RR (05-5351)4.4 Q"
P.O. BOX 1504 VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 12/08/05
Application Number: CO'5=00005351 Owner:
Property, Address: 51431 AVENIDA NAVARRO MR. BERG
APN: 773-103-011-5 000000 51431 AVENIDA NAVARRO'
Application description:, RE-ROOF LA QUINTA; CA 92253
Property Zoning: COVE RESIDENTIAL -
Application valuation: 8000
Contractor: rFp"CE
Applicant: Architect or Engineer: LEHMAN ROOFING, INC. 0 200512 WATER LILY WAY
COTO DE CAZA, CA 92679
(949)888-1665 LJ'QU1104Lic. No:: 499608 DEPT
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed u er provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Business nd Profession s 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: C3 9 Lic rise No.: 4 9960 8 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
Date: _, ' �Co�ua.or:_% _ 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:
I hereby affirm under penalty of perjur that I am exempt from the Contractor's State License Law for the Carrier STATE FUND Policy Number 0000154-2005
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 the4subje
hich 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 becoo 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 d agree that, if I sho become sworkers' compensation provisions-of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of [he Business and Professions Codel or 7'of the Labor Co I shall fo with those provisions.
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 IS5001: Applica� nt�_
(_ 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 WARNING: AILURE TO SECURE WORKERS' COMP NSATION 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 I, 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 contractors) 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
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
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.
certify that I have read this application and state that the above information ' correct. I agree to comply with all
city and county o//,rr�riifinances and state laws relating to buil
"rig constructi6n d hereby authorize representatives
of this counjyto,agtej upon the above-mentioned proper for insac rpoE2s. —
Application Number . . 05-00005351
Permit RE -ROOF
Additional desc .
'Permit Fee . . . . 30.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
0
- Expiration.Date 6/06/06
Qty Unit.Charge Per
Extension
BASE FEE
30.00
----------------------------------------------------------------------------
.Special Notes and Comments
REROOF: TEAR -OFF EXISTING, SHEET WITH
1/2" PLYWOOD OSB/30#FELT/COMP
SHINGLES -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 #
City -of La Quinta
Building u Safety Division
P.O. Box ,1'504, 78-495 Calle Tampico .
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit # �tj1
\
Project Address: "—1 -1 3 AA VE'
• VA rf A' R Q
Owner's Name: j/'
Address:
City, ST, Zip:
A. P. Number:
Legal Description:
Contractor: vv(a. A./ �(f 10
Telephone:
Address: 'Z (/�/ L i L- (�v
City, ST, Zip: &4-1 �� l ✓� �- %/1
Project Description:
..v Vz- ' f - ✓L Po I V, 93
State Lie. #: �p �j/ O C City Lie. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
Construction Type: Occupancy: C�
State Lie. #:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: (, L
Sq. Ft.:
#Stories:
#Units:
Telephone # of Contact Person - jt -1 t. f7. Z ZZ Jf
Estimated Value of Project:
APPLICANT: -DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
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.
II.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