RR (07-0170)50201 Calle Maria
07-0170
:U BOX 1504
78-495 CAL•LE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
07-00000170 1
Property Address:
56201 CALLE MARIA
APN:
773=340-013-13 -14496
Application description:
RE -ROOF
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
3640 4
Applicant:
T44f 4 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Architect or Engineer:
Owner:
SETTLES KEITH_A
6542 CRISTA PALMA
HUNTINGTON BEACH, CA 9264
Contractor:
WESTERN PACIFIC ROOFING
3462 LA CAMPANA WAY
-ALM SPRINGS, CA 92262
(760)416-5877
Lic. No.: 235717
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date:' 1/18/07
JAN 29100) ID
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 70001 of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
_ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: B C39 License No.: 235717
for by Section 3700 of the Labor Code, for the performance of the work for which this pei mitis
ate: Zi ontra_ctor: 4JeSTe/w tif.c i%.
issued.
IV- 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:
hereby affirm under penalty of perjury that I am -exempt from the Contractor's State License Law for the
Carrier STATE FUND Policy Number . 046001635506
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 Code) or
3700 of the Labor Code, all rthwith those provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
7/hpI7
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
Date:/LI cant: '7//` / • _
( 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
00,
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The
WARNI(: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
SUBJECT AN EMPLOYER TO CRIMINAL 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, thebuildingor 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.).
1 _ 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
propertywhobuilds or improves thereon, and who contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
( ) I am exempt under Sec. , B.&P.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: yA
Lender's Address::
LQPER,MIT
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 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 have read this application and state that the above information is correct. I agree to comply with all
city nd county ordinances and state laws relating to building construction, and hereby authorize representatives
this oun upon eabove- mentioned property in ect' n purp es
Date: ) gnature (Applicant or Agent): /(//
LQPERMIT
Application Number . . . . . 07-00000170
Permit RE -ROOF
Additional desc .
Permit Fee . . . . 30.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
0
Expiration Date 7/17./07
Qty Unit Charge ,Per
Extension
BASE FEE
30.00
--------------------------------------------
Special Notes and Comments
REMOVE EXISTING TILES & INSTALL NEW
UNDERLAYMENT. REPLACE ORIGINAL TILES
Fee summary Charged Paid
- -------- - - - - - -
Credited
Due,
- ----- - - - - ------ - - -
Permit Fee Total 30.C)
- ------ - - -
.00
- -----
.00
- - - - - - -
30.00
Plan Check Total .00'
.00
.00
.00
Grand Total 30.00
.00
.00
30.00
LQPERMIT