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BRER2014-1007i Property Zoning: Application Valuation: $6,800.00 Applicant 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: _ License No.: _ ",/ae: 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 Contractor: 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 Add Contractor: Llc. No.: 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, I shall forthwith comply with those provisions. 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 building construction, and hereby authorize Fe ntatives of this city to enter Xupone above* mentione a for' ion purposes. i, - r Date: �v Signature (Applicant or Age t): 0 L VOICE (760) 777-7125 78-495 CALLE TAMPICO D FAX (760) 777-7011 FAX LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT (760) 777-7153 LDING PERMIT D Date: 9/15/2014 Application Number: BRER2014-1007 Owner: Property Address: 49920 COACHELLA DR SEP j 5 2014 WILLIAM REARDON APN: 646260002 44920 COACHELLA Application Description: REPLACE EXISING PAPER AND ILE CITY OFI Afu0 er, LA QUI NTA, CA 92253 Property Zoning: Application Valuation: $6,800.00 Applicant 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: _ License No.: _ ",/ae: 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 Contractor: 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 Add Contractor: Llc. No.: 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, I shall forthwith comply with those provisions. 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 building construction, and hereby authorize Fe ntatives of this city to enter Xupone above* mentione a for' ion purposes. i, - r Date: �v Signature (Applicant or Age t): 0 L FINANCIAL INFORMATION DESCRIPTION ACCOUNT - QTY AMOUNT PAID PAID DATE BSAS SB1473 FEE 101-0000-20306 0 $1.00 $1.00 9/15/14 PAID BY METHOD RECEIPT # CHECK # CLTD BY WILLIAM REARDON DEBIT R1152 MFA Total Paid forBUILDING STANDARDS ADMINISTRATION BSA $1.00 $1.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RE -ROOF - FIRST 2,000 SF 101-0000-42404 0 $49.31 $49.31 9/15/14 PAID BY METHOD RECEIPT # CHECK # CLTD BY WILLIAM REARDON DEBIT R1152 MFA DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RE -ROOF - FIRST 2,000 SF PC 101-0000-42600 0 $98.62 $98.62 9/15/14 PAID BY METHOD RECEIPT # CHECK # CLTD BY WILLIAM REARDON DEBIT R1152 MFA Total Paid for RE -ROOF: TOTALS: $147.93 $148.93 $147.93 $148.93 Description: REPLACE EXISING PAPER AND TILE Type: RE -ROOF Subtype: Status: SUBMITTED Applied: 9/15/2014 MFA Approved: Parcel No: 646260002 Site Address: 49920 COACHELLA DR LA QUINTA,CA 92253 Subdivision: TR 5544 & INT IN COMMON AREA Block: Lot: 2 Issued: Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $6,800.00 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0 AMOUNT Details: REPLACE EXISTING TILE AND PAPER [CRRC: 0942-0008] 2010 CALIFORNIA ENERGY CODE. ADDITIONAL CHRONOLOGY CONDITIONS CONTACTS • NAME TYPE' NAME ADDRESSI CITY STATE ZIP PHONE FAX EMAIL OWNER WILLIAM REARDON 44920 COACHELLA LA QUINTA CA 92253 ( Printed: Monday, September 15, 2014 10:56:58 AM loft CRWSYSTEMS FINANCIAL•' • CLTD DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY BY BSAS SB1473 FEE 101-0000-20306 0 $1.00 $1.00 9/15/14 R1152 DEBIT WILLIAM REARDON MFA Total Paid for BUILDING STANDARDS ADMINISTRATION $1.00 $1.00 BSA: RE -ROOF - FIRST 2,000 101-0000-424040 $49.31 $49.31 9/15/14 R1152 DEBIT WILLIAM REARDON MFA SF Printed: Monday, September 15, 2014 10:56:58 AM loft CRWSYSTEMS REVIEWS REVIEW TYPE REVIEWER SENT DATE DUE DATE RETURNED STATUS REMARKS NOTES DATE Printed: Monday, September 15, 2014 10:56:58 AM 2of2 Cg?"fSYSTEMS CLTD DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY BY RE -ROOF - FIRST 2,000 101-0000-42600 0 $98.62 $98.62 9/15/14 R1152 DEBIT WILLIAM REARDON MFA SF PC Total Paid for RE -ROOF: $147.93 $147.93 TOTALS: INSPECTIONS SEQID INSPECTION TYPE INSPECTOR SCHEDULED COMPLETED RESULT REMARKS NOTES DATE DATE FINAL" PRE -ROOF REVIEWS REVIEW TYPE REVIEWER SENT DATE DUE DATE RETURNED STATUS REMARKS NOTES DATE Printed: Monday, September 15, 2014 10:56:58 AM 2of2 Cg?"fSYSTEMS Bin # �.. City of La Quinta Building &r Safety Division [t07 P.O. Box 1504, 78-495 Calle Tampico. r La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # f 4 Project Address:. g?X7('7efe-elt `,L Owner's Name: l �,eA I-a�G A. P. Number: Address: Legal Description: City, ST, Zip: Contractor: ad Ire Telephone: Address: Address: Cg GJ ���. Project.Description: Q p y Go City, ST, Zip: o ua 7.r,ee h,e Z/ -e- Ct 19� - Telephone: o v State Lic. # : City Lie..#: d Arch., Engr., Designer: Z,lLo Address: City, ST, Zip: Telephone: n •.,::}::;:;.«:;;.::},::<> i}:4.v}}ix}. btri: - . tir Construction Type: Occupancy: Project type (circle one): New Addf n Alter Repair Demo State Lic. #: - - 'r;l. �... ...................................................... Name of Contact Person: Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: A Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE it Submittal Req'd Rcc'd TRACKING PERMIT FEES, Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Cala. Called Contact Person Plan Check Balance. Title 24 Cala. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan tad Review, ready for corrcctions(ssue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.1. H.O.A. Approval Plans resubmitted Grading IN I10USE:- 3" Review, 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