04-3627 (RR)79705 Arnold Palmer
IIIIIIIIIIIIIIIIIIIIIIIII 21
IE
BUILDING &.SAFETY DEPARTMENT
•c -
P-0-BOX 1504 (7.60) 777:7012
0()F 78-.495 CALLS.TAMPIco FAX (760) 777-7011
LA .Q.UINTA. CALIFORNIA 92253INSPECTION REQUESTS (760).777-7153-
BUILDING
760)•777-7153BUILDING PERMIT
Application .Number . . 04-00003627 Date 4/21/04
Property Address 79705 ARNOLD PALMER
APN: 775-241-040- - -
- Application description RE-ROOF
Property Zoning LOW DENSITY RESIDENTIAL
Application valuation : . 7500
:Owner Contractor
-------.-.----------------- ------------------------ .
KEATING WALTER EMERALD ROOFING INC
797.05 ARNOLD -PALMER P.O. BOX 1963
LA' 'QUINTA CA .9225.3 PALM .DESERT CA 92261" .
::WCC; . .. STOVE INS ...
WC.:. 63910804 01/01/05
` CSLB:'` .. • .. 770940:.• 11'/30/05
CCC:. C39
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Permit RE--ROOF
Additional :d6sc .
Permit Fee 30 . 0Plan Check Fee. . . 00
Issue: Date0• Valuation 0
Qty. Unit 'Charge. . Per Extension
BASE :FEE 3 0 :-0.0
Special Notes and Comments
..RE-ROOF. WITH. .POLYFOAM
Feersummary Charged Paid Credited . Due
Permit. Fee.-Total 3.0 ,00 0.0 . 00' -:30 .00.
Plan Check Total : 00 ..00 : :;00,: .• 00 .
Grand- Total 3O :.Q0 00, 00 30 : 00
P.O. Box 1504 w
VOICE (760)777-7012
78-495 CALLE TAmpico FAX.(760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS'(760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: (' -.3(o a 7 Date:
Applicant: Architect or Engineer.
Applicant's Mailing Address: Architect or Engineer's Address:
Uc.No.
BUILDING PERMIT DECLARATIONS .
LICENSED CONTRACTOR'S DECLARATION
I tereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9(commencing wUh Section 700.0)of Division 3 of the Business and Professionals
Code.and my Lioemse is i Lull force and effect.
License Classes — 3 l (License No. 7 ? o
OL-
OWNER-BUILDER DECLARATION
I herabY atfinrm!+nder penalty of perjury that 1 am exempt from the Contractors'state License Law for the following reason(Sec.7031.5.Business and Professions Code: Any
�Y or county that permitro
that s a b cansb cL albM improve.demirepair any or reany st uctum prior b its issuance.also requires the applicant for"permit In file a signed
statement that he or the Is licensed pursuant bin provisions of the Cw*acbW State License Law(Chapter 9(commencing with Section 7000)of Division 3 cite Business
and Professions Code)or that he orshhe Is exempt lherefrpn and the basis br the alleged exemption. Army violation of Section 7031.5 by any appicar I bra pemtt subjects
the applicant to a civil penalty of not more than five hundred dollars($500).):
U 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 olk ed 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 or trough his or her own employees,provided that the improvements aro not intended or offered for sate. If.lwweyer.the buidsg or improvement is
sold within one year of completion.the owner-builder wig have the burden of povvV that he or she did not build or improve for the purpose of sale.}
U Las owner of.the properly.am exclusively coftociirV with licensed contractors b construct the project(Sec.7044.Business and Professions Code: The Contractors'
state License Law does not apply to an owner of poperty who builds or improves thereon.and who contracts for the pmpc s with a comtrador(s)licensed pursuant to
the Contractors'State License Law.).
U 1 aim exempt under Sec. B.&P-C.for trs reason
Date Owner
WORKERS'COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the 1o0ov*V declarations:
_1(have and will maintain a certificate of consent b selNruure for workers'compensation,as provided for by Section 3700 of the Labor Code.for the perlomhance
of the work br which this pet..ht Is Issued..
I have and will maintain'�compensaion insurance.as required by section 3700 of the Labor Code.for the performance of the work for in this permit is
Issued. lyh waivers' ea dw and policy number are:
laws
of�Whiich tris mint is issued.l chap nal
Pe empty any person in any rrharrier so as to become arblect b the workers'
Caitork and agree that,if I should become subject b the workers'compensation provisions of Section 3700 of the Labor Code,l shat
brthwth.00mply with those provisions.
WARNING: FAILURE TO SECURE W COMt`ENSATION COVERAGE IS UNLAWFUL.AND SHALL Si OBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100.000).N ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE.INTEREST.AND ATTORNEYS FEES. .
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.Cur.C.).
LendeesNara
Lenders Address
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application IS hereby made to the Director of BWW"V and Safety for 8-Permit subject to the cor tions and restrictions set forth on this appiaafim
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 of this application,the owner.and the applicant,each agrees to.and shat,defend.indemnity and hold hamdess the City of La Cuir t .Its
offcm.agents and employees for any ad or omission related to the wok being perfomhed under or todowing issuance of this permit.
. 2. Any permit Issued as a result of this application becomes null and void If wok is not commenced within 160 days from date of Issuance of such permit,or
cessation of work for 160 days will subject permit b cancellation.
1 certify that I have read this application and state that the above Information is carred. 1 agree to eorply with at 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.
iD a�1 —LG `C \ ig�a nature(Appri ,nt orAgent):*
..
IIIIIIIIIIIIII 22 Page . r of
IIIIIIIIIIIIE DAVE STEAVENS
�F Inspection Services
.PROJECT P& l; ) S"T— PID A PROJECT # cz:.700 q 'j'
ADDRESS CLIENT PCS G S-r H v A.
74; OL:\i �ALtn,4'0 DATE i39A Y c>)vU q
BLDG. PERMIT* Q.`>F Q l - 3 . ARCHITECT C,6 c:,&P�k iq(ZC z j
ENGINEER J 11 M SkUo t r_ Tic CONTRACTOR PAC-, 13
INSPECTION TYPE.
INSPECTION REPORT..
JL
21
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h z-7 A (t._5 -7/5 3, q
CERTIFICATION OF COMPLIANCE:To the best of our knowledge,all of the reported work, unless otherwise noted,
substantially complies.with approved plans, specifications and applicable sections of the building.codes.This report covers
the locations of the work inspected.only and does not constitute engineering opinion or project control.
CERT.NO, 095 L?&e716?'6?" :50 INSPECTOR NAME
(Pr Clearty)
DATE (6a 7 �y F INSPECTOR SIGNATURE