BRER2015-008578-495 CALLE TAM PICO
LA QUINTA, CALIFORNIA 92253
COMMUNITY DEVELOPMENT DEPARTM
Application Number: BRER2015-0085
Property Address: 77500 CALLE CHILLON
APN: 774161012
Application Description: ROBERTS RESIDENCE / REROOF
Property Zoning:
Application Valuation: $12,000.00
Applicant:
BECERRA BROTHERS ROOFING
69712 PALM SPRINGS AVENUE
MOUNTAIN CENTER, CA 92561
BUILDING PERMIT
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.
,, W/5—C-Clontractor: License Class: C339 Licensee No.: 887380
COf�e: &6e ADS -
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 thee
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.).
(1 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
Lender's
SEP p g
C0M1V1JNCITY
fryEVEt0p QN)_ N
TA—IAI—TME
Owner:
NETTIE BREWER ROBERTS
77500 AVENIDA CHILLON
LA QUINTA, CA 92253
Contractor:
BECERRA BROTHERS ROOFING
69712 PALM SPRINGS AVENUE
MOUNTAIN CENTER, CA 92561
(760)349-9705
Llc. No.: 887380
(760) 777-7125
(760)777-7011
(760)777-7153
Date: 9/8/2015
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 the work for w ich this permit is issued_Lkll.
ave 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 subject to the
workers' compensation provisions of Section 3700 of the LabpCoadI shall forthwith
comply with those rovisions.
.Date: d Applicant:
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 ($100,000). IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT: Application is hereby made to the Building Official for a permit subject to
the conditions and restrictions set forth on this application.
1. Each person upon whose behalf this application is made, each person at whose
request and for whose benefit work is performed under or pursuant to any permit
issued as a result of this application , the owner, and the applicant, each agrees to, and
shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and
employees for any act or omission related to the work being performed under or
following issuance of this permit.
2. Any permit issued as a result of this application becomes null and void if work is
not commenced within 180 days from date of issuance of such permit, or cessation of
work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this city to enter upon the ove-
mentioned pr pe y for inspection purposes.
�te: l J Signature (Appl� t o, Agent): M�l
6.1
FINANCIAL
•• •
+ J 'DESCRIPTION "� r ;_
: ' ACCOUNT
_ * ,., QTY.
AMOUNTS
PAID "�`u
PAID DATE'
�$
. .-�
`
e,. ..
BSAS SB1473 FEE
101-0000-20306
0
$1.00
$1.00
9/8/15
... PAID . r
�� ' METHOD
#
CH Edil�
CLTD BY,'.:
.
�f
:....."'`RECEIPT
&
BECERRA BROTHERS ROOFING
DEBIT
R9047
MFA
Total Paid forBUILDING STANDARDS ADMINISTRATION BSA
$1.00
$1.00
u
.m ' -•. ;',DESCRIPTION , e, ,
e #'` :;ACCOUNT "
QTY
e. `AMOUNT . `
4-.. PAID r' _
PAID DATE.
RE -ROOF - EA ADDITIONAL 1,000 SF
101-0000-42404
0
$11.60
$11.60
9/8/15
PAID BY" "4
* _ `� _ METHOD°
#
ti '.RECEIP,T # x'°'
CHECK#-,:
CLTD BY
BECERRA BROTHERS ROOFING
DEBIT
R9047
MFA
DESCRIPTION `"�
.. ACCO.UNT_;
'QTY :
'AMOUNTp ,
' PAID,'-
PAID DATE
<.
RE -ROOF - FIRST 2,000 SF
101-0000-42404
0
$49.31
$49.31
9/8/15
PAID BY
METHOD`
;� RECEIPT #
,CHECK #
CLTD BY ,
BECERRA BROTHERS ROOFING
DEBIT
R9047
MFA
-� DESCRIPTION F`z q,
ACCOUNT _,
^ g
aQTYiF
:; AMOUNT",,
a PAIDg
PAhD.DATE':
RE -ROOF - FIRST.2,000 SF PC
101-0000-42600
0
$98.62
$98.62.
9/8/15
v-}aPAID BY ` `'
METHOD
x` RECEIPT #
CHECK #'
' CLTD.BY
BECERRA BROTHERS ROOFING
DEBIT
R9047
MFA
Total Paid forRE-ROOF:
$159.53
$159.53
TOTALS:.0$160.53
Description: ROBERTS RESIDENCE / REROOF
Type: RE -ROOF Subtype: Status: ISSUED
Applied: 9/8/2015 MFA
Approved: 9/8/2015 MFA
Parcel No: 774161012 Site Address: 77500 CALLE CHILLON LA QUINTA,CA 92253
Subdivision: SANTA CARMELITA VALE LA QUINTA Block: 235 Lot: 13
Issued: 9/8/2015 MFA
UNIT 22
Lot Scl Ft: 0 Building Scl Ft: 0 Zoning:
Finaled:
Valuation: $12,000.00 Occupancy Type: Construction Type:
Expired: 3/6/2016 MFA
No. Buildings: 0 No. Stories: 0 No. Unites: 0
Details: REMOVE OLD GRAVEL ROOF AND INSTALL MULE HIDE ROOF MEMBRANCE 1 BAGESHEET 1 CAPSHEET COOL ROOF COATING EC100
PER DOES NOT INCLUDE TILE ROOF AREA 2013 CALIFORNIA BUILDING CODE
ADDITIONAL- SITES
FINANCIAL INFORMATION
Printed: Tuesday, September 08, 2015 12:54:42 PM 1 of 2
sysreMs
SEQID INSPECTION TYPE INSPECTOR SCHEDULED COMPLETED ,. ; RESULT REMARKS NOTES
DATE ; DATE
PRE -ROOF BLD
FINAL*"
BLD
BOND INFORMATION
Printed: Tuesday, September 08, 2015 12:54:42 PM 2 of 2
SYS TERAS
CLTD_
DESCRIPTION
ACCOUNT -
QTY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK # '
METHOD
PAID BY
_
BY
BSAS SB1473 FEE
101-0000-20306
0
$1.00
$1.00
9/8/15
R9047
DEBIT
BECERRA BROTHERS
MFA'
ROOFING
Total Paid forBUILDING STANDARDS ADMINISTRATION $1.00 $1.00
BSA:
RE -ROOF - EA
101-0000-42404
0
$11.60
$11.60
9/8/15
R9047
DEBIT
BECERRA BROTHERS
MFA
ADDITIONAL 1,0000 SF
ROOFING
RE -ROOF - FIRST 2,000
101-0000-42404
0
$49.31
$49.31
9/8/15
R9047
DEBIT
BECERRA BROTHERS
MFA
SF
ROOFING
RE -ROOF - FIRST 2,000
101-0000-42600
0
$98.62
$98.62
9/8/15
R9047
DEBIT
BECERRA BROTHERS
MFA
SF PC
ROOFING
Total Paid for RE -ROOF: $159.53 $159.53
$160.S3 $160.53
SEQID INSPECTION TYPE INSPECTOR SCHEDULED COMPLETED ,. ; RESULT REMARKS NOTES
DATE ; DATE
PRE -ROOF BLD
FINAL*"
BLD
BOND INFORMATION
Printed: Tuesday, September 08, 2015 12:54:42 PM 2 of 2
SYS TERAS
Qin # ` '
Permit #
Project Address: '� 5700
city of La Quinta
Building &r Safety Division
78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Owner's Name:' r
A. P. Number:
Address:
Legal Description:
. P� �
CityST Zi d--�l Ou• nt
Contractor:
l
11
T h
ele P one:
Address: A-) 12—c�io�
�
Project Description:
City, ST, Zip: ' fin �-�—
/��
"l�
I
V -&M OUyZA le
Tele h ne
P o .
b
� s-tII � h
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State Lic. # :
City Lie. #•:
hid. ►LD1 bvr c0
Arch., Engr., Designer:SYI
Address:
(2001 YbO Cno a �' 100
City., ST, Zip:
Telephone.-
.
Cn truction TY
•o
Pe: Occupancy:
cY
State i # `
S te L c. .
Project type (circle one): New Add'n Alter Repair t De m 0
Name of Contact Person:�LA ► ll'i�
Sq. Ft.: Z 3
#Stories:
#Units:
Telephone # of Contact Person: 700 Oft
Estimated Value of Project: b�i�
APPLICANT: DO NOT WRITE BELOW THIS LINE
N
Submittal
Req'd
Rce'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cales.
Called Contact Person
Plan Check Balsnce
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2°" Review, ready forcorrectionsfissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
Ii.O.A. Approval
Plans resubmitted
Grading
IN IiOUSE:-
Review, ready for correct ionsrssue
Developer Impa:t Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees,
Total Permit Fps