04-3621 (RR)\F
BUILDING' &. SAFETY DEPARTMENT
P.O... BOX 150.4
(760) 7774012
'OF, 78-495 CALLS-'TAMPICO' ..
-FAX (760);777-701'1. .
LA .Q:UINTA, CAiiFORNiA 92253 " '1NSP.ECTIOWREQ.UESTS (760)-777-71,53
:. BUILDING PERMIT ..: `
Application.Number -:1-0-4-70-0
0"03621 Date 4/21/04
Property' Address
55.7.60 PINEHURST
APN.c
775,-241;-012
-Application description;.>.
RE -ROOF;....
.Property. Zoning
LO.W DENSITY ;RES-I�DENTIAL
Application valuation
., 7500
-Owner
Contractors
THOMPSON• G PRESTON/.JOANNE"
EMERALD 'ROOFING` INC.
6 3.2-5. EMBARCADERO '•:DR
P; : O : BOX -1963
:STOCKTON '' : " CA 952:19
PALM DESERT .: CA,.,92'2.61 .:
WCC STOVE INS
WC 63910804 01/01/05
C.SLB. -7094'0. 11/30/05
CCC C39
-----.----------.----- --- - --- - -•-=
Permit RE=ROOF..:
-.------- - - - --------.----------.--- - - -
Additional:desc
Permit Fee 3.0.00
Plan`Check Fee.,:.. 00
: -Issue. Date
Valuation 0
Qty. Unit Charge:. Per
Extension
BASE : FEE :0
30 .0
Special Notes-and_Comments
:.. RE - ROO- .. W I TH..POLYFOAM
Fee. summary Charged
-.4 .
Paid `Creel'ted Due
Permit: Fee.,Total.' 30•,'00
00 :'00: ..30..00"
J Plan .Check Total :0.0 ..
.. :0.0 .:::00.: ..00'..
Grand Total 30::00<,':
, ::00> 00: 30:00
' R.-2
.;r,
P.O. BOX 1504 UW(VOICE (760) 777-7012
78-495 CALLS TAMtICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number. Q Date:
Applicant:
Applicant's Mailing Address:
Architect or Engineer.
Architect or Engineer's Address:
Lic. No.
sll h
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I twebY offimm under PAY of pejmxy that I am rioensad under provisions of Chapter 9 (Comhnmencing wlth Secio i 7000) of Division 3 o(he Business and Piotessbnals
and rY license k In full force and effect
No. '7 `) O 4 tel.
v1i
OWNER-BULDER DECLARATION
I hereby dfrm Lxnder penalty of pelurY Yml I am exempt from he Contractors- State Lioense Law for he following reason (Sec. 703.1.6, Business and Professions Code: Any
citY a Coxmtyal �s hs PWwA b construct, atter. kvWvim. dernoish, or repair any sbucb^ prior to Its issuance, also requires to appicsnt for he Pam* to fib a sighed
stabment that he 0r she Is licensed pursuant in lte provisions of he C4ntrscl0m- Stab License law Poplar 9 (commencing with Section 7000) of Division 3 of he Business
OW Professions Code) or hat he orshe is exempt heelronm WW'" bask forth* alleged exempipn. Any violation o(Secion 7031.5 try army appicard bra permit subjects
he appicant to a dvl penalty of not more hen ive hundred dollars ($500).):
U I, as owner. of he property, or my employees with wag" as heir sale oonpensation,.w11 do" work, and the structure Is not Intended or offered for sob (Sac. 7044.
Business and Professions Code: The Contracbrs' Stab License Law does not appy to an owner of property who builds or improves hereon, and who does the work
himself or herself or twough his or her own employees, provided that the improvements are not intended or offered for sale.hIf, tmovreyer, the a' ero a
sold within one yeCompletion; he ow(w-biAder wNl have he burden of proving at he or she did not build or improve for the purpose d sale.
ar d
U L ss owner 0f.he property. am exdusively contaciknp whh lapsed oontraCbrs b construct the project (Sac. 7044. Business and Pro(esslons Code: The Cw&ac%wV
Stab Lkense Law does not appy to an owner of property who builds or improves hefe0n, and who contracts for the projects with a Cahtracla(s) icensed pursuant to
he Cohtracbrs' Stab License Law.).
U 1 am exempt under Sec. _ , a.a P -C. for his mason
Date' - Owns
1 hereby affirm under WORKERS' COMPENSATION DECLARATION
Penalty of pejmxy are of the folowing declarations:
_ I have and wll maintain a cu icate 0f Consent to seK-ins" for workers' compensation, as provided forDy Section 3700 of the labor Code. for he performancet
of he work for whidh this permit k issued.
_ 1 haws and wll maintain
Ca insurance. ss required by Section 3700 of he Labor Code. for the performance of the wok for whidm Itis pemmlt k
S A �K' N cornier aid policy number aft:
_ I oerii(y ithaf, in the pebmance of the work for which thk permnit k irsuad, I sial rat empty any person in any newer so as to become subject b he workers'
oompermsalon laws of Caibmia, and agree what, If I should became subject b the workers' compensation provisions of Section 3700 of l e Labor Code. l shall
foftvM.Wmply With apse provisto s.
• � � O V mpnt
/WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES LOP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN'
SECTION 37011 OF THE LABOR CODE, IrITEREST, AND ATTORNEYS FEES. .
Y affirm under CONSTRUCTION LENDING AGENCY
I
DAY of Pam Viet here is a construction lending agency for he Par(omanoe of the work for which this permit is Issued (Sec. 3097. CH. C.).
Lenders Name
Lenders 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 his application.
1. Each person upon whose behaff hk spplca*m Is made, each person at whose request and for whose benefit work is pedonred under or pursuant to any pony*
issued as • result of hk application, he owner. and the appicwt. each agrees to. and shat, defend. indemnify and hold harmless the City of La Qukhta. Its
2 Any Permit iso SOWd a result efnPloyee ( or ay ad or omission related b performed the work being perfoed under or following issuance of this permit.
Ppkation becomes null and void K work is not commenced within 190 drlys from date of issuance of such perm lL or
Cessation of work for 180 days writ subbed permit b cancellation.i ramify that I have read Iris application and stale hat the above information Is correct. I agree to comply with al city and county ordinancds and state lays
bukkq
censhOCU . and hereby but -in representatives of this county b enter upon the above-mentioned property for Inspection Purposes. relatrng b
�Zro --6 C( S'Applmcamt or