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05-0392 (RR)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING. PERMIT BUILDING & SAFETY DEPARTMENT (760).777-7012 FAX (760) 777-7011 INSPECTION REQUESTS (760) 777-7153 Application.Number . . . . . 05-00000392 Date 2/0.3/05 Property Address 80695 CHERRY.HILLS APN: 775-132-011- Application 75-132-011 Application description.. RE -ROOF Property Zoning . . . . . . . LOW DENSITY RESIDENTIAL Application valuation 5796 Owner SUNRISE DESERT PARTNERS G KELLEY 76,375 COUNTRY CLUB DR PALM DESERT CA 92211 Contractor EMERALD ROOFING INC P.O. BOX 1963. PALM DESERT CA 92,261 WCC.: STOWE.INS WC: 00063910,805 01/01/06 CSLB: 77094.0 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 e� 0100 BASE FEE D Special Notes and Comments FEB 0 4 1005 RE -ROOF WITH POLYURETHANE FOAM ROOF SYSTEM. CITY OF LA QUINTA FINANCE.DEPT 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 P.O. Box 15044 4 a" VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7133 BUILDING & SAFETY DEPARTMENT Application Number: 5-392, Date: Applicant: Applicant's Mailing Address: ,D /VTKA C %CCK Architect or Engineer: Architect or Engineer's Address: Lic. No.: BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION Code,I rebyaffim under, penalty.of perjury that I am licensed under rovisions of Chapter (commencing with Section 7000) of Division 3 of the.Business and Professionals ali nd my Lice s�is.� fy�J force -and effect.. —7 V License Class s i cense No. / 7 4 �V ✓Dated —y — dt Contractorz-- OWNER-BUILDER 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 toconstruct„ 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 pursuantto 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** alleged exemption. Any violation of Section 7031.5 byany applicant for a permit subjects the applicant to a civil penaltyof 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 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 his or her own: empioyees; 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,projecQSec. 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(s)licensed pursuantto the Contractors' State License. Law.). U I am exemptunder 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 self -insure for workers' oompensation, es 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' gompensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My worke ompen tion insurance came / I certify that, in the performance of the work for which this permit it issued, I shall not employ any person In any manner so as to become subject to the workers' compensation laws ofCaiifomia. and agree'that, if I should become subject to the workers' compensation provisions of`Section 3700 of the Labor Code, Iishall forthwith comply with those provisions. ate0 � Applicant �— WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE I& 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 a(firm 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. Cl. Lender's Name Lender's Address APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made tothe Director of Building and Safety for.a permit subject to the condilions 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 0uinta, 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 corysfructionn,,, and'hereby authorize representatives of this county to enter upon the;above-mentioned property for inspection purposes. Date —Signature. (Applicant or Agent)