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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-