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BRER2017-008078-.495.U111.E.TAMP.JL0 • , LA QUINTA, CALIFORNIA 92253 Application Number: BRER2017-0080 Property Address: SS176 LAUREL VALLEY APN: 775340005 Application Description: DESERT RESORT MGMT / Property Zoning: Application Valuation: $11,990.00 Applicant: B R S ROOFING INC 777 SOUTH LUGO AVE SAN BERNARDINO, CA 92408 Tit�t 4 4v Q" DESIGN & DEVELOPMENT DEPARTMENT ING PERMIT �In r AUG 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 Class: C39 License No.: 907600 Date:I L i _ontrador. OWNER -BUILDER D)CLARATION 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).: (_) 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, thebuilding 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 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 Na Lender's Add VOICE (760).777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 8/14/2017 Owner: DESERT RESORT MANAGEMENT 55176 LAUREL VALLEY LA QUINTA, CA 92253 Contractor: B R S ROOFING INC 777 SOUTH LUGO AVE SAN BERNARDINO, CA 92408 (909)884-8505 Llc. No.: 907600 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 which this permit is issued. I have 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: STATE COMPENSATION INSURANCE FUND Policy Number: 9141962 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 WiT tho!j provisions. �� D to - —Applicant:— WARNING: FAILURE TO SECURE WORKERS' COMPENSATION CO ERAGE 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 <--tate that the above information iscorrect. 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 abov�` do ed property for inspection purposes. Date: Signature-(ApplieantorAgent). r Date: 8/14/2017 Application Number:.. BRER2017.0080 Owner: Property'Address: "'55176L'AUREL VALLEY DESERT RESORT MANAGEMENT APN: 775340005 55176 LAUREL VALLEY Application Description: DESERT RESORT MGMT / REROOF LA QUINTA, CA 92253 Property Zoning: Application Valuation: $11,990.00 Applicant: Contractor: B R S ROOFING INC B R S ROOFING INC 777 SOUTH LUGO AVE 777 SOUTH LUGO AVE SAN BERNARDINO, CA 92408 SAN BERNARDINJ, CA 92408 (909)884-8SOS ------------------------------------------------- LIc. No.: 907600 ------------------------------ -------------- Detail: INSTALL NEW SYNTHETIC UNDERLAYMENT AND RESET SAME TILE. REPLACE TILE AS NEEDED. NO ENERGY FORMS NEEDED. PER 2016 CALIFORNIA - BUILDING CODE FINANCIAL INFORMATION < :-.cA—)ZCRJJ-TJON ACCOUNT - QTY AMOUNT BSAS SB1473 FEE 101-0000-20306 0 $1.00 Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 DESCRIPTION ACCOUNT QTY AMOUNT RE -ROOF - EA ADDITIONAL 1,000 SF 101-0000-42404 0 $36.48 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 -200F: $191.52 . DESCRIPTION ACCOUNT QTY AMOUNT TECHNOLOGY ENHANCEMENT FEE 502-0000-43611 0 $5.00 Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00 Bin .# City. Of La Quinta Bldtdmg 8T Safety Division P.O. Box 1504,•78-495 Calle Tampico La.Qdnta, CA 92253 4760} 777-7012 Building Permit -Application and Tracking Sheet Pe # i � � Project Address: 5 5 I-7 (o LAUR6 (-. dlkLLe ^/ Owner's Name:. A P. Number. Address: RE(, v AA LL�� Legal Description: City, ST, Zip: (-A Q V 1 II.ITt C-R 9 Z.2S3 Contractor. t3 �,S Koo F �J c Address: 7 '� S LU C ..v Telephone: g... Project Description: ?Cr-Fv(yq. TO 2 0011 .5 G 00 City, ST, Zip: t 'e,s Telephone: Fa SD 5 stateLic.#: (�1(0(2.0 City Lii� . Arch., Eagn, Designer. Address: City., ST, Zip: ---------------- Telephone: State Lic. #: ;. Construction Type: , Oscapancy: Project type (circle one): New Add'ii Alter Repair Demo of Contact Person: js Ft:O#Stories: j #Uni1Name o Telephone # of Contact Person: 7 b 03 3 3 11 (o Estimated Value of Project: al .c'l % 0 0 APPLICANT: DO NOT WRITE BELOW THIS UNE # Submittal Req'd Recd TRACMG PERMIT FEES Plan Sets Plan Check submitted. Item Amount Structural CaIes. Reviewed, ready for corrections Plan CbedcDeposit. . Truss Calcs. Called Contact Person Plan Check Balance. Tide 24 Calci. Plans picked up Constracti(m Flood plain plan Plans resubmitted.'. Mecbarilcal Grading plan 2ad Review, ready for corrections/issue Electrical Subcontactor List • Called Contact Person Plumbing Grant Deed Pians plciced up SM.i. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- '^` Review; ready for correetions/mme Developer Impact Fee Planning Approval Called Contact Person A.LP.P. Pub. Wks. Appr Date of permit Issue School Fees Total Permit Fees