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07-0179 (RR)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 07-00000179 . Property Address: 50107 CALLE OAXACA APN: 773-340-024-24 -14496 - Application description: RE -ROOF Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 3770 Applicant: Architect or Engineer: ,SIA ----------------- LICENSED CONTRACTOR'S DECLARATION 4 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT I hereby affirm under penalty'of perjury that am licensedunder provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my license is in full force and effect. License ss: B C39 LiceriseNo: 235717 ate: (�2 ntractor: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from tf a 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 o 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'ernployees,'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 hear she did not build or improve for the purpose of sale.). f—) 1, 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. 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: LQPERMTT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 1/18/07 Owner: HAMMILL CRAIG W *NOT ON.FILE UNKNOWN, CA 99999 Contractor. D WESTERN PACIFIC ROOFING CO d 3462 LA CAMPANA WAY PALM SPRINGS, CA'92262 p (760)416-5877 JAN 2 g 2007 Lic. No.: 235717 QTYLAQUINTA -------------------------------------------- WORKER'S COMPENSATION DECLARATION hereby affirm under penalty of perjury one -ofthe following declarations: _ I have and will maintain a certificate 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 STATE FUND Policy Number' 046001635506 _ 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 Code', I sshh II forthwith c mplY with those provisions. ate:, ' f cant:./!L✓/ WARN( 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 1$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 fora 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. 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 oft ���Applicant above-mentioned property for inspe oS urpos ate: or Agent)' Application Number . . . . . 07-00000179 Permit . . . . . . RE -ROOF Additional desc . . Permit Fee 30.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 0 Expiration Date 7/17/07 Qty Unit Charge Per Extension BASE FEE 30.00 ------------------------------------------7--------------------------------- Special Notes and Comments REMOVE EXISTING TILES & INSTALL NEW UNDERLAYMENT. REPLACE ORIGINAL TILES 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 LQPERAI IT