BRER2017-002978-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: BRER2017-0029
Property Address: 80260 MERION
APN: 762140015
Application Description: TILE RESET
Property Zoning:
Application Valuation: $23,500.00
Applicant:
WILLIAMS ROOFING
P 0 BOX 391841
ANZA, CA 92539
4
DESIGN & DEVELOPMENT DEPARTMENT
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 70001 of Division 3 of the Business and Professions. Code,
and'my License is in full force and effect.
License Class: C39 License No.: 774482
Date:
Contractor:
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/6/2017
Owner:
DAVID PHIFE
11695 EASTFIELD RD
POWAY, CA 92253
Contractor:
WILLIAMS ROOFING
P 0 BOX 391841
ANZA, CA 92539
(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 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:
OWNER -BUILDER DECLARATION
Carrier: STATE COMPENSATION INSURANCE FUND Policy Number: 1890178
1 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
I certify that in the performance of the work for which this permit is issued, I
city or county that requires a permit to construct, alter, improve, demolish, or repair
shall not employ any person in any manner so as to become subject to the workers'
any structure, prior to its issuance, also requires the applicant for the permit to file a
compensation laws of California, and agree that, if I should become subject to the
signed statement that he or she is licensed pursuant to the provisions of the
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division
comply with those provisions.
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
Date: Applicant:
permit subjects the applicant to a civil penalty of not more than five hundred dollars
($500).:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
(_) I, as owner of the property, or my employees with wages as their sole
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
compensation, will do the work, and the structure is not intended or offered for sale.
ONE HUNDRED THOUSAND DOLLARS ($100,000; IN ADDITION TO THE COST OF
(Sec. 7044, Business and Professions Code: The Contractors' State License Law does not
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
apply to an owner of property who builds or improves thereon, and who does the work
INTEREST, AND ATTORNEY'S FEES. .
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
APPLICANT ACKNOIIIW-,EDGEMENT
within one year of completion, the owner -builder will have the burden of proving that
IMPORTANT: Application is hereby made to the 3uilding Official for a permit subject to
he or she did not build or improve for the purpose of sale.).
the conditions and restrictions set forth on this application.
(_) I, as owner of the property, am exclusively contracting with licensed contractors
1. Each person upon whose behalf this application is made, each person at whose
to construct the project. (Sec. 7044, Business and Professions Code: The Contractors'
request and for whose benefit work is performed under or pursuant to any permit
State License Law does not apply to an owner of property who builds or improves
issued as a result of this application , the owner, and the applicant, each agrees to, and
thereon, and who contracts for the projects with a contractor(s) licensed pursuant to
shall defend, indemnify and hold harmless the Cty of La Quinta, its officers, agents, and
the Contractors' State License Law.).
employees for any act or omission related to the work being performed under or
(_) I am exempt under Sec. . B.&P.C. for this reason
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 is_uance of such permit, or cessation of
Date: Owner:
work for 180 days will subject permit to cancellation.
CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is correct.
I hereby affirm under penalty of perjury that there is a construction lending agency for I agree to comply with all city and county ordinances and state laws relating to building
the performance of the work for which this permit is issued (Sec. 3097, Civ. -C.). construction, and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
Lender's Name:
Date: Signature (Applicant of Agent):
Lender's Address
,'a
Application Number:
BRER2017-0029
Owner:
Property Address:
80260 MERION
DAVID PHIFE
APN:
762140015
11695 EASTFIELD 2D
Application Description:
TILE RESET
POWAY, CA 9225_
Property Zoning:
•;,Application Valuation:
$23,500.00
tri
Applicant:
Contractor:
WILLIAMS ROOFING
WILLIAMS ROOFING
P O BOX 391841
P 0 BOX 391841.
ANZA, CA 92539
ANZA, CA 92539
(760)399-9394
Llc. No.: 774482
Detail:
Date: 3/6/2017
FINANCIAL INFORMATION
DESCRIPTION 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
Credit Card Fee
101-0000-43505
0
$3.56
Total Paid for Credit Card Fee: $3.56
DESCRIPTION
ACCOUNT.
QTY
AMOUNT
RE -ROOF - EA ADDITIONAL 1,000 SF
101-0000-42404
0
$36.48
DESCRIPTION
ACCOUNT
QTY
AMOUNT
RE -ROOF - FIRST 21000 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-POOF: $191.52
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00