05-2470 (RR)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description
Property Zoning:
Application valuation:
Applicant:
>05-0000247.0
46840 CAMEO PALMS DR
643-194-005-60 -2117
RE -ROOF
LOW DENSITY RESIDENTIAL
7000
T4t�l 4 4 Q"
Architect or Engineer:
P M_
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Bu_qgNand Professionals Code, and my License is in full force and effect.
License Class: 9/ License No.: 810537
/ Date��` ontractor. KI
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to
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 Contractor's State
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
(_ 1 1, 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 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.).
1 _ 1 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 contractor(s) licensed
pursuant to the Contractors' State License Law.).
(_ I I am exempt under Sec. I , B.&P.C. for this reason
Date:
Owner:
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:
Lender's Address:
Li PERMIT
Owner:
SIESS KENNETH R
46840 CAMEO PALMS
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/20/05
Contractor:
N.FINANICE
ROOF TILE SPECIALTY, INC
P.O., BOX 11257A'nPALM DESERT, CA 92255N 2 2005
(760)200-0811
Lic. No.: 810537 Y OF IA Q1IINTA
DEPT.
--------------------------------------------
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
for by Section 37.00 of the Labor Code, for the performance of the work for which this permit is
issued.
have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
Code, for the performance of the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier EXEMPT Policy Number EXEMPT
I certify that, in the performance of the work for which this permit 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 should become subject to the workers' compensation provisions of Section
3700 of the La or -C , I shall forthwith comply with those provisions.
bate: �jQ pticant: _
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 ATTORNEY'S FEES.
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 Quinta, 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 permit, or cessation of work for 180 days will subject -
permit to cancellation.
I certify that 1 have read this application and state that the above information is correct. I agree to comply with all
city and county ordinances and state law relating to building construction, and hweby authorize representatives
of t�hiss c unt to']enter upon the above -me t o roperty for ins rposes.
DafE�- r/ ature (Applicant or ent):
V
-3'
LQPEINtIT
Application Number . . . 05-00002470
Permit . .
. RE -ROOF
Additional desc .
.
Permit Fee . . .
. 30.00'
Plan Check
Fee
.00
Issue Date . . .
.
Valuation
. . .
. 0
Expiration Date
12/17/05
Qty Unit Charge
Per
Extension
BASE
FEE
30.00
--------------------------------------
Special Notes and
Comments
--------------------------------------
RE -ROOF WITH CLASS
"A" SHINGLES
Fee summary
Charged
Paid Credited
Due
-----------------
Permit Fee Total
--------------------
30.00
----------
.00
----------
.00
30.00
Plan Check Total
.00
.00
.00
.00
Grand Total
30.00•
.00
.00
30.00
II JUN 2 0 2005.
CIn OF �A QUINTA
Bin #. - .
City: of La Q uin to
Building 8r Safety, Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address:
C�`v Owner's Name:
A. P. Number:
y�
Address:Qcitr ' I
Legal Description:
Contra r:
tra o
City, ST, Zip: V\ C F
1
1 P
Address: X
�2S Project Description:
City, ST, Zip:C
_
Tele on e:
'h
P �7 �.J V
-
State Lic. #:
Arch., Engr., Designer:
City Lic. #:
Address:
Citv, ST, Zip:
Telephone:
StateLic. #:
Name of Contact Person:
Constructionon Type:c• O ecu an _ --:
Project type (circle one):. : New A dd'n Alter r RcP atr Demoo
Sq. Ft.: # Stories: # Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd TRACKING PERMIT FEES
Plan Sets
Plan Check submitted Item Amount
Structural Cates.
Reviewed, ready for corrections Plan Check Deposit
Truss'Calcs.
Called Contact Person Plan Check Balance
Title 11 Cates..
Plans picked up Construction
Flood plain plan
Plans resubmitted Mechanical
Grading plan
2"' Review, read.• for correctionslissue Electricat
Subcontactor List
Called Contact Person Plumbing
Grant Deed
Plans picked up S.11i.1.
H.O.A. Approval
Plans. resubmitted Grading
IN HOUSE:-
Review, ready for corrections/issue Developer Impact Fee
Planning Approval
Called Contact Person A.I.P.P.
Pub.INTs. Appr
Date of permit issue
School Fees
Total Permit Fees