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04-3587 (RR)"TM w iBU1[ DING ,`& SAFETI ;DEWLTMENT � P.D.: BOX 1504, (760) 777-7012 cOF:Tt�9 7.8-495 CALLE TAMPICo FAX (760) 777-7011 LA ,QUINTA; CALIFORNIA '92253 INSPECTION ;REQUESTS (760).777-7153 , BUILDING PERMIT'. Application' Niimber 04; 00003587. Date 4/19/04 Property:Address' . 5:5.920 PI<NEHURST APN : `775 - 2'41`-:0.1"8 -_ Application description.'. RE RGOF.` Property Zoning ;;LOW': DENSITY RESIDENTIAL Application valuation. 3:SOD. Owner .Contractor', -=---- -------------- ------------------- FAIT, - --' -=-- FAIT, EYE L. TRUSTEE EMERALD'ROOFING INC 5`5920. P,INEHURST. P.',P. BOX 1963 LA . QUINTA, CA -'PALM DESERT-. CA 92 261 LA' QUINTA,. CA 92.2.5.3. . STOVE-. INS 6391.0804 01./01/05 ?,, 3 CSLB;.. 770940:° 11/30/05 CCC'.: C39.. Permit RE' -ROOF .. Additional de'sc ' . Permit Fee. 30.00 Plan:-Che'ck': Fee .00 Issue Date . . . Valuation : 0 Qty Unit Charge Per Extension 'BASE. FEE 30.00 --------------------------------==--------- ----------------J------------ Special.Notes'and Comments RE` -ROOF `WITH 'POLYFOAM' Fee summary, Charged PaidCre:d:ted '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. ..^ 4v f230 P.O. BOX 1504 :���� VOICE (760) 777-7012 78-495 CALLE TAM►ICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 449 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: Jr 1 1 nafp- Applicant: Applicant's Mailing Address: /h . A �b C/P %.01 Architect or Engineer. Architect or Engineer's Address: Lic. No.: BUILDING PERMIT DECLARATIONS I hereby affirm under LICENSED CONTRACTOR'S DECLARATION P �(Yuo1f perjury final 1 am licensed under provisions a Chapter 9 (commencing with Section 7000) of Division 3 a the Business and-Prolessionals �Clamyss c�—+-UWPSO le �S brce and effect 1 hereby affirm under penalty of perjury that I am OWNER�BUIL ER DECLARATION City Of =KKY that requires a permit b congkUCL fiSher, from the 'Stab License Law for the following reason (Sec 70316. Business and Probs:Iorms Code: Any 'statenm that he or R licensed 01ia derrmoish, Or repair any structure. priorto its Issuance. also requires the appww for ths penNt b Use signed and Prvfe::iors Code) «that he «stiesk a b to provisions a the CorMraebrs' State lkanse Law (Chapbr 9 (oamrencing with Section 7000) a Division 3 a the Business the applicant b a Civl exec the�0fm and the b�ssis for Mme alaged exemp6m Any violation of Section 7031.5 by" appieant for a permit subjects U I, as owner of the Ory of not more than live hundred dollars ( SW0 ): property. or my °lnaoY°es �n �s as their sole oompensaf on. will do the work and the structure is not intended of dIered for cab (Sec, 7044. Business and Professions Cade: The Cortraabrs' State License Law does not apply b an owner of property who bualds or improves thereon, and who does the work soldhirnself or herself n one or through his « her own efrpbyees, provided that the improvements am not Intended or offered for sale. ff. however, the building or irpvvwnent is year of completion, the owner: builder will have the burden of provirp that he or she did not build or improve for the purpose of sale.). U 1, $s owner of the properly. am exclusively owner of g with licensed contractors b construct the Project (Sec, 7044, Business and Professions Code: The Cortracbrs' the Contractors' State License Law.). Stab License Law does not appy b an owner of property who builds Or irtproves thereon, and who contacts for the projects with a contrador(s) licensed pursuantb U I.am exempt under Sec _.a.& P.C. for this reason Date Owner 1 hereby affirm under WARS' COMPENSATION DECLARATION penalty of Perjury one of the following declarations: I aVefhe workand wilt maintain a cerffcate of consent b seWrsu m for w0fkeW compensation. as provided for by Section 3700 of the Labor Cade, for the pdfomnanoe midthis pet.. is issued. I have and will mai rtain wokeW com0en4a60m insuaanee, ss required by Section 3700 of the Labor Code. for the performance of the worts ler which this permit is Issued. My V506 s' enSation Insurance carrier and policy number am: _ I cef4fy that, in the Performance of the work for which this permit is liessued. I shall not employ any persm in any nwn ner so as to become subod b the w0riers' Compensation laws of Caibmta, and agree that, if 1 shOM become subject b the waters' compensation Provisions of Section 3700 of the labor Code. l shall forthwith comply wtlh Diose provlsiorm WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS 11Pt AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE Hl1NDRED THOl1SANp DOLLARS (=100.000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR 1N SECTION 3706 OF THE LABOR CODE, IREREST, AND ATTORNEYS FEES. . I hereby affwm undo CONSTRUCTION LENDING AGENCY Many d De>t+!Y that there k a conation lending agency for the performance of the work ler which this permit is issued (Sec. 3097. Civ. C.). Lendees Name Lenders Address tjIMPORTANT Application Is hereby made b the Director of APPLICANT ACKNOWLEDGEMENT Btaddii ng and Sefey ler a permit subject b the conditions and restrictions set forth on this 1. Each person upon wfwse behalf this appiea6pn is made, each Person at whose request and for whose benefit work is performed under or pursuant to b any penult B aa a result of this i om, Nthe owner, and the apPrf=K each agrees b. and shall, defend. indemnify and hold harmless the City of Le Oidia, Its vents and erpbyees for any act «omission retated b 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 eofmmneed within 190 dltys from date of issuance of such pentyl, or cessation of worts for 180 days will subject Pem* b canoeltafion. I certify that I have read Us application and state that the above information is correct. I agree b comply with ail city and county ordinances and state laws relating b cofstrudion, and hereby auitmorrixe representatives of this County b enter upon the above-mentioned property for inspection purposes. building ,-.,DateU ^LG "C-C�lig„ nature (Applicant or Agent).