05-3180 (RR)P.O. BOX 1504 VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7.153
BUILDING PERMIT
Date: 7/25/05
Application Number: 05-00003.180.. - - - -
Owner:
Property Address: 52540 AVENIDA JUAREZ
KREPELIN EARLE .W
APN: 773-281-003-21 -000000-
Property Zoning: COVE RESIDENTIAL
Application valuation: 9380 D Q
Contractor:
Applicant: Architect or Engineer:J�L .2 5 Z�fl�
PALM DESERT CONTRACTORS
0 79945 TRINIDAD
CITyQF
INDIO, CA 92201
LAQUINTA
FINAobCEp�PT.
(760)346-2420
Lic. No.: 477507
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LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Business and Professionals C Oda° 1. License is in full force and effect.
1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: C39 kens e� 477507
_
- for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
—7.�Zr=�aT�----'.__ -
issued. -
j Dater ( Contractor._ -
_ I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
-'�-
Code, for the performance of the work for which this permit is issued. My workers' compensation
- ' OWNER -BUILDER DECLARATION
insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
Carrier EXEMPT* Policy Number EXEMPT
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to
_ I certify that, in the performance of the work for which this permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
person in any manner so as to become subject to the workers' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's,State
and agree that, if I should become subject to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Codel or
3700 of the Labor Code, I shall forthwith comp! visions. -
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
_
Z
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
Date: .7— Applicant:
(_ 1. 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
_
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the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The
WARNING:. FAILURE TO SECURE WO OMPENSAT IS UNLAWFUL, AND SHALL
Contractors' State License Lawdoesnot apply to an owner of property who builds or improves thereon,
SUBJECT AN EMPLOYER TO CRIMMME PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
one year of completion, the owner -builder will have the burden of proving that he or she did not build or
improve for the -purpose of sale.!.
APPLICANT ACKNOWLEDGEMENT
1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
_
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the '
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
conditions and restrictions set forth on this application.
- property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
1. Each person upon whose behalf this application is made, each person at whose request and for
pursuant to the Contractors' State License Law.).
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
(_ 1 I am exempt under Sec. _ , B.&P.C. for this reason -
'the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City .
of La Quinta, its officers, agents and employees for any act or omission related to the work being
'
performed under or following issuance of this permit.
Date: Owner:
2. Any permit issued as a result of this application becomes null and void if work is not commenced
'
within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject
CONSTRUCTION LENDING AGENCY
permit to cancellation.
_
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the_
I certify that I have read this application and state that the above information is correct. I agree to comply with all
work for which this permit is issued (Sec. 3097, Civ. C.).
.city and county ordinances and state laws relating to building constructio ere4 orize representatives
"
of thisPatupon the above-mentioned property for ' ion purposes.
Lender's Name:--
�Date:-- Signature (Applicant or Agent),i::::::_
Lender's Address:
LQPERMIT
LQPERMIT
Application Number . . . . . 05-00003180
Permit .. . . RE -ROOF
Additional desc .
Permit Fee . . . . 30.00 Plan Check
Fee
.00
Issue Date . . . . Valuation
. . .
. 0
Expiration Date 1/21/06
Qty Unit Charge Per
Extension
BASE FEE
30.00
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Special Notes and Comments..
REMOVE EXISTING ROOFING AND REPLACE
WITH EAGLE LITE LIGHT WEIGHT TILE.CLASS
"A" MATERIALS ONLY
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
0
PALM DESERT CONTRACTORWROOFING
P.O. Box 2795 Palm Desert.
California, 92261 Uc# 477507.
760-346-2420• Fax 760-345-3924
DATE: 4-16-05
PROPOSAL submitted to; WORK to be performed at;
Earle Krep cel 52540 Ave. Juarez L Q
Palm Desert Contractors/Roofing hereby proposes to furnish material and
perform the labor necessary for the completion of;
Total removal of existing roof and re -roof as follows;
TILE: Install 40 Ib base sheet,. Install Eagle light weight concrete tile #412,
install standard metal which includes tile pan, saddle, drip edge, valley metal
and roof to wall. Install ridge and trim as needed, use cement as needed.
Paint all roof jaxs.
FLAT: Install 28 Ib base sheet, install John Manville modified tar commercial
roofing membrane, white. Install standard metal, paint all roof jaxs.
Extras; Permit, plywood @$40.00 per sheet, extra painting, custom sheet
metalwork, vents @$75.00 per vent.
5 Year contractor warranty..
The work will be performed in accordance with the drawings and
specification submitted for the above work and completed in a workman like .
manner for the sum of; $9380.00
With payments as follows: 10% down, Balance upon completion
Respectfully submitted -
ACCEPTANCE OF PROPOSAL
The above price, specification and. conditions are satisfactory and are hereby
accepted. Palm Desert Contractors/Roofing is authorized to do the work as
specified. Payments will be. made as outlined.
Date - 22-(, W , .
Signature
P
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