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14-0932 (RR)4 P.O. BOX 1504 VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 6/25/14 Application Number: 14-00000932 Owner: Property Address: 78555 HIGHWAY 111 BRETT LANDES APN: 643-020-003- - - 3701 STEVENS CREEK BLVD Application description: RE -ROOF SANTA CLARA, CA 95050 Property Zoning: COMMUNITY COMMERCIAL Application valuation: 19225 Contractor: D tOF Applicant: Architect or Engineer: GOGREEN ROOFING CORP 3360 DE LA CRUZ BOULEVSANTA CLARA, CA 95054 J 20'1 (408)343-8495 Lic. No.: 980023 c�nrua,ur�► ---------------------------------------'----------- UCENSED CONT ACT 'S DECLARATION - I hereby affirm under penalty of perjury that I am licens oder pr 'si sof Chapter 9(commencing with Section 7000) of Division 3 of the Business and Prof si nals Code, an4y License is in full force and effect. License Class: V3 9 License No.: P40023 D Contractor: 4,—'f /_)r - 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).: 1 _ 1 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.). ( 1 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: LQPERMIT ----------------------------------------------- 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 EXEMPT r Policy Number EXEMPT ertify 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 le orkers' compensation laws of California, and agree tha)i� if I should becom�Iowokeirmpensation provisions of Section �3100 of the �:abor Codel I shprovisions. D ree�(•i1eef s- 1 LL ,pplicant: 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 Director of Building and Safety 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 i on rrec . ree to comply with all city and county ordinances and state laws relating to building,c ucti , and h eby au ho representatives of s cou - nt r upon the above-mentioned property for thi' cti pos ate: ignature (Applicant en Application Number . . . . . 14-00000932 Permit . . . RE -ROOF Additional desc . . Permit Fee . . . . 48.62 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 0 Expiration Date 12/22/14 .Qty Unit Charge Per Extension 1.00 48.6200 LS MISC RE -ROOF, 1ST 2000 SF 48.62 ---------------------------------------------------------------------------- Special Notes and Comments REROOF WITH TPO. 2013 CALIFORNIA ENERGY CODE. ---------------------------------------------------------------------------- Other Fees . . . . . . . . . PLAN CHECK, RE -ROOF 97.24 Fee summary Charged ------------------------------------- Paid Credited -------------------- Due Permit Fee Total 48.62 .00 .00 48.62 Plan Check Total .00 .00 .00 .00 Other Fee Total 97.24 .00 .00 97.24 Grand Total 145.86 .00 .00 145.86 LQPERMIT Bi" Permit # Project Address: �kk City of La - Quinta Building.a Safety Division P.O. Box 1504, 78-495 Calle Tampico . La Quinta, CA 92253 - (760) 777-7012 B&1r ing.P&iryit /application and Tracking Sheet o, Ar_ CA' Owner's Name: A. P. Number: Address: S—t- ` Legal Description: City, ST, Zip: Contractor: `�0�� Telephone: L-�O�j • �\� ' y\L\ 1 ;t<:?.s;<>;:<>.::> �=:x.>:z<2v>::. Address: �M?> Project Description: City, ST, Zip: CC` c1'� ��Q� r'7 \ r� Telephone: State Lic. #:- City Lie. #•: .� Arch., Engr., Designer. Address: City., ST, Zip: Telephone: P ;.•r,:F>, ," :>: •;v:•>:? r.»":> .'::> ::: ::::< (� Construction Type: �OTS`r Occupancy: State Lic. #: v<. . ...: Pro ect a circle one): New Ad 'n Alter ea Demo Name of Contact Person: �� C� 0. Sq. Ft.: �U # Stories: # Units: Telephone # of Contact Person: e4 O� • C1 Estimated Value of Project: 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 Cala. 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 Deed Plans picked up S.M.I. Ii.O.A. Approval Plans resubmitted Grading IN ROUSE: '"' Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees _._..� 76-5% 4rtwrrt t ! IIIIU��IIIIIIIIIIIII��IIIIIIIIIIIIU�IIIIIIIU��••••�••_ =� I 11 mono �I IS --SIS iluq 111 iE.) � 0 � � � N _ ✓� �l --� -� _ G � �