RR (08-1759)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
c&t�t °F 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: 08-00001759 Owner:
Property Address: 51675 AVENIDA NAVARRO BOB FAY
APN: 773-144-021-9 -000000- 51680 AVENIDA
Application description: RE -ROOF LA QUINTA, CA
Property Zoning: COVE RESIDENTIAL
Application valuation: 7800
Contractor:
Applicant: Architect or Engineer: BUSKIRK ROOFIN
PO BOX 141
YUCCA VALLEY,
(760)365-4720
\I Lic. No.: 6737
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 the Business and Professionals Code, and my License is in full force and effect.
License Class: C39 LicenseNo.: 673783
Date: ontract
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that 1 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 0500).:
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 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:
Lender's Address:
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/23/08
NAVARRO
92253
G ) - & 0 0
C 2 86 OCT 2 3 2008
&—
83
CITY OF LA QUINTA
FINANCE DEPT.
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 7130017089
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 should become subject to the workers' compensation provisions of Section
3700 of Pe Labor de, I shall forthwith comply with those provisions.
Date: /b^23 -O$ pplicant:
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 ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. '
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
conditions and restrictions set forth on this application.
1 . Each person upon whose behalf this application is made, each person at whose request and for
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La Quinta, its officers, agents and employees for any act or omission related to the work being
performed under or following issuance of this permit.
2. Any permit issued as a result of this application becomes null and void if work is not commenced
within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the above information is correct. I agree to comply with all
city ��and county ordinances and state laws relating to building construction, and hereby authorize representatives
0Ltnis county to enter upon the above-mentionedrty for inspection purposes.
Date: - —o$ ignature (Applicant or Agent
Application Number . . . . . 08-00001759
Permit RE -ROOF
Additional desc .
Permit Fee . . . . 30.00 Plan Check Fee
.00
Issue Date . . . . Valuation
0
Expiration Date 4/21/09
Qty Unit Charge Per
Extension
BASE FEE'
30.00
----------------------------------------------------------------------------
Special Notes and Comments
TEAR OFF AND RE -ROOF WITH FLAT DECK WITH
APP MODIFIED CAPSHEET REROOF.PITCHED
WITH OWENS CORNING COMP.
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 Quints
Building & Safety Dlvislon
P.O. Box 1504, 78-495 Calle Tampico
La Qulnta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
permit #
Project Address: 51675 AVENIDA NAVARRO
Owner's Name: BOB FAY
A. P. Number. 773-144-021
Address: 51680 AVENIDA NAVARRO
Legal Description:
City, ST, Zip: LA QUINTA, CA. 92253
Contractor. BUSKIRK ROOFING
raw:
Telephone: ::y;.<;::c:;:N::E':>":"s;
Address: PO. BOX 141
Project Description: REROOF
City, ST, Zip: YUCCA VALLEY, CA. 92284
TEAR OFF
Telephone: 760 365-4720
P
2-2
REROOF FLAT DECK WITH APP MODIFIED CAPSHEET
State Lie. # : 673793 City Lie. #:
Arch., Engr., Designer.
REROOF•.PITCHEDblITH OWENS CORNING COMP
Address:
City, ST, Zip:
N.Tele hone: N.
p �.,:�.�• aw:::
State Lie.w,ss,•-,;;� �;;;:¢€;,:,'„;.
Name of Contact Person: LONNIE BUSKIRK
Construction Type: Occupancy:
Project type (circle one): New Add, n Alter Repair Demo
Sq. Ft.: # Stories: 9 Units:
Telephone # of Contact Person: 760 220-4913
Estimated Value of Project: $7800
APPLICANT: DO NOT WRITE BELOW THIS LINE
q
Submittal
Req'd
Rec'd
TRACMG
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Pian Check Balance,
Title 24 Calca.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2'! Review, ready for corrections/issue
Electrical
Subcontaetor List
Called Contact Pcrson
Plumbing
Grant Deed
Plans picked up
S.M.L
H.O.A. Approval
Plans resubmitted
Grading
IN 110USE:-
''' Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.T.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees