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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