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05-0381 (RR)BUILDING & SAFETY DEPARTMENT P.0 Box 1504 (760).777-7012' 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT Application Number . . . 0.5-00600381 Date 2/03/05 Property Address . . . . . 80647 CHERRY HILLS APN: 775-132-007- - - Appl,ication description . . RE -ROOF Property Zoning .. . . . . . . LOW DENSITY RESIDENTIAL Application valuation 5112 Owner SUNRISE DESERT PARTNERS G KELLEY 76.37.5 COUNTRY CLUB DR PALM DESERT CA 92,211 Contractor ------------------------ EMERALD ROOFING INC P.0'. BOX 19'63 PALM DESERT CA 92261 WCC: STOWE INS WC: 00063910805 0.1/01/06 CSLB': 770940 11/30/05 CCC:. C39 Permit . . . . . . RE -ROOF Additional desc . Permit. Fee . . . . 30:00 Plan Check Fee .00 Issue Date . . . . Valuation 0 Qty Unit Charge Per BASE FEE ----------------------------------------------------------- Special Notes and Comments RE -ROOF WITH POLYURETHANE FOAM ROOM SYSTEM. Fee -summary Charged Paid Credited Permit Fee Total 30.00 .00 .00 Plan Check Total .00 .00 .00 Grand Total 30.00 .00 .00 Extension ---v--n---d---- FEB 0 4 2005 QUINTA 30.00 .00 30.00 P.O. Box 1504• �� VOICE (760) 777-7012 78-495 CALLE TAMpleo FAX (760) 777-7011 ? a LA QUIN,TA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING. & SAFETY DEPARTMENT Application Number: �� ' M I Date: 1- V - d S Applicant: I Architect or Engineer: Applicant's Mailing Address: r7 Al %XA C %U Architect or Engineer's .Address: Lic. No.: BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION �IhCby.affirm under penalty of perjury that'I am licensed under visions of Chapter 9 (commencing with Section 7000) of.Division 3,of the Business and Professionals ad my License is in full force and effect.cense ass G "3 C f / License No. at`D e�Contractor c✓Lb • o i+t 1 OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that l am,exempt.from the Contractors' 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, demolhsh,,or repair any structure, prior to its issuance, also requires the applicant for the.permitto file assigned statementhat he or sheis licensed pursuant to the provisions of the Contractors' State License taw (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 fora permit;subjects the,applicant to a civil penalty of not morethan five hundred dollars ($500).): O 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, fousale (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 or through hisor 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.burderi of proving thathe or she did not build or)mprove 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 contra, ctor(s) lieensed;pursuant to the Contractors' State License Law.). U I am exempt under Sec. . BA P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certificate of consent to.selNnsum 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 insuran , as required by Section 3700.of the Labor Code, for the performance of:the'work.for which this permit is res ued. Myworkers' pensItion insurance ca an amar S7 �rr� AJ/J Policy Number _ I certifythat,, inthe;pe'rforrnance of the work for which this permit is issued, I shall not employ any person In 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 the Labor Code, I shall /at,�7 forthwith comply with1hose provisions. �Y --OL Appiicanfl� WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT ANIMPLOYER 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. CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury thatthere is a construction'lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.), Lenders Name Lenders Address 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 madereach person at whose request and for whose benefit work,is performed under or pursuant to any permit issued asa result of this application, the owner, and the applicant, each agrees to, and shall, defend, indemnify and hold harmless the City of La Quintaofts officers, agents, and employees,for any actor omission related to the work being performed.under or following issuance of this permit. 2. Anypermit Issued as a result of this application becomes.nuli and void if work hs not commenced within 180 days from date of issuance of such permit, or, cessation of work for 186 -,days will subject pernitto cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with allcity and county ordinances and statedaws relating to building cons truction, and hereby authorize representatives of this county to enter upon the above-mentioned property for inspection purposes. �l Signature (Applicant or Agent);