BRER2017-0127C (`w
4„I auucl6l/ VOICE (760) 777-7125
78 495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date:. 11/9/2017
Permit Type/Subtype: RE -ROOF/ Owner:
Application Number: BRER2017-0127 LQR GOLF
Property Address: 80453 OAK TREE 1 BUSH ST STE 1100
APN: 775081093 SAN FRANCISCO, ZA
Application Description: PGA WEST / REROOF FLAT AREAS / ADDRESS 80435, 441, 447, 453
Property Zoning:. A
UApplication Valuation: $2,310.00
Applicant:I,fContractor:
NOV
B R S ROOFING INC 0 9 2017 B R S ROOFING 1W_
777 SOUTH LUGO AVE 777 SOUTH LUGO AVE
SAN BERNARDINO, CA 92408 CITY OF LA QUINTA SAN BERNARDINO, CA 92408
DESIGN AND DEVELOPMENT DEPARTMENT (909)884-8505 .
Llc. No.: 907600
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm under penalty of perjury that I am licensed underrprovisions 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.: 907600
Date:
Contractor:
OWNER -BUILDER DECLARATION
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
dty 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 ofthe Business and Professions Code) or that he or she is exempt therefrom and the
basis for the alleged exemption. Any violation of Section 1031.5 by any applicant for a
permit subjects the applicant to a civil penalty of not more than five hundred dollars
($500).:
(_J 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.).
(_J 1, 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 contractors) 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:
WORKER'S COMPENSATDN DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
1 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 Polity 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 with those provisions.
Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMIN91L PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,000. IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOR M SECTION 3706 OF THE LABOR CODE,
INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOIM_EDGEMENT
IMPORTANT: Application is hereby made to the 3uilding 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 ai 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 Ci 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 applicabon 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 cancellafion.
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 purposzs.
Date: .. Signature (Applicant orAgent):
Date: 11/9/2017
Application Number:
BRER2017-0127.., ...:
Owner:
Property Address:
80453 OAK TREE:
LQR GOLF
APN:
775081093
1 BUSH ST STE 1170
Application Description:
PGA WEST/ REROOF FLAT AREAS /ADDRESS 80435, 441, 447, 453
SAN FRANCISCO,:=A
Property Zoning:
Application Valuation:
$2,310.00
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 BERNARDINO, CA 92408
(909)884-8505
--------------------------------------------------------------------=------------------------
Llc. No.: 907600
Detail: REROOF WITH FOAM AT FLAT -AREAS ONLY [CRRC: 0770-0002] 2016 CALIFORNIA ENERGYCODE.
7-7
f
DESCRIPTION . ..
fINANCIALINFORMATIM
ACCOUNT QTY
AMOUNT
BSAS SB1473 FEE
101-0000-20306 0
$1.00
-Total Paid for BUILDING STANDARDS ADMINISTRATION BSA:
$1.00
DESCRIPTION
ACCOUNT
iQTY
AMOUNT
RE -ROOF - FIRST 2,000 SF
101-0000-42404
0
$53.05
Total Paid for RE -ROOF:
$53.05
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE:
$5.00