BRES2017-0078wit
78-495,CAlif;(TAMP1CQ T D 1 Qumraj
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTM
BUILDING PERMIT
Application Number: BRER2017-0078 4
Property Address: 80496 RIVIERA,i ---mil
APN: 762200034 IVI
Application Description: DESERT RESORT GMT / REROOF
Property Zoning: QUG
Application Valuation: $19,200.00
I
• C','f'i �? � ` fig' �StiI'•. ;aY
Applicant: CO3jJ 1j'i
B R S ROOFING INC _tee
777 SOUTH LUGO AVE
SAN BERNARDINO, CA 92408
-------------------------------------------'---------------
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter I hereby affirm under penalty of perjury one o- the following declarations:
9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, I have and will maintain a certificate of consent to self -insure for workers'
and my License is in full force and effect. n compensation, as provided for by Section 370C of the Labor Code, for the performance
License Class C39 _ License No.: 907600 n A. ' 1 of the work for which this permit is issued.
1 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 FLND Policy Number: 9141962
(909)884-8505
Llc. No.: 907600
OWNER -BUILDER DECLARATION 1 —
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, 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, 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.).
(_) 1 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:
I certify that in the performance of -he work for which this permit is issued, I
shall not employ any person in any manner so 3s to become subject to the workers'
compensation laws of California, and agree thzi, if I should become subject to the
workers' compensation provisions of Section 3 700 of the Labor Code, I shall forthwith
comply with those revisions.
Dater'11 e�pli ant:
WARNING: FAILURE TO SECURE WORKERS' CO PENSATION COVE GE 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 thisapplication.
1. Each person upon whose behalf this appliotion 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 ownek 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 i_suance of such permit, or cessation of
work for 180 days will subject permit to cancellrtion.
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 representaLves of this 'ty to enter upo the
above-menf-I property for inspection purpcses.
"Signature (Applicant cr Agent
VOICE (760) 777-7125
FAX (760) 777-7011
ENT
INSPECTIONS (760) 7777153
Date: 8/14/2017.
Owner:
DESERT RESORT MANAGEMENT
80496 RIVIERA.
LA QUINTA, CA 92253
Contractor:
.B R S ROOFING IFC
777 SOUTH LUGC, AVE
SAN BERNARDINO, CA 92408
(909)884-8505
Llc. No.: 907600
OWNER -BUILDER DECLARATION 1 —
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, 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, 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.).
(_) 1 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:
I certify that in the performance of -he work for which this permit is issued, I
shall not employ any person in any manner so 3s to become subject to the workers'
compensation laws of California, and agree thzi, if I should become subject to the
workers' compensation provisions of Section 3 700 of the Labor Code, I shall forthwith
comply with those revisions.
Dater'11 e�pli ant:
WARNING: FAILURE TO SECURE WORKERS' CO PENSATION COVE GE 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 thisapplication.
1. Each person upon whose behalf this appliotion 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 ownek 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 i_suance of such permit, or cessation of
work for 180 days will subject permit to cancellrtion.
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 representaLves of this 'ty to enter upo the
above-menf-I property for inspection purpcses.
"Signature (Applicant cr Agent
'
r
Date: 8/14/2017
ApplicationNLmber:
BRER2017s0078
Owner:.
Property Address:
80496 RIVIERA
DESERT RESORT MANAGEMENT
APN:
762200034
80496 RIVIERA
Application Description:
DESERT RESORT MGMT / REROOF
LA QUINTA, CA 9,2253
Property Zoning: .
Application Valuation:
$19,200.00
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: INSTALL NEW SYNTHETIC UNDERLAYMENTAND RESET SAME TILE.
REPLACE TELE AS NEEDED. NO ENERGY FORMS NEEDED. PER 2016 CALIFORNIA
BUILDING CODE
.i
3
GINANfim IW:nRMATintu
a:?*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
RE -ROOF - EA ADDITIONAL 1,000 SF
101-0000-42404
0
$48.64
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 -ROOF: $203.68
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
0• .68
e
Bin.#
City of La Qulnta
^ Building Br Safety Division
60 P.O. Box 1504,78-495 Calle Tampico
!.a.Quinta, CA 92253 -:(760) 777-7012
Building pP Permit A lication and TrackingSheet
Pe 't #
ILI
Project Address: soHq
Owner's Name:. i-eSC(-� 9,4Z5-oCA- MGNQ Coe.Vl
A. P. Number.
Address: Ct r
Legal Description:City,
ST, Zip:ZS3
Contractor. 13 ?,s 00 F �J it
Telephone: . ;�,;,' . 0 n:M.
Address: 711 S , LU GO
Project Description: �C f . T 1P— roi I s e n
City, ST, Zip:
Telephone: �gy $ s� 5
�'�s � 1 y
h tcoolyyi Pili (nS
' d
State Lic. # :
Q r
Arch., Engr., Designer.
Address:
City., ST, Zip:
Telephone:y Y
State Lic. #: ; • r .: ;;
Construction Type:. Cacupancy:
Project type (circle one): New Add'a Alter Repair Demo
Name of Contact Person:J
Sq. Ft.: %Q
Stori es
# Units:
Telephone # of Contact Person: 7 to 03 3 3 1 1 2 (p
Estimated Value of Project: Q 2 0 (7 b O
APPLICANT: DO NOT WRITE BELOW THIS UNE
N
Submittal
Req'd
Recd
TRACE NIG
PERMIT FEES
Plan Sets
Plan Check submitted
Item Amount
Structural Cala.
Reviewed, ready for corrections
Plan Chect Deposit. .
Truss Calcs.
Called Contact PersonPlan
Chect Balance.
Tide 24 Calci.
Pians picked up
Constructhn
Flood plain plan
Plans resubmitted
Mechariiczi
Grading plan
211Review, ready for correctionslissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
SALL
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'^' Review; ready for correctionMasue
Developet Impact Fee
Planning Approval.
Called Contact Person
A.%P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees