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04-4559 (RR)MAY 2 =2004ITiht BUILDING & SAFETY DEPARTMENT C{T"(' Alail�Tl# FF -1 (760).777-7012 C�dfOF 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 922.53 INSPECTION REQUESTS -(760) 777-7153 BUILDING PERMIT Application Number 04-00n04559 Date .5/25/04 Property Address ..-. . . . . 46290 CAMEO PALMS.DR APN:. .643-182-001-6 -2043 - Application description . . . RE -ROOF Property Zoning . . . . . . LOW DENSITY RESIDENTIAL Application valuation 6000 Owner Contractor VANDORN'JAMES E -LEHMAN ROOFING, INC. 46290 CAMEO PALMS 13 SEACLIFF LA QUINTA. CA 92253 DOVE CANYON. CA 92679 (949) 888-1665 WCC: STATE FUND WC: 285000154 01/01/05 CSLB: 499608 10/31/04 CCC: C39. ------------------------------------ Permit 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 Special Notes and Comments.*. TEAR OFF EXISTING ROOR & RE -ROOF WITH 30 YEAR SHINGLES/ CLASS "A"- MATERIALS ONLY. Fee summary Charged' Paid Credited Due Permit Fee Total 30'.00 .00 ..00 30'.00 Plan Check Total 00 .00 .00 .00 Grand Total 30.0.0 00 .•00 30.00 P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number:�� Applicant: Applicant's Mailing Address: u�l �ti6v BUILDING & SAFETY DEPARTMENT "1 VOICE (760) 777-7012= FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: � Architect dl ngineer. Architect or Engineer's Address: tic. No.: BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION affirm I hereby arm under penalty of perjury that lam licensed under provisions of Chapter 9 ( ncing with Section 7000) of Division 3 of the Business and Professionals Code, and myLicens ' 1* I ice and effect.—,T`/^+/} 'License Class License No. `�� v rC. +� rA o a- �r ✓I.s Date � Contractor T OWNER-BUILDEk DECLARATION I hereby affirm under penalty of perjury that 1 am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any City or county that requires a permit lo construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions-Code)-or-ftt.he-or-she-is-exempt4herefrom-and-the-basis-for-On-alieged-exemption - inyMotaU of"S�031:576y any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): (-.) ),as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself or through his or her own employees, provided that the improvements are not 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.). U 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 to an owner of property who builds or improves thereon, and who contracts for the projects with a contractors) licensed pursuant to ft Contractors' State license Law.). U I am exempt under Sec. . B.& P.C. for this reason. Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certificate of consent to self4nsure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. _ I have and will mai�]Wn workers' compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is ue . wo�Yers' cOmg�nsation insurance prier nq ,-Carrier f� c� Policy Number _ I certify that In the performance of the work for which this muit is issued. 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 sh d become subject to the workers' compensation provisions of Section 3700 of the Labor code, I shall forthwith comply with those provisions. .Date �• �J G Applicant WARNING: FAILURE TO SECURE WORKERS' COM ENSATION 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 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. 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.). Lender's 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 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 Ouinta, 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 pemrit, or cessation of work for 180 days will subject permit to cancellation. h I certify that I have read this application and state that the above information is tamed I to amply with all city and county ordinances and state laws relating to building constructio ,and retry authorize representatives of this county lo ter upon the abo n • red property for inspection purposes. Z Date Signature (Applicant or Agent): FROM : LEHMAN FAX NO LtAMAN ROOFING INC. 12 WATER LILY WAY COTO DE LAZA, CA 92679 TELlFAX 949/888-1665 ITEM NAME / ADDRESS VANDORN RESIDENCE 46--290 CAMEO PALMS DR. LA QUINTA, CA 92253 ,.� --------- ITEM REROOF 949 888-166' May. 25 2004 08:10AM P1 DESCRIPTION TEAR OFF EXISTING ROCK R00>: TO PLYWOOD INSTALL NEW EDGE METAL AT PERIMETER OF ROOF NAIL 1 LAYER 30# FELT OVER PLYWOOD INSTALL 30 YR. DIMENSIONAL SHINGLES OVER COMPLETE INSTALL DURA -RIDGE AT ALL HIPS AND RIDGES INSTALL NEW ROOF FLASHINGS WHERE NEEDED SEAL AND PAINTALL ROOF FLASHINGS CLEAN AND HAUL AWAY ALL ROOFING DEBRIS. 5 YEAR LABOR GUARANTEE. CONTRACTOR WILL SUPPLY PERMITS EXTRA: $3.00 PER FOOT FOR ANY PLYWOOD REPLACEMEN( RESPECTIVELY SUBMITTED PROPOSAL ACCEPTED DATE VALID FOR 30 DAYS PLEASE SIGN AND RETURN OR FAX YELLOW COPY. THANE' CALIFORNIA STATE FUND - WORKERS COMPENSATION INSURANCE GEMINI - LIABILITY INSURANCE PROPOSAL DATE ! ESTIMATE NO. 04/13/'04 I 1563