BRER2015-003778-495 CALLC TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application Description:
Property Zoning:
Application Valuation:
Applicant:
BAZUA ROOFING
P 0 BOX 818
MECCA, CA 92254
BRER2015-0037
49429 GUIJARRO PL
646270033
PYLE RESIDENCE/REROOF
$20,000.00
Ce 0 U 4 Qa4tmfU j• GL2\ L� (760) 777-7125
(760) 777-7011
COMMUNITY DEVELOPMENT DEPARTMENT AP i U 01IN60-cri (760) 777-7153
BUILDING PERMIT
Ii1 rlF Lf �Ii^ QjTA e: 4/30/2015
( n;;rFd ;ftl 1 Fdi_ �, l rlFti'r�fiirl lE .-
Owner: _.
THOMAS PYLE
4806
CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 {commencing with Section 7000} of Division 3 ofthe Business and Professions Code,
and my License is in full force and effect.
i
License Class: C39 License No.: 628223
Date: y! In 20 eS Contractor: ACF20- �14L"4
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 ofthe
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 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.).
(_) 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.).
(�_) I am exempt under Sec. B.&P.C. for this reason
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 Add
Contractor:
BAZUA ROOFING
P0BOX 818
MECCA, CA 92254
(760)776-7663
Llc. No.: 628223
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one ofthe 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
of the ry6rkfor which this permit is issued.
J 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: Policy Number:
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 ofthe Labor Code, I shall forthwith
comply with those provisions. /��
Date: 30 7 Applicant: 4Q WLFA V /, Z-w A
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE 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 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 ofthis 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 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 issuance of such permit, or cessation of
work for 180 days will subject permit to cancellation.
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 purposes. �,//�
Date: S� �7� Signature (Applicant or Agent): �✓ "
DESCRIPTION
FINANCIAL INFORMATION
ACCOUNT
CITY AMOUNT
PAID
PAID DATE
BSAS SB1473 FEE
101-0000-20306
0
$1.00
$1.00
4/30/15
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
BAZUA ROOFING
CASH
R5648
MFA
Total Paid forBUILDING STANDARDS ADMINISTRATION BSA $1.00 $1.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
PAID
PAID DATE
RE -ROOF - EA ADDITIONAL 1,000 SF
101-0000-42404
0
$23.20
$23.20
4/30/15
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
BAZUA ROOFING
CASH
R5648
MFA
DESCRIPTION
ACCOUNT
CITY
AMOUNT
PAID
PAID DATE
RE -ROOF - FIRST 2,000 SF
101-0000-42404
0
$49.31
$49.31
4/30/15
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
BAZUA ROOFING
CASH
R5648
MFA
DESCRIPTION
ACCOUNT
CITY
AMOUNT
PAID
PAID DATE
RE -ROOF - FIRST 2,000 SF PC
101-0000-42600
0
$98.62
$98.62
4/30/15
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
BAZUA ROOFING
CASH
R5648
MFA
Total Paid forRE-ROOF: $171.13 $171.13
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Bin #
City/ of La QUinta
Building &r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address:
Owner's Name: 1�
A. P. Number:
Address:
Legal Description:
City, ST, Zip:
Contractor: Ztn
Tele hone:
Address: 9M() M •f7 e77)N
Project Description:
City, ST, Zip: L-
t< 1� IVC 12 L
Telephone: � 7c
State Lie. # : 7, �'� 3
CityLic.
t
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lie. #: ` � �: .F� „�'
;� : ;,;• .- J¢
Name of Contact Person:
Construction Type: e6 (,�b, r Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: & Qa(J # Stories: # Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Reed
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calls.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cales.
Called Contact Person
Plan Check Balance
Title 24 Calls.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2vd Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
Review, ready for correctionstissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees