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07-2619 (RR)\4 P.O. BOX 1504 ^' VOICE 760 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date:. 9/'28/07 Application Number: 07-00002619 Owner: Property Address: 55556 PINEHURST PGA WEST RES 1 HOA APN: 775-241-004 - - P.O. BOX 1060 Application description: RE -ROOF LA QUINTA, CA 92253 Property Zoning: LOW DENSITY RESIDENTIAL ( - Application valuation: 7450 1n� fI Contractor: Applicant: Architect or Engineer: EMERALD ROOFING. INC OCT 012007 P.O. BOX -1963 - -� PALM DESERT, CA 92261 ) CM! OF Lb+W4NIA (760) 347-9869 FINAN0,L-'0E'P1. LiC. No.:_770940 LICENSED CONTRACTOR;,S:DECLARATION I hereby affirm under penalty: of. perjury 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. = `Cicense Class; .C39., : 4 -, License No.: 770940.. - Date: &—t C;7'Contiactor. OWNER=BUILDER'DECLARATION I hereby affirm under penalty of -perjury that I am exempt from theConfractor's State License Law foi,the following reason (Sec. 7031x'5, Business and Professions Code: "Any city or county that requuesa:permit to construct -alter, improve, demolish, or repair any structure, prior to its issuance, also 'requiies: tFie 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 fora permit subjects:the applicant to a civil penalty of not more than'five hundred dollars J$500).: ( 1 1, as owner of the,property,,or my employees with wages.as their sole compensation; will do the work, and the structure -isnot intended or offered for sale.(Sec.'7044, Business and Professions Code: The Contiactors' State'License Law does not apply to an owner of propertywho builds or improves thereon, and'who does the work himself or herself through his or her own employees, provided that the improvements arenot.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 town 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 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.I. Lender's Name: Lender's Address: LQPERMIT 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,'fotthep ormance;gf`the work for which -this permit is issued. I haJe'and'will maintain workers' compensation insurance, as required by Section 3700 of the.Laboi Code; for the performance of the wo"rk for which this permit is-issuedZ Myiworkers' compensation insurance carrier and policy number are:. Carrier. STATE,�FUND Policy Number 639-0000108 _ Icenify: that,: in the performance of the work for which this permit isoissued, I 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 becoine�subject•to the workers' compensation'provisions'of Section 11 3700 of the Labor Code, I shall forthwith comply with those provisions. Date lb Applicant: _ WARNING: FAILURE TO SECURE-WORKERSCOMPENSATION 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 theDirector 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. certify that I have read this application and state that the above information is correct. I 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 purposes. Date: 10—i— Signature (Applicant or Agent)" 1��1 Application Number . . . . . 07-00002619 Permit . . . RE -ROOF Additional desc . Permit Fee . . . . 30.00 Plan Check Fee .00,. Issue Date Valuation 0 Expiration Date 3/26/08 Qty Unit Charge Per Extension BASE FEE 30.00 ---------------------------------------------------------------------------- Special Notes and Comments REROOF WITH FOAM SYSTEM 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 LQPE"11T