RR (07-1005)53520 Avenida Madero
07-1005
y -"
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 0.7z 00001005'
Property Address:
53520-AVENIDA MADERO
APN:
774-103-026-24 -000000-
Application description:
RE -ROOF
Property Zoning:
COVE RESIDENTIAL
Application valuation:'
6500
Applicant:
Tii!t- 4 4 Q"
Architect or Engineer:
alA
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of thellusiness and Professionals Code, and my License is in full force and effect. '
Licen se 11ass: C3 !t license No.: 604598
Contract
OWNER -BUILDER DECLARATION
I hereby affirm under penalty oflBustVie
t I am exempt from the Contractor's State License Law for the
following reason (Sec. 7031.5, nd 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 70001 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 (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 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.).
(_) 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 _ 1 1 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.).
Lender's Name:
Lender's Address:
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: ' 4/02/07
Owner: ,
SANCHEZ
53520 AVENIDA MADERO
LA QUINTA, CA 92253.
Contractor:
WAYNE ROOFING
P.O. BOX 1155
PALM DESERT, CA 92261
(760)772-2151
Lic. No.: 604598
r
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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 theworkfor which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier STATE FUND Policy Number 000285
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 s uld become subject to the workers' compensation provisions of Section
3700. of the bor ! I shall forthwith comply with those provisions.
.. 1
*e:
pp
WARNING. FAILURE TO SECUR RS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL '
SUBJECT AN EMPLOYER TO CRIMI 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. r
1. Each person upon.whose behalf this application is made, each person at whose request and for
whose benefit work is performed under or pursuant to 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.
I certify that I ave read this application and state lot h above information is correct. I agree to comply with all
city a cunt ordinances and state laws relatin to u' ng construction, and hereby authorize representatives
Wcoyter upon th above-mentione p p for inspection purposes.
'Si ature (Applicant or A e
Application Number
07 -00001005 -
Permit . . . RE -ROOF
Additional desc .
Permit Fee . . . . 30.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
. . .
0
Expiration Date 9/29/07
Qty Unit Charge Per
Extension
BASE
FEE
30.00
Special Notes and Comments
REMOVE & REPLACE EXISTING ROOF
WITH
CLASS A FIBERGLASS COMP SHINGLE
30 YEAR
DIMENSIONAL
" 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
B'° #
City of La Quinta
Building & Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address:
Owner's Name: G 7
A. P. Number:
Address:
Legal Description:
Contractor:
City, ST, Zip: Qu,"IA
Telephone: — G
Address:
Project Description:
City, ST, Zip:
p t'
Telephone:
LLv C
State Lic. # :
City Lic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:)
w ` j;
Emu=,
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
State Lic. #:
Name of Contact Person:
Sq. Ft.:
#Stories:
# Units:
Telephone # of Contact Person:
.
Estimated Value of Project: ,7
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING.
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
''" Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees