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06-1966 (RR)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Applicant: Td4t.4 stAQ"'. NORTE RESIDENTIAL Architect or Engineer: QIP. ------------------ LICENSED CONTRACTOR'S DECLARATION, BUILDING & SAFETY DEPARTMENT . BUILDING PERMIT 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 my License is in full force and effect. License Class: C39 License No.: 828478 ate: - t IOUtractor: 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).: (_ 1 I, as owner -of the property, or my employees with wages as their sole compensation, will do the work, and 40 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.). . (_ 1 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.). I—) I am exempt under Sec. , BAP.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: RICHARD YORK 78200 CALLE NORTE LA QUINTA, CA 92.253 Contractor: CASTRO ROOFING INC P O BOX 122 THOUSAND PALMS, CA 92276 (760)343-0042 Lic. No.: 828478 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 G Date: 5/11/06 MAY 12 2006 D wr_LA WORKER'S COMPENSATION DEC �RA� -7_ "rpm.QUIiVTA- I hereby affirm under penalty of perjury one of the following declarations: ���•t DE�"+•�� I have and will maintain a certificate of consent to self -insure for workers' compensation, as pro rded­ 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 285000245205 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 tr 1-3700 of the Labor Code, I s II forthwith comply with those provisions. ' te: F ` � ap plican WARNING: FAILURE TO SECUR ORKERS' 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 as or omission related to the work being performed under or following issuance of this permit. 2. Any permit issued as 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 county to enter upon the above-mentioned propert in ection purposes. Ba t gnature (Applicant or Age Application Number: . E 06-00001966 Property Address: 78200 CALLE APN: 7.70 -011 -008 - Application description: RE -ROOF Property Zoning: LOW DENSITY Application valuation: 4312 Applicant: Td4t.4 stAQ"'. NORTE RESIDENTIAL Architect or Engineer: QIP. ------------------ LICENSED CONTRACTOR'S DECLARATION, BUILDING & SAFETY DEPARTMENT . BUILDING PERMIT 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 my License is in full force and effect. License Class: C39 License No.: 828478 ate: - t IOUtractor: 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).: (_ 1 I, as owner -of the property, or my employees with wages as their sole compensation, will do the work, and 40 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.). . (_ 1 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.). I—) I am exempt under Sec. , BAP.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: RICHARD YORK 78200 CALLE NORTE LA QUINTA, CA 92.253 Contractor: CASTRO ROOFING INC P O BOX 122 THOUSAND PALMS, CA 92276 (760)343-0042 Lic. No.: 828478 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 G Date: 5/11/06 MAY 12 2006 D wr_LA WORKER'S COMPENSATION DEC �RA� -7_ "rpm.QUIiVTA- I hereby affirm under penalty of perjury one of the following declarations: ���•t DE�"+•�� I have and will maintain a certificate of consent to self -insure for workers' compensation, as pro rded­ 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 285000245205 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 tr 1-3700 of the Labor Code, I s II forthwith comply with those provisions. ' te: F ` � ap plican WARNING: FAILURE TO SECUR ORKERS' 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 as or omission related to the work being performed under or following issuance of this permit. 2. Any permit issued as 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 county to enter upon the above-mentioned propert in ection purposes. Ba t gnature (Applicant or Age LQPERMIT Application Number 06-00001966 Permit . . . RE -ROOF Additional desc . Permit Fee 30.00 Plan Check.Fee .00 Issue Date Valuation 0 ..Expiration Date 11/07/06 Qty Unit Charge Per Extension BASE FEE 30.00 ----------------------------------------- Special Notes and Comments. RE -ROOF WITH.FOAM THEN TILE, CLASS "A" MATERIALS ONLY Fee summary Charged Paid Credited- Due ` - Permit Fee Total=s 30.0.0 .0.0------.00 ----3C_�00 Plan Check Total 00 .00 ` .00 .00 Grand Total 30.00 .00 00 30.00 LQPERMIT