04-3635 (RR)BUILDING &- SAFETY DEPARTMENT
P.O..Box 1504
(7.60) 777=7012
OFT19 78-495 CALLE -TAMPICo
FAX (760) 777-7011
LA .Q:u1NTA, .CA6.F0RN.IA 92253
-INSPECTIONREQUESTS (760).777-7153
BUILDING PERMIT
Application Number —0-0-0-0-3-63-5
�, Date 4/21/04
Property Address -55900
RIVIERA --'
APN: 775-241.-043-
~Application description RE
ROOF.
Property:Zoning _ .LOW
DENSITY RESIDENTIAL.
A�pli-cation valuation
3500
Owner
Contractor
GREEN TRUST
EMERALD ROOFING INC
55,900 RIVIERA.
:P.O. BOX 1963 =
LA: `QUINTA . CA .9225.3
PALM DESERT ... CA '92.2.61'
'WCC. .
:.: STOVE INS .
. ....
WC:..: 639.10$04 01/01/05
.. .
CS 7709.44:' 1.1/30/05
Permit RE -'ROOF
.Additional :desc :
Permit Fee 30.00
Plan Check Free.. .00
Issue Date
Valuation 0
Expiration Date 10%21/04.
"Qty Unit Charge r.Per
"Extensro.n
BASE -FEE..
'..30.00
. ..
:t...Secial . Notes -and..:Cominents
RE-ROOF.WITH POLYFOAM
Fee summary Charged
Paid. Credited Due
.Permi.t . FeeTotal , 30:00
:. 00. :: 00: 34.00
Plan Check Total . 00:`:'.:.
00 ° 0y0 00
Grand Tota -1. 3 0. 0 0.
..00.. 0:0 30.-00
P.O. BOX 1504
78-495 CALLS TAM►ICO cu VOICE (760) 777-7012FAX (760) 777-7011
LA QUINTA, CALIFORNIA 42253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: 0 - 31, 3 Date:
Applicant: Architect or Engineer.
Applicant's Mailing Address: Architect or Engineer's Address:
T
Lic. No.
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
1 hereby affan under penalty Of perjury that I am licensed under provisions of Chapter 9 (conmen*Q wth section 7000) of Division 3 of to Business and Professionals
Code. and my License is tzn form &A foand effect
e --
Class Z ! /license IVo. 70 g 14 d
OWNER$UILDER DECLARATION
I hereby aftm Vnder ply Of perjury tat I am exempt from to CpWaclas• Seale License Law for the kmowkq reason (Sec. 703.1.5. Business and Prolessions Code: Any
.may o wj* tathfegiles a pema b consb ck alter. knprvve. demolish, or repair any structure. priorto Issuance. also Issuanalso requires the applicant for the permit b tie a signed
stalemerM that he or she Is licensed pursuant to to provisions of to ContraclW State License Law (Chapter 9 (camrondng with Section 7000) of Division 3 of to Business
and Professions Code) or tat he orate k exempt taiefrom and the basis for to alleged exernption. Any violation of Section 7031.5 by any applicant for a permit subjects
to applicant to a cavi penalty or not mere than live hundred dollars OW).r .
U 1. as owner, of the property. or my employees with wages as their sole compensation. YA do to wok. and the shucl re is not Intended or offered for sale (Sec. 7044.
Buskress and Professions Code: The Contradofs' stale License Law does not apply to an owner of property who builds or improves thereon. and who does the wok
himself or herset or trough his or her own employees. provided tat the improvements are not (Mended or offered br sale. W. howeyer. the buidi g or krproveaent is
sold within one year of completion, the owner -builder win have to burden of proving that he or she did not build or knpnove for to purpose of sale.).
U I. ss owner of to property. am exclusively contracting with licensed contractors to construct the Pry (Sec. 7044. Business and Professions Code: The Conlractos'
State License Law does not apply to an ower of property who builds or improves tensor, and who contracts for the projects with a oontractor(s) licensed pursuant to
to Contractus' State License Law.).
U I am exempt under Sec . SA P.C. for this reason
Date" � Owner
1 hereby affirm under WORKERS' COMPENSATION DECLARATION
penalty of perjury one of to bbwi ng 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 perfonnano
of the work for which this permit k issued
j _ II have and will maintain wokeW compensatwn insurance. as required by Section 3700 of the Labor Code, for the performance of to work for whidm this permit is
SW016, tc
"j _d 4- Densa canner and policy number are:
I-- POWNumber
_ I certdy that. In the performance of the walk br which V k permit is Issued. I shat not-employan
compensation laws of California.d ra. aagree tat, i 1 should become y mon in any manner so as b become subject b the workers'
.may with Lase v�+s subject b to Workers! compensation provisions of section 3700 of the Labor Code. I snail
Z� —0L—
WARNING.
aL
WARNING: FAILURE TO SECURE WORKERS' COiAF'CNSATION COVERAGE IS UNLA AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES LIP 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. .
1 hereby affirm under CONSTRUCTION LENDING AGENCY
Ply of perjury slat t We is a construction lending agency for to performance of the work tor which urs pan* is Issued (Sec. 3097. Civ. C.).
Lendees Name
Lenders Address
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Apptiaion is hereby Malde b the Director d Building and Safety for a Perm subject to the conditions and restrictions set forth on this application.
1. Each person upon whose behalf this #,a owner,
k made. each Penson at whose mutest and for whose benefit wok is Penton ed under or pursuant b any pemmrt
issued as •result of this appticaion, time owner. and the applicant, each agrees b. and shat, defend. indemnity and hold harmless the City of La QukMa, Its
officers. agents and employees for any ad or omission related to the work being perfumed under or foiowing issuance of this penNL
2. Any per" issued as a result of this appliatio► becomes nun and void if wok is not comrremoed within 160 days from date of issuance of such permit, or
cessation of wok for 180 days win subject perm b cancellation.
1 certify that I have read this application and state that the above information is torted. I agree to comply with all city and county ordirnances and state laws relating to bukWv
cOnsaucOM and hereby authorize representatives of urs county to enter upon the above-mentioned property for inspection purposes.
ate CJ ignature (Applicant o
gym):