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09-0001 (RR)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 T4ht 4 4 Q" BUILDING & SAFETY DEPARTMENT BUILDING PERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 1/05/09 Application Number: 09-00000001 Owner: Property Address: 53600 AVENIDA CARRANZA LIZ CARTER APN: 774-121-006-19 -000000- Property Zoning: COVE RESIDENTIAL Application valuation: 4840' Contractor: D 0 Applicant: Architect or Engineer: 4 STAR ROOFING INC 30775 AVENIDA DEL YERM �� ®� CATHEDRAL CITY, CA 922 (760)770-4535 LiC. No.: 826947 cIryOFLAQUINTA FINANr ------------------------------------------------------------------------------------------------- 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 7000) of Division 3 of the Business and Professionals Code, and my License is i full force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided License Class: C19 Licen No.: 8 Z6947 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued.4i::::R Date:/ ontractor: Y_ I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor iiia Code, for the performance of the work for which this permit is issued. My workers' compensation OWNER-BU0gR 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 3001555 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, 1 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 sh uId 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 C e, I It fo wit om Iy with th a provisions. that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by (�/O/► any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: ate) "' " ` pplicant (_ 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: FAILURE TO SECURE WORKERS' UMPENSATION 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 (_) 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 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, (_ 1 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: LQPERMLT 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 aw relating to buil ng cons ruction, and h eby a horize representatives of this Lnty toenter upon the ve- ntioned p per fo ins cti n p^urpos te:% �� / J�JSign re (App c v M Application Number . . . . . 09-00000001 Permit RE -ROOF Additional desc . Permit Fee 30.00 Plan Check Fee .00 Issue•Date Valuation . . . . 0 Expiration Date 7/04/09 Qty Unit Charge Per Extension BASE FEE 30.00 ---------------------------------------------------------------------------- Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) • 1.00 Fee summary ----------------- Charged ---------- Paid Credited Due Permit Fee Total ---------- 30.00 -------------------- .00 .00 30.00 Plan Check Total .00 .00 .00 .00 Other Fee Total 1.00 .00 .00 1.00 Grand Total 31.00 .00 .00 31.00 LQPERMIT JAN -09-2005 15:46 From: FROM : 4*STAR RFg. 4 Star Roofing, Inc. 30775 Ave. Del Yen -no Cathedral City, CA 92234 Phone (760) 770-4535 FAX NO. : 760 7704535 PROPOSAL. DATE: 1.2-2009 CLIENT: Lie ADDRESS; 53600 Carranxa li.e Quinta. CA, PHONE: 564-905BFax 564-5906 To:760 7704535 P.1/1 Jan. 02 2009 03:26PM P1 4A 1161***fo Proposal #: OW -7 D6SCR P PON - IMIE * Sumiy and insWi 2 `Quares of 2 ply built UP roofing on low slope roof * 8uppiy and install 22 squares of Owens Coming 30 year dimensional roof shbigle, snd all components except, colt nails, and 150 roiled tooting Thank you! ( 3 year kW wwanty) .LABOR &SERuICE5 $4,840.00:. f - - .ti1.1 •• :�I :=vSVi:.:.'�•�...':.�' ,r'•. ', ... .�y�j�•��, 1 i .•4^`}y� .':12 .i'� �•: PAYMENY SCHEDULE: `: �lolillai.� •'. 1l: y<9g ` iDus u Atsed� dal . Quo iftA Mof complagm (Nosh -- 7 .'qo 5�ls�/s` Pr vml prepared by Contract acceptance: A ffhame tJwp ar 1,VA pa, month wig be dferged an b&W=s 30 doe past mo wng�h is aro amusl pemw tsp rete of f mn• sn action a brought to wtiact a pe*4w account, the buyer agrees to pay ap ooua oust &v &uwluy fE+¢s Mabe All. OWke Payable to 4 Star Roolfilg, Ina — Thenlr you 1br your Auwnasal Bi" # City of La Quints Building a Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit. # Project Address: Owner's Name: A. P. Number: Address: Legal Description: City, ST, Zip: Contractor: Telephone: - ,.� Address: Project Description: I A 14NU &j NAJ 'AAJANILIA City, ST, Zip: Telephone:a.- tS State Lie. # : City Lie. #:oil Arch., Engr., Designer: Address: City, ST, Zip: UV U Telephone: rs Construction Type ,, ,) Occupancy: State Lie. #: Project type (circle one): New Add'n Alter Repair Demo Name of Contact Person: Sq. Ft.: a oo # Stories: I # Units: Telephone # of Contact Person: Estimated Value of Project: O O�OG 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. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- 3'" 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