctionstissue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees