09-1080 (RR)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
109-00001080
Property Address:
56110 PEBBLE
APN:
775 -132 -021 -
Application description:
RE -ROOF
Property Zoning:
LOW DENSITY
Application valuation:
20000
Ant:
�i . X&I 47
BEACH
RESIDENTIAL
Architect or Engineer:
4*
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
PGA WEST RESIDENTIAL
P.O. BOX 1060
LA QUINTA, CA 92253
Contractor:
BIENEK ROOFING CONST
9707 PINEWOOD AVENUE
TAJUNGA, CA 91042
(760)625-7796
Lic. No.: 885157
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10./08/09
U
OCT0' 20239 E ;
-------------------------------------------------------------------------------------------------
LICENSED CONTRACTORh DECLARATION
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that lice sed under pr Bions of Chapter 9 (commencing with
I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Busi s and ro sionats Co and my License is in full force and effect.
I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
license Class: C3 9-B Lice No.: 885157
_
- for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued. .
Contractor:
I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
G/
Code, for the performance of the work for which this permit is issued. My Workers' compensation
OWNER -BUILDER DECLARATION
insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
Carrier STATE FUND licy Number 1889944
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to
_ I certify that, in the performanc oft a work for which this rmit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
person in any manner so a o be ome su ' ct to the ers' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
and agree that, if 1 should ecom sub'e to the wor ' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
3700 of the Labor Cod shal orth . comply those provisions.
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).:
a .q Applicant:
(_ 1 1, 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
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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.).
APPLICANT ACKNOWLEDGEMENT
(_) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
conditions and restrictions set forth on this application.
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
1. Each person upon whose behalf this application is made, each person at whose request and for
pursuant to the Contractors' State License Law.). -
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
(_ 1 I am exempt under Sec. , BAP.C. for this reason
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
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:
LQPERMIT
Z�
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 oissuo.f such permit, or cessation of work for 180 days will subject
permit to cancellation.I certify that I have read this application at a informa o is correct. I agree to comply with all
city and county ordinances and state lawbonstructs and hereby authorize representatives
of this county to enter upon the abov pinspecti purposes.
�� Signature IA licant
Application Number . . 09-00001080
Permit RE-ROOF
Additional desc .
Permit.Fee.• 30.00 Plan Check Fee
.00
Issue.Date . . . . Valuation . . .
. 0
Expiration Date 4/06/10
Qty Unit Charge Per
Extension
BASE FEE
30.00
Special Notes and Comments
RE-ROOF PERMIT REMOVE ROCK INSTALL (1)
INCH SPRAY FOAM (4) UNITS 56110-56074
PEBBLE BEACH INVERNESS .PER 112007"
CODES.
----------------------------------------------------------------------------
Other Fees . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid Credited
-------------------------------------
Due
--------------------
Permit Fee Total 30.00 .00 .00
30.00
Plan Check Total .00 .00 .00
.00
Other Fee Total 1.00 .00 .00
1.00
Grand Total 31.00 .00 .00
31.00
LQPERMIT
Bin #
Qty of La Quinta
Building &r Safety Division.
1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit # /P.O..Box
oc��
Project Address "� -Q
A. P. Number: e e,¢-
Owner's Name:
Address:
Legal Description:
Contractor: A)
/v
City, ST, Zip:
Telephone:
one.
Address: q 7o "I d Ale,
Project Description:
City, ST, Zip: y ` iv `/�• Q 2
e
Telephone
6
O
State Lic. # :99-5 1:57 City Lic.
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
a
St to Lic. #• '.
Con tru ' T
s cti n
o e: P
Y P Occu anc Y•
one : New
n Alter Repair Demo type Cc'u
Add'
Name of Contact Person: �(� N�.
Sq. Ft # Stories:
# Units:
Telephone # of Contact Person7& re a S
Estimated Value of Project: 0 UCS
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2°" Review, ready for corrections/issue
Electrical
Subcontai:tor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
30 Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
IZ.,