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
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Telephone:
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State Lic. # :
City Lie..#:
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Arch., Engr., Designer:
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Address:
City, ST, Zip:
Telephone:
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Construction Type: Occupancy:
Project type (circle one): New Addf n Alter Repair Demo
State Lic. #:
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......................................................
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