BRER2015-0029S S .
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 9225'.
Application Number:
Property Address:
APN:
Application Description
Property Zoning:
Application Valuation:
LIKLKLUIS-UULy
DEVELOPMENT DEPARTMENT
WILDING PERMIT
79450 BRIARWOOD
776020004
ESTATES AT RANCHO LA QUINTA/REROOF 6400 FOAM AND GAVEL
$20,950.00
Applicant:
CASTRO ROOFING INC
P 0 BOX 122
THOUSAND PALMS, CA 92276
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 License No.: 828478
Date �b �S Contractor: -
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) 777-7011
INSPECTIONS (760) 777-7153
Owner:
EDWARD CHIRGWIN
Contractor:
CASTRO ROOFING INC '
P 0 BOX 122
THOUSAND PALMS, CA 92276
(760)343-0042
Llc. No.: 828478
Date: 3/16/2015
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. A�--1
Date: 311 b!"l J 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 building
construction, and hereby authorize representatives of this city ^to enter upon the above
mentioned property for inspection purposes. - /)
Date: l r.I I S ' Signature (Applicant or Agent):
z
C7
Ii
M
m o
-0
P -
;C
M
o
O
M D
Ln
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. A�--1
Date: 311 b!"l J 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 building
construction, and hereby authorize representatives of this city ^to enter upon the above
mentioned property for inspection purposes. - /)
Date: l r.I I S ' Signature (Applicant or Agent):
D
DESCRIPTION
FINANCIAL INFORMATION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
BSAS SB1473 FEE
101-0000-20306
0
$1.00
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLYD BY
Total Paid forBUILDING STANDARDS ADMINISTRATION BSA
$1.00
$0.00'
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
RE -ROOF - EA ADDITIONAL 1,000 SF
101-0000-42404
0
$58.00
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
DESCRIPTION
ACCOUNT
QTY
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 forRE-ROOF:
TOTALS;0.
$205.93
$0.00
0.00
Description: ESTATES AT RANCHO LA QUINTA/REROOF 6400 FOAM AND GAVEL
CONDITIONS
Type: RE -ROOF
Subtype: Status: UNDER REVIEW
Applied: 3/16/2015 SKH
Approved:
Parcel No: 776020004 Site Address: 79450 BRIARWOOD LA QUINTA,CA 92253
Subdivision: TR 26524
Block: Lot: 4
Issued:
Lot Scl Ft: 0
Building Scl Ft: 0 Zoning:
Finaled:
Valuation: $20,950.00
Occupancy Type: Construction Type:
Expired:
No. Buildings: 0
No. Stories: 0 No. Unites: 0
PHONE
Details: REROOF WITH WHITE FOAM AND REGRAVEL - [CRRC: 0790-0001] 2013 CALIFORNIA ENERGY CODE.
CHRONOLOGY
CONDITIONS
CONTACTS
NAME TYPE
NAME
ADDRESSI
CITY
STATE
ZIP
PHONE
FAX
EMAIL
APPLICANT
CASTRO ROOFING INC
P 0 BOX 122
THOUSAND
PALMS
CA
92276
CONTRACTOR
CASTRO ROOFING INC
P 0 BOX 122
THOUSAND
PALMS
CA
92276
OWNER
EDWARD CHIRGWIN
56065 SCHOOL HOUSE
RD
BEND
OR
92253
Printed: Monday, March 16, 2015 9:44:46 AM 1 of 2 OrMfflYSTEMS
PARENT PROJECTS
ATTACHMENTS
Printed: Monday, March 16, 2015 9:44:46 AM 2 of 2
SYSTEMS
CLTD
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK #
METHOD
PAID BY
BY
BSAS SB1473 FEE
101-0000-20306
0
$1.00
$0.00
Total Paid for BUILDING STANDARDS ADMINISTRATION $1.00 $0.00
BSA:
RE -ROOF.- EA
101-0000-42404
0
$58.00
$0.00
ADDITIONAL 1,000 SF
RE -ROOF - FIRST 2,000
101-0000-42404
0
$49.31
$0.00
SF
RE -ROOF - FIRST 2,000
101-0000-42600
0
$98.62
$0.00
SF PC
Total Paid forRE-ROOF: $205.93 $0.00
TOTALS:0. 0.0•
PARENT PROJECTS
ATTACHMENTS
Printed: Monday, March 16, 2015 9:44:46 AM 2 of 2
SYSTEMS
Bin # City of La Q uin to . .
Building 81' Safety Division .
Permit # P.O. Box 1504, 78-495 Calle Tampico .
"901�- La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Project Address: -1 q 4 S 0 (3 r %y C wco � Owner's Name: fy a 0A%r w 14
A. P. Number:
Address: S,,,,,,, -
Legal Description:
City, ST, Zip:
Contractor: C. rslko l200�11v
Telephone:
Address: P 0 0"0" 12t
Project Description: ell. M �-t r.\Vek 1,,3
City, ST, Zip: --t �x0,)Sp,1V 0 P44�Ls 0i12 i 6
Q OAtnA I r o�r� Ct3c, J ► k1.
414 16
Telephone: 3O 0
r
� `r1
f
State Lie. 4.: . .02 (6Ltl e
City Lie. #:
0em 0 — 000
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
"<:>....
Construction TYPe: �fo�-^ty Occu an
cY: Z Sl na`
Reair DcmoProject type (circle one): New Add'n Alter
State Lie. #
..........'
Name of Contact Person: 4LP, k t:
Sq. Ft.: by Da
#Stories: i
#Units:
Telephone #,of Contact Person:
(, 0— ki Witt tt O a
Estimated Value of Project:
It Submittal Req'd
APPLICANT: 00 NOT WRITE BELOW THIS LINE
Rcc'd TRACKING PERMIT FEES
Plan Sets
Pian Check submitted
Itcm
Amount
Structural Cala.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cates.
Called Contact Person
Plan Check Balance.
Title 24 Cales.
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 HOUSE:-
'`d 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 Fccs
Total Permit Tees