04-3586 (RR)BUILDING &`:,SAFETY DEPARTMENT
c s - P.0 .Box 1:504
(760) 771-7011',"
OF:T1'�9 78-495 CALLE°TAMPICO
FAX (760)'777-7011
LA .Q.UINTA, CALIFORNIA 922'53
INSPECTION -REQUESTS (760):777-7153
BUILDING PERMIT
Application Number
-04000`35.8.6 Date' 4/19%04 J
Property Address
55-8-5.&- P-IN•EHURST
APN:
775-2.4,1-0.15-' - -
Applicat.ion descri;pt pn . •.
RE -ROOF
Property Zoning
;LOW .DENSITY RESIDENTIAL
Application valuation
3"500 ? "
Owner
Contractor
---------------------------------
------ --_--------
DELGRANDE KEVAN/ANITA
EMERALD •ROOFING INC
,19,63:
PAtk- DESERT - CA 92-261
WCC-__. ' 'STOVE -INS
WC 615 f0804 01/01/05.
CSLB770940.. 11/30/05
Ca:3 9'.
--.------------------------ - -----
'., pCC.C
7- -------
Prmit . . . RE.ROOF •
Additional + desc
-Permit Fee 30.00
..Plan Check Fee '.00
Issue Date.
Valuation' : 0
Qty. Unit.Charge: Per.
.Extension
BASE -FEE -30.00
Y:::' .. -
Special Notes and Comments.."
RE -ROOF WITH POLYFOAM
Fee..summary Charged
Paid Credited Due
------------- ----
--_=_=� _r =- -- ------------
----- ---Permit
Permit.Fee Total 30.'00°;
~00.'.. .00 .30.00
Plan Check Total 00;
00. 00« :00.
Grand Total 30 .`00
00 : 00: ' 30...00
P.O. Box 1504 • � VOICE (760) 777-7012
78-495 CALLS TAMIICO FAX (760) 777.7011
LA QUINTA, CALIFORNIA 92253 44a
INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number.04-.358(o Date:
Applicant:
• ..Address*
Architect or Engineer. --
Architect or Engineer's Address:
Lic. No..
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under panalty d�
pY that I am licensed m nCW se is in face .nit enact. °f °1"�01a d Chapter 9 (00mm�with n Sectionn 7000) d a Division 3 to easiness «nit Piolessionnls
j, o=Cl :my Lioerh
' 3 . -7'7 Q q L4 c�
I hhereby affrm under penally d perjury Mat I am OWNER$UII.DER DECLARATION
city or county that reQuires s pemrt b corstrnrct irorrh the Cormtraelors' Stsb License Low !« the fig reason (Sec 7031 5. Business and Processions Code: Any
staeertment Mat he «she is licensedlovemove' ' or array structure. D� b Rs issuance. also requires the applicant forte permit fi
t e a signed
d Professions Code) «Mat he d pu suart provisions d the Contraclors' Stab License Law (Ctapler 9 (commencing with section 7000) d Division► 3 d 1 e Business
anor she Is d
appkant n a ria exempt 1"aaarn and the Innis f« the alleged exer Vkm /any vtoletion d mit section 7031.5 by any appiarmt for a persubjects
Inen�y d not more Man lire hundred dollars (SM).):
U I. as owner of the property. Or my employees with wages as their sale compensation, will do the work, and Ma structure Is not irlended «offeree ler sale (Sec. 7044•
Business and Prdessions Code: The Contractors' Stale License Law does not appy to an owner of property who builds Or Improves thereon. and who does the work
himsel or herself or through his or her own employees, provided that the improvements are not intended or offered for sale. If. however, the 6 A S n «improvement is
sold within one year of completion, the owner builder will have the burden of proving that he or she did not (wild or improve for the purpose of sale.).
() 1, as owner of to property, am l y to an o contracting with
State License Law aces not apply an olcsrmW �tractOm b construct the project (Sec. 7044. Business and Professions Code: The Contraciors'
the Contractors' state License Law.). owner d property who bt" «improves twmt and who contracts f« the projects with a contrsctor(s) icensed pursuant lo
U 1 am exempt under Sec. . 8.3 P.C. for this reason
Date t>tiwmer
1 affirmWORKERS' COMPENSATION DECLARATION
hereby am under
ply of pejurY one of the bowing declarations:
—I have and win maintain a catiiate of orient bI•h
sesue ler w«rs
ke' compensation. as provided f« by Section 3700 d Labor LabCode. ler Me performance
of the work ler which this pet.. is issued.
I have and willorkeain workers' compensation insurance, as required by Section 3700 a the Labor Code. f« the performance a the work ler which Mrs Pew is
wow S' comPenuion-d Poky number am:
tswArnm cornier an
I certify riot, in the performance of the work ler which the permit is issued, l shall not employ any Person in any manner so as to become subject b the workers•
ompcompensation
laws of California. and agree Mat, It I should became subject b the workers' compensation provisions of Section 3700 d the tabor Code. I shall
Y with those provisions.
� p .2- — C,
WARNING: FAILURE TO SECURE WORKERS• COMPENSATIO�CMIM�Unxc 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 TI
SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. .IN
I hereby afirm undo CONSTRUCTION LENDING AGENCY
penalty of perjury that here is a construction lending agency for the performance of the work ler which this permit is issued (Sec. 3097. Civ. C.).
Lenders Name
Lenders Address _
IMPORTANT Application Is hereby made to the Director dAPPLICANT ACKNOWLEDGEMENT
Building and Safety ler a permit subject to the conditions and restrictions set brth on this appiatiom
1. Each Person upon whose behalf Mrs application is made. each person at whose request and for whose benefit work is perlormed under «pursuant b any permit
Issued a$$resulta f this application, the owner. and the applicant, each agrees 10. defend
.indemnify
and shall. defe. indemnity and hold harmless the City d la Quints. Its
2 employees for any ad or omission rotated to the work being performed under «following issuance a Mrs
Y permit issued as a result a this application becomes null and void I work is no(commenced within 190 dhlys from date a issuance of such per.. or
cessation Of work ler 180 days will subject permit b cancellation.
I certify that I have readyth is application � a above Information is correct. 1 agree b comply with all city and county ordinances and state laws relating b building
construction, and hero authorize representatives county to enter
upon the above-mentioned property for inspection purposes.
/vane ` z L ^ y L
nature (Appicarnt « Agent