14-0934 (RR)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
14-00000934
Property Address:
78595 HIGHWAY 111 STE 100
APN:
643-220-025- - -
Application description:
RE -ROOF
Property Zoning:
COMMUNITY COMMERCIAL
Application valuation:
32750
c&t�/440"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
BRETT LANDES
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/25/14
Contractor:
Applicant: Architect or Engineer: GOGREEN ROOFING CORPd
3360 DE LA CRUZ BOULE
SANTA CLARA, CA 95054
(408)343-8495 JUN t7 Zoll{
LiC. Noo..:: 9 980023
tCnOFu►euw,e
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am lic sed er provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Pr ssionals d my License is in full force and effect.
License.El6ss: IC39 �. Licens No.: 80023
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.).
(_ 1 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:
LQPERM IT
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— Policy Number EXEMPT
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 sAZqt to the workers' compensation laws of California,
and agree that, if I should becom nbj t to workers' compensation provisions of Section
700 of the Labor Code, I shall fo ith co "h those provisions.
Date: Ap cant:
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 160 days from date of issuance of such permit, or ces ' n of work for 180. days will subject
permit to cancellation.
I certify that I have read this application and state that the above inf mation is co t. I agree to comply with all
city a"cotances and state laws relating to building co ctio and her by thorize representatives
of thiser upon the above-mentioned property siia purpose
Date:Signature (Applicant or Agent):
Application Number . . . . . 14-00000934
Permit . . . RE -ROOF
Additional desc . .
Permit Fee . . . . 174.46
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
11.00 11.4400 EA MISC
RE -ROOF, ADDL 1000 SF
125.84
----------------------------------------------------------------------------
Z,
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 174.46
.00 .00
174.46
Plan Check Total .00
.00 .00
'00
Other. Fee Total 97.24
.00 .00
97.24
Grand Total 271.70
.00 .00
271.70
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 #
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Project Address: 46_ s9s qzL
wner's Name: �a L6^&S
A. P. Number:
Address: �"
Legal Description:
City, ST, Zip:
Contractor:
C
Telephone:
Address:
Project Description:
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City, ST, Zip: 'Vt��+— '�
Telephone:
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State Lic. # : 9 bC`?T0
City Lie. #;
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Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone: ::::-::::r;:<;
P >. ; : ..
:<s:... ::...N:.:
Lic. #:
Name of Contact Person:f1C_V0.
Construction T e: 'v � ccu an
YP �o tl P cY•
Project hPa (circle one): New Add'n Alter air
R
Demo
Sq. Ft.: j''Z 1
# Stories: \
# Units:
Telephone # of Contact Person: 1A0b • '_-k6(o T
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 C21cs.
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 corrcctions/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Decd
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN ROUSE:-
'"' Reyiew, 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
w
446
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