05-0393 (RR)BUILDING & SAFETY DEPARTMENT
P.O. Box 1504 (760).777-70.12
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
Application Number . . . 05-OQ000393 Date 2/03/05
Property Address . . . 80671 CHERRY HILLS
APN: 775-1:32-009- - -
Application description RE -ROOF
Property Zoning . . . . . LOW DENSITY RESIDENTIAL
Application valuation . . . 5796
Owner
SUNRISE DESERT PARTNERS
G KELLEY
76375 COUNTRY CLUB DR
PALM DESERT CA 92211
Contractor
EMERALD ROOFING INC
P.O. BOX 1963
PALM DESERT CA .92261
WCC:
STOWE INS
WC:
00063910.805
01/01/06
'CSLB:
770940
11/30/05
CCC:
C39
Permit . . .
RE -ROOF
Additional d'esc .
.
Permit Fee
. 30.00
Plan
Check Fee
.00:
Issue Date . . .
.
ValuatICTFr,y,,
0
Expiration Date
8/03/05
Qty Unit Charge Per
FEB 0 4 2005E'
sion
BASEFEE
0.00---------------------------------------------------OFLA
-
�UINTASpecial
--------
Notes and
Comments
ANCE DEPT.
RE -ROOF WITH POLYURETHANE -FOAM ROOF
SYSTEM.
Fee summary
Charged
Paid
Credited Due.
Permit Fee Total
30.00
.00
.00 3.0.00
Plan Check Total
:00
.00
.00
:00
Grand Total
3,0.00
.00
.00 30.0.0
R.O. Box 1504 •4 � VOICE (760) 777-7012
78-495 CALLE T'AMPICO FAX (760) 7777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-71.53
BUILDING & SAFETY DEPARTMENT
Application Number: 3- — 3 93 Date:
Applicant:
Applicant's Mailing Address:
JON -1 eACTOlf
Architect or Engineer:
Architect or Engineer's Address:
Lic. No.
BUILDING PERMIT DECLARATIONS
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 ofthe Business snd. Professionals
ode, and my License is fyyll force,and effect.
License Class G 7 cense No. —7 7 Q D
_p r Contractd/ '1 ' 11 O cO
OWNER -BUILDER DECLARATION
I hereby affirm. under penalty of perjurythat 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 or she is licensed pursuant to the provisions of,the Contractors' 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 thealleged exemption. Any violation of Section 7031.5by any applicant for a 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 compensatior,.wili do the worki and the structure is not intended or offered for sale (Sec. 7044,
Business and Professions Coder The Contractors' State License Law does not apply to anowner 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 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 notbuild 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 Coder 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(p) licensed pursuant to
the Contractors'" State License. Law.):
(_.) I am exempt under'Sec. , 6A P.C. for this reason
Date Owner
WORKERS' COMPENSATION'DECLARATION
I hereby affirm under penalty of, perjury one ofthe 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 isiissued
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, permits
j�sued. My worker'V., pensation insurance carriQrandpo / �
Cartier S //. /'STC f ZI � � Polley Numbef-
_ I certify that, in the performance of the work for which'this per itis 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 the Labor Coder l shall
forthwith comply with those provisions.
ate .Z " '7 —�J Applica*' G�
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.
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
Lenders Address LA
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the oonditionsand restrictions set forth on this application.
1. Each person upon whose behalf this application„is made, each person at whose request and for whose benefitwork.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 Quints, its
officers, agents and employees for any act or omission related to the work tieing 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 190 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 coned. I agree to comply with all city and county ordinances and state Ism relating to building
con ruction, and!hereby authorize representatives of this county to enter upon the above-mentioned property for inspection purposes.
'D — 7 -
ate i natu e(Applicant A ✓/
.Z $!. r or Sent):