BRER2014-101478-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application Description
Property Zoning:
Application Valuation:
Applicant:
SOUTHWEST ROOFING
0 OUTSIDE CITY LIMITS
LA QUINTA, CA 92253
c&tit 4 4v Q91utz -
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
BRER2014-1014
49320 AVENIDA FERNANDO
658280021
REMOVE & REPLACE E)
$25,000.00
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
DONNA MARTIN
49320 AVENIDA FERNANDO
LA QUINTA, CA 92253
Contractor: .
SOUTHWEST ROOFING
P.0 BOX 126
LA QUINTA, CA 92253
(760)57873740
Lic. No.: :LIC -0006525
Date: 9/23/2014
-
-------;---------------------------------------------------------------------- -------- - - - - - -
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: License No.: :LIC -0006525
Date: Z `f — 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 allege
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).:
(_) 1, 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 Na
Lender's Address:
06-7� i7 6/
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 subj the
workers' compensation provisions of Sectio ' 700 of the Labor Code, aj forthwith
comply with those provisions.
Pate: % �L3^�`� Applican
WARNING: FAILURE TO SECURE WOR ERS' 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 an4slate s rela 'n building
construction, and hereby authorize representatives of thent n t e above-
mentioned operty for inspection purposes.
Date: Signature (Applicant or Agent):
r
FINANCIAL INFORMATION
DESCRIPTION
ACCOUNT
CITY AMOUNT
PAID.
PAID DATE
BSAS SB1473 FEE
101-0000-20306
0 $1.00
$0.00
PAID BY
METHOD .
RECEIPT #
CHECK #
CLTD BY
Total Paid forBUILDING STANDARDS ADMINISTRATION BSA $1.00 $0.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
PAID
PAID DATE
RE -ROOF - EA ADDITIONAL 1,000 SF
101-0000-42404
0
$69.60
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
DESCRIPTION
ACCOUNT
CITY
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
CITY
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 for RE -ROOF: $217.53 $0.00
TOTALS:00
Description: REMOVE & REPLACE EXISTING UNDERLAYMENT
CHRONOLOGY
Type: RE -ROOF Subtype:
Status: APPROVED
Applied: 9/23/2014 PJU
Approved:
Parcel No: 658280021 Site Address: 49320 AVENIDA FERNANDO LA QUINTA CA 92253
Subdivision: LA QUINTA GOLF ESTATES 1 Block:
Lot: 154
Issued:
Lot Sq Ft: 0 Building Scl Ft: 0
Zoning:
Finaled:
Valuation: $25,000.00 Occupancy Type:
Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0
No. Unites: 0
ZIP
Details: REMOVE EXISTING TILE AND REPLACE UNDERLAYMENT AND REINSTALL SAME TILE 2013 CBC.
FAX
FINANCIAL INFORMATION
DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY CLTD
BY
BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00
Total Paid forBUILDING STANDARDS ADMINISTRATION
$1.00 $0.00
BSA:
Printed: Tuesday, September 23, 2014 12:46:04 PM 1 of 2
SYC iFMG
CHRONOLOGY
CONDITIONS
NAME TYPE
NAME
ADDRESSI
CONTACTS
CITY
STATE
ZIP
PHONE
FAX
EMAIL
APPLICANT
SOUTHWEST ROOFING
0 OUTSIDE CITY LIMITS
LA QUINTA
CA
92253
CONTRACTOR
SOUTHWEST ROOFING
P.O BOX 126
LA QUINTA
CA
92253
OWNER
DONNA MARTIN
49320 AVENIDA
FERNANDO
LA QUINTA
CA
92253
FINANCIAL INFORMATION
DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY CLTD
BY
BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00
Total Paid forBUILDING STANDARDS ADMINISTRATION
$1.00 $0.00
BSA:
Printed: Tuesday, September 23, 2014 12:46:04 PM 1 of 2
SYC iFMG
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK #
METHOD
PAID BY
LTD
CBY
PRE -ROOF
BY
RE -ROOF - EA
101-0000-42404
0
$69.60
$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 for RE -ROOF: $217.53 $0.00
TOTALS:00
Printed: Tuesday, September 23, 2014 12:46:04 PM 2 of 2 �l��CyC iFMC
INSPECTIONS
SEQID
INSPECTION TYPE INSPECTOR SCHEDULED COMPLETED
DATE DATE
RESULT REMARKS NOTES
FINAL"
PRE -ROOF
Printed: Tuesday, September 23, 2014 12:46:04 PM 2 of 2 �l��CyC iFMC
Bin # City of La Quinta
Building &, 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: p
J 5— 3 2,<D 'iStlaRi a, FC6ti.gN Owner's Name:
`1
A. P. Number:
Address:
Legal Description:
City, ST, Zip:
Contractor: J
'T
VA
Telephone:
Address: Jpt Q11C-L•
Project Description:e �W
City, ST, Zip: M•,� ,l
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t t lI� C'� -x_;d.G7v iAAe,,-tT
Tele hondQ—& 3,C1.g"(o—%&�
State. Lic. #: .0 Z
City Lic. #:
Arch., Engr., Designer:
Address:
City., ST, Zip:
5
Telephone:
Construction Type: Occupancy:
State Lic. #`.
Project a circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project: offo
# Submittal Req'd
APPLICANT: DO NOT WRITE BELOW THIS LINE
Rec'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
2" Review, ready for correctionstissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'`d Review, ready for corrcctions(ssue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees