08-0971 (RR)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92.253
Application Number: 11 8 OOOAA-9-7-1
Property Address:
54545 AVENIDA RAMIREZ
APN:
4-275-014-2
-000000-
Application desc I
• Section 7000) of Division''3'ofthe Business and Professionals Ckde, and my.Licerise is in full force and effect.
-R
_ I have and will maintains certificate of consent to self -insure for workers' compensation, as provided
Property Zoning`.
RE IDENTIAL
Application Val tion
6 00
,[issued.
Date: W
0% ontiactor:
have andwill rnaintain workers"compensatioo-insurance, as required by Section 3700 of the Labor
N
2Q
Code, for the performance of the,work'for which this permit is issued. My workers' compensation '
Applicant:
CYQ
ngineer:O
Architect or Engineer.-
C)
following reason (Sec: 7031.5, Business and Professions Code: Any city or'county,that requires.a permit to
.perfo
_ I certify that, in theante of the work for which this permit'isissued, Ishall not employ any
.
02
person in`any manner as to become subject to the workers' compensation• laws of California,
permit to file a signed statement that he or'she is licensed pursuant to the provisions of the Contractor's State
and agree that, if l shou become subject to the workers' compensation provisions of Section
dk
3700 of the Lab shall forthwith comply with those provisions.
that he or, she is exempt therefrom and'the basis for the alleged exemption. Any violation of Section 7031.5 by
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
BROWN RICHARD R
54545 AVENIDA RAMIREZ
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Contractor:
ABOVE'AND BEYOND ROOFING SYSTM
78676 CASCADIA DRIVE
BERMUDA DUNES, CA 92201--0
(760).702=5984
Lic. No:.: 859337
Date: 6/06/08
LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION -DECLARATION
I .hereby affirm under penalty of perjury that I.am licensed under provisions, of Chapter 9 (commencing with
I hereby_ affirm under penalty of perjury one" of; thefollowing declarations:-
• Section 7000) of Division''3'ofthe Business and Professionals Ckde, and my.Licerise is in full force and effect.
_ I have and will maintains certificate of consent to self -insure for workers' compensation, as provided
Licen lass: C39No;: 859337 -
for by Section 3700 of the Labor;Code,.for theperformance of.the work for.which this permit is
,[issued.
Date: W
0% ontiactor:
have andwill rnaintain workers"compensatioo-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 '
OWNER -BUILDER DECLARATION -
insurance carrier and policynumberare:
•I hereby affirm under penalty of perjury that I am exempt from the'Contractor's State License Law for the
Carrier STATE FUND Policy. Number 3015949
following reason (Sec: 7031.5, Business and Professions Code: Any city or'county,that requires.a permit to
.perfo
_ I certify that, in theante of the work for which this permit'isissued, Ishall not employ any
construct, alter„improve, demolish,.or repair any structure, prior to its issuance, also requires the applicant for the
person in`any manner as to become subject to the workers' compensation• laws of California,
permit to file a signed statement that he or'she is licensed pursuant to the provisions of the Contractor's State
and agree that, if l shou become subject to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
3700 of the Lab shall forthwith comply with those provisions.
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).:
-/Date-J(.10-1pp"cant: -
(_ 1 1, as "owner of the property, or my employees,with wages as,the'ir sole compensation, will do the work, and
the structure is not intended or offered for sale (Sec. 7044, Business -and Professions Code: The
WARNING: F LURE TO.SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors'-State'License Law does not apply to an owner of property who builds or improves thereon,
SUBJECT AN EMPLOYER TO. CRIMINAL PENALTIES AND CIVIL.FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees,: provided that the
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES. AS PROVIDEDFOR IN -
improvements are not intended or offered for sale.,:If, however, the building or improvement is sold within.
SECTION 3706.OF THE LABOR CODE, INTEREST, AND ATTORNEY'S -FEES.
one year of completion,'the.owner-builder will have the burden of proving that h4 or she did not build or
-
improve for the purpose of sale.).-
APPLICANT ACKNOWLEDGEMENT
(_ 1 I,� as owner of the"pioperty,'am exclusively contracting with licensed contractors to construct the project (Sec.
IMPORTANT Application is hereby made to. the Director of Building and Safety for a permit subject to the
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
conditions and restrictions set forth on this application.
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
11 Each person upon whose behalf this application is made, each person at whose request and for
pursuant to the Contractors' State License Law.). -
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
(_ 1 I am exempt under Sec. , B.&P.C. for this reason
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
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
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 o4stateat
such permit, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application anhe above information is correct.I agree to comply with all
city an county ordinances and state lawsilding construction, and hereby authorize representatives
the above-merty for inspection purposes.
re (Applicant
f
Application Number . . . . . 08-00000971
Permit . . . RE -ROOF
Additional desc .
Permit Fee . . . . 30.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
. . .
. 0
Expiration Date . . 12/03/08
Qty Unit Charge Per
Extension
BASE FEE
30.00
----------------------------------------------------------------------------
Special Notes and Comments
REMOVE EXISTING COMPOSITION SHINGLE ROOF
THEN INSTALL NEW 30 YR. OWENS CORNING
SHINGLE ROOF.
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
Bin #
City of Via. QUlllta
Building at SafetyDivision
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 9225.3 = (760) 777/7012
Building Permit A . lication and Trackin Sheet
Permit #
`
Project Address:5 tv)_ a
Owner's Name: P, wc,w
A. P. Number:
`Address:.
Legal Description:
City, ST; Zip: L
Contractor:
crlo�Telephone'
9 �(
(_ '3p `
Project Description: ;
Address: C: 4
City, ST, Zip:
Telephone:
State Lic. # : rj Cl� '� .
CiLic. #: ooty
�,.C n
Arch., Engr., Designer: ,
0-
Address:
City, ST, Zip:
Telephone:
man
Construction Type: Occupancy:
State Lic. #:
Project type (circle one): New , Add'n Alter Repair Demo
Sq. Ft.:.., 2S0e # Stories: # Units:
Name of Contact Person: 11L (
Telephone # of Contact Person: -102 -
• ;Estimated Value.of;Project: \
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT•FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan-Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2nd Review, ready for"corrections/issue
Electrical
Subcontactor List
Called•Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval.
Plans resubmitted •
Grading
IN HOUSE:-
''d Review, ready for corrections/issue
Developer"Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
'Date of permit issue
School Fees
Total'Permit Fees