05-2905 (RR)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
�.1
Application Number:
50.0"T 00 2�9.0� 5� _
...__ �.
Property Address:
1 51,960 r_AVENIDA RAMIRE2J
APN:
773-1T1s'0"111`4 000000 -
Application description:
RE -ROOF
Property Zoning:
COVE RESIDENTIAL
Application valuation:
4755
Applicant:.
Architect or Engi
4� 6tt4-a
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
- LICENSED CONTRACTOR'S DECLARATION
I hereby affirm undo"r penalty of peijury that I: 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.
License Class: C39Li6enseNo.: 736420
. ' . • ._cam . Q�� .,_ '.
Date: �y Contractor:
• l OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exemptfrom* thetontractor's State License Law for the
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to
. constructi•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,Contractor's State
ns
Licee Law.(Chapterr9.(commenoing with Section 7000) of Division.3 of the Business and Professions Code) or
that he`or she is exempt therefrom an6the 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 155001.:
(_) I; as owner of the property, or;myemployees with wages as their sole compensation, will -do the work, and
ttie structure is not intended or offered for sale (Sec. 7044,•66siness 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 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 yeai of completion, the owner -builder will have the burden of proving that he or she did not build or
iniprove.for the purpose ,of,sale.):
(_ 1 I, as.ownerof.ihe property,`am exclusively contracting with licensed contractors to construct the project (Sec.
7044; Business andProfessions 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.).
(_ 1 I am exempt under Sec. , BAP.C. for this reason
Date: Owner: -
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:
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 7/13/05
Owner:
HAMILTON BRAD
51960 AVENIDA RAM'IREZ
LA QUINTA, CA 92253
Contractor:
URETHANE FOAM CONSULTING/SRVC
P.O. BOX 638
THOUSAND PALMS, CA.92276
(760)346-9840
Lic. No.: 736420
WORKER'S COMPENSATION DECLARATION
hereby affirm under -penalty of -perjury one of the following declarations:
1 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 issued. My workers' compensation
insurance carrier _and policy number are:
Carrier STATE FUND Policy Number 0460005057
_- I certify tKat,' in the performance of the work for which.this permit is issued, 1 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
3,7,000 of the Labor Code, I shall forthwith comply with those provisions.
Date: �, :dI7_. plicapt:
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. -
APPLICANT -ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to'the Director Aduilding and Safety for a permit subject to the .
conditions and restriction sssetfortli on this application. .x'•
1. Each, per &=u—'bon whose behalf. this application is.made, each person at whose request and for
w)iose`beriefit�work is Performed under or pursuant to any permit issued as a result of this application,
the owner', and the applicanteach agrees to, and shall defend, indemnify and hold harmless the City
of 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 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 i pe '
— e� e■ -7e
—�-�%' t S•ignature•fApphcant:or A___. -g��
Application Number . . . . . 05-00002905
�s
Permit . . . RE -ROOF
A Additional desc . .
Permit Fee . . . . 30.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
. . .
. 0
Expiration Date 1/09/06
Qty Unit Charge Per
Extension
BASE
FEE
30.00
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Special Notes and Comments
REROOF URETHANE FOAM. 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
LQPERMIT