BRER2014-10131
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
T -dT 4 4 QuiKtoj
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number:
BRER2014-1013
Property Address:
78447 HIGHWAY 111
APN:
604050016
Application Description:
REPLACE TILE ON FASCIA ONLY
Property Zoning:
Application Valuation:
$20,448.00
Applicant:
CENTIMARK CORPORATION
12 GRANDVIEW CIRCLE
ATTN: ERIC B EFAW
CANONSBURG, PA 15317-8533
SEP 19 2014
CITY OF LA QUINTA
COMMUNITY 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 7000) of Division 3 of the Business and Professions Code, and
my License is in full force and effect.
License Class: C39, D06 License No.: 497859
t'' s
Date: Ci 19 It 4 Contractor:
i-/
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
Lender's Address:
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/19/2014
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
WORKER'S COMPENSATION DECLARATION
1 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 ork 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: q 1 q 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.
r
Date: Signature (Applicant or Agent): �_�
DESCRIPTION
FINANCIAL INFORMATION
ACCOUNT
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
c •
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:
$147.93
$148.93
$0.00
00
Permit Number: BRER2014-1013
Applied: 9/19/2014
Issued:
Status: APPROVED
Parent Permit:
Parent Project:
Approved:9/19/2014
Finaled:
Description: REPLACE TILE ON FASCIA ONLY
Site Address: 78447 HIGHWAY 111
City, State Zip Code: LA QUINTA, CA 92253
Applicant: CENTIMARK CORPORATION
Owner: HARSCH INV REALTY
Contractor: CENTIMARK CORPORATION
Details:
RE -ROOF - TEAR OFF EXISTING TILE PORTION ONLY AND REPLACE (46) SQUARES (2) 40# LINER AND BORAL MISSION - 2 PIECE CLAY
TILE, ALONG FASCIA NEAR ROOFLINE ONLY, [CRRC 0942-0129]. 2013 CALIFORNIA BUILDING CODES.
LIST OF
RETURNED
SENT DATE DUE DATE TYPE CONTACT STATUS REMARKS
DATE A
Printed: Friday, 19 September, 2014 1 of 1
� u Sr57: nii
Bin #
City Of La Quillta
Building 8l: Safety Division
P.O. Box 1504, 78 495 Calle Tampico .
La Quints, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
22
Project Address: _?8yy-7- m
Owner's Name:
A. P. Number:
Address: • 78?go) W w 111
Legal Description:
City, ST, Zip: La` C)vth C_- CA' Q2 -.5-j
Contractor: CCr"�imark COTR
Telephone:
Address: G -;I C koV\-CZ.
Project Description:
City, ST, Zip:
Telephone. ne '114,
�
State Lic. #: y Q 7$ 5 Cj
City Lic. C.
M SS
Arch., Engr., Designer:
SQ.: iol-) CR -9C. 0gy2- 01Z •
Address:
y5. S vv��S A l ii
City., ST, Zip:
1d; r
Telephone:
.;<:;;<:<<:<n:.>.;<:<:: <> s ; < ::<:
<`A "::`Y:::`:"''%;:;:::;::;;'^ :
Construction Type: Occupancy
State Lic. #:
Project circle one): New Add'n Alter Repair Dem
J h'Pa � ) P o
Name of Contact Person: Sarn
Sq. Ft.: 14, 550
# Stories:
# Units:
Telephone # of Contact Person: -)1,4- 2t4 y- Ce29e
Estimated Value of Project: moo, 'd 1 8, Ov
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES.
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Cala.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN ROUSE:-
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