BRER2017-0008Z
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: . BRER2017-0008
Property Address:
51895 AVENIDA RUBIO
APN:
773161019
Application Description:
AMMERMAN / REPAIR
Property Zoning:
Application Valuation:
$4,000.00
Applicant:
LEHMAN ROOFING INC
81-612 ANDALUSIA DRIVE
LA QUINTA, CA 92253-8251
T4'yl 44 Quw(v.*
DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 (commencing with Se'ttion 7000) of Division 3 of the Business'and Professions Code,
and my License is in full force and effect.
License Class: C39 License No.: 499608
i
Date . 2— Contractor: '-ti✓f/�h� d �� 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 Name:
Lender's Address:
VOICE (760) 777-7125
FAX (760) 777-7611
INSPECTIONS (760) 777-7153
Date: 2/2/2017
Owner:
DENVER AMMERMAN
, 92253
Contractor:
LEHMAN ROOFING INC
81-612 ANDALUSIA DRIVE
LA QUINTA, CA 92253-8251
(760)238-4867
Llc. No.: 499608
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 workf 9r, which this permit is issued.
!ave 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: APPLIED UNDERWRITERS CAPTIVE RISK ASSURANCE COMPAN Policy
Number: 467862650102
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 su ct to the
workers' compensation provisions of Section 3700 of the Labor Cod shall forthwith
comply with those provisions. W p
Date: 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 b ding
construction, and hereby authorize representatives of this city enter on
above-mentioned property for inspection purposes. ,
Date:7— — \Signature (Applicant or Agent
Date: 2/2/2017
Application Number: BRER2017-0008 •
Owner: • .
Property Address. 51895 AVENIDA RUBIO
DENVER AMMERMAN
APN: 773161019
Application Description: AMMERMAN / REPAIR
92253
Property Zoning:
Application Valuation: $4,000.00
Applicant:
Contractor:
LEHMAN ROOFING INC
LEHMAN ROOFING INC
81-612 ANDALUSIA DRIVE
81-612 ANDALUSIA DRIVE
LA QUINTA, CA 92253-8251
LA QUINTA, CA 92253-8251
(760)238-4867
---------------------------------------------------------------------------------------------
Llc. No.: 499608
Detail: ROOF REPAIR - ADD PAPER AND PLACE CONCRETE TILE. 2016 CALIFORNIA ENERGY CODE.
DESCRIPTION
FINANCIAL INFORMATION
ACCOUNT
QTY
AMOUNT
BSAS SB1473 FEE
101-0000-20306
0
$1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA:
$1:00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
RE -ROOF - FIRST 2;000 SF
101-0000-42404
.0
$51.68
DESCRIPTION
ACCOUNT
QTY
AMOUNT
RE -ROOF - FIRST 2,000 SF PC
101-0000-42600
0
$103.36
Bin. #
City of La Quin to
Building 8z: Safety Division
Permit # 78-495 Calle Tampico
r _ n1 La Quinta, CA 92253 - (760) 777-701,2
wilding Permit Application and Tracking Sheet
Project Address: ✓ ! Owner's Name: �� jG /A-.
A. P. Number: ..
Address: S �,�7 S �'f/L• (Ti//�y ,
Legal Description:
City, ST, Zip:
Contractor: 6_:O
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T ele h ne: -/
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Address: A J. 4- A"'5 i P;)-.
City, ST, Zip:
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Project Description: i✓ - ;J/L..C�r
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State Lic. # : 6 0
City Lic. #:.
:
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Arch., Engr., Designer:
7.
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Address:
City, ST, Zip:
Telephone. h
one:
Construction TY Pe: Occupancy: j
cY: i
State Lic. #
Pr oJ tyPa (circle one)• New Add'n Alter P Demo
Name of Contact Person?-
SS�Stories:
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#Units:
Telephone # of Contact Person: j L f7 N 7 �iZ z
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Estimated Value of Project: ' G i% ) ✓ i) -)('
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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 Calcs.
Plans picked'up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Review, ready for corrections/issue
Electrical .
Subcontactor List
Called ContactPcrson
Plumbing
Grant Dced
Plans picked up
S.M.I. '
Ii.O.A. Approval
Plans resubmitted
Grading
IN HOUSE.-
'rd Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.T.P.P.'
Pub.. Wks. Appr
Date of permit issue
School Fecs,
Total Permit Fees