04-3585 (RR)BUILDING_&SAFETY: DEPXRTMENT
•c � P.D..BOX-.1504 (760) 777-7012
rOFti9 78-495 CALLE'TAMP1Co, FA -X (760).77.7-7011
Lw"Q.uINTA, CA IFORMA 922653 INSPECTION REQUESTS (760p777.7153
BUILDING PERMIT
Application. Number 04_ 00.03-5-8.5 Date 4/19/04
Property Address 55830 RINEHURST
APN: 775-.241.7014- -
Application description ARE=ROOF
Property -Zoning LOW DENSITY RESIDENTIAL
Application valuation` 3.5-00.
Owner Coiitract:or
,.
=--=----------.--------_-----:------
ELIASON DONALD R/CHATTY'C EMERALD•ROOFING INC
55830 PINEHURST P.O BOX 1963.
LA.QUINT CA,. 92253`d PAL -DESERT. -MS . CA 92261
WCC..: ' STOVE INS
C
W. 63:910804. 01/0.1/05.
CSLB:. 77.0940 11./30/05
CCC.: C3 9
- - - - - -- =3 _---- - - - - -- -- -- -----
Permit RE -ROOF'`
Additional. desc.
Permit.Fee 30.00 Plan -Check Fee •.00
Issue Date. Valuation 0
Expiration'Date 10/,19/.041.
Q'ty Urit Charge .Per Extension
'BASE, FEE 30.00
Special Notes and -Comment's
RE' ROOF MITH POLYFOAM
Fee summary Charged Paid Cred-ted Due
Permit .Fee .To:tal 30.00 .. 00• .00 30.00.
Plan .`Check Total . 00. .00 .00. ...'00
Grand Total ;30'.0:0 •.00 .00 30.00
P.O. BOX 1504 l�I��
VOICE (760) 777-7012
78-495 CALLS TAM►ICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 a INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: 6) 4-35-8-5 1 Date.
Applicant:
Applicant's Mailing Address:
Architect or Engineer. ' '
Architect or Engineer's Address:
Lic. No..
BUILDING PERMIT DECLARATIONS
8�1A
1 hereby affirm under LICENSED CONTRACTOR'S DECLARATION
try ll perjury that I am kwmad under provisions a Chapter 8 (=n=ncig with Section 7000) a Division 3 a the Business
an0 Professiornats
ane my license is h tu0 force and ettwset
1 hereby affirm under OWNER-BUIL.DER DECLARATION
penalty a perjury that I am exempt from fro Contrados' Stale license Law for the Wowing reason (Sec. 7031.5. Business and Professions Code: Any
city or county that repairers a Permit b comstrud, WW. improve. demolish, or repair any ctrucgrre, prior b Its iuuamoe, also requires the applicant for this permit b Tis a signed
statenmeri that hire orilhe is ioensed pursuant b the ppvisions Of Ire Contractors' Stab License Law (Chapter Y (consrbncing with Section 7000) of Division 3 of the Business
an aPP Code) or that he or she is exempt i mehom and the basis for the alleged exaWbon• Any violation a icant Section 7031.5 by any appfor a permit subjects
ICY Of not more than live hundred dollars ($500).):
C.) 1. as owner a the
PVP". or my WnPbyees vft wages as their $ob C=VensaiiM will do the work and the structure is not intended or offered for sale (Sec. 7041.
Business and Professions Code: The Contractors' Stab License Law does not apply to an owner of property who builds Or improves thereon, and who does the work
himselfold el
or through his or her own employees, provided that the improvemeft we not intended or aft ed for sale. H. however. . building or improvement is
thin one year a completion, the owmer"Wilder will have Yue burden a proving that he or she lid not build or improve for Yue purpose a ).
sale.
C.) 1, as owner of the property. am exclusively contracting with licensed contractors to construct the Project (Sm 7041. Business and Professions Code: The Contractors'
Stab License Law does not appy b an owner of property who builds Or improves thereon, and who contracts ter the projects with a COntracbr(s) licensed pursuant to
the Cw acboW State License Law.).
V I am exempt under Sec. _ . a.& P.C. for this reason
Date Owner
affirm node penalty a WARS' COMPENSATION DECLARATION
1 hereby a
Perjury one a the following declarations:
_ I have and wilwork
or w! d in a is pot.. i a consent b self -insure for wOrkers eeapensad0n. as primed for by Section 3700 a the Labor Code. for the
perttimmmanoe
a the work for which this pemNt is issued.
_ I have nd will maintain wwkeW compensation insurance, as required by section 3700 a the Labor Code, for the performance of the work ter which this permit is
CP l eerier and policynunmber see:
T 3=
_ I Certify that, in the per{orrrmance a the work terfor which this permit is issued. I shall not employ any person in any marrmer so as to become subject to the workers'
compensation laws qt Cablorria. ant agree 9181. it 1 should become subject b the workers' compensation provisions of Section 3700 of the Labor Code. I shall
forthwith Comply with those provisions,
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 ATTORNEYS FEES. .
I hereby affix minder CONSTRUCTION LENDING AGENCY
P°^�y a P�u!y that trove is a construction lending agency for the performance of the work for which tis pe... is Issued (Sec. 3087. Civ. C.).
Lenders Name
Lenders Address
IMPORTANT Application is hereby made to the Director of BAPPLICANT ACKNOWLEDGEMENT
on upon whose behalf Uis ung and Safety for a permit subject b time conditions and restrictions set forth on tis application.
1. Each pers
issued as o result a Itis a troy' is fie' each person at whOSe request and for whose benefit work is performed under or pursuant b any permit
officers, saris aryl fib' the owner, and the applicant• each agrees b. and shall, defend. k0mvi nify and hold harmless ft City a La Oufrnta, Its
employees for any ad or omission related to the work being performed under or tonowina Issuance of this perrrdt.
Any permit Issued as a result Of this application becomes null and void N work is not commenced within 160 days from date of Issuance of such permit or
cessation of work for 180 days wM subject peril to cancellation.
1 certify that I have read this application � nod stat et a above Information is correct. I agree b comply with all city and county ordinances and state laws relating b building
construction, and hero w0wrize representatives County 10 enter
upon the above-mentioned property for Inspection purposes. .
Signature (Applicant or Agee