BRER2019-009378-495 CP .LE TAMPICO T-v � 4 4P QuIR& VOICE (760) 777-7125 LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011
DESIGN & DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 5/20/2019
Permit Type/Subtype: RE -ROOF/ Owner:
Application Number: BRER2019-0093 U S BANK TRUST NATL ASSN SD
Property Address: 78237 SAN TIMOTEO ST P O BOX 64142
APN: 646160015 ST PAUL, MN 92253
Application Description: BURT / FOAM REROOF
Property Zoning:
Application Valuation: $12,632.00
Applicant: U MAY 2 0 2019 Contractor:
RELIABLE ROOFING BY T G Y RELIABLE ROOFING BY T G Y
P 0 BOX 1961 P 0 BOX 1961
PALM SPRINGS, CA 92263 CITY OF LA QUINTA PALM SPRINGS, CA 92263
DESIGN & DEVELOPMENT DEPARTMENT
(760)323-2705
Llc. No.: 764608
LICENSED CONTRACTOR' EC TION
I hereby affirm under penalty of perjury tha m li nsed u visions of Chapter
9 {commencing with Section 70001 of Dig�31§Lsines nd Pro a ns Code,
and my License is in full force and effe
License Clas : C39 License No.: 7646
Oate: Contract./
OWNEF�IJILDER RATION
I hereby affirm under penalty of perjury that I i exempt from th onttactvr's State
License Law for the following reason (Sec. 70 .5, Business and ofessions Code: Any
city or county that requires a permit to cons uct, alter, imp e, demolish, or repair
any structure, prior to its issuance, also req res the ap nt for the permit to file a
signed statement that he or she is licensed p su 16 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.).
() 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 NDme:_
Lender'sAdrlress:
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
o�for which this permit is issued.
I have and will maintain workers' compensation insurance, as required by
L' r
Section 3700 of the Labor Code, for the performance of the w v6or which this permit
is issued. My workers' compensation insurance carrier and iicy number are:
Carrier: STATE COMPENSATION INSURANCE FUND olicv Number: 1795377
I certify that in the performance of th ark for which this permit is issued, I
shall not employ any person in any manner so to become subject to the workers'
compensation laws of California, and a fire at, if I should b ct to the
workers' compensation provisions of 5 rfln 370 Labor Code, I sha arthwith
comply with ose pr isions.
`Date: �0 pllEant:
WARNING: FAILUR TOS URE WORKER OMPENSATION ERAGE IS UNLAWFUL,
AND SHALL SUBJECT EMPLOYER TO IMINAL PE S AND CIVIL FINES UP TO
ONE HUNDRED THOU 'DOLLARS ($ 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 actor omission related to the work being performed under or
following issuance of this permit.
2. Any permit issued as a result of this application become ull and void if work is
not commenced within 180 days from date of issuance of ch permit, or cessation of
work for 180 days will subject permit to canceufron.
I certify that I have read this application 6
I agree to comply with all city and county
construction, ap
d hereby authorize ep !
above mend ed pr erty for insprrvn
Date: S1�1
(Appll
that the above informatr is correct.
ces and laws relating building
s of rs dt to enter upontie
Date: 5/20/2019
Application Number:
BRER2019-0093
Property Address:
78237 SAN TIMOTEO ST
APN:
646160015
Application Description:
BURT / FOAM REROOF
Property Zoning:
Application Valuation:
$12,632.00
Applicant:
RELIABLE ROOFING BY T G Y
P 0 BOX 1961
PALM SPRINGS, CA 92263
Owner:
U S BANK TRUST NATL ASSN SD
P O BOX 64142
ST PAUL, MN 92253
Contractor:
RELIABLE ROOFING BY T G Y
P 0 BOX 1961
PALM SPRINGS, CA 92263
(760)323-2705
Llc. No.: 764608
Detail: REROOF WITH FOAM ON FLAT ROOF SIMPLE OVERLAY[CRRC: 0001-7007] PER 2016 CALIFORNIA ENERGY CODE
DESCRIPTION
FINANCIAL INFORMATION
ACCOUNT CITY
AMOUNT
BSAS SB1473 FEE
101-0000-20306 fl
$1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA:
$1.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
RE -ROOF - EA ADDITIONAL 1,000 SF
101-0000-42404
0
$25.62
DESCRIPTION
ACCOUNT
QTY
AMOUNT
RE -ROOF - FIRST 2,000 SF
101-0000-42404
0
$54.43
DESCRIPTION
ACCOUNT
QTY
AMOUNT
RE -ROOF - FIRST 2,000 SF PC
101-0000-42600
0
$108.87
Total Paid for RE -ROOF:
$188.92
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE:
TOTALS:
$5.00
Property Owner's Name:
Address:
City, ST, Zip
Telephone:
Email:
New Co iial / Tenant Impr ments:
Total Building SF
Construction Type: Occupancy:
78495 CALLE TAMPICO
LA QUINTA, CA 92253
760-777-7000
OFFICE USE ONLY
# Submittal Required Received
Plan Sets :
Structural Calcs
Truss Calcs
Title 24,,Calcs
Soils Report
Grading- P_lan_(PM10)
Landscape Plan
Subcontractor List
Grant Deed
HOA Approval
School Fees
Burrtec Debris Plan
Planning approval
Public Works approval
Fire approval
City Business License