06-0315 (RR)P.O. BOX 1504
78495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 06 -00000315 -
Property Address: 78675 SAGEBRUSH AVE
APN: 646-311-017-17 -000000-
Application description: RE -ROOF
Property ZoniY MEDIUM DENSITY RES
ApplicatiQSI?j y00n: 5000
I hereby affirm ur
Section 7000) of
License Class:
Date: Contractor:
T"y/ . 4.44"
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING -PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
HARVEY R ANTHONY
130 VISTA VALLE
PALM DESERT, CA 92260
---------------------------------
Contractor:
Owner
Date: 1/19/06
--------------------------------------------------------------=
LICENSED CONTRACTOR'S DECLARATION .WORKER'S COMPENSATION DECLARATION
rjury that I am licensed under provisions of Chapter 9 (commencing withI I hereby affirm under penalty of perjury one of the following declarations:
Business and Professionals Code, and my License is in full force and effect. - _ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided -
License No.: for by Section 3760 of the Labor Code, for the performance of the'work for which this permit is
' OWNER -BUILDER DECLARATION - -
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 I, 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 hot 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.).
I, s.owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, business and Professions (:ride: The Contractors' State License Law does not apply to an owner of
U --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 am exempt under Sec. , B.&3,e7or this reason
Date: l t t" It f alp ! Owne 1 Y -
_ t f 3
�- CONSTRUCTION LENDING A CY _
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:
LQPERMIT
issued.
_ I 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 Policy Number
I�certtify 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 s become subject to the workers' compensation provisions of Section
3700 of the La ode/I shall forthwith comply with those provisions.
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COV.ERrAGE 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 I have read this application and state that the above information is correct. I agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of this�couply to enter upon the above-mentioned proper r inspection purposes.
61e[e: t \`►q fl� Signature (ApTplicant'gorAgennit -.
_ r
�. Application Number . . . . 06-00000315
Permit . . . RE -ROOF
Additional desc .
Permit Fee 30.00
Plan Check
Fee
.0"0
Issue Date
Valuation
0
Expiration Date 7/18/06.
Qty Unit Charge Per
Extension
BASE
FEE'
30.00.
Special Notes and'Comments
REROOF
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
LQPERMIT
1 ..
PERMIT APPLICATION
County of Riverside
t, Department of Building
and Safety
i. 4080 Lemon St. 2nd Floor 135 N. Alessandro Rd. Am. 203 880 N. Slate Street
227 North "D` Street 46209 Oasis 3t. Am. 310 160 N. Oro Jway
lI Riverside. CA 92501 Banning, CA 92220 Hemet. CA 92343
Perris. CA 92370 Indio, CA 92201 Blythe. CA 92225
E'• Ph: 787.6146 Ph: 849.7312 Ph: 658.4464
- Ph: 657.3898 Ph: 342.827 Ph: 922.2670
F? This permit becomes void it work nor commenced within 180 days Jrom date of issuance. OR. it work has been suspended or abandoned Ior a period of 180 days. : )
�i
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need rim be com-
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 ( comment-
pleted it The permit is for one hundred ($100) or less. I certify Thai in The performance 01 the work for which this,
Ing with Sectioh.7000) of Division 3 of the Business and Professions Code. and my license is in full force and effect.
permit is issued. I shall not employ any person in any ma I net so as to become subject to the Workers' Compensa-'
Zion Laws of California.
'
Date Apflicanl
eNOTICE
OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's License Law for the
TO APPLICANT: If, after making this Certificate ciExemption. you should become subject to the Workers' '
Compensation provisions Of The Labor Code. you must foil-iwith comply with such provisions or this permit shall be'
i following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to con-
deemed revoked.
• slruct, alter, improve. demolish, or repair any structure, prior to its issuance, also requires the applicant for such
'
permit to file a signed statement that he is licensed pursuant to the provisions of The Contractor's License Law
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
(Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Prolessions Code) or that he is ex-
ex-
1
❑I hereby that live feel into
and the basis for the alleged exemption. Any violation of Section 7031.5 by 0)any applicant for aper- '
empt subjects the
., mil subjects the applicant to a civil penalty of not more than five hunderd dollars ($500).):
certify no excavation (5) or more in depth which a person is required to descend. will,
be made in connection with work authorized by This perm , and that no building structure. scaffolding, falsework,
�• ❑ T, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the
or demolition or dismantling thereof. will be more than Ihir y -six (36) feet high. (Chap. 3.2. Grp 2. Art 2. Sec 341..
Title 8. C.A.C. ).
structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License
OAS owner -builder. I will not employ anyone to do war- which would require a permit Tom the Division of In -
Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or
dustrial Safety. as noted above. unless such person ha=_ a permit to do such work from the division.
through his own employees. provided that such 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 prov.
❑Division of Industrial Safety Permit No.
Y ing that he did not build or improve for the purpose of sale.)
� SS9S
iF ❑I, as owner of the property, am exclusively contracting with licensed contractors to construct the
CONSTRUCTION LENDING AGENCY: I hereby affirm ME there is a construction lending agency for the perfor-
project (Sec.
,t 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of properly who
mance of The work for which this permit is issued (Sec. 3097. Civ. C.).
builds or improves thereon, and who contracts for such projects with a contractors) licensed pursuant To The Con-
Lender's Name
reactor's License Law.)
Lender's Address
j ❑I am exempt under Sec. . B.d P.C. (Attach Certificate).
_. Dale Owner
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and stale
that the information given is correct. I agree to compl- with all slate laws and county ordinances relating to
' WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to sell -insure, or a
building construction, and authorize a representative of the County of Riverside. Department of Building and Safety
'-cerlilicale of Workers' Compensation Insurance, or a certified copy Thereof (Sec. 3800. Lab. C.).
to enler upon the properly for -which I have applied for,biis permit for the purpose of making inspections'/
r„`� Y �"� r
/�� •��
�,❑Certified copy is hereby furnished.
" '' ��'�
`�'~`
❑Certilied copy is filed with the County Building Inspection Department or County Department.
" fSignalure of Applicant or Agent - Dale "
—.:.PilR1
'APPLICANT NAME (L, F, MI) '
HARMON . ISUZANNE
MNO MARTINIQUE
&.C'.P�►`ISTAONES CTA 922010000
t1�7/�Y�9SJJr�R��yRy7EyS�S(gIIS�pP•ACE SAGEBRUSH AVE.
SAGEBRUSH
STPAC
�ISICjj�J°.�U,JAi'I CA 922530000
9O.A'I
.4V 1
u A-7
1
O T1
06,60TWIN
P E R M1-55484
to
S
WWTa a a 0 Vit
17
°�
Se
0MIIt' CLUB -.MANOR 01
pjF alB (`,MI)SUZANNE
PHONEp
CONTRACTOR -FIRM NAME
LICNC If
ADDRESS
CITYICOMMUN ITYISTATEIZIP
PHONE #
BLD NSPE OR FINAL DATE yyL
ARCIENG FIRM NAME
'Ile
LICNC #
ADDRESS
�D
CITYICOMMUN ITYISTATEIZI P
PLAN# _
PLANS EXAMINER
APPROVE DATE
WdUL INSP-,SE TI , SYS.
Do
% fN
FSB
� SS9S
COUNTER L.U.T.
D..
ZONE:ORD'#
LOT SZ
END/�
V V V V'
_ 1
8 .P E C I A' t.•
APPLIPRMT p PS
DATE 55484
1 N S P E
O T1
0 N
P E R M1-55484
t.
SPECIAL ANS"'M
FEE $30100
TOTAL.
FEE
$30,00
CA
CrX,
NC
•C UNT
COUNTER L.U.T.
•rc TAL PERMXT COST IS $30.00
`ORM 284.208 (11.81) INSPECTOR.
1 N S P E
O T1
0 N
P E R M1-55484
•rc TAL PERMXT COST IS $30.00
`ORM 284.208 (11.81) INSPECTOR.
NO.
OPERATION DATE
INSPECTOR
NO.
OPERATION
DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs 8 Frms
34
Plenums & Ducts
2A
Slab Grade
35
Furnace Comport.
3
Steel
36
Inlets & Outlets
4
Grout Blocks
37
Combustion Air
5
Bond Beams
38
Compressor
6
Roof Deck
39
Appl. Clearance
7
Framing
40
Fire Damper
8
Vents
41
Smoke Detection Device
9
-Garage Fire Wall
42
Commercial Hood 1
10
Fireplace P. L. E]
43
Final
10A
Fireplace T. 0.
OP"N
NO
_
ADDITIONAL INFORMATION
_ _
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13.—Finish.Grade. — — - • . • — _
INSULATION
Thick R
Value
7A Walls (Batts)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final
_PLUMBING APPROVALS
15 Ground Plumb
16 Water Piping
17 Rough Plumb
18 Vents
19 Sewage Disposal L
20 Sewer r
21 Water Heoter
22 Water Softener
23 Water Service
24 Gas Test
25
Final 2 `L
Tank Pit L.Line
REAR OF PROPERTY LINE
p
PSLp l P)
ff f
X 0 yy-
VV
ELECTRICAL APPROVALS
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final
STREET NAME
I— — — — — — — — — — — — — — — — — — — — — — — — — — — -- — — — — — — — — — — — —
a I .
DEPARTMENT OF BUILDING AND SAFETY . COUNTY OF RIVERSIDE
OFFICE DATE "
TIME -7" PERMIT NUMBER
INSPECTION
/REUUESTED
ADDRESS 1 SPACE N0. FOR:
;7e�— A. M.
OWNER OMMUNITY
P.M.
BUILDING PLUMBING ELECTRICAL MECHANICAL a PION
I
/ TUES.
WED j
REMARKS:
TH W
L
FRi
OWNER/CONTRACTOR TEL.NO.