05-0379 (RR)BUILDING & SAFETY DEPARTMENT
P.O. Box 1504 (760).777-7012
78-495 CALLS T.AMPICO FAX '(760) 777-7011.
LA QUANTA, CALIFORNIA 9225.3 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
Application Number . . . . . 05-00,0003.79 Date 2/0.3/05
Property Address . . . . 8,0707 CHERRY HILLS
AM 775-132-012- - -
Applicati,on 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
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EMERALD.ROOFING INC
P.O. BOX 19'63
PALM DESERT CA 92261.
WCC: STOWE INS
WC, 00-0639108,05 01/01/06.
C$LB : 770940 1,1/30/05
CCC: C39
Permit . . . . . RE -ROOF
Additional desc .
Permit Fee 30.00 Plan Check Fee .00
.Issue Date . . . . Valuation 0 -
Qty Unit Charge Per Extension
BASE FEE 30.00
'Special Notes and Comments
RE -ROOF WITH POLYURETHANE FOAM ROOM
SYSTEM.
Fee summary Charged Paid Credited Due,
Permit Fee Total 3:0.00 .00 .00 30.00
Plan (Check Total .00 .00 .00 .00
Grand Total 30,.00 :00 :00 30 0,0
T._0.. BOX 1504, a � VOICE (760) 777-10-12
78-495 CALLE TAMPICO FAX (760) 777-701.1
LA QU.IN.TA, CALIFORNIA .92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number:
Applicant:
Applicant's Mailing Address:
o K
Date:
Architect or Engineer:
Architect or Engineer's Address:
Lic: No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOW&DECLARATION
I he ebyaffirtn.unden,penaltyofperjurythat I am licensed,undeyprovisions;of Chapter.9 (commencing with SeCtion.7000) of Division 3 of the Business and Professionals
de, and my License is in full force and. effect. .� ? p L, b/0
I class License No. i
ateZ Lr{ �� Contractors �✓' ��E� o® if
OWNER43UILDER DECLARATION
I hereby affirm under penalty'of perjurythat lam exempt from th6contractors' State Ucerise,Law for the:(ollowing reason (Sec. 7031.5, Business and Professions Code: Any
city or countythat;requires a rnitto construct„aiter, improve, demolish, or repair an structure, the permit to file a signed
req pe p pa y prior to its issuance, also requires the applicant
statement that he or she is licensed pursuant to the provisions of, the Contractors' State.L'icense Law (Chapter 9 (commencing with Section 7000) of Divislon 3 of the Business
and Professions Code) or that he orshe•is exempt therefrom and the basis for the alleged exemption. Any violation of Section,7031.5 by any applicant for` a permit subjects
the applicant to,acivil'penalty of notmore than five hundred ;doliars;($500).):
U '1, as ownerofthe propertyror my employees with wages as their solecompensation; 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 applytoean owner of property who builds or improves thereon, and who does the work
himself or herselfor through his or'her own;empioyees; provided that the improvements are not intended or offered for sale. If, however, the ;building orimprovern is
sold -within one year of completion; the owner builder will have the burden of proving that he orsheAid'notbuild'or improve for the purpose of sale.).
L) Inas owner of the property-arr exclusively contracting with licensed contractors to constnict-the project (Sec,. 7044, Business and Professions Code: The Contractors'
State License Law does notapply:to�anowner of property who builds or improves thereon, and who contracts for the projects with a oontractor(s) licensed pursuant to
the Contractors'State License Law:).
(_) 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'fhe,following declarations
_ I, have,and,will maintain &certificate of consent to self-insureforworkers' compensation, as provided for by Se0ion 3700,of the Labor Code, for the performance
of the work,for which this permit is,.issuedl
I'have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor.Code;dor the performance of the work for which this perrmit is
C er . My workers' on insancematia
of the work for whit !this permit is issued,.tshall not:employ any person in any mannerso as,to become subjectto the,workers'
compensation laws ofCalifomia, and agree that, if I should:become subject to the workers' compensation, provisions�of Section 3700 ofthe Labor Code, I shall
forthwith comply with those provisions.
0 Annliran} /X /' �
WARNING`. FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,.AND SHALL SUBJECTAN EMPLOYER TO CRIMINAL,PENALTIES AND
CIVIL FINES UP TO ONE,HUNDRED THOUSAND DOLLARS4100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED, FOR1N
SECTION',3706 OF THE LABOR:CODE, INTEREST, AND ATTORNEY'S FEES.
CONSTRUCTION LENDINGAGENCY
I hereby affirm under penalty of,pedury that thereis a construction lending agency for the performance of.the work,for which this permit1s issued (Sec. 3097, Civ. C:).
Lender's Name
AlLender's Address
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application.is herebymade-to the Director of Building and Safety for a permit subject to the conditions andsrestrictions set forth on this application.
1.. Each person upon whose behalf this application.is made, each person At whose request and for whose:benefit.work4s performed under or pursuant to any permit
issued as a result.of this appiication,.the owner, and the applicant, each agrees to, and shall,,defend, indemnity and hold harmless the Cityof 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,permitissued as a result of this; application becomes null and void if.work is not t commenced within 1B0'days from date of issuance of such permit; or
cessation of work for180 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 allyaty and county ordinances and state laws, relating to building
cons ction, and hereby authorize representatives of this county enter upon the above-mentioned property1166rispection,purposes.
L
ate 1 �� t` Signature (Applicant or Agent):•