14-0223 (RR)P.O. BOX 1504
78-495 CALLE TAMPICO y
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT C,
Application Number:
14-00000223
Property Address:
54125 AVENIDA RUBIO
APN:
774-201-019-7 -000000-
Application description:
RE -ROOF
Property Zoning:
COVE RESIDENTIAL
Application valuation:
11000
Appl�a�� / � ArchitectEngineer:
----------------MOWNER-BUILDER
--- ----------------------
SED TOR'S DECLARATION
I hereby affirm under penalty of perjurder rovisions of Chapter 9 (commencing with
Section 7000) of Division of the Busls C e, and my License is in full force and effect.
LicenseClla%sss: C39Lice eNo.: 947919
Dat v `I Contra
ILDER 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 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:
LQPERMIT
Owner:
JOYCE BRINKMENN
54145 AVENIDA RUBIO
LA QUINTA, CA 92253
(
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 77717153
Contractor: D a
DIVERSIFIED ROOFING SRVC, INC1.
74040 HWY 111, STE L-207IAL:1�;II
PALM DESERT, CA 92260
(760)895-4465
LiC. No.: 947919 CITY OF LAQUMTA
Date: 3/03/14
--------------- - - -
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 polic umber are:
Carrier COMPANION PROP Policy Number CPCA17249
I certify 4LaborCod
e perfor an of th o�i for which this permit is issued, I shall not employ any
persoanner a to be me subject to the workers' compensation laws of California,
and a that, if I shou becom subjec( to the workers' compensation provisions of Section
3700bor Cod , shall f rth 't�i comply with those provisions.
Date '15' WARNING: FAILURE E WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLORIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000DITION 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 ny act or omission related to the work being
performed under or following issuance of this ermi .
2. Any permit issued as a result of this applKction,
null and void if work is not commenced
within 160 days from date of issuance or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state tharmation is correct. I agree to comply with all
city and county ordinances and st laws relating to ion, and h authorize representatives
of this county to(�jj^�ter upon the ab v mentioned pr tion purpo es.
Date.
- —I I Signature (Applica r tl:
4.
LQPERMIT
Application Number . . . . . 14-00000223
Permit . . . RE -ROOF
Additional desc . .
Permit Fee . . . . 60.06 Plan Check Fee .00
Issue Date Valuation . . 0
Expiration Date 8/30/14
Qty Unit Charge Per Extension
1.00 48.6200 LS MISC RE -ROOF, 1ST 2000 SF 48.62
1.00 11.4400 EA MISC RE -ROOF, ADDL 1000 SF 11.44
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Special Notes and Comments
RE -ROOF 2300 SQ FT 2013 CALIFORNIA
BUILDING CODE.30 YEAR COMPOSITION.CRCC
08900005.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00
PLAN CHECK, RE -ROOF 97.24
Fee summary
-----------------
Permit Fee Total
Plan Check Total
Other Fee Total
Grand Total
Charged Paid
60.06 .00
.00 .00
98.24 .00
158.30 .60
Credited Due
.00 60.06
.00 .00
.00 98.24
.00 158.30
M
go
10
1
a
dA
Bin #
City of La Quinta
Building U Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Bv4dbkPermlt Application and Tracking Sheet
Permit #
I Project Address: I e Vii Owner's N o C �/ J w
A. P. Number: ,Address: Cy
Legal Description:(City, ST, Zip:
IGontrac or: l v (Z—v- 5 _ 06p o !'
Tele h ne
1 �A`ddress: -7 A— :' ect Description:
E 7.4y; ST, Zii4_') �`R1 ��-� ctZ14eG _3\n 6
I Telephone:
ESmote Lic. # : of
FCity Lie. #:
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone: Construction Type: Occupancy:
YP P cY:
State Lie. #: Project type (circle one): New Add, n Alter Repair Demo
1`lame of Contact Pers o r1 O Ft,.ct# Stories: #Units:
[F lee phone #,of Contact Person:(_qL. r, Z—( 43 — 41 to V ttstimated Value of Projec4A 1 o vV
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
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 Cities.
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 IIOUSE:-
7rd Review, ready for correctionstissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
Schodl Fees
Total Permit Fees