BRES2019-0026 Revision 1p6evillillibi
78-495 CALLE TAMPICO Tih/ D 44o Quk& VOICE (760) 777-7125
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011
DESIGN & DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 11/4/2019
Permit Type/Subtype: BUILDING RESIDENTIAL/DWELLING - SINGLE FAMILY DETACHED Owner:
Application Number: BRES2019-0026 ROBERT BYRUM
Property Address: 78940 VIA FLORENCE 78940 VIA FLORENCE
APN: 643120001 LA QUINTA, CA 92253
Application Description: BYRUM / (23) WINDOW CHANGEOUT
Property Zoning:
Application Valuation: $19,474.31 �fr
��JIJ cQNT� Gr0 R
Applicant: D
Contractor:
SEARS - ALIYAH QUIROZ TRANSFORM SR HOME IMPROVEMENT PRODUCTS L
P 0 BOX 522290 PO BOX 522290
LONGWOOD, FL 32752 NOV 0 4 2019DD LONGWOOD, FL 32752
CITY OF LAQUINTA (407)551 5402 DESIGN & DEVELOPMENT DEPARTMENT Llc. No.: 1055034folo
LICENSED CONTRACTOR'S DECLARATION
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: - 4
License No.: 1055034
Date: Contractor: 1�z /6X/
OWNER -BUILDER DECLARATION
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).:
(_) 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 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
Lender's
WORKER'S COMPENSATION DECLARATION
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'
ompensation, as provided for by Section 3700 of the Labor Code, for the performance
if the work for which this permit is issued.
I have and will maintain workers' compensation insurance, as required by
ection 3700 of the Labor Code, for the performance of the work for which this permit is
;sued. My workers' compensation insurance carrier and policy number are:
:arrier: NATIONAL UNIQN FIRE INSURANCE COMPANY OF PITTSBUPolicy
lumber: 014649106
_ I certify that in the performance of the work for which this permit is issued, I
hall not employ any person in any manner so as to become subject to the workers'
ompensation laws of California, and agree that, if I should become subject to the
porkers' compensation provisions of Section 3700 of the Code, I shall rthwith
omply with those provisions,
late: Applicant:
VARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
,ND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
)NE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF
OMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
4TEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
APORTANT: Application is hereby made to the Building Official for a permit subject to
ie conditions and restrictions set forth on this application.
1. Each person upon whose behalf this application is made, each person at whose
?quest and for whose benefit work is performed under or pursuant to any permit issued
s a result of this application, the owner, and the applicant, each agrees to, and shall
efend, indemnify and hold harmless the City of La Quinta, its officers, agents, and
mployees for any act or omission related to the work being performed under or
)Ilowing issuance of this permit.
2. Any permit issued as a result of this application becomes null and void if work is not
:)mmenced within 180 days from date of issuance of such permit, or cessation of work
>r 180 days will subject permit to cancellation.
:ertify that I have read this application and state that the above information is correct.
agree to comply with all city and county ordinances and state laws relating to building
instruction, and hereby authorize representatives of this city toe r upon the bove-
lentioned property Eor inspection purposes.
ate: Signature (Applicant or Agent):
Date: 11/4/2019
Application Number: BRES2019-0026 Owner:
Property Address: 78940 VIA FLORENCE ROBERT BYRUM
APN: 643120001 78940 VIA FLORENCE
Application Description: BYRUM / (23) WINDOW CHANGEOUT LA QUINTA, CA 92253
Property Zoning:
Application Valuation: $19,474.31
Applicant: Contractor:
SEARS - ALIYAH QUIROZ TRANSFORM SR HOME IMPROVEMENT PRODUCTS L
P 0 BOX 522290 PO BOX 522290
LONGWOOD, FL 32752 LONGWOOD, FL 32752
(407)551-5402
Llc. No.: 1055034
--------------------------------------------------------------------------------------------
Detail: CHANGE OUT 23 WINDOWS LIKE FOR LIKE. 4 WINDOWS FACING NORTH, 2 WINDOWS MCING EAST, 7 WINDOWS FACING SOUTH, AND 9
WINDOWS FACING WEST. THIS PERMIT DOES NOT INCLUDE ANY OTHER MODIFICATION. PER 2016 CALIFORNIA ENERGY CODE.
0
FINANCIAL INFORMATION
DESCRIPTION ACCOUNT QTY AMOUNT
PLAN CHECK/PERMIT EXTENSION PROCESSING
101-0000-42600 0 $107.87
Total Paid for ADMINISTRATIVE: $107.87
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
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DOOR/WINDOW, RETRO/REPAIR, EA ADDITION 5
101-0000-42400
0
$44.84
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DOOR/WINDOW, RETRO/REPAIR, FIRST 7
101-0000-42400
0
$67.24
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DOOR/WINDOW, RETRO/REPAIR, FIRST 7 PC
101-0000-42600
0
$65.64
Total Paid for WINDOW/SLIDING GLASS DOOR/FENESTRATION: $177.72
Agent Authorization for Contractor
Company Name: Transform Home Improvement Products LLC dba "Sears Home Improvement"
Contractor's Name: Alfred William hLyman
Contractor's License Number:
Email: al.n manigtransformhomepro,com
The below listed individual employee(s) are authorized to apply or cancel to the city/county for a
building permit and purchase of a business license on behalf of the above identified
licensed contractor. I understand that it is the licensed contractor's responsibility to provide a copy
of this form with each building permit application. If a copy of this form is not provided at the time
that a building permit application is filed, an agent(s) of the above identified licensed contractor
may not apply for a building permit.
The below listed employees are authorized to apply for permits for the above identifiPtl iirancorl
contractor:
1.
Samuel Vallejo
2.
Bruce Edgar
3.
Carolyn Christian
4.
Charles Shaw
5.
Daniel Brizuela
6.
Daniel Ochipinti
7.
Evan Volkwein
8.
Jacob Kinney
9.
John Maltman
10.
Kedar Sotomey
11. Laura Johnson
12. Mark Becker
13. Matt McHattie
14. Nate Colyott
15. Peter Lujan
16. Don Stone
17. Shawn Kunsemiller
18. Stephanie Smith
19. Stephen Krale
20. Stephen Swinney
21. Tamia Williams
22. Teresa Kump
23. Tim Lane
24. Todd Chronister
25. Tony Thai
26. Tracy Marroquin
27. Brianne McLaughlin
28. Tia Moffatt
29. Kyle Au Coin
30. Nicholas Settle
Printed name and title of signor:
Authorized signature: '
31. Joshua Smelser 41. Tyler Walton
32. Alyssa Ross 42. Mitchell Gay
33. Eric Berivalt 43. Cam Hiscock
34. Breanna Peterson
35. Jessica Barajas
36. Shawnna Young
37. Lidia Vega
38. Shon Fleming
39. Zohaib Gardezi
40. Kendrick Hyde
Witness of Sienature
Date: 09/12/2019
STATE OF 17L-ORL_�e COUNTY OF 5A10L6
On this September, day of 12, 2019, before me, the undersigned notary public, personally appeared
,1�1"� z ,(name of person acknowledging) proved to me through satisfactory evidence, which
was PQ /`. o✓ (type of identification) to be the person whose name is ciy he preceding or
attached do �ument in my presence.
_ Bethan
*� COMMissipn 0 GG066686 , Signotur Notory Public
.,= Expires: Jan. 26, 2021 -
Bonded Mru Aaron Nola
Cpmlrl&pn Expiration DDLe of Notary Public
Phone- i-877-600-0123 www,energuy.coni Fax1.877-571-0123
tsQiJiie Plaza '215 K Street, l th L oop Se, iameniG, Ci-,, 95814