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04-6497 (RR)3 02 BUILDING & SAFETY DEPARTMENT P.O. Box. 1504 (760).177-7012 71�-495 r f1 LE TAMPICo FAX (760) 777-7011 L -A-1 TN I CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153. Hj SP 2'92004 BUILDING PERMIT 0111 OP LAQUINTA A�+,�"n" � - . i -E a t rombe 0 4= 0-0`0 0 6.4:9.7--� Date 9/28/04 Property Address . . . . . . 48801 SANTA URSULA ST APN: 646-130-0111- Application 46-130-011 Application description RE -ROOF Property Zoning . . . LOW DENSITY RESIDENTIAL Application valuation . . . . 250000 Owner Contractor COOK MARK D BAZUA ROOFING 48801 SANTA URSULA STREET P.O. BOX 1078 LA QUI NTA CA 92253 MECCA `. CA 92254 WCC: EXEMPT WC: EXEMPT 05/31/05 CSLB: 628223 09/30/05 CCC: C39 Permit . . . RE -ROOF Additional desc Permit Fee . . . 30.00 Plan Check Fee .00 Issue Date Valuation . . . . 0 Expiration Date 3/28/05` Qty Unit Charge Per Extension BASE • FEE 30-00. Special Notes and Comments RE -ROOF -WITH CLASS "A" MATERIALS - Fee summary Charged Paid' ' ` "Credi'ted Due Permit Fee Total 30.00 00 .00 .30.00, Plan Check Total 00 .00, .00 00 Grand Total 30.00 00 .00 30.0.0 4 P.O. Box 1504 78-495 CALLE TAMPICO VOICE (760) 777-7012 LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: Applicant: Applicant's Mailing Address: Date: q 1;7-E-0 Architect or Engineer: Architect or Engineer's Address: Lic. No.: MUILUINU PLKMIT DECLARATIONS 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 Business and Professionals Code, and ss Lice i in full force and effect /� /License Class ! License No. e1 7 /� � Date bntractor 042tA 4 &F iA,& OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I 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 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 Contractors' 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).): U 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 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 the Contractors' State License Law.). U I am exempt under Sec. BA 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 certifica(e of consent to self -insure 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 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 1 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 Labor Code, I shall forthwith comply /with those provisions. Date Y A=1� pplicant�� 11L� Lt P/ WARNI G: 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. 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 / t IMPORTANT Application is hereby made to the Director of Buildingand APPLICANT ANT CKNOWLEDGEMENT asubject to the conditions and s set forth on this application. 1. Each person upon whose behalf this application is made, each person at permit request and for whose benefit e work snPerformed under or pursuant to any permit issued as a result of this application, the owner, and the applicant, each agrees to, and shall, defend, indemnity and hold harmless the City o1 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. 1 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 county to enter upon the above-mentioned property for inspection u � purposes. Date g /i Signature (Applicant or Agent): cam. , BAZUA ROOFING CAL LIC # 628223 3027 DATE: -9/- P.O. BOX 1078 MECCA, CA 92254 WORK ORDER NO.. (760)397-3200 BILL T0:PHONE: CUST. L JOB: JOB ES AamA L DESCRIPTION OF WORK START DATE m WA MATERIAL WARRANTY,' LABOR GUARANTEE $50.OK FEE ON ALL RETURNED OR CANCELLED CHECKS. 10% -FEE ON ALL CANCELLED ORDERS. 4 Thank You TOTAL AMOUNT DUE AMOUNT PAID DOWN TOTAL BALANCE DUE NOT RESPONSIBLE FOR WIND OR INTERIOR DAMAGE. I REQUEST THE AB IE WO �ON 9 • ADP1�ir wr. e...... ... _ _ _ P.O. Box 1504 LA QUINTA, CALIFORNIA 92247-1504- BUILDING & SAFETY DEPARTMENT 78-495 CALLS TAMPICo (760) 777-7012 LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011 April 18, 2005 Mr. A. Bazua Bazua Roofing Company RE: Building Permit Extension Request — 48801 Santa Ursula Street. Dear Mr. Bazua: have received your letter dated 4/18/05, requesting an extension for the re-roof being performed at the above address under Building Permit#04-6497. Permit status: Permit issued: 9/24/04 180-day expiration date: ' 3/28/05 180-day extension date: 9/26/05 Under the provisions of California Building Code Section 106.4.4, your request is hereby granted. Because the Building Code specifies that "no permit shall be extended more than once," please be advised that unless the project passes its next required inspection on or before Monday, September 26, 2005, your building permit will expire automatically.