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BRER2014-101278-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: 4P N: Application Description Property Zoning: Application Valuation: BRER2014-1012 COMMUNITY DEVELOPMENT DEPARTMENT BUILDING PERMIT 78483 HIGHWAY 111 604050069 REPLACE TILE ON FASCIA ONLY $30,560.00 Applicant: CENTIMARK CORPORATION 12 GRANDVIEW CIRCLE ATTN: ERIC B EFAW CANONSBURG, PA 15317-8533 SEP 19 2014 CITY OF LA GUINTA 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 Date: I Contractor: c>lAtitTLi �� OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that 1 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 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 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, 1 shall forthwith comply with those provisions. ��-- Date: 1 I=f' 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. 1 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: Gl 4 Signature (Applicant or Agent) �Z_ DESCRIPTION FINANCIAL INFORMATION ACCOUNT QTY AMOUNT PAID PAID DATE BSAS SB1473 FEE 101-0000-20306 0 $2.00 $0.00 PAID BY METHOD RECEIPT # . CHECK # CLTD BY Total Paid forBUILDING STANDARDS ADMINISTRATION BSA $2.00. $0.00 DESCRIPTION ACCOUNT ' QTY1 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: $147.93 $0.00 TOTALS:4• 00 s Permit Number: BRER2014-1012 Applied: 9/19/2014 Issued: Status: APPROVED Parent Permit: Parent Project: Approved:9/19/2014 Finaled: Description: REPLACE TILE ON FASCIA ONLY Site Address: 78483 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 68 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 SENT DATE 'RETURNED', DUE DATE f TYPE CONTACT STATUS REMARKS DATE ' Printed: Friday, 19 September, 2014 1 of 1 . �SyS i:ti!i . , Y Bin # City of La Quinta Building 8i Safety Division Permit # P.O. Box 1504, 78 495 Calle Tampico. La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Project Address:;"72-483-7N 111 Owner's Name: \ Z o L - A. P. Number: Address: -?Q440) H w 111 Legal Description: City, ST, Zip: [-a CA ciZZS25 Contractor: Ce�n��mar� Co• Telephone: Address: - q8-7 N -Br—,A a,; e. Project Description: City, ST, Zip: ( c.CA q $(07 Rvoo� ` Tear QM C -xi ini.� le.. Telephone: 71q_-744- q _ - y O i—14e_ Liner . 13orc.1 State Lic. # : tAct7,%S 9 City Lie. #.. - 7- ns_ se Z l �e.e` CSA` Ti k". . Arch., Engr., Designer: ES'L_ Ip�-J CR RC OG�12- 012 9 Address: (o$ S vo�re . - C "004i e," City, ST, Zip: QSC i -Q �ui 1 Telephone: P State Lie. #:»::_ `:;:.A:::-;:.<;;;:;r>.::;:>:<;•;:.;.::,r>:<:: <::t:::>:::<:<>:::• <::::;.s:<.<.<_.;;:»>:: ::<: •>:::»>;<::>: :; -- ..................:............... Construction Type: Occupancy: Project type (circle one): New Add'n Alter Repair Demo Name of Contact Person:S� mm Sq. Ft.: (,1800 # Stories: #Units: Telephone #,of Contact Person: ILI Zye.l_ (oZq 3 Estimated Value of Project: Go. APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING PERMIT FEES. Plan Sets. PIan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Title 24 Calcs. 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 Decd Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN IiOUSE:- 'rd Review, ready for correctionsfissue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees