RR (05-5490)51453 Avenida Martinez
05-5490
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Applicant:
Td!t 4 4 Q"
Architect or -Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012.
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 12/19/05
Owner:
MACON DOUG
51453 AVENIDA MARTINEZ
LA QUINTA, CA 92253
actor:
ONELLA ROOFING COMPANY
DEC 19 2805AAT
4 KIELEY ROAD
EDRAL-CITY, CA 92234CITY OFtJ ►QUINTA)324-5482
.. nCDT No.: 460707
--------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed and provisio of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Professionals ode, any/''y License is in full force and effect.
License Class: C39 ^ ^_ L' en e NoJ► 460707
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury 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).:
(_) 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 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.).
Lender's Name:
Lender's Address:
LQPERMIT
--------------- - - -
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 1801579
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 sub'ect to th orkers' compensation laws of California,
and agree that, if I should become subje,o thers' compensation provisions of Section
3700 of the Labor Code,J shall forthwit ympl wi those provisions.
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 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 and county ordinances and state laws relating to building construction, and here u orize representatives
of this county to enter upon the above-mentioned property/or in9oectI2apurpys
Application Number:
05-00005490
C,rp
Property Address:
5'14T3_AVENIDA=MAR-T-INEZ
APN:
773-092-009-4 -000000-
Application description:
RE -ROOF
ji
Property Zoning:
COVE RESIDENTIAL
Application valuation:
7230
4b
Applicant:
Td!t 4 4 Q"
Architect or -Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012.
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 12/19/05
Owner:
MACON DOUG
51453 AVENIDA MARTINEZ
LA QUINTA, CA 92253
actor:
ONELLA ROOFING COMPANY
DEC 19 2805AAT
4 KIELEY ROAD
EDRAL-CITY, CA 92234CITY OFtJ ►QUINTA)324-5482
.. nCDT No.: 460707
--------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed and provisio of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Professionals ode, any/''y License is in full force and effect.
License Class: C39 ^ ^_ L' en e NoJ► 460707
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury 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).:
(_) 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 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.).
Lender's Name:
Lender's Address:
LQPERMIT
--------------- - - -
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 1801579
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 sub'ect to th orkers' compensation laws of California,
and agree that, if I should become subje,o thers' compensation provisions of Section
3700 of the Labor Code,J shall forthwit ympl wi those provisions.
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 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 and county ordinances and state laws relating to building construction, and here u orize representatives
of this county to enter upon the above-mentioned property/or in9oectI2apurpys
Application Number . . . 05-00005490
Permit RE -ROOF
Additional desc .
Permit Fee 30.00
Plan Check
Fee
.00
Issue Date. . . . .
Valuation
. . .
. 0
Expiration Date .6/17/06
;7
Qty Unit Charge Per
Extension
BASE
FEE
30.00
y----------------------------------------------------------------------------
Special Notes and Comments
REMOVE EXISTING ROOFING/ REROOF WITH
TAR & GRAVEL(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
LQPERMIT
Bin #
'Permit-# / -
5 7
Project Address: s 3
A. P. Number:
Legal Description:
Contractor: (
Address: V49 !
City. ST, Zip: C
Telephone: X .
.State Lic. # : X.
Arch., Engr.. Designer:
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person:
Telephone # of Contact Person: YC
# Submittal Req'd
Plan Sets
Structural Calcs.
Truss Calcs.
Title 24 Calcs.
Flood plain plan
Grading plan
Subcontactor List
Grant Deed
H.O.A. Approval
IN HOUSE: -
Planning Approval
Pub. Wks. Appr
School Fees
City Of La Quinra
Building 8c Safety Division .
- --- -- - — - — P:O.-Box 1504; 78=495 -Calle Tampico ---- -- - -- - ----
La Quinta, CA 92253 - (760) 777-7012
Building Permit. Application and Tracking Sheet
I&rl z—. Owner's Name:
Address: X Z
City. ST, Zip: K
C Telephone:
Project Description: X Z_ A
V
Lic. #: .
Total Permit Fees
Construction Type:
Y P:
Oc c u P anc%••
'.
Pr '
0 e ct
e (circle J np ( cle one):
New Add' n Alter Repair Demo
Sq. Ft.:
# Stories:
# Units:
Estimated Value of Project: X Z O
APPLICANT: DO NOT WRITE BELOW THIS LINE
TRACKING
PERMIT FEES
Plan Check submitted
Item
Amount
Reviewed, ready for corrections
Plan Check Deposit
Called Contact Person
Plan Check Balance
Plans picked up
Construction
Plans resubmitted
Mechanical
tad Review, ready for correctionslissue
Electrical
Called Contact Person
Plumbing
Plans picked up
S.M.I.
Plans resubmitted
Grading
'rd Review, ready for corrections/issue
Developer Impact Fee
Called Contact Person
A.I P P
Date.of permit issue
Total Permit Fees
Corporate Office.:. Desert Office:
2626 Newport Blvd. 68.314 •Kieley Road
Costa Mesa, (_;A 92627 Cathedral:City, CA 92234
949.548.16,' 5 / Fax: 949.548-2617 License 11460707 760.324.5482 / Fax: 760.328.4612
PE:TRONt I LA ROOFING hrn•Intllier t n1kt:(I --l_ttntridor' and:or •Seller' acre . to rnteHlr Ihr lollultinp luted Intra nr.,lltrnt l )inti eomatio ttn
NAME/OWNER DOUG MIACON ^_ ONE NO: (50).520-1035
REROOFPROJECT'ADDRESS 51453 AVENIDA MARTINEZ
CITY, STATE & ZIP CODE LA QUINTA, C.A.. 92253
BILLING ADDRESS:
CITY, STATIC', .4t ZIP CODE!
ADDITIONAL PHONE NUMBER:
UENUR11 1 1()N ()It' LA110H MA'FE RIALS ANA) MISC'.-
Petrunella Roofing will furnish all -labor and Materia) to install
OPTION #2
CNS -3 SPECIFICATION
FAX NUMBER: (509) 529-5606
Petronella Roofing will issue a 10 Year "Weathershield" Warranty
C,US'r...................•...................................................$7,230.00
* Covering opcnings where swamp coolers are included in the price.
SI'd C`IAL INSTRUCTIONS: CONTRAd rums.,i
1. Replace da maned plywood at $2.50 per 5.F., as required by city inspector.,,
2. .Any electrical or plumbing work will be hilted at $75.00 per- nia ll per holln 10% Upon award of contract
3, 1'1& -irate and install bonderized metal cla(lding forcutire fascial at X975.00. +40">/S-iFpop Progress
4. lust.all approximately 50" of bisria at'S 325.011, 50% Upon Completion
5. There might he more ftsci:a.to be replaced.
114If lt'1R' I; Rlltatr;'1WOlt)htl'lL.IINCaVk(llh('I Wort; 511.111 tc,Huutnr_c NIt1Un Itt1 (10) dA)x lions thr dine ul xvlc tlrlttil' PtL1(iat n111Clv,r::c
Ind hc'xuh;:ranti dls WRII)Il'ILd al epproxi na)t•rt KII ( I0..) %korktiui dui=: Nitll Adddiau.d hrnt ht be ai &Litilttl in 114rlLlupll q o1 Ili(term: ulndWtal:: amtlNituec 111 01111:1 Un Iltt bink hertul Suhx6mtinl t',tmmun.tulanl ul work :;hall b( Jclined a: -.-IN: inSRtllalum of :m) ntlttlrcll; aud.'nr Inhnr
L t:111r,i4lor; I':Hrur, 10 .;Ilhi; F•lhlllllly L0111AWlIll Murk wt(Ilou1 lHNfill cY , lli(. ,aldllll tNtUl\. t2ll) +I;I% ff.:11 Ilse dale-;Paalllld. lbove• Ix :I v11-01•1tiull U( the C 0110ki.1ur•'
tit 111(1 T'. ) lstJ I k I 00 1101 4Tlli.i ai__Tlllllellt be'furr )oti rt?I(I It (2) 1'Uu alc ellillIt'u ln.;t COIIII)ICIel% filled Ill kq)) tit II11Rtlta llCllllld 11) O\t nC;t
Anlhnrvcu I(y rpon;lbk party alknoNlvder.= thnl It ' :;hc ha; read and tc rlvcd a Ic rhlt eupy of the the•::tcrecult.nl sruncd ht d trltl11lI(-W.Hn htdnl . 111 Itnnx.
( oildiUt;n. -mid to ( )w'ntr on II1C frvll'3t Adc. Mott all) Nwrk lt'11x Ooiiv rind Ilia( lie ---he h:l; rn1(I rnd t'etelved N legible ktlp) of ey(.ry 4y thnc.ul Ih'It l hvn;.t
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ONn/t•r Nrepnn.xihtt 11.I11-tt: 4tttuulme I'e irrdI Mingurbott[ed hell x• :I t(yr •ti;(tartture
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TH
RE.RUD,1. r.1NCSTECIALISTS
INC.11
Corporate Office.:. Desert Office:
2626 Newport Blvd. 68.314 •Kieley Road
Costa Mesa, (_;A 92627 Cathedral:City, CA 92234
949.548.16,' 5 / Fax: 949.548-2617 License 11460707 760.324.5482 / Fax: 760.328.4612
PE:TRONt I LA ROOFING hrn•Intllier t n1kt:(I --l_ttntridor' and:or •Seller' acre . to rnteHlr Ihr lollultinp luted Intra nr.,lltrnt l )inti eomatio ttn
NAME/OWNER DOUG MIACON ^_ ONE NO: (50).520-1035
REROOFPROJECT'ADDRESS 51453 AVENIDA MARTINEZ
CITY, STATE & ZIP CODE LA QUINTA, C.A.. 92253
BILLING ADDRESS:
CITY, STATIC', .4t ZIP CODE!
ADDITIONAL PHONE NUMBER:
UENUR11 1 1()N ()It' LA110H MA'FE RIALS ANA) MISC'.-
Petrunella Roofing will furnish all -labor and Materia) to install
OPTION #2
CNS -3 SPECIFICATION
FAX NUMBER: (509) 529-5606
Petronella Roofing will issue a 10 Year "Weathershield" Warranty
C,US'r...................•...................................................$7,230.00
* Covering opcnings where swamp coolers are included in the price.
SI'd C`IAL INSTRUCTIONS: CONTRAd rums.,i
1. Replace da maned plywood at $2.50 per 5.F., as required by city inspector.,,
2. .Any electrical or plumbing work will be hilted at $75.00 per- nia ll per holln 10% Upon award of contract
3, 1'1& -irate and install bonderized metal cla(lding forcutire fascial at X975.00. +40">/S-iFpop Progress
4. lust.all approximately 50" of bisria at'S 325.011, 50% Upon Completion
5. There might he more ftsci:a.to be replaced.
114If lt'1R' I; Rlltatr;'1WOlt)htl'lL.IINCaVk(llh('I Wort; 511.111 tc,Huutnr_c NIt1Un Itt1 (10) dA)x lions thr dine ul xvlc tlrlttil' PtL1(iat n111Clv,r::c
Ind hc'xuh;:ranti dls WRII)Il'ILd al epproxi na)t•rt KII ( I0..) %korktiui dui=: Nitll Adddiau.d hrnt ht be ai &Litilttl in 114rlLlupll q o1 Ili(term: ulndWtal:: amtlNituec 111 01111:1 Un Iltt bink hertul Suhx6mtinl t',tmmun.tulanl ul work :;hall b( Jclined a: -.-IN: inSRtllalum of :m) ntlttlrcll; aud.'nr Inhnr
L t:111r,i4lor; I':Hrur, 10 .;Ilhi; F•lhlllllly L0111AWlIll Murk wt(Ilou1 lHNfill cY , lli(. ,aldllll tNtUl\. t2ll) +I;I% ff.:11 Ilse dale-;Paalllld. lbove• Ix :I v11-01•1tiull U( the C 0110ki.1ur•'
tit 111(1 T'. ) lstJ I k I 00 1101 4Tlli.i ai__Tlllllellt be'furr )oti rt?I(I It (2) 1'Uu alc ellillIt'u ln.;t COIIII)ICIel% filled Ill kq)) tit II11Rtlta llCllllld 11) O\t nC;t
Anlhnrvcu I(y rpon;lbk party alknoNlvder.= thnl It ' :;hc ha; read and tc rlvcd a Ic rhlt eupy of the the•::tcrecult.nl sruncd ht d trltl11lI(-W.Hn htdnl . 111 Itnnx.
( oildiUt;n. -mid to ( )w'ntr on II1C frvll'3t Adc. Mott all) Nwrk lt'11x Ooiiv rind Ilia( lie ---he h:l; rn1(I rnd t'etelved N legible ktlp) of ey(.ry 4y thnc.ul Ih'It l hvn;.t
AHrhnnicd kr::ptm:Ibl( parr, hal aemd durink: tilt ne; oltltron.; (:J) Yl )(J. 1I11 H115FR wIAY I. AN( I I IH1S TRAMA( 1'ION :AT 1N1 IIMF 111(101( t'(t
M11111";ltilll'•1f Till THIRD 11U)INI iS l)AY AE IM ME DATl OI min II( 1NSAC nON l(9 NUI IEYINi,_TI11=.•S ):FI I FR-iN UvkLF4AKrI+.,*i } +1--..---
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"'1 ill 1111`t 1 0NIRA( I1 A0 O kNU( ()R II N.AN') HAVI 1'1lr RI(1111 11) RI.OUIRL' TIIL ( ()NIR AC1T(')It TO IIAb► AP 'RIOM. Nr('I 1Tvf)
rr+.lnal!:1 Hil :I)(1R•i•Ii"A)D4,(AIN1Rt)t
()11NTR! T(E.SYUN•y1E1L•I1: ['.41(11 C(.)iV7.RACTO R (SEL.UR) CON It.4(7 PRICE.
_ _'1•likr. Scheid
/NII("r: r hU11 A'IIIIC• Party_ Ntrnt Namr 1'r•trnnoll;1 --•--- ""•— 't
.oufin Autl La present• Ivc- Print N,trne
ONn/t•r Nrepnn.xihtt 11.I11-tt: 4tttuulme I'e irrdI Mingurbott[ed hell x• :I t(yr •ti;(tartture
(• G .tlb.. .... ........\Ih-t mill
--
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