06-4374 (RR)S -v
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
06-'00004374 -
Property Address:
77010 AVENIDA FERNANDO
APN:
658-240-012- -
Application description:
RE -ROOF
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
24110
Tit 4 4vQ"
Applicant: Architect or Engineer:
-----------------
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
I hereby affirm under penalty of perjury that I am licensed under pro ns of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Professionals Code, d my
nse is in full force and effect.
License Class: C39 icense 4 Li 07
/! s
ate:/ Z� l/ tractor:
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).:
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.).
(_) 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.).
(_ 1 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:
LQPERMIT
Owner:
DIXON
77010 AVENIDA
LA QUINTA, CA
FERNANDO
92253
Contractor:
PETRONELLA ROOF CO
68314 KEILEY ROAD
CATHEDRAL CITY, CA
(760)324-5482
Lic. No.: 460707
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 12/26/06
---------------------------------- ------ --
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 3700 of,the Labor Code, for the performance of the work for which this permit is
issued.
1 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 1801579
I certify that, in the performance of the work for which this permit is' sued, I shall not employ any
person in any manner so as to become subject to the workers' pensation laws of California,
and agree that, if I should become subject to thew rkers' co pe ation provisions of Section
3700 of the Labor CodA, I shall rthwit ly ith os pro sions.
plicant:
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 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 hereb authorizer resentatives
of this ' my to enter upon the above-mentioned property Jor insp ction pur 4.
ate: 12—_26_"V lure (Applicant or Agent):
—.11, 111-f
Application Number
06-00004374
Permit . . . RE -ROOF
Additional desc .
Permit Fee 30.00
-Plan Check
Fee
.00
Issue Date . . . .
Valuation
. . .
. 0
Expiration Date 6/24/07
Qty Unit Charge Per
Extension
BASE FEE
30.00
---------- -----------------------------------------------------------------
Special Notes and Comments
RE -ROOF WITH POLYURETHANE FOAM SYSTEM
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
Bin # City of La Quinta
Building 8t Safety Division _
----- --permit#J— -O. Box 1504, 78-495 Calle Tampico
3'1 - La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
1 I I I 1 I - I Total Permit Fees
Project Address: /
�•
Owner's Name: X
GN
A. P. Number:
Address: y,
Legal Description:
Contractor: e4oOnff.44 /�/U�/�d t5r
City. ST, Zip: K,
Telephone:
��. �� •
Address:�
Project Description:x
City. ST, Zip: y� &1L d Z [* Ol
t A44.7er
Telephone: ne: K
G
a
D
State Lic. # : k, p+
City Lic. #:
Arch., Engr.. Designer:�`�
Address:
City, ST. Zip:
Telephone:
State Lic.
Name of Contact Person:x
��A
Construction Type:
O ccu cN•:
Project tYPecirc a one1
Sq. Ft.:
New A dd'n Alter Repairair Demo
#Stories: # Units: 460
Telephone # of Contact Person: (
Estimated Value of'Project: Xor_Z�4,11,00
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Ree'd
TRACKING
PERA{IT FEES
Plan Sets
Plan Check submitted
Item Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cales.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
"Grading plan
2nd Review, ready for corrections/issue.
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
SMJ.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
1rd 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
1 I I I 1 I - I Total Permit Fees