05-0383 (RR)T-Vf 4 4 a"
P.O. Box 1504 .
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number . . .
Property Address . . . .
APN:
Application description .
Property Zoning .
Application valuation .
BUILDING PERMIT
BUILDING & SAFETY DEPARTMENT
(760) .777-7012
FAX (760) 777-7011
INSPECTION REQUESTS (760) 777-7153
05-00000383 Date 2./03/05
. 80659 CHERRY HILLS
775-132-008-
. RE -ROOF
LOW DENSITY RESIDENTIAL
5112
SUNRISE DESERT PARTNERS
G KELLEY
76375 COUNTRY CLUB DR
PALM -DESERT CA 9'2211
Contractor
---------------------
EMERALD ROOFING INC
P.O. BOX 1963.
PALM DESERT CA 92261
WCC:
STOWE INS'
WC:
000639108'05
01/01/06.
CSLB:
770940
11/30/0.5
CCC:
C39
Permit .. .
. RE -ROOF
Additional desc .
.
Permit Fee . . .
. 30.00
Plan
Check Fee..
.00
Issue. Date . . .
.
Valuation
. . . .
0
Qty Unit Charge Per
E n
-- - - - - - - - - - - - - - - - - - - - - -
- - - - - - ----BASE-FEE-
.-------
- - - - -- -
---30 .0-
Special Notes and
Comments
4 V45
RE --ROOF WITH POLYURETHANE ,FOAM ROOF
FEg
O i
SYSTEM.
CITY OF
L A QU
Fee summary
Charged
Paid
Credite FI
Permit Fee Total
30.00
.00
.0'0'
30.00
Plan Check Total
.00
.00
.00
.00
Grand Total
30.00
.00
.00
30.00
P.O. Box 1504 VOICE (760) 777-70.12
78-495 CALLS TAMPICO FAX (760) 777-70,11
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT'
Application Number: J7- 3 -f 3 Date: Z1 -!Y-0 S�
Applicant: I Architect or Engineer:
Applicant's.Mailing Address:
Architect or Engineer's Address:
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
�eby affirm under penalty of perjury that I am licensed under isions of Chapter. (commencing with Section 7000) of Division 3 of the Business and Professionals
ode, and my License lain fun force and effect. -7 � Y ��
License Class r'i - cense No.
LA ate c� —ar Contra 1KIr
OWNER43UILDER DECLARATION
I hereby affirm under penalty of perjury, that I 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, demolish, or repair any structure, prior to its issuance, -also requires the applicant for the permit to file a signed
statement that he orrehe is licensed pursuant to the provisions of the Contractors' State License Law (Chapter9.(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 more than five hundred dollars ($500).):
U 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 License1aw does not 'apply to an owner of property who builds or improves,thereon, and who does the work
himself or herself or through his or her own employees, provided that the improvements are not intended or offered forsale. 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:);
U 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 forthe projects with a contractor(s) licensed pursuant to
the Contractors' State License Law.);
U I am exemptvrnder Sec. , B.& P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of pedury 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.
iv I'have and will maintain workers' compensation insurance s required by Section ofthe Labor Code, for the performance of the work for which this permit is
�is ,ued: My workers' mens on insurance cam nd otic
_ I certify that; in the performance of the work for which this permit is issued, I shall not employ any penton in any manner so as to become subject to the workers'
compensation laws of Califomia, and agree that, if I should become subject;to the workers' compensation provisions of Section 3700 of the Labor Code„ I shall
forthwith comply with those provisions.
Applicant k
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGEIS UNLAWFUL, AND".SHALL. SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES'AND
CIVIL FINES UP i0 ONE.HUNDRED THOUSAND DOLLARS ($1001000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED ;FOR IN
SECTION 37013 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
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.).
Lender's Name
Lenders Address
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for 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 resultof:this application, the owner, andthe.applicant, each agrees,to; and shall, defend, indemnify and hold harmless the City of La Quintiii.A6
officers, agents and employees for any act or omission related to the work being perforated under or following Issuance of this permit
2. Any pennit'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 pernit.to cancellation.
I cerlifythatd have read this application and state that the above information is correct: 1 agree to comply with all city and county ordinances and,state"laws-relating to building
construction, and hereby authorize representatives of this county to enter upon the above-mentioned property for inspection purposes.
Date oZ _p Signature (Applicant or Agent): Af