12-1340 (RR)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 12-00001340
Property Address: 49800 COACHELLA DR
APN: 646-250-017-17 -4275 -
Application description: RE -ROOF
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 7026
T4&f aF stP4"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
CARYL BELTCHENKO
49800 COACHELLA DRIVE
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 11/13/12
Contractor: '
Applicant: Architect or Engineer: CASTRO ROOFING INC *QG
122
THOUSAND PALMS, CA 92276 cFrYOF l3249
11?I (760) 343-0042 �H,q
/ ---------------------------------------------------------------------------------------------
l Lic. No.: 828478
LICov' ' ENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION.
I hereby affirm under penalty of perjury t at I am licensed under prns of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Busin s and Professionals e, and my License is in full force and effect. _ I have and will maintain a certificate of consent to self -insure for workerscompensation, as provided
Licen a 51ass. PC29 icense No.: 828478 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
ate: r Z�ontractor: L *-ave 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
OWNER -BUILDER DECLARATION insurance carrier and policy number are:
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 6391472011
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to _ I certify that, in the performance of the work for which this permit is issued, l shall 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 o 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 I sh uld 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 Labor C e, I hall forthwith compl 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).: ate: I pplicant:
(_) 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 WARNING: FAIL RE TO SECURE WO KERS' 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 PROVIDED FOR 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 he or she did not build or
improve for the purpose of sale.). APPLICANT ACKNOWLEDGEMENT
(_) I, as owner of the property, 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 1. 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,
I—) 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 of issuance of suc ermit, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the a ove information is correct. I agree to comply with all
city and county ordinances and state laws relating to buildin constructi ereby authorize representatives
of this un to ent�upotabove-mentioned property fo
te: ) �/ Applicant or Agent):
Application Number . . . . . 12-00001340
Permit RE -ROOF
Additional desc .
Permit Fee . . . . 30.00 Plan Check
Fee
.00
Issue Date . . . . Valuation
. . .
. 0
Expiration Date 5/12/13
Qty Unit Charge Per
Extension
BASE FEE
30.00
-------------------------------------------------------
Special Notes and Comments
-------
--_------------
REMOVE EXISTING TILE, SET ASIDE. REPAIR
OR REPLACE UNDERLAYMENT, REINSTALL
ORIGINAL TILES. 2010 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
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City. DI Ira Qj.1inta
Building SL Safety Division
P.O. Box 1504,78-495 Calle Tampico
14.Quinta, CA 92233 - (760) 777-7012
Building Permit "Application and Tracking Sheet
Permit #1
i
l
Project Address:
L
Owner's Name:. `�\ V b� �/ f'V ' " "'
A. P. Number.
Address: . 4MA �r 1
Legal Description:
City, ST, Zip: LAP►1 [ (' ,;E6 2
Contractor. ILO a r� `
Rffit 10—
Telephone:
Address: T® ti
Projec'Description:
City, ST, Zip: " Ch • V"Lii<3
Telephone: 1Ub 3�3 oeLj
t{p .• Fl %;�
if j (�� 11 VVLj �i.�A� --t� j
State Lic. # : g
City Lic, #: r
L1`
"`�► U fj i1; / V' t/' V `LpO O'�I. �' s l r l " "
Arch., Engr., Designer.
Address:
Sf�+!lly MV dIti .
City., ST, Zip:
Telephone: `
State Lic. #: w
Name of Contact Person:
Construction Type: n Occupancy:
roJect tYPa (circle one): New Add'n Alter Repair Demo
Sq. Ft.:
# Stories:#
Units:
Telephone # of Contact Person:
Estimated Value of Project —107"
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item Amount
Structural Cates.
Reviewed, ready for corrections
Plan Check Deposit. .
'Fuss Cates.
Called Contact Person
Plan Check Balance"
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Pians resubmitted..
Mechanical
Grading plan
Zi° Review, ready for correctionsfissue
Electrical
Subcoatactor List
Called Contact Perso.n
Plumbing
Grant Deed
Plans picked up
S.XL
H.O.A. Approval
Plans resubmitted
Grading
IH ROUSE:-
''' Review, ready for correctionsrmue
Developer Impact Fee
Planning Approval
Called Contact Person
A LP.P.
Pub. Wks. Appr '
Date of permit issue
School Fees
Total Permit Fees