BRER2014-102178-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/9/2014
Application Number: , BRER2014-1021
Property Address: 78565 SAGEBRUSH AVE U L
APN: 646311006 OCj n 9 G
Application Description: REMOVE GRAVEL FOAM OVER ROOF 12 SQU
Property Zoning: Q�11fOFB?r
Application Valuation: $4,688.00pffp8&1
Applicant:
CASTRO ROOFING INC
P0BOX 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 70001 of Division 3 of the Business and Professions Code,
and my License is in full force and effect.
License Class: C39 License No.: 828478
Dal 10 1't Contract"28oar. C 4S CR u Q arc f ��
V V
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).:
(__j 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
Lender's Address:
E ALCOTT
92253
Contractor:
CASTRO ROOFING INC
P 0 BOX 122
THOUSAND PALMS, CA 92276
(760)343-0042
Uc. No.: 828478
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one c the following declarations:
I have and will maintain a certifica:e 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' oompensation 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
comp. y with those priovisions.
,ate: t O) �1 1 1 /p�iWARNING: FAILURE TO SECURRS' 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 91he 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 owser, 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 app ication becomes null and void if work is
not commenced within 180 days from date cf 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 represerttatives of this city to enter upon the above-
mentioned property for inspection purposes.
Dal �CSignature (Applica it or A ent):
FINANCIAL • 1
rt y
d DESCRIPTION' }t ACCOUNTS AiMOUNT
RAID DATE
r tPAID
BSAS SB1473 FEE 101-0000-20306 0 $1.00 $1.00
10/9/14
METHOD CHECK #
CLTD Blf
a <RECEIPT�# r
E _
.>. i.:
CASTRO ROOFING INC CHECK R1891 14339
MFA
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA $1.00 $1.00
a < DESCRIPTION "' �'
; �• ACCOUNT ;
i QTY*
AMOUNT `' `
RAIDS
PAID DATE
P
„N"pi
.
RE -ROOF - FIRST 2,000 SF
101-0000-42404
0
$49.31
$49.31
10/9/14,
z 7PAID BY
�'; r g x
METHOD<
4
RECEIPT #
'h< CHECK # zCLTD
BX ;
Y
.unE
CASTRO ROOFING INC
CHECK
R1891
14339
MFA
R z DESCRIPTION` `
r �ACCO.UNT "
QTY"
%AMOUNT-`
'; "'PAID
PAID DATE,.
,....,_...,...�,�,.,._:.
RE -ROOF - FIRST 2,000 SF PC
101-0000-42600
0
$98.62
$98.62
10/9/14
°} PAID BY
i4- p 4�. rEwS[ E ..
METHOD}
RECEIPT # 4
-'�, }+' g
' CHrECK # -
CLTD BY ;?
, zt
T. T. ... �'� :, •`k TN ..
,.:. 4
E f .wrt'.g'.> .�t
.v
F r <Y.-.: f f
_
'.}.,
CASTRO ROOFING INC
CHECK
R1891
14339
MFA
Total Paid for RE -ROOF: $147.93 $147.93
TOTALS:4: 1: .93
a .
Description: REMOVE GRAVEL FOAM OVER ROOF 12 SQUARES
Type: RE -ROOF Subtype: Status: SUBMITTED
Applied: 10/9/2014 MFA
Approved:
Parcel No: 646311006 Site Address: 78565 SAGEBRUSH AVE LA QUINTA,CA 92253
Subdivision: DESERT CLUB MANOR TR 1 Block: Lot: 6
Issued:
Lot Sq Ft: 0 Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $4,688.00 Occupancy Type: Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0 No. Unites: 0
Details: REMOVE GRAVEL AND FOAM OVER 12 SQUARES (2013 CALIFORNIA ENERGY CODE).
�.. W..w.
„ .. CONDITIONS
FINANCIAL INFORMATION
Printed: Thursday, October 09, 2014 11:07:10 AM 1 of 2 -
Printed: Thursday, October 09, 2014 11:07:10 AM 2 of 2 --..
Bin #.. City Of LQ Q U in to
-Building &r Safety Division
Permit # P.O. Box 1504, 78-495 Calle Tampico .
La Quinta,CA 92253 - (760) 777-7012
Building Permit Application, and Tracking Sheet
Project Address: -7 S" S 'e, % �) r o Owner's Name: L 2 S I t k l C�
A. P. Number:
Address: 5� he
Legal Description:
City, ST, Zip:
Contractor: C C)s
Telephone: -
-- �<>:s>�'` �-::•
Address: l
Project Description:
City, ST, Zip:�� o No Q�l,�s C �ZLl�.
ii
• .Y, .� !3�`e v^ C �eawt cV e� Ree
Telephone: —G
P 6 3K 'L
: ` ?'> . .
Statc Lic. # :
City Lie. C
Arch., Engr., Designer:
Address:. '
I
City., ST, Zip:
Truss Cala.
fele h ne:
P o
�
Construction Type: , 1` �IZeof� Occupancy:
Project c (circle one): New Add'n Alter Repai r o-
Demo
atato Lie. #:
Plan Check Balance.
Jame of Contact Person: co, ( •4_
Sq. Ft: V10r.
#Stories: I
h Units:
Cclephone # of Contact Person: -7 �0 _ 1A c -(:- i, t er,
6�
Estimated Value of.Project: q 6
APPLICANT: DO NOT WRITE BELOW THIS LINE
ff
Submittal
Rcq'd
Rcc'd
TRACKING
PERMIT FEES.
Plan Sets
Plan Check submitted
Item
Amount
Structural Cates.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cala.
C211ed'Contact Person
Plan Check Balance.
Title 24 Cala.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2"" Review, ready for corrcctionsrssue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I. '
II.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
3" Review, ready for correctionslissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.T.P.P.
Pub. Wks. Appy
Date of permit issue
School Fees
Total Permit Fccs