BRER2017-002678-495 CALLE TAMPICO .
LA QUINTA, CALIFORNIA 92253
Application Number:
BRER2017-0026
Property Address:
79770 TANGELO
APN:
776230004
Application Description:
HOLCOM / RE -ROOF
Property Zoning:
Section 3700 of the Labor Code, for the performance of the work for which this per nit is
Application Valuation:
$30,625.00
Applicant:
CCCn
WESTERN PACIFIC ROOFING.CORP
W
LL
2229 EAST AVENUE Q
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PALMDALE, CA 93550
compensation laws of California, and agree that, if I should become subject to the
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f DESIGN & DEVELOPMENT DEPARTMENT
i
BUILDING PERMIT
VOICE (760) 777-7125
FAX(760)777-7011
INSPECTIONS (760) 777=7153
Owner:
TOM HOLCOM
400 W 49TH TERRACE #2164
KANSAS CITY, MO 64112
Contractor:
WESTERN PACIFIC ROOFING
2229 EAST AVENUE Q
PALMDALE, CA 93550
(661)273-1336
LIc. No.: 235717
Date: 2/28/.2017
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LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9. I1 hereby affirm under penalty of perjury one of the following declarations:
(commencing with Section 70001 of Division 3 of the Business and Professions Code, and
I have and will maintain a certificate of consent to self -insure for worker.:
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of the wor for which this permit is issued.
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'Date: b / Contractor.
Section 3700 of the Labor Code, for the performance of the work for which this per nit is
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CCCn
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compensation laws of California, and agree that, if I should become subject to the
structure, prior to its issuance, also requires the applicant for the permit to file a signed
---------- - - - - ----------- '---=---------------------- --
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9. I1 hereby affirm under penalty of perjury one of the following declarations:
(commencing with Section 70001 of Division 3 of the Business and Professions Code, and
I have and will maintain a certificate of consent to self -insure for worker.:
my License is in full force and effect: !
compensation, as provided for by Section 3700 of the Labor Code, for the performance
License Class: B. C39 License No.: 235717
of the wor for which this permit is issued.
C/ 1
Zhaveand will maintain workers' compensation insurance, as required by
'Date: b / Contractor.
Section 3700 of the Labor Code, for the performance of the work for which this per nit is
issued. My workers' compensation insurance carrier and policy number are:
OWN ILD DECLARATION
Carrier: ARCH INSURANCE -COMPANY Policy Number: ZAWC19401700
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State '
_ I certify that in the performance of the work for which this.permit is issued, I
License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
shall not employ any person in any manner so as to become subject to the workers"
city or county that requires a permit to construct, alter,. improve, demolish, or repair any
compensation laws of California, and agree that, if I should become subject to the
structure, prior to its issuance, also requires the applicant for the permit to file a signed
workers' compensation provisions of Section 3700 of the Labor Code, l shall forthwith
statement that he or she is licensed pursuant to the provisions of the Contractor's State
comply with those provisions.
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business
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and Professions Code) or that he or she is exempt therefrom and the basis for the
Date: Applicant:
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).:
WARNING: FAILURE TO SECURE WOR S' CO ' ENSATION COVERAGE IS UNLAWFUL,
(� I, as owner of the property, or my:employees with wages as their sole
AND -SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP To
compensation, will do the work, and the structure is not intended or offered for sale.
ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF
(Sec. 7044, Business and Professions Code: The Contractors' State License Law does not
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
apply to an owner of property who builds or improves thereon, and who does the work
INTEREST, AND ATTORNEY'S FEES.
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
APPLICANTACKNOWLEDGEMENT
within one year of completion, the owner -builder will have the burden of proving that he
IMPORTANT: Application is hereby made to the Building Official for a permit subject to
or she did not build or improve for the purpose of sale.).
the conditions and restrictions set forth on this application.
(� I, as owner of the property, am exclusively contracting with licensed contractors to
1. Each person upon whose behalf this application is made, each person at whose
construct the project. (Sec. 7044, Business and Professions Code: The Contractors' State
request and for whose benefit work is performed under or pursuant to any permit issued
License Law does not apply to an owner of property who builds or improves thereon,
as a result of this application , the owner, and the applicant, each agrees to, and shall
and who contracts for the projects with a contractor(s) licensed, pursuant to the
defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and
Contractors' State License Law.).employees
for any act or omission related to the work being performed under or
(� I am exempt under Sec. B.&P.C. for this reason
following issuance of this permit.'
Date: Owner:
r
CONSTRUCTION LENDING AGENCY 1
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: I
Lender's Address:
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 representatives of this city to enterupon the above-
mentioned property for inspection purposes.
Date: f Signature (Applicant or Agen
Date: 2/28/2017
Application Number:. BRER2017-0026
Owner:
`Property Address: .79770 TANGELO
TOM HOLCOM
APN: 776230004
400. W 49TH TERRACE #2164
Application.Description: HOLCOM / RE -ROOF
KANSAS CITY, MO 64112
Property Zoning:.
Application Valuation: $30,625.00
Applicant:
Contractor:
WESTERN PACIFIC ROOFING, CORP
WESTERN PACIFIC ROOFING CORP
2229 EAST AVENUE Q,•
2229 EAST AVENUE Q
PALMDALE, CA 93550
PALMDALE, CA 93550 .
(661)273-1336
Llc. No.: 235717.
Detail: REROOF WITH ACRYLIC COATING WHITE COLOR [CRRC: 0626-0010] REMOVE EXISITNG TILE ADD UNDERLAYMENT AND RESET TILE. 2016
CALIFORNIA ENERGY CODE.
FINANCIAL INFORMATION
DESCRIPTION ACCOUNT QTY
AMOUNT
BSAS SB1473 FEE 101-0000-20306 0.
$2.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $2.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
RE -ROOF - EA ADDITIONAL 1,000 SF
101-0000-42404.
0
$48.64
DESCRIPTION'
ACCOUNT
QTY
AMOUNT
'RE -ROOF -FIRST 2,000 SF
101-0000-42404
0
$51.68
DESCRIPTION
ACCOUNT -
QTY
AMOUNT
RE -ROOF -'FIRST 2,000 SF PC
:101-0000-42600.
0
$103.36 .
Total Paid for RE
-ROOF: $203.68
DESCRIPTION
ACCOUNT
QTY .:
_ AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0 .,
$5.00
.. S