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04-4247 (RR)i. 4: i P.O. Box 1504 Fly,vvv,, 7 C4OFIVV 9 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 7,77-7153 BUILDING PERMIT .Application Number r04--0.0004-247 Date 5/17/04 Property Address J54860 AVENIDA RAMIRrEZ APN: 774-301-008-17 -000000- Application description RE -ROOF Property Zoning . . . . . COVE RESIDENTIAL Application valuation 546.5 Owner Contractor ------------------------ VAUGHN BUCKNER MILLER & SONS ROOFING INC, AL P 0 BOX 1495 68760 SUMMIT DRIVE LA QUINTA CA 95523 MECCA CA 92254 (760) 328-6616 WCC: VIRGINIA INS WC: 1CW50109600. 09/01/04 CSLB: 336547,'' '07/31/05 CCC: C39 Permit . . . RE -ROOF .Additional desc Permit Fee 30.00 Plan Check Fee .00 Issue Date Valuation 5465 Qty Unit Charge Per. Extension BASE FEE 30. 0'0 ----------------------------------------- ---------- 8pecial Notes and Comment s'-: REROOF-WITH CLASS A MATERIALS Fee summary Charged ;_ Paid -Credited Due .Permit Fee Total -30.00 .0'0 ..00 30.00 Plan Check Total .00 .00 .'00 _ 00 Grand Total 30.00 •.00 .00 30.00 P.O. Box 1504 78-495 CALLS TaMPICo VOICE (760) 777-7012FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: Applicant: Applicant's Mailing Address: •5 Architect or Eng�� Architect or Engineer's Address: Lic. No.. tSUILUINU PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm under penalty of perjury that I am licensed der provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my Lice isVIand effe j r! License Class cense No._ r Date !S,— Contractor OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that 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 con ct, 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.). (, 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 oontractor(s) licensed pursuant to the Contractors' State License Law.). U I am exempt under Sec. , BA P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION 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 �ed. My workers' comZens on insurance carier nd policy number are: Cartier , l ice.-,/Y� -f /� Policy Number G✓ D / aO 1 certify that, in the performance on.nd r�jj for which is permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of CalifornigQae that, if should become subject to the workers'compensation provisions of Section 3700 of the Labor Code, 1 shall forthwith comply with those pro^� Date !I Applicant ---W1 ' WARNING: FAILURE TO SECURE WORKER COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUS D DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INT EST, 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.). Lenders Name p� 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 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 1, not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to can lati gn,I certify that I have read this application and state that the above in f ti n is correct a tee to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county t e ter pon the abo ntioned property for inspection purposes. Date —� Signature (Applicant or Agent): APR -14-2004 09:53 AM L • e. P.01 0�v603 AL MILLER AND SONS ROOFING CO.,11"k- "BETTER NC."BETTER KOOFS FOR HF7TE1t LIVING" 68.7001 DRIVE, CATHIiDML CITY, CA 92234 p}t, (j"34&12t4 FAX. (761) 32L-'1097 L10ENSF 4 3b6M47 PIkOPOSAL AND CONTRAcr "REN' SED DID" ` Coattactor: buck VautbalCaro! DuAnt 1'roJt:ci: 81Im-3 Address; 54.860 Ave Ramirez Address: City: Le Quintan Ca. 92253 City- La Quinin Phone: IIm: 771-5542 Wk: 568-9699 S6 ISM -2260 s •113-tw WE PROP(>'W TO FURN1811 TIS FOLLOWING MA't'L'RIAI 9 AND PEW-0XM At.L 1,001% TO ROOF DIG AIWVK lA A 1 u)N . Rooferto "MaR p1hitioCroof damAbAgWOM Any dijrnffL— he at_1!Le _t':AtepiS35,00 Qcr sheet, SI C r,il'� liner, Canyon Ultra Tiimh��'line sltlnc(� gsSt . ANM undcriaymen� per,MMMNcturww �pcd ir*ggtgns, hoofer to i"Indg gey gftim, ctrl. UrAW-I --- - l�rinf >j�triic�' �5A(i IG:tCwSlON6: f nnHa t•I�1�jlaAcr, tNsI1L,6jT M Cao.� ATTENTION Soatloe 7018 of the Contractors License 1•4w fwovidts that starting July t,1466, cvcrynrtc Itccnscd by 60 UMW-w-t9W% 11"M: %hull give a copy of the fotlowior,cot:ce to lite paym our to mct;iyina fronx the owner of rho proputly or his aQ.e111 nny pay►ruttl Por work whit''h a cootnt0lor'SIi06n4o is required. WtICF, "Under Otc mcohanios' Lion L AW ; any subcantrwiar, laboter, supplier or other peravn who Iwtps 10 1111"a}sur prapt.�rty but Is twl pnld far thw mark or svppUcs hos a rift b Cntotrce a cleltri 0gsin>ac your properly. This tncnns tbot, alter a court heue reg, your IinpY cotdd tC sold by a court ollicer *w the prateeds of the sale mod to satisfy the indu mbtess. This Gin Itappca oven if you nave pfd your own mmkitcyne In 11dl, IPthe subcontrut'tor, labow, or supplier remained unpaid." Al Miller & Soni RooGog CO., Inc. AFrcos to tumult Its rcEtdnr fsrm ClUARANTUX Por !,_, -Nears atter raatplction of Its fold work. gold guanttdce to cover dcfccta iA etnlurial and workinvnship only and not to exWnd to d2n1W to mrlftg CJI(Iw 1 NN the cicthenly, other uutlslutl ACAs of Grid and shall tied coot r any liability for din►age lu lnletiots rncturcs, d=ratiotst, nails, oontcm9 of Wilding at edict purls 0f pucture nM to du nilp orfaulty construction. It t+ also understood and ngrcod that the above guaruntiv shall ban lc ►nd t> moln only witut attd if paynuxd is o+rle m asrmd bt Otis coittilut, Al Miller & Sons !shot mponsible for TV anlcttnus , We ora fully eovcred by Wort meat's compensation and public liability in uraaco, Carriers' names mid policy tluutbers aro availoblc on ruquesl• Any nkatntfons or (1010011S from the above specifications )trvolvutg CX coat of uitttcrl0l or WVr .,vlll oufy'ao axwotod upas tvriji(m orders fbr same, out) will become in extra chago over awn mctttiomd in this pfopont. All agreements trust lie tnorth iii writing. llda 40 Is valid lot unc week )tem the duto o[wtinutto told is hazed on [Yee recess to builxling for dircot loodieg from our tmdL }rices atti bawd old evi rust cast of nuticrhl turd labor, intmascs or dccrcmcs will be rcl]ccW al citric of signing of contrecl. Al Mlllcr c@ Sons R9vGno Co., Inc. net m.-ponsibtc Pur any durnego to aldawilky, wrltf or driveways, r_ it there Is any conflict belwta:n this proposal, and gay utbor cotitlict or Wxit'alion rotall�tfl to the -above rcLruaood pmJcet ilia d.'ents or this ptppe,aal shall ptvvalt • Itus�pcot6t11ydat+�lt,:d, Al, MILLER & soNg ItOOW40•, INC. Aecepted: p yc fAl �vl1 ny Matthew Miller, Estfrnotor Date: I t, r I Datet041104 r n it n 'J GAA4GG7.7,R YIN wi o I X008 SVCS I x911 I W lE• Wy. 'N: BC UN b00Z41-add r