BRER2015-011178-495 CALLE TAMPICO .
LA QUINTA, CALIFORNIA 92253
c&t!t 4 4v Q"
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
26
VOICE(760)777 -7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Application Number:
BRER2015-0111
Owner:
Property Address:
78650 AVENIDA TUIUNGA
CORTEZ
APN:
770092010
78650 AVENIDA TUJUNGA
Application Description:
CORTEZ / RE -ROOF REPLACE UNDERLAYMENT
LA QUINTA, CA 92253
Property Zoning:
Application Valuation:
$13,000.00
Applicant:
Contractor:
BAZUA ROOFING
�'! � ' -�,�'
w� ��
BAZUA ROOFING
PO BOX 818
w
PO BOX 818
MECCA, CA 92254
_
MECCA, CA 92254
(760)776-7663
Llc. No.: 628223
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 Cla s: C39 License No.: 62822/3
Date: % fl Q 1� Contractor: AW t 0 6)y- 0 0
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.).
(_J 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, Liv. C.).
Lender's Name:
Lender's
Date: 11/30/2015
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 thek for which this permit is issued.
I have and will maintain workers' compensation insurance, as required by
Section 700 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 wi?h those provisions.f1
�'l
Date: 13� �/ S Applicant: / l`�y ��2��
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-mrtionyd property for inspection purposes.
Date: �I ��� Signature (Applicant or Agent): v µ
rt-DESCRIPTION
BSAS 581473 FEE 101-0000-20306
0, $1.00. $1.00 11/30/15
4c
BAZUA ROOFING CASH
R11146 SGU
Total Paid fbrBUILDING STANDARDS ADMINISTRATION BSA: $1.00
ti
P.ESCRIPTION,?'.r,
NovPAID g"
.:
RE-11001� - EA ADDITIONAL 1,000 SF
0
$11..60
$11.60
11/30/15
W,It�
METHODS_'
irk
5-_� 4"
NO,13YI
.":,_,p �,, U',..: Q',.1,11 u.k;!"
R34Q.-,
� -,R�" 'R 74,la
BAZUA ROOFING
CASH
R11146
SGU
11,-D Rl
E OTI
SC 0
N2,
man-
W,
IN
16UNf V
RE-ROOF - FIRST 2,000 SF
101-0000-42404
0
$49.31
$49.31
11/30/15
"F id
jl,,� "t mjig ETHOUP
"
BAZUA ROOFING
CASH
R11146.
SGU,
DESCRIPTf 0 -j'q
-A
514f,x
QTY
a�� AMOUNTS
20
gPAID
PAID DATE
RE-ROOF FIRST 2,000 SF PC
101-0000-42600,,
0
.$98.62
$99.62
11/30/15
PAID
A -k
�jFCfTDii I
BAZUA ROOFING
CASH
1111146
SGU
Total Paid for RE=ROOF: $159.53 $159.53
A 0.'53 $160.53
JLS.,�;,, ��,�:$16
OT
Description: CORTEZ / RE -ROOF REPLACE UNDERLAYMENT
Type: RE -ROOF Subtype: Status: APPROVED
Applied: 11/30/2015 SGU
Approved: 11/30/2015 SGU
Parcel No: 770092010 Site Address: 78650 AVENIDA TUJUNGA LA QUINTA,CA 92253
Subdivision: DESERT CLUB TR UNIT 5 Block: Lot: 22
Issued:
Lot Sq Ft: 0 Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $13,000.00 Occupancy Type: Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0 No. Unites: 0
NAME TYPE
Details: REROOF WITH SAME TILE REPLACE UNDERLAYMENT -CALIFORNIA MISSION BLEND COLOR [CRRC: 0942-0008] 2013 CALIFORNIA
ENERGY CODE.
CHRONOLOGY
CONDITIONS
INFORMATION
CONTACTS
DESCRIPTION ACCOUNT QTY
AMOUNT
PAID
PAID DATE RECEIPT # CHECK # METHOD PAID BY
NAME TYPE
NAME
ADDRESSI '
CITY
STATE
ZIP
PHONE
FAX'
EMAIL
APPLICANT
BAZUA ROOFING
P 0 BOX 818
MECCA
CA
92254
CONTRACTOR
BAZUA ROOFING
P 0 BOX 818
MECCA
CA
92254
OWNER
CORTEZ
.78650 AVENIDA
TUJUNGA
LA QUINTA
CA
92253
Printed: Monday, November 30, 2015 12:05:09 PM. 1 of 2
LJ i3 LJ L SYS7Eti1S
FINANCIAL
INFORMATION
DESCRIPTION ACCOUNT QTY
AMOUNT
PAID
PAID DATE RECEIPT # CHECK # METHOD PAID BY
ESG
BSAS SB1473 FEE 101-0000-20306 0
$1.00
$1.00
11/30/15 R11146 CASH BAZUA ROOFING
Total Paid for BUILDING STANDARDS ADMINISTRATION
$1.00
$1.00
BSA:
Printed: Monday, November 30, 2015 12:05:09 PM. 1 of 2
LJ i3 LJ L SYS7Eti1S
DESCRIPTION
ACCOUNT
QTYAMOUNT
PAID
PAID DATE
RECEIPT #
CHECK #
METHOD
PAID BY
CLTD
BY
RE -ROOF - EA
101-0000-42404
0
$11.60
$11.60
11/30/15
R11146
CASH
BAZUA ROOFING
SGU
ADDITIONAL -1,000 SF
RE -ROOF - FIRST 2,000
101-0000-42404
0
$49.31
$49.31
11/30/15
R11146
CASH
BAZUA ROOFING
SGU
SF
RE -ROOF - FIRST 2,000
101-0000-42600
0
$98.62
$98.62
11/30/15
R11146
CASH
BAZUA ROOFING
SGU'
SF PC
Total Paid for RE -ROOF: $159.53 $159.53
$160.53 $160.53
PARENT PROJECTS
Printed: Monday, November 30, 2015 12:05:09 PM 2 of 2
SYSTEMS
Bin #
City of La Quinta
Building a Safety Division
�b`ll 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
IJ�J
Project Address:'7 D � w V A16A
Owner's Name: C O f CMZ
A. P. Number:
Address: 'T-0 Ta j LI V6
Legal Description:
City, ST, Zip:LA QU,Iji-1,4,ek q22 S 3
Contractor: �Z N �OoF a
TelePhone• a G �
Address: ,0, �OX•
Project Description:
City, ST, Zip: MUC6,CA 9 ZZ S
RS IAf 5 A -M ✓�� (,�
h n
Tel e P o e.` d 77
N � - L 1
W
State Lie. # : :3
City Lie. #:
Arch., Engr., Designer:
Address:
City., ST, Zip:
ne:
Telephone:
CnTY Occupancy:cY
onstruction
ctt Type:
StateLie.hP
r Repair r Dem
(circle one): Add'n Alter o
Name of Contact Person: 4 FdMb WZ A 1q/
Sq. Ft.: 700 % 1—
I # Stories:
# Units:
Telephone # of Contact Person: �%�� S7
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
if •
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cafes.
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.
I-I.O.A. Approval
Plans resubmitted
Grading
IN IiOUSE:-
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