04-3634 (RR)79723 Arnold Palmer
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BUILDING &.SAFETY DEPARTMENT
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P.O.-BOX 1504 (7.60) 777=7012
OFT9 78-495 CALLE TAMPICo FAX (7 60) 777-7011
LA .Q.'UINTA, CAiiFORN.IA'92253INSPECTION REQUESTS (760).777-7153
BUILDING PERMIT
Application .Number 04-00003634 Date 4/21/04
Property Address 79723 ARNOLD PALMER
APN: 775-2417-038'- -
Application description RE-ROOF
Property Zoning. .. :.LOW DENSITY RESIDENTIAL
Application valuation .. . 3500
:Owner Contractor
CRANK TRUST EMERALD ROOFING INC
79723 ARNOLD 'PALMER P.O. BOX 1963
LA `QUINTA : CA 9225.3 PALM DESERT .. :` CA '92.2..61' .
WCC.:. STOVE INS
WC: 63910904 . .: 01/01/05
: /3 0
`CS.LB: . ' 77Q9.40` 11' 0/ 5
CC.C: . :.. ..: :.C3.9
Permit RE-ROOF '
.Additiorial :desc
Permit Fee . . . 30 . 00Plan Check Fee- . . .. . 00
Issue Date Valuation 0
Expiration Date 10/21/04
Qty Unit Charge Per "Extension
BASE. FEE . 30 . 00
Special .Notes and, Comments
RE-ROOF .WITH POLYFOAM
Fee summary Charged Paid Credited Due
Permit .Fed Total 30 : 00 00 . : : 00,. .30- 0,0 .
Plan Check Total . 00 . 00 . 00 : 00
Grand Total 30'. 00 . 00 . 00 30 . 00
tIG� Ct/
P.O. Box 1504 4. VOICE (760)777-7012
78-495 CALLS TAMPICOFAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253' '- '''.. INSPECTIONS'(760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number. Q G(- , �, Date:
Applicant: Architect or Engineer.
Applicant's Wiling Address: Architect or Engineer's Address:
Uc.No.
BUILDING PERMIT DECLARATIONS .
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm under penalty of Pe*"that I am licensed under provisions of Cl plea 9(commencing wtth section 7000)of Division 3 of rie Business and Prolessia+als
and my License 1
3
9n force end eliect
Class e—
cohaactor � / —�
OV W43U1LDER DECLARATION
I hereby titan 4rrder penalty d perjury riot I am exempt from the Contractors•Stale License Law for the following reason(Sec.7031.6.Business and Professions Code: Any
�y orcounty that�a Permit loconsbuct,alter.improve.demolish.or repair any stucture.Prior to its issuance.also requires bre applicant for ria permit io fie a siprad
city
riot he or she b tioased pursuant b rie Provisions d the Contraclors'State Uoerse Law(Chapter 9(commencing ening with Section 7000)of Division 3 of the Business
and Professions Code)or riot he orshe is exempt rierefrdm and the basis tom the alteped exemption. Arty violation d Section 7031.6 by any ap,k P t fora permit subjects
ria applicant too dvl penally d not more than Eve hundred dollars($500)_):
U 1,as owner.of to property,or my employees with waves as their sole oortmpersa6on we
do ria work snd the structure is not Wended or ofteved for sale(Sec.7044.
Business srd Prolessios Code: The Contractofs'Stale License Law does not apply to an owner of property who builds or impro4et thereon.and who does the work
himself or herself or though his or her own employees,provided riot the improvements are not intended or offered for sate. If,however,the buidrmg or improvement is
sold w(thin one year of completion,the owAer4Ader will have rie burden of proving that he or she did not build or improve for the purpose of sale.)_
U L as owner Of the property.am exclusively contracting with licensed contractors to construct the Project(Sec.7044.Business and Professions Code: The Contractors'
state Lloerse Law does not apply to an owner of property who builds or improves theieom,and who contracts for the projects with a contractor(s)licensed pursuant to
the Contractors'State License Law.).
U 1 air exempt under Sec. a.&P-C.for riffs reason
Date` Owner .
affirm under WARS'COMPENSATION DECLARATION
1 hereby a
Penalty d perjury one d the bMowing dectazatiors:
_I t►ave and will rmmatraaih a certificate of consent to sop-iswars for woAcers•corpersa6on,as provided for by Section 3700 of the Labor Code.for the performance
d tie wok for which this pemnit is issued.
I have and will maintain p compensation kmxance.as required by Section 3700 d the Labor Code.for the performance of the work for which this peril is
issued. Mx kvorkers'C it sabormk4orance racier and Policy number are:
1500,Number
1 oertdy th hue pecfommarwce d tine wok for which this Permit is Issued.I shall not employ any person in any manner to as to become subject to rie workers•
compensation laws of Cafitomia.and agree that.91 sh0M become subject to Mme wnrkers'compensation provisions of Section 3700 of the Labor Code.l snap
forthwith.comply with those provisions.
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 ADOPTION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE.MEREST.AND ATTORNEYS FEES. .
CONSTRUCTION LENDING AGENCY
1 hereby affirm order penally of perjury out Hero is a cormmstruudiorh Tending agency for the Pedormmmanee d the wok for which this pemdt is issued(Sec.W97.Civ.C.).
Lenders Name
Lender's Address
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application Is hereby made to the Director d Sutkfing and Safety for a perNt 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 end for whose benefit wok Is performed under or pursuant to any permit
issued as a result of this eppkeSM the owner.and the applicant,each agrees Io.and shall,defend.Indemnify and hold harmless the City of Lo Quinta,its
Officers.agents and employees for any ad of 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 wok is not commenced within 160 days from date of Issuance of such permit,or
cessation Of work for 160 days will subject permit 10 rancellaGon.
1 •have end read this application and state that the above information is cored. I agree to comply with all city and county ordhmnods and state laws relating to building
corntructic' hereby
igna
y auttnriin representatives d this county to enter upon the above-mentioned property for inspection purposes.
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0T /Sture(Applicant or
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DAVE STEAVENS _ _-----�
Inspection services IIIIIIIIIIIIIIIIIIIIIIIII 63
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INSPECTION TYPE
INSPECTION REPORT
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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.' S U INSPECTOR NAME a f��G S-t" Jam' 0S
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DATE c Q 14144't\ 41 "`POO-3 INSPECTOR SIGNATURE%2)�2�
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Inspection Services
PROJECT PROJECT #
ADDRESS `74 - 7 a 3 '} '?It CLIENT ��A w t-5T- Hy �
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BLDG. PERMIT # ARCHITECT ( ,OC 43A ArzC-0
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INSPECTION TYPE
INSPECTION REPORT
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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. C3��� �, `� !�~ '�U INSPECTOR NAME � )Ali1 J��d��J ► )�..
(Pri`jClearly)
DATE .� '0'A Y 7'c� INSPECTOR SIGNATURE _�.T.7,� (\7"., ,.s