BRER2016-0002LICENSED 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: C39 License No.: 7744/82•+—
Da '"��—� S Contractor<7�a'�
( _ 4 h-!hy
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).:
(1 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 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 Name:
Lender's Address
(760)399-9394
Llc. No.: 774482
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& kfbr which this permit is issued.
,L./ I have and will maintain workers' compensation insurance, as required by
tio 3
Sec00 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.
Dat 2:�* — ! / —/ ro/ Applicant-.
E, L,),Qe"
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 representatives of this city to enter upon the /%�
above-mentioned property for inspection purposes. � li�' // ;
Date — ���� Signature (Applicant or Agent): �iC
2,
Ct
Q�i
VOICE (760) 777-7125
78-495 CALLE TAMPICO
•
0 D
FAX
FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253
COMMUNITY DEVELOPMENT DEPARTMENT
(760) 777-7153
BUILDING PERMIT
DateApplication
Number:
BRER2016-0002
Owner:
Property Address:
79695 NORTHWOOD
THOMPSON RK / THOIv1PSON CE TRUSAPN:
762022034
79695 NORHTWOOD
Application Description:
PGA ASSN / RES it / REPLACE UNDERLAYMENT
LA QUINTA, CA 92253
]10
Property Zoning:
Application Valuation:
$13,600.00Applicant:
Contractor:
WILLIAMS ROOFING
WILLIAMS ROOFING
P 0 BOX 391841
P 0 BOX 391841
ANZA, CA 92539
ANZA, CA 92539
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: C39 License No.: 7744/82•+—
Da '"��—� S Contractor<7�a'�
( _ 4 h-!hy
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).:
(1 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 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 Name:
Lender's Address
(760)399-9394
Llc. No.: 774482
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& kfbr which this permit is issued.
,L./ I have and will maintain workers' compensation insurance, as required by
tio 3
Sec00 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.
Dat 2:�* — ! / —/ ro/ Applicant-.
E, L,),Qe"
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 representatives of this city to enter upon the /%�
above-mentioned property for inspection purposes. � li�' // ;
Date — ���� Signature (Applicant or Agent): �iC
DESCRIPTION
FINANCIAL • a.
ACCOUNT; QTY AMOUNT
< PAID
PAID DATE
BSAS SB1473 FEE
101-0000-20306
0
$1.00
$0.00
PAID BY
:METHOD
RECEIPT '#, ' ".
`::: 'CHECK # .
CLTD BY:
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA:
$1.00
$0.00.
DESCRIPTION .:
ACCOUNTQTY
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 " "
QTY;,,'
AMOUNT;
PAID
PAID.DATE;
RE -ROOF - FIRST 2,000 SF PC
101-0000-42600
0
$98.62
$0.00
PAID BY
METHODRECEIPT
# ;.
CHECK #
CLTD BY
Total Paid for RE -ROOF:
TOTALS:•0
$147.93
$0.00
Description: PGA ASSN / RES II / REPLACE UNDERLAYMENT
CONDITIONS
Type: RE -ROOF
Subtype: Status: UNDER REVIEW
Applied: 1/11/2016 SKH
Approved:
Parcel No: 762022034 Site Address: 79695 NORTHWOOD LA QUINTA,CA 92253
Subdivision: TR 24801
Block: Lot: 3
Issued:
Lot Scl Ft: 0
Building Scl Ft: 0 Zoning:
Finaled:
Valuation: $13,600.00
Occupancy Type: Construction.Type:
Expired:
No. Buildings: 0
No. Stories: 0 No. Unites: 0
Details: REPLACE UNDERLAYMENT AND REPLACE ORIGINAL TILE. 2013 CALIFORNIA ENERGY CODE.
ADDITIONAL SITES
CHRONOLOGY
CONDITIONS
NAME TYPE
NAME
ADDRESSI
CONTACTS
CITY
STATE
ZIP
PHONE
FAX
EMAIL
APPLICANT
WILLIAMS ROOFING
P 0 BOX 391841
ANZA
CA
92539
CONTRACTOR
WILLIAMS ROOFING
P 0 BOX 391841
ANZA
CA
92539
OWNER
THOMPSON RK / THOMPSON CE
TRUST
79695 NORHTWOOD
LA QUINTA
CA
92253
Printed: Monday, January 11, 2016 2:06:56 PM 1 of 2 r
syszeMs
Printed: Monday, January 11, 2016 2:06:56 PM 2 of 2
SYSTEMS
I
CLTD
DESCRIPTION
ACCOUNT
CITY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK #
METHOD
PAID BY
BY
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: $147.93 $0.00
Printed: Monday, January 11, 2016 2:06:56 PM 2 of 2
SYSTEMS
I
Bin #
Permit #
201cP_
Project Address: -6 S
City of La Q tin to
Building a Safety Division
. _ 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
(a1 D 1 Owner's Name:
A. P. Number:
Address: 9 W 0 O
Legal Description: L,.
.
City, ST, Zip: L e
ct r: II ``
Contra o W -v�. S
(Lyof,
Tel hone:
P !
Address:Pv&W
Project Description:
City, ST, Zip: A,,v-jA to A
A 2d --L
Telephone: V`
State Lic.
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
..................................................
Construction TYPe: r Occu an cY: 4e CZ,
State Lic. #
Project (circle ne • Neww Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.: 7,/V •
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project: U
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rcc'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted'
Iter
Amount
Structural Cales.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cates.
Called Contact Person
Plan Check Balance
Title 24 Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2nd 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 ROUSE:-
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
ll
For: PGA West Residential II, C/O Desert Resort Management.
job Address: Thompson Residence, 79-695 Northwood, La Quinta, Ca. 92253
Date: December 30, 2015
Attn: JoAnne Rose
Schedule of extras if applicable:
t� During the repair process, if any asbestos is discovered, the removal and disposal cost would Fne°bv-OWM; Arr -d of will be
replaced for an additional charge based on QO-per-hourlabor'an8'7x6 or IWmagri9s afvno p`e3 foot -Any danuaged raftei ends
be replaced for an additional ctlarge based on $109.00 each and•fascia board at $'1200 per lin Ft Any CDX/ OSB plywood t`o bet b
an additional clharge•based on $ 2.00 per sq. foot, la5o--B clude: """—•--......_.-......: _..•.._...____....._.
Op
r
Scope of Work: Complete Tile reset on 4 roof decks, North East side, on the above said
unit only. Thompson residence only.
Remove existing roof tiles, set aside for reuse.
Install two layers of SBS, UDL the underlayment, mechanically fastened.
Install ridge board at hip transition, covered with an additional layer of UDL underlayment.
Snap all chalk lines as needed.
Install new ridge -boards. Cover with one layer UDL.
install stall roof tiles, nailing each one in place using approved fasteners.
st#or said the reset- $13,600.00 - To be paid as billed. --�
work- Complete tile reset on all 21
ifthirwood, excludine 3 roof decks i
set
Of
n three units 79-6 X9 -685i
on 79.685 No wood that have
tlk ' es, ro f tiles, g ach one in p2a3e- g approved
5agpEsEmechanically
. Co with one la UDL.
at ridge boards and roof to wall, as needed.
fastened with secondary seal.
Complete tile reset- $53,250.00 - To be paid as billed.
STANDARD WARRANTY: All work shall be warranted, subject to the general conditions included hereirt, for a period of Ten (10) years
from the date of completion. This shall warrant the owner that the roof shall be free of defects. Williams Roofing to repair without cost to the
owner, roof membrane defects, which are discovered during the temp of the warranty. All work to be completed in a reasonable amount of
time and in a wodpartqke . Roof rnqWbrane splitting caused by were structural or seismic movement of the btulding, acts of God,
and abuse bypdiir tradisor rants is _$pg5Q&Uy excluded from this warranty'
Contractor Date
4 d,J
75-6q�5-