The URL can be used to link to this page

04-3354 (RR)t��► APR p g 2Q0 �IGGI�/ BUILDING .& SAFETY DEPARTMENT P.O. 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 . . Property Address . . . APN: Application description Application valuation . Owner HEALD JOHN H 77325 CALLE ARROBA LA QUINTA LA QUINTA CA 92253 (505) 244-3774 04-00003.354 Date 4/09/04 77325 CALLE ARROBA 774-152-029-24 -000000- RE-ROOF 3300 Contractor ------------------------ EMERALD ROOFING INC P.O. BOX 1963 PALM DESERT CA 92261 WCC: STOWE INS WC: 63910804 01/01/05 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 Extension BASE FEE 30.00 ---------------------------------------------------------------------------- Special Notes and Comments REROOF - REMOVE AND REPLACE EXISTING TILE CLASS A MATERIALS ONLY 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 r • P.O. BOX 1504�� VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 4INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: 3 3J if Applicant: �ME� D f2oo -11�'IA17 Applicant's M�iL2 1 dr� s: 6/3 /3 fA,1, %%rJ_VF (�:4 Date: Architect or ngineer: n" Architect or Engineer's Address: Lic. No.: BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. 7 „7 License Class C — 3 --f _ License No. Date "L Contractor K4 0 C' OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that 1 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 the alleged exemption. Any violation of Section 7031.5 by 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 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 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 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 for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). U I am exempt under Sec. , B.& 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' 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 insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issue A. My workers' compensation insurance carrier and policy number are: Carrier S,7/t7 a-9 A , Policy Number _ 1 certify that, in the perfbrmande of the w–ft for which this permit is 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, it I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date "�/ �� Li Applicant50, T� 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 Lender's 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 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 Ouinta, 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 construction, and hereby authorize representatives of this county to enter upon the above-mentioned property for inspection purposes. Date A ^ Q_ —4) � Signature (Applicant or Agent): 04/06/2004 17:00 FAX 503 274 7979 PARSONS FARNELL GREIN :Apr 06 04 06:36a EMERRLD ROOFING 7603479879 y UC#l)rl� PHONE: 760-347 9869 P.O. BOX 1%3 FAX: 760-347-9879 PAILM DESSERT, CA. 92261 OWNERS/AGENT JOHN HEALD OWNERS ADDRESS: 77325 CALLE ARROBA CITY: LA QUINTA, CA. PH# 503-244-3774 FAX: 503-274-7979 JOB ADDRESS : SAME AS ABOVE THE TOTAL PRICE FOR PERFORMING THE OUTLINED WORK INCLUDING LABOR ARID MAT EP AL IS: CONTRACT AMOUNT: REAR OF HOUSE: 3,300.00 / IT IS HEREBY AGREED THAT EMERALD ROOFING INC. SHALL NOT BE HELD LIABLE FOR ANY OF THE FOLLOWING, DIRT OR ANY DEBRIS THAT MY FALL BETWEEN THE SHEATHING BOARDS INTO LANG AREAS, DAMAGES TO ANY CEILING MOUNTED FIXTURES, VENTS AND OR CONDUIT PIPES. EMERALD ROOFING INC. SHALL NOT BE HELD RESPONSIBLE FOR ANY CONSEQUENTIAL DAMAGE RESULTING FROM LEAKAGE OR GENERAL DAMAGES OF ANY KIND BUT SHALL REPAIR SAID LEAKAGE AS GUARANTEED BY THE TERMS OF EMERALD TE "fl- d - 05i SEE PAGE (3) FOR TERMS AND CONDITIONS 1. REINSTALL SKYLIGHT WITH PROPER CURB HIGHT NEEDED. 0003/004 p.2 2