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RR (05-1897)77183 Calle Mazatlan 05-1897 P.O. BOX 1504, 78-495 CALLE TAMPICO ' LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: _ Application description: Property Zoning: Application valuation: 05-0000189-7.. -. 7'718 3'—CAI2;E-MAZATLAN 658-230-005- RE-ROOF 58-230-005-RE.-ROOF LOW DENSITY RESIDENTIAL 6505 TWif BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Applicant: Architect or EngineX -VOICE (760) 777-7012 FAX .(760) .777-7011 - INSPECTIONS (76.0).777-7153 Date: 5/19/05- ------------------------------------------------------------------------ • LICENSED CONTRACTOR'S DECLARATION Owner: ------------------------- - WORKER'S COMPENSATION DECLARATION BUIE MARION C 1111 GRANVILLE DR Section 7000) of Division 3 of the ei s and Professionals Code, and my License is in full force and effect. - NEWPORT BEACH, CA 92660 _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided License CI s: B C39 License No.: 23,;,717 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is / /1 ate: _ tf\ Contractor: / /. Contractor: SAY 2 0 2005 WESTERN PACIFIC ROOFING CORP 3462 LA CAMPANA WAY QUIN.T PALM SPRINGS, CA 92262 CITY ®v T. (760)000-0000 F9NA1 CVI)e Lic. No.: 235717 Date: 5/19/05- ------------------------------------------------------------------------ • LICENSED CONTRACTOR'S DECLARATION ------------------------- - WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that,l am licensed under provisions of Chapter (commencing with I hereby affirm under penalty of perjury one of the following declarations: - Section 7000) of Division 3 of the ei s 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 CI s: B C39 License No.: 23,;,717 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is / /1 ate: _ tf\ Contractor: / /. 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 - OWNER -BUILDER DECLARATIONinsurance 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 0457624-2005 ' 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' com ensation provisions of Section License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 00 of the L Code, I sha!allI/ ,?t/hhv%Ahh ccoom/ply with tho ovisions: that he or she is exempt therefrom and the basis for the alleged exemption: Any violation of Section 7031.5 by - J any applicant for a permit subjects the applicant to civil penalty of not more than five hundred dollars ($500).: e: ar Applicant: (_ 1 1, 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 - WARNING: 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, the building or 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.). APPLICANT ACKNOWLEDGEMENT ( 1 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the _ 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of conditions and restrictions set forth on this application. ( - property who builds or, improves thereon, and who contracts for the projects with a contractor(s) licensed 1. Each person upon whose behalf this application is made, each person at whose request and for pursuant to the Contractors' State License Law.). whose benefit work is performed under or pursuant to any permit issued as a result of this application, (_ I I am exempt under Sec. , B.&P.C. for this reason _. 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. Date: Owner: 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 CONSTRUCTION LENDING AGENCY permit to cancellation. _ I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the 'I certify that I have read this application and state that the above information is correct. I agree to comply with all work for which this permit is issued (Sec. 3097, Civ. C.). - city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this upon the abo •mentioned property for ins ioln purpos Lender's Name: - ' - J5.r ature (Applicant or Agent): L'/` - Lender's Address: LQPERMIT Application Number . . . 05-00001897 Permit . . . RE -ROOF ` Additional desc. . Permit Fee 30.00 Plan Check Fee .00 Issue Date . . Valuation 0 Expiration Date 11/15/05 Qty .Unit Charge Per 'Extension. . BASE.:FEE 30.00- Special Notes and Comments RE -ROOF WITH -POLYURETHANE FOAM COATING SYSTEM 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 G. 30.00, P.O. BOX 1504 N Q , Building77'133 Maza •laP# 78-105 CALLE ESTADO AddresLA QUINTA, CALIFORNIA 92253 ` Owner La € uinta vJ3� t Venture. . Mailing �. ^. BUILDING:'TYPECONST` OCC: GRP: Address P. 0. Bos 9$9 A.P. Number Santa Rasa Cove City Zip Tel. TA oninta: 1.. 92253 564-1315 Legal Description Contractor ProjectDescriptionP-2 Ca Address .....,.. _...... _ r .. P. A. BOX 154€4 .. City, Zip Tela 92253 564-65244 State Lic. City & Classif. Lic. # 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 DECLAMATION ! I herebyy affirm'that I am licensid under provisions of Chapter -9 (commencing with Section 7000) of DDivision 3 of the Business ahcl pProfessiionns Code, and my license is.in/fu I folbe°and - effect. I,� `;.�1./l moi,,_ ff _-tel r;�k'e % t T * f // _ SIGNATURE - .Y ' / DATE OWNER;BUILDER DECLARATION' I hereby affirm that I am exempt from the Contractor's License Lawlor the following reason: (Sec. 703 1.5, Business and Professions Code: Any - city or county which requires •"a permit to construct, alter, improve, demolish, or-repair'any structure, prior to its issuance also. requires the applicant for such permit to, file a signed statement than he is licensed pursuant to the provisions of the Contractor's License 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 7031c5 by 'any applicant for a permit subjects the applicant to a civil penalty of not more than rive 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. (Se6.17044, Bussness and Professions Code: The Contractor's License Law does not apply foman owner of property who builds or improves thereon and who does such work'himself.or through his own employees, ,. provided that'such, improvements are not intended or offered for sale. If, .however„the building Estimated Valuation �� 97 PERMIT- - - ' AMOUNT Plan Chk. Dep. 112 - Plan Chk. Bal. 409.42 COr1St.( 50 _ r Mech. +�9 p/� :+ a tJ Electrical - ” �' or improvement is sold within one year of completion, the owner -builder will have.the burden- of proving !hat he did, not build or improve for. the purpose of sale.) . Plumbing MOO ❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- struct•the project. (Sec 7044, Business and Professions 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) licensed pursuant to the Contractor's License Law.) ' O I am exempt under. Sec. B. & P.C. for this reason A S. M.I: was j� Grading Driveway Enc. Date" Owner Infrastructure 2,843 .941 WORKERS' COMPENSATION DECLARATION ' I hereby affirm that I have a certificate of consent.to self -insure; or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. .Company - - ❑ Copy is filed with the city.- ❑ Certified copy is hereby furnished. TOTAL �� 3�S�.S��` lif�'�, .� .. .. REMARKS • CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATIONINSURANCE (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 thg 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. ��• 2 iS��f:td t.7y.f`t1t' a"t'~-:e� "" ;<,,> >:t f • Date Owner NOTICE TO APPLICANT: If, 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 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Side Street'Setback from Center Line Side Setback from Property Line Lender's Name FINAL DATE INSPECTOR - Lender's Address This Is a building permit when properly filled out, signed and validated, and is Subject to ' expiration if work thereunder is suspended for 180 days. 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: Date Permit Validated by: Signature of applicant Date Mailing Address Validation: City, State, Zip HARD COPY CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SQ. FT. ® $ 2ND FL. SO. FT. POR. SQ. FT. ® GAR. SQ. FT. ® CARP. SQ. FT. WALL SO. FT. ® SQ, FT ® ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN URINAL WATER PIPING NOTE: Not to be used as property tax valuation BONDING FLOOR DRAIN MECHANICAL FEES FORMS WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER S (ROUGH) Z GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APPJEOUIP. LAUNDRY TRAY AIR HANDLING UNIT CFM POLE KITCHEN SINK ABSORPTION SYSTEM. B.T.U. TEMP USE PERMIT SVC WATER CLOSET COMPRESSOR HP POLE, TEM/PERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SQ. FT. ® c BATH TUB SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ac HOUSE SEWER REMARKS: VENTILATION GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. S (ROUGH) Z METER LOOP HEATING (FINAL) OTHER APPJEOUIP. REINF. STEEL AL) 122 --%-TEMP. �+ POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ =$ LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING tnn NA INSPECTION 01 CERT. OCC. FENCE FINAL , INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL I Desert Sands Unified School District NOTICE: THIS DOCUMENqEFV6,,WdN OF PAYMENT BE DUPLICATED. OF SCHOOL FACILITY FEES (LAI TO: City of La Quinta DATE: O10n Department of Community Development 78-105 Calle Estado La Quinta, CA 92253 This is toce tfy ithat(�(� .�Uti.�✓ developer of whi is located at its this District, h s p id scho 1 f cili fe s imposed p uant to e authority generate by Go rnment Co eSec 'oft 5 080 'n t ount of $ l � iT .'90 ( lCnj covering a total of square feet of (/Vf,.cksidentiaf or ( ) industrial/commercial development and that builcfing permits for this footage in this development may now be issued by your jurisdiction. Oo�r/DESERT SANDS UNIFIEY SCHOOL DISTRICT White - Building Department • Yellow - Facilities Planning • Pink - Accounting • Gold - Developer (10)-37