RR (08-0726)77621 Los Arboles Dr
08-0726
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
08-00000726
Property Address:
77621 LOS ARBOLES
APN:
658 -260 -019 -
Application description:
RE -ROOF
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
5018
Applicant: Architect or Engineer:
COU3 if _ &-YV
----------------
LICENSED CONTRACTOR'S DECLARATION
,BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 70001 of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
Licens eC.lass: B C39 Licens 235717
Date: / O Contractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjtiry that I am exempt from the Contractor's State License Law for the
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's 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 civil penalty of not more than five hundred dollars ($500).:
(_ 1 I, 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 ISec. 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 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 -builder will have the burden of proving that he or she did not build or
improve for the purpose of sale.).
(_ 1 I, as owner of the property, am exclusively contracting with. licensed contractors to construct the project (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 contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
1 _ I I am exempt under Sec. , BAP.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
I 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, Civ. C.I.
Lender's Name: _
Lender's Address:
LQPERAIIT
Owner:
SANTA ROSA COVE HOA
P.O. BOX 12920
PALM DESERT, CA 92255
(760)564-8864
Fro
VOICE (760)777-7 12
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/01/08
Contractor: J
WEST
3462ELA PACIFIC
CAMPANARWAYING P 4y 0 2nog
PALM SPRINGS, CA 92262 /6 U
(760)416-5877 CFryOF QUI '
Lic. No.: 235717 N'4NCEn _NlA
-----------------------------------------------
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one 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 performance of the work for which this permit is
issued.
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
insurance carrier and policy number are:
Carrier STATE FUND Policy Number 852-0002600
I certify that, in the performance of the work for which this permit is issued, I shall not employ any
person in any manner so as to become subject to the workers' compensation laws of California,
and agree that, if I should become subject to the workers' compensation provisions of Section
S /X8700 of the Labor Code, I shall foromply th a provisions.
Date: 7 QOM Applicant:.
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 ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit 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 work is performed under or pursuantto any permit issued as a result of this application,
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.
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
permit to cancellation.
1 certify that I have read 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 constructions, and here y authorize representatives
of this corty o enter upon the above-mentioned property for ' !Xn, ses.
Date: OI Signature (Applicant or Agent)
Application Number . . . . . 08-00000726
Permit . . . RE -ROOF
Additional desc .
Permit Fee . . . . 30.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
. . .
. 0
Expiration Date 10/28/08
Qty Unit Charge Per
Extension
BASE
FEE
30.00
-------------=--------------------------------------------------------------
Special Notes and Comments
RE -ROOF INSTALLATION OF NEW TILE
UNDERLAYNET.
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
LQPERMIT
77591 Los Arboles Dr
77601 Los Arboles Dr
77611 Los Arboles Dr
77621 Los Arboles Dr
15705
I1 4 Ir
•
Lrb o l ^ P.O. BOX 1504
Building LA pUINTA, CALIFORNIA 92253
Address _77-59!,601,611,01
Owner
Santa Rosa Cova H.O.A.
D1"i6, s9/
No. 15705
Mailing
BUILDING: TYPE CONST. OCC. GRP.
Address 50107 CAlle Oaxaca
A.P. Number
City
Zip
Tel.
La Quinta
92253
Legal Description
Project Description
Install new poly urethane, foam
Contractor
Rr ate►. Universal
roof and coating
over exisisting built u
Address
3462 LA Camp ana
City
- Pali: Springs
Zip
92260
Tel.
320-6022
State Lic.6 } 5 7
& Classif.
City
Lic. # 2243
Sq. Ft.
No. No. Dw.
Size
Stories Units -
Arch., Engr.,
Designer
New ❑ Add ❑
Alter ❑ Repair ❑ 'Demolition ❑
Address
Tel.
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Divlsiori 3 of the Business and Professions Code, and my license is in ffull force and
effect. , ` .1 S , <--
SIGNATURE DATE
OWNEWBUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031,.S,Business and Professions Code: Any city or county which requires a
permit to construct, after, Improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to
the provisions of the Contractor's Lkense Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that. he, 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 civil penally of not more than five hundred dollars ($500).
❑ I, 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. (Sec. 7044, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon and who does., such work himself or through his own employees,
provided that such inprovements are not intended or offered for sale. ff, however, the building
or improvement is sold within one year of comp/elan, the owner -builder will have .the burden
of proving that he did not build or improve for the purpose of sale.) .
Estimated Valuation
$9,798
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
r1
-r • G 0
$10
Mech.
Electrical
Plumbing
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business andProfessions Code: The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) Pcensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B. 8 P.C. for this reason
S.M.1.
Grading
Driveway Enc.
Date owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Workers Compensation Insurance, or a cert)fted'copy thereof. (Sec. 3800, Labor Code.)
Policy No _L-' _ Company ` _
O Copy Is filed with the city. O Certified copy is hereby furnished.
TOTAL
$30.00
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS
(This section need not be completed if the permit Is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of the work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT., d, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
ZONE: BY:
Minimum Setback Distances: ..
Front Setback from Center Line
Rear Setback from Rear Prop. Line
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND.
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
Side Street Setback from Center Line
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
Side Setback from Propprty tine
ATTORNEY'S FEES.
This is a building permit when properly filled out, signed and validated, and is subject to
expiration It work thereunder is suspended for 180 days.
FINAL DATEINSPECTOR
1 certify that I have read 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
construction, and hereby authorize representatives -of this city to enter the above-.
mentioned property for Inspection purposes.
Issued by:
Validated by:
ate Permit
Signature of applicant -Date-
ateMailing Address
Mailing
Validation:
City, State, Zip