10-0842 (RR)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 10-00000842
T-itit 4 4 a"
BUILDING & SAFETY DEPARTMENT
. . BUILDING PERMIT
Property Address:
48640 PASEO TARAZO
APN:
646-082-056-. -
Application description:
RE -ROOF
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
• 19032
Applicants Architect or Engineer:
/V V
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty ofperjury 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: B C39 Lice seNo.: 235717
Date: 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).:
(_) 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 I 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
J
Owner:
LAGUNA .DE LA PAZ
48300 VISTA DE.NOPAL
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011 }
INSPECTIONS'(760) 777-7153
Date: 9/02/10
Contractor:
WESTERN PACIFIC ROOFING CORP
3462 LA CAMPANA WAY
PALM SPRINGS, 9~iZ
(760)416-5877 d
Lic. No.: 235 y'
SEP 072010
----------------- --------------- ------
RKER'S 10
I hereby affirm under penalty of perjury one %q
1 have and will maintain a certificate of cons e - 1br workers' c pensation, as provided
for by Section 3700 of the Labor Code, for the performa'T1Ce•o4. work or 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 CYPRESS INS Policy Number 33000053308101
I certify that, 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
3700 of the Labor Code, I shall forthwith comply 'th those provi ions. -
- Date:— 7-/G -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 thi's application and state that the above information is correct. 1 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 property for inspection-purpoo
" Date: %�[� Signature (Applicant or Agent): �N
. - t
LQPERMIT
LQPERMIT
Application.Number . . 10-00000842
Permit . . .. RE -ROOF
-
Additional desc .
Permit Fee 30.00 Plan Check
Fee
.00
Issue Date . . . . Valuation
0
Expiration Date'. 3/01/11
Qty Unit Charge Per.
Extension
BASE FEE
30.00
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Special Notes and Comments
INSTALLATION OF A POLYURETHANE FOAM &
COATING.ROOF SYSTEM. 2007 CODES. 48-640
& 48-642 PASEO TARAZO.
----------------------------------------------------------------------------
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