14-0287 (RR)P.O. BOX 1504 ,-
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:"
14-00000287
50735 CALLE PALOMA
770=096-004- - -
RE -ROOF
LOW DENSITY RESIDENTIAL
6485
Architect or Engineer:
4
BUILDING & SAFETY DEPARTMENT
------------------
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT
I hereby affirm under penalty of perjury th t I amlicensed under provisions of Chapter_ 9 (commencing with
section 7000) of Division 3 of the Busing s and Professionals Code, and my License is in full force and'effect.
L�iccee`6e: ass: C39 License No.: ,828478 '
aU to Contractor:
OWNER -BUILDER DECLARATION
herebyaffirm.under penalty of perjury lat I am exempt from the Contractor's State License Law for the
following_reason,ISec. 7031 .5, Business and Professions Code: Any city or county that requires 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(1Chapter8&(coinmencing.with Section 7006) -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 7.031.5 by
any applicant for a permii,subjects the applicant to a civil penalty of not more than -five hundred dollars ($500)":
1 _ 1 I, as. owner of the property, or my employees with wages as their sole compensation, wiil'do the work, and
the structure is notintended 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•pioving.that he brshe did not build or
improve for the purpose of sale.). -
(_ I 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 buildslor improves thereon, and who contracts for the projects with a contractors) licensed
pursuant to the Contractors' State License Law.).
1 _ 1 I am exempt under Sec. I , 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.I.
Lender's Name: _
Lender's Address:
LQPERMIT
Owner:
BRADDOCK WILLIAM R/GABRIELE
50735 CALLE PALOMA
LA QUINTA, CA 92253
VOICE (760) 77? -7012.
FAX (760) 777_701,1
INSPECTIONS (760) 777`7153:j.
Date: 3/21/14
Contractor:
GASTRO ROOFING; N
-P O- BOX 122 j a>ic a
THOUSAND. PALMS" r 922tT6
(7'60) 343-00421.
Z1C. No.: `828478- ,��rriljCe _
WORKER'SCOMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
_ I'have and will maintain a certificate,of consent to self-insurefor workers' compensation, as provided
or by Section 3700 of the Labor:Code, for the performance of the work for which this permit is
yissued
J.
' j I have and will maintain workers' compensation insurance, as required -by Section 3760 of the Lalior
�I Code, for the performance of the work for which this permit is issued. My workers' compensation
insurance carrier.and poli -number are:
Carrier ,STATE FUND Policy Number 6391472013
_ I certify that, in theperform ce of the work for which.this permit is issued, I shall not employ any
person in any manner so s to become subject to the workers' compensation laws of California,
and agree that should become subject to the workers' "compensation provisions of Section
Y/ 3700 of. abor C_ with .comply with those provisions.
Date: 3: u Applicant: -
WARN NG: 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 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, eachagrees-to,and shall defend, indemnify and hold harmless the City
of La Quinta, its officers, agents and employees for any act or omissionrelated 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 o such permit, or cessation of work for 180 days will subject
permit to cancellation.
I certify th have read this applic n and state t t he above information is correct. I agree to comply with all
city an ounty rdinances and to laws relating to ilding construction, and hereby authorize representatives
oft i c uunt-y enter upon above-mentioned ction purposes.
Date y'w Signature (Applicant or Agent):
Application Number . . . . . 14-00000287
Permit . . . RE -ROOF
Additional desc .
Permit Fee . . . . 48.62 Plan Check
Fee
.00
Issue Date . . . . Valuation
. . .
. 0
Expiration Date . . 9/17/14
Qty Unit Charge Per
Extension
1.00 48.6200 LS MISC RE -ROOF, 1ST 2000
SF
48.62
----------------------------------------------------------------------------
Special Notes and Comments
RE -ROOF - TILE RESET. REMOVE EXISTING
ROOF TILES, INSTALL NEW 40#
UNDERLAYMENT,.REINSTALL EXISTING ROOF
TILES TO SPEC. 2013 CALIFORNIA BUILDING
CODES.
-------------- ----------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN ('SB1473)
1.00
PLAN CHECK, RE -ROOF
97.24
Fee summary Charged Paid Credited
--------=-------- ------ - --- ---------- ---------- ----------
Due
Permit Fee Total 48.62 .00
.00
48.62
Plan Check Total .00 .00
.00
.00
Other Fee Total 98.24 .00
.00
98.24
Grand Total 146.86 .00
.00
146.86
0
LQPERMIT
g'" #
City of La Q uin ta:
Building &r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7072
Building Permit Application and Tracking Sheet
Permit #
Project Address: (14
Owner's Name: (I L
A. P. Number:
Address:
Legal Description:
City, ST, Zip: QJ 1 /--M wU1 ;3 '
Contractor: V
Telephone: 1 0
Address: �� l L�
Project Description: H'p 1//L
City. ST, Zip:
(-00 —),I VV/ . (i i 1� /i ' I" Lj12vT`
Tele hone )i
�
'1/
U � � tP5 JlY U N � N
State Lic. #
City Lic?#:Y
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
nstruction °YPe:OrOccu Occupancy:
State Lic. #:
Project type.(circle w
cle one : New A dd n' -Alter Repair Demo
0
Name of Contact Person: ��{ (,{�h'D !�N (`�
Sq. Ft.: '10-0
# Stories:
# Units:
Telephone # of Contact Person: b 6' 5:[x 3
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 Calcs.
Called Contact Person
Plan'Check Balance
Title 24 Calcs.
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 HOUSE:-
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 Fees
Total Permit Fees