09-1031 (RR)Applicant:. Architect or En ineer
BUILDING & SAFETY. DEPARTMENT
BUILDING PERMIT
Owner:
HUBBARD LEO
52952 AVENIDA OBREGON
LA QUINTA, CA 92253
(760)238-2764
Contractor: '
ALPINE ROOF COMPANY,
P.O. BOX 167
YUCCA VALLEY, CA 922•
(760)365'3100
Lic. No.: 761151
VOICE (760) 777-7012
FAX (760) 777-7011
- INSPECTIONS (760) 777-7153
Date: 9/24'/09
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P.O. BOX 1504
.WORKER'S COMPENSATION DEC 110N----=--.—.__ '
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA
92253
Application Number:
09-0000103i
. Property Address:
52952 AVENIDA OBREGON
APN:
773-315-016-10 -000000-
Application description:
RE -ROOF
Property. Zoning:
COVE RESIDENTIAL
Application valuation:
5943
Applicant:. Architect or En ineer
BUILDING & SAFETY. DEPARTMENT
BUILDING PERMIT
Owner:
HUBBARD LEO
52952 AVENIDA OBREGON
LA QUINTA, CA 92253
(760)238-2764
Contractor: '
ALPINE ROOF COMPANY,
P.O. BOX 167
YUCCA VALLEY, CA 922•
(760)365'3100
Lic. No.: 761151
VOICE (760) 777-7012
FAX (760) 777-7011
- INSPECTIONS (760) 777-7153
Date: 9/24'/09
------------------------ ---------------------------------------------------=`---'zata'-f,
, -- ----
LICENSED CONTRACTOR'S DECLARATION
.WORKER'S COMPENSATION DEC 110N----=--.—.__ '
I hereby affirm under penalty of perjury that l am licensed under provisions of Chapter 9 (commencing with
I hereby affirm under penalty.of perjury one of the following declarations: '
'Section 7000) of Division 3 of the Business and'Professionals Code, and my License is in full force and effect.
_' I have and will maintain a certificate of. consent to self -insure far workers' compensation,as provided —
License Class: C3'9 • Licerise No.: 761151
for by Section 3700'of the Labor Code, for the performance of the work for which.this permit is
_1 ./ of
�1
�
issued.. .
te''�I'';L I Contractor: � �
— 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
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 Policy Number 2850002001
following reason (Sec. 7031 .5, Business and Professions Coile: Any city or county that requires a permit to
_ I certify that, in the performance of the work for which this permit 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 as to become subject to the workers' compensation laws of California,
., permit to file a signed statementthat he or she is licensed pursuant to the provisions of. the Contractor's State
and agree that, if I should become subject to the workers' 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'Code, I sh�l forthwitl c ply with those provisions.
that he or she is exempt therefrom and the basis for 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�
Dal— 1;1 y _(J q C/,
Date: / a ,�Applr icant, - --- -
(_ 1 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 ISec. 7044, Business and Professions Code:.: The:
WARNING: FAILURE TO SECURE WORKERS' G(5MPENSATION 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 ($1.00,000). 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.)
'-'- i APPLICANT ACKNOWLEDGEMENT
(_ 1 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 _ 1 I am exempt under Sec. , B.&P.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 .
1 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
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 county to enter upon the above-mentioned pro ^ dior insp do purposes.
Application Number . . . . . 09-00001031
Permit . .
. RE -ROOF
Additional desc .
.
Permit Fee . . .
. 30.00
Plan Check Fee
.00
Issue Date . . .
.
Valuation . . .
. 0
Expiration Date
3/23/10
Qty Unit Charge Per
Extension
BASE FEE
30.00
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Special Notes and
Comments
RE -ROOF TEAR OFF
(PARTIAL) 2007 CODES;
CLASS "A" MATERIALS.
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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 #
City of La Qwnta
Building &Safety Division
P.O. Box 1504, 781,495Calle Tampico
La Qdilita, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
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Project Address: -a 9S� ve n ltiQq 0i7rP pil
Owner's Name: PU v h'bar�
A. P. Number:
Address:q
J � I Sa ' X ✓.erg rP o i1
Legal Description:
Contractor. /� a O
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City, ST, Zip:
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•� Tel e hone: 8, a�
P 3� 7 � Y
Address: �, �j p �' �6'
City, ST, Zip: `yv c c o. Va 1(e_ Ca 92 z 8
Project Description: Te e74� C'642
Telephone: G 0 3 G 3100
S'— 0 U
State Lic. # : 76//T/
City Lie. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
>`»<''« ::
on
C stru '
coon Type: Occupancy
P Occu Y
State Lie. #
S L
'
Pro'ect e: i
c rcle one : New Add'n Alte r Re air
J. Demo
tYP �. ) P
Name of Contact Person: �/ E�....
Sq.:Ft.
Fstories: ,
#Units:
Telephone # of Contact Person: %G - `I7C�1%
Estimated Value of Project:.
APPLICANT: DO.NOT WRITE:BELOW THIS' LINE
#
Submittal
Req'd
Recd
TRACKING
PERMITTEES
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
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
.Plans resubmitted
Grading
IN HOUSE:-
3rd 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