04-3629 (RR)79683 Arnold Palmer
IIIIIIIIVIIIIIIVIIIIIII 71 '
IE
BUILDING &.SAFETY DEPARTMENT
P.O.-BOX 1504 (7.60) 777=7012
C OF'11 :9¢ 78-495 CALLS TAMPICG FAX (760) 717-7011
-LA .Q.UINTA. CALIFORNIA 92253 INSPECTION REQUESTS (760).777-7153-
BUILDING
760) 777-7153BUILDING PERMIT
Application .Number , 04-00003629 Date 4/21/04
_ Property Address 79683 ARNOLD PALMER
APN: 775-241-042- - -
--A,pplication description RE-ROOF
Property Zoning. .. LOW DENSITY RESIDENTIAL
Application valuation 7500
Owner Contractor
LEIT MITCHELL/DORIS . EMERALD ROOFING* INC
10380 -WILSHIRE .BLVD. ##19.01. P.O. BOX. 1963
LO'S ANGELES CA .90024- - PALM DESERT .. CA 92.261' .
WCC:, _ . STOVE INS ,
WC , ._ 63910804 . .: 0.1/01/05
:CSLB: .. :.770940: ' 11/30/05
CCC: . ... C39
Permit RE-ROOF
-Additional :ddsc
Permit Fee . . . 30 . 00 Plan Check Fee. . : .. . 00
-Issue- Date. . . . . Valuation 0
Qty Unit Charge. Per Extension
BASE ;FEE 3 0 r0.0
Special Notes and Comments
. ..RE-ROOF . WITH. .FOLYFOAM
Fee' ' summary Charged Paid Credited Due
Permit. Fee..Total 3.0 :00 0.0 .•. 00- . 30 . 00
Plan .Check Total 00 .00 . : : 00.:. 00 •.
Grand Total 30.. 00`: 00' 00 30 . 00'
J
P.O. BOX 1504 VOICE (760)777-7012
78-495 CALLE TAM►ICO FAX.(760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS•(760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number. Q -.3(o o Date:
Applicant: Architect or Engineer.
Applicant's Mailing Address: Architect or Engineer's Address:
Uc.No.
BUILDING PERMIT DECLARATIONS .
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under pINOfy of perjury that I am icensed under provisions of chapter 9(commencing wbh section 700.0)of Division 3 of he Business and fthessionals
Code.and my License is i nt&xce and effect.
it
, OW"Class G —3 V► No. 7 7 4 t 1-10
OWNER•BULDER DECLARATION
t Eby Mph 4nder ply of PO4 MY hat 1 am exempt tram he Contractors!Stale License Law for"following reason(Sec.7031.5.Business and Professions Code: Any
city or county that Mquires a Permit b construct eller.improve.demoist>.«repair any ctructum prior to Its issuance.also requires to Wpkam for to Permit b fie a signed
staWnent hat he or she Is licensed pursuant b he povisiona of he Contractors'state Liouse Law(Chapter 9(commencing with Section 7000)of Division 3 of fie Business
and Professions Code)«hat he orshe is exempt therefrom and'"basis for the a aged exemption. Any violation of Section 7031.5 by any applicant fora permit subjecs
he applicant to a clivi penalty of not more than ire hundred doians($500))
U I.as owner.of the property,or my employees with wages as heir sole compensation,will do he work and the structure is not intended or offered Por We(Sec.7044..
Business and Professions Code: The Ccntracas'Stab Lioense Law does not apply b an owner of property who bulls«improves hereon.and who does the work
WrAf or herself or trough his or her own employees,provided that he improvements aro not intended or offered for sale. If.howeyer,he
sold within one year of completion,the owner builyder:will have the burden of bu�hg«impnovenmmemt is
U Las owner of.he properiy.an exdusively owtaoting with licensed contractors construct to p she del not build improve fund the expose of sale.}
state t.boense Law does not Project(See.7044.B Business and Professions Code: Time Contractors•
appy b an owner of property who builds or thereon and who Contracts for the pvjects with a contractor(s)licensed pursuant to
the Contractors•State License Law.).
U 1 am exempt under sec. B.&P-C.for 2-is,reason
Date Ovne�
1 here affirm under WARS'COMPENSATION DECLARATION
by petty of ped ury one fine tofowing 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 he perfon anoe
of the work for wtkh this permit is issued.
/ _1 have and will maintain workers•compensation insurance,as required by Section 3700 of the Labor Code.for he performance of he work lorwhich this permit is
Cy-
issued. wawdws
Number and policy number are:
— -4206517_I certify that,in he Performance of fe work for which his Permit is issued.I shall not employ any person in any manner so as to become subject b he workers'
compensation laws of California.and agree that,if 1 should became subject Io the workers'compensation Provisions of section 3700 of he Labor Code.I strap
• brthwft.complywith those provisions,
WARNING: FAILl1RE TO SECURE WORICERS'COMPENSATION COVERAGE IS UNLAWFUL-AND SHALL,SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CML FINES UP TO ONE KMDRED T1iDUSAND DOLLARS($100.000).IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE.WERE*,AND ATTORNEYS FEES. .
CONSTRUCTION LENDING AGENCY
1 he affirm under penalty of perjury hat two is a Construction lending agency f«the performance of the work for which his permit is issued(Sec.3097.Civ.C.).
Lenders Name
Lenders Address
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building andSafety for a pemh
At subject to e conditions and restrictions sel forth on this appirarm.
I. 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 of his application,the owner,and he app"at.each agrees lo,and shall,defend.indemnify and hold hamUess the City of La Auinta.its
2 Any Permit and as�ult s or application act«omission related to the work being performed under or following issuance of this perhit.
ppication becomes null and void K work is not conmenoed within 180 days from date of issuance of such permit,or
cessation of work for 180 days will subject permit to cancellation.
ve
1 certify that I haread this application and state that he above information is correct. I agree b comply with aft city and county ordinances and state laws relating to building
construction.and hereby authorize representatives of this county to enter upon the above-mentioned property for inspection purposes.
�BaCe '2 G– l 8 nature(Applicant or