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07-1928 (RR)Tit(t 4 P.O. BOX 1504 VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 7/03/07 Application Number: 07-00001928 Owner: Property Address: 78451 PALM GARDEN. PL TIM LANDRUM APN: 643-181-001-38 -2117 - 78-451 PALM GARDEN PL Application description:. 'RE-ROOF LA QUINTA, ,CA 92253 Property Zoning:, LOW DENSITY RESIDENTIAL Application valuation: 14800 n Contractor: Applicant: Architect or Engineer: CASTRO ROOFING INC C P O BOX 122 n THOUSAND PALMS, CA 9227 O (760)343-0042 RlQ W Lic. No.: 828478 - � r LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATIO I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with_ _ I hereby affirm under penalty of perjury one of the following declarations: _ Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. - " - _ I have and will maintain a certificate of consent to self-insure for workers' compensation, as provided License Class: C39 ense o.: 828478 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is , issued. Date 3 D ? Contractor: (� 0 j �/ bG� - - _ 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 OWNER-BUILDER DE RATION insurance carrier and policy number are: I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier STATE FUND Policy Number 285000245206 following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to _ I certify that, in the performance of the work for which this permit is issued, 1 shall not employ any construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any manner so as to become subject to workers' compensation laws of California, ' permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if I should become subject to th orkers' compensation provisions of Section License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and-Professions Code) or 3700 of the Labor Cody7 shall forthwith with se rovisions. 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).: Date: Applicant: ( 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 WARNING: FAILURE TO SECURE RKERS' COMPENSATI COVERAGE IS UNLAWFUL, AND SHALL Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRI NAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND and who does the work himself or herself through his or her own employees, provided that the DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. 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.). APPLICANT ACKNOWLEDGEMENT (_ 1 .1, as owner of the property, am.exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of conditions and restrictions set forth on this application. ' property who builds or improves thereon, and who contracts for the projects with -a.contractor(s) licensed . 1. - Each person upon whose behalf this application is made, eachpersonat whose request and for pursuant to the Contractors' State License Law.).. whose benefit work is performed under or. pursuant to any permit issued as a result of this application, (_ 1. I am exempt under Sec. ,B.&P.C. for this reason 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 followingissuance of this permit. ' Date: Owner: - 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 CONSTRUCTION LENDING AGENCY permit to cancellation. 1 hereby affirm under .penalty of perjury that there is a construction lending agency for the performance of the I certify that I have read this application and state that the above informationis correct. I agree to comply with all work for which this permit is issued (Sec. 3097, Civ. C.). • cityand county ordinances and state laws relating to buildinWinsspact2n ion, and he authorize representatives . of this county to enter upon the above-mentioned property purpo s - Lender's Name: Date: Signature (Applicant or Agentl: • Lender's Address: - - LQPERMIT Application Number . . . 07-00001928 Permit . . . RE-ROOF Additional desc . Permit Fee 30.00 Plan Check Fee .00 Issue Date . . . . Valuation 0 Expiration Date 12/30/07 Qty Unit Charge Per Extension ' BASE FEE 30.00 Fee summary Charged Paid Credited Due Permit.Fee Total 30.00 .00 .00 30.00 t Plan Check Total .00 .00 .00 .00 Grand Total 30.00 .00 .00 30.00 LQPERAIIT Bin # City of La Quinta Building U 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: ,. Owner's Name: O A. P. Number: Address: Legal Description: City, ST, Zip: JI z Z Contractor: Telepho �w� 6� 2 GtO Project Description: s . , Address: City, ST, Zip: Telephone:a a State Lic. # : Arch., Engr., Designer: City Lic. #: Address:. ' City, ST, Zip: Telephone: 'N Construction Type: Occupancy: State Lic. #: Project type (circle one): New Add'n Alter , Repair Demo Name of Contact Person: 621 Sq. Ft.: 5300 1 # St ries: T# Units: Telephone # of Contact Person(%V ) Estimated Value of Projec Le C V APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rec'd TRACKING PERMIT FEES Plan Sets Plan Check submitted,- Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Energy Calcs. Plans picked up Construct®n Flood plain plan Plans resubmitted Mechanical . Grading, plan 2"d Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. 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. Wks. Appr Date of permit issue School Fees j Total Perm it Fees