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10-0367 (RR)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: r, 10-00000367 Property Address: 79465 BROOKVILLE APN: 772-040-009- - - Application description: RE -ROOF Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 23000 Ti -ht 4 4v Q" Applicant: Architect or Engi er: ------------------ LICENSED CONTRACTOR'S DECLARATION BUILDING & SAFETY DEPARTMENT BUILDING PERMIT I hereby affirm under penalty of perjury t t I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Busine and Professionals Code, and my License is in full force and effect. License ass: IC39 LicenseNo.: 859337 (Date: t� Contractor: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's 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 Contractor's 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).: (_ 1 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 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.). (_ 1 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.). (_ 1 1 am exempt under Sec. , B.&P.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 Owner: NYLUND BOB 79465 BROOKVILLE LA QUINTA, CA 92253 ( VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 4/27/10 Contractor: ABOVE AND BEYOND ROOFING S 78676 CASCADIA DRIVE BERMUDA DUNES, CA 92201--0 (760)702-5984 Lic. No.: 859337 ------------------------------------------------ WORKER'S 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 issued. My workers' compensation insurance carrier and policy number are: Carrier STATE FUND Policy Number 238-006219 I certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any mann so as to become subject to the workers' compensation laws of California, and agree that, if 1 s become subject to the workers' compensation provisions of Section 7 0 of the La I shall forthwith comply with those provisions. Date: �i 21 0 Applicant: 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 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 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 aAionede above information is correct. I agree to comply with all city and county ordinances and state lawsing construction, and hereby authorize representatives of this cou ty t enter upon the above-mey for inspection purposes. Date: Zl �� Signature (Applicant _ Application Number . . . . . 10-00000367 Permit . . . RE -ROOF Additional desc . Permit Fee 30.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 0 Expiration Date 10/24/10 Qty Unit Charge Per Extension BASE FEE 30.00 ---------------------------------------------------------------------------- Special Notes and Comments RE -SET TILE ;LIFT TILE REMOVE PAPERS. INSTALL SELF SEALING TILE UNDERLAYMENT ;REINSTALL TILE. 2007 CODES. ------------------------ Other Fees . . . ---------------------------------------------------- . . . . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary - - - - - -- Charged Paid Credited Due - - -- - - - - - - - Permit Fee Total ---- - - - - ------ - - - 30.00 - ------ - - - - ---- .00 .00 -- - - - - - 30.00 Plan Check Total .00 .00 .00 .00 Other Fee Total 1.00 .00 .00 1.00 Grand Total 31.00 .00 .00 31.00 LQPERMIT To ( .g QFJN -2 YSTEIvIS ...... ... ... i Berm Oda: Du mss; CJt9'120,3 [PS1760y702�5984> f. (780}1:731618; ;email '-b' - .. -1-111--, .... . .... .. . .to egin:ap.ofd Z- 7. iiid'�Wll tikeWpFo Zq�ro dW ;:Accepts gr/p L-7,-2- J Bin # City Of L QUinta Building & Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # r1 -0 Project Address: -1q11(05- Owner's Name: A. P. Number: Address: dt �((� 1 C V Legal Description: City, ST, Zip: R 2 2 S Contractor: �� v e 4. t Telephone -. _ Project Description: Address: g�¢�(o GS Cf cX City, ST, Zip: n. J 5 Ck Q ZZ0 3 L, r e ,re Telephoner 0 --102 ?a s >` r..<a State Lic. # : iq • '1 City Lic. #: 100 C(C('2 Arch., Engr., Designer: Address: City., ST, Zip: Telephone: ;:. Construction Type: Occupancy: State Lic. #: , 4 Project type (circle one): New Add'n Alter epair Demo Name of Contact Person: r. LQ a �� q Sq. Ft.: 5'0 0 d# Stories: i # Units: Telephone # of Contact Person: (00 ^'� a 2 - S 9 K Estimated Value of Project � 2 '� � 8 . � APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cates. Reviewed, ready for corrections Plan Cheek Deposit Truss Calm Called Contact Person Plan Cheek Balance. Title 24 Cala. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2'' Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up H.O.A. Approval Plans resubmitted Grading IN HOUSE:- ''' Review, ready for correctionshaue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees