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04-3633 (RR)79731 Arnold Palmer IIIIIII VIII III VIII IIII 75 IE C p V BUILDING &:SAFETY DEPARTMENT P.O. Box 1504 (760) 777-7012 OF 78-495 CALLS TAMPICO FAX (760) 7'77-7011 LA .QMINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760).777-7153- BUILDING PERMIT Application Number . . . . . .1 1, 04-00003633 Date 4/21/04 Property Address 797.31 ARNOLD PALMER APN: 775-241-037- - - Applic.ation description . . RE-ROOF Property Zoning. .. LOW DENSITY RESIDENTIAL Application valuation 3500 Owner Contractor MOORE RUSSELL L EMERALD .ROOFING INC 111-W. SAINT JOHN ST # 1100 P.O. BOX 1963 .....AN JOSE ,.. CA 951:1-3.' . PALM.,DESERT CA 9226.1 WCC:.. STOVE 'INS WC: 639/0804 01./01/05 'CS-LB: 7709.40 .. . 11/30/05 CCC:. C39 Permit RE-ROOF -Additional desc . Permit Fee . . . 30 . 00 Plan Check Fee . 00 Issue Date Valuation 0 Expiration .Date 10/21/04 Qty Unit Charge Per Extension BASE FEE 30 . 00 Special Notes and.:Commei-nts. RE=ROOF WITH POLYFOAM Fee summary Charged Paid Credited Due ..Permit .Fee Total' . 30 . 00 . 00 : -.00'.. 30 ..00• Plan Check Total . 00 . 00 . 00 . 00 Grand Total . 30.. 00.. . ..00 . 00 30 . 00 P.O. BOX 1504 a QUW4 VOICE (760) 777-7012 78-495 CALLS TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 44 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: 0!q 5(0.33 Date: Applicant: Architect or Engineer. Applicant's Mailing Address: Architect or Engineer's Address: LIV- Uc.No. BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9(commencing with Sectioni 7000)of Division 3 of the Business and Professionals Code,and my is in full force and effect / ^se Gass "' 3 No. Z O 0 ate-Qt.^Z6-0�"actor L_ OWNI R$URMER DECLARATION hereby affirm under penalty of perjury that I am exempt from the contractors'State License Law for the following reason(Sea 703.1.5.Business and Professions Code: Any city or county that mgttres a permit b construct•alter.improve.demofish•or repair any structure.prior to its issuance.also requires the applicant for the permit b fie a signed statement that he or the is licensed pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a cavi penalty of rat more than five hundred dollars(5500).): U1.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(sea 7044. Business and Professions Code: The Contractors'State License Law does not apply b an owner of property who builds or improves thhemon,and who does the hvork himself or herself or through his or her own employees,provided that the improvements are not intended or offered for sale. If,however,the building or improvement is sold within one year of completion,the owner-biuider wig have the burden of proving that he or she did not build or improve for the purpose of sale.). mU I.as owner of the properly,am eXCIWAeely contracting with licensed contractors b construct the project(Sea 7044,Business and Professions Code: The Contractors' State License Law does not appy to an owner of property who builds or improves tnereom•end who contracts for the projects with a contractor(s)licensed pursuant to the Contractors•State License Law.). U I am exempt under Sec. 8.3 P.C.for this reason Date' Owner 1 hereby affirm under WORKERS'COMPENSATION DECLARATION Y penalty of Perjury ache of the following 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 perfomhance of the work for which this permit is issued. I have and will maintain workers'comperhsation insurance,as required by Section 3700 of the Labor Code.for the performance of the work for which this peril is my workers.' sationou�oe carrier and policy number are: -rC y /Pbrwv Number _1 certify riot,in the pedomhatmce of the work for which this permit is issued.I shag not empty any person in any manner so its to become subject b the workers' cortpenmsafm taws of Caifomia,and agree that,t I should become subject b the workers'compensation provisions of Section 3700 of the Labor Code.l shag fortrwith.comply with those provisions. ,_Date� �uo WARNING: FAILURE TO SECURE WORKERS-COMPENSATION COVERAGE IS UNLAWFUL,AND SMALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP 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 ATTORNEYS FEES. . CONSTRUCTION LENDING AGENCY hereby affirm under penally of perjury that there is a construction lending agency for the performance of the work for which this pertt is issued(Sec.3097.Civ.C.). Lender's Name Lenders Address IMPORTANT Application is her APPLICANT ACKNOWLEDGEMENT hereby made to the Director of Building and Safety for a.pemhit 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 and for whose benefit wok is performed under or pursuant to any permit Issued as a result of iris application,the owner,and the applicant,each agrees to.and shag•defend,indemnify and hold harmless the City of Le Outnta.Its officers.agents and employees for any act or Omission related to the work being performed under or following issuance of this pemrdt 2- Any permit issued as a result of this application becomes null and void It work is not commenced within 180 days from date of issuance of such permit,or certify cessation of work for 180 days will subject permit to cancellation. Iconskuctat I end haveread 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 by representatives of this county to enter upon the above4nentioned property for Inspection purposes. mate 1 � �S gt'nature(Applicant or Agent)