07-0747 (RR)ft
c'1•
if
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: E-07-00000747
Property Address' 79660 CORTEZ IN
APN: 649-063-004-72 -2180 -
Application description: RE -.ROOF
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 12500
T44t 4 4 Q"
Applicant: Architect or Engineer:
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
I hereby affirm under penalty otperjury that I am licensed under provisions of Chapter 9'(commencing with
Section 7000) of Division 3 of the:Business and Professionals Code, and my.Ucense is.in full force,and effect.
License Class: G39 License No:: 786931
Date= `s - Contractor'41-4
OWNER -BUILDER DECLARATION
I hereby affirm under -penalty rjury that 1 am exempt from the Contractor's State License Law for the
following reason (Sec. 7031:5, sinew 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 (8500).:
1 _) I,. as owner of the property, or my employees with wages as their sole comperisation,. will.do the work, and
the structure:is not intended or offered for,sale ISec. 7044, Business and Professions Code: The
Contractors' State License Law does not.apply to an owner of property who buildsor 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. it, however,the building or improvement is sold within
one year of completion, the.,owner-builder will have the burden of proving the he or she did not build or
improve' for the purposa' 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 contractors) licensed
pursuant to the Contractors' State License Law.).
1 _ 1 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 thwperfarmance:of the
work for which this permit is:issued (Sec. 3097, Civ. C:1.
Lender's Name:
Lender's Address:
LQPERMIT
Owner:
MR PATTERSON
79660 CORTEZ'LANE
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/13/07
. 6 1
Contractor: q q
JLM ROOFING CO ��HR 1 3 Lool
18449 LA CANADA CT _
BLOOMINGTON, CA 92316 CiiYOFLA Qbr
(951) 805-6386
Lic. No.: 786931 ---
WORKER'S COMPENSATIOWDECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certificate ofconsent toself-insure for workers' compensation, as provided
for by Section 3700. oftfie Labor Code; for the performanceof 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 1826276
_ I certify that, in the performance, of the work for which this permit is issued, I shall not employ any
person in any manner sores to.become subject to the workers' compensation laws of California,
and agree that, if I should become subject to the workers' cympensation provisions of Section
7 3700 of the LZan
bCod.0 I shall forthwith comply with th Sre provisions.
-Date!3/ ,Applic
WARNING: FAILURE TO SEKERS' COMPENSATION COVERAGE IS'UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TL PENALTIES AND CIVIL FINES'UP TO ONE HUNDRED THOUSAND
DOLLARS (,$l 00,000). 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.
t. Each person.upon whose behalf this application is made, each person at whose request and for
whose benefit work is performed under or pursuantto 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
of Le Ouinta, 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�:heereby authorize representatives
of-thjs,eounty to enter upon the above-mentioned property r 1-s7cion purpop
- Signature Applicant Agent): .�
s0
t:QPMmff
Application Number . . . . . 07-00.000747
Permit . . . RE -ROOF
Additional desc .
Permit Fee . . . . 30.00 Plan Check
Fee
.00
Issue Date . . . Valuation
. . .
. 0
Expiration Date 9/09/07
Qty Unit Charge Per
Extension
BASE FEE
30.00
-------- - -----------------------------------•----
SpecialNotes and Comments
REMOVE EXISTING WOOD SHAKE ROOF -REPLACE
WITH MONIER CEDARLITE.TILE PER ICC ER
2656. CLASS "A" MATERIALS ONLY
Fee summary Charged Paid Credited
Due
--------- --------- ----------- ---------I-
Permit Fee Total 30.00 .00
----------
.00
30.00
Plan Check Total .00 .00"
.00
.00
Grand Total 30.00 .00
.00
30.00
B'" #
City of La Quinta.
Building at Safety.Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
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Project Address:'
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Owner's Name:
A. P. Number:
Address:r, 7
Legal Description:
Contractor: J L nj
(c) 60 ,
City, ST, Zip: v Z Z 3
Telephone:
Address:
LCA
At' CC C
Project Description:
City, ST, Zip:
Telephone:
/z4rJ.kMIS6
— vi741
State Lic. # : G 75I
Arch., Engr., Designer:r
City Lic. #:
l C 3
CE� >" 1
Address:
'
City, ST, Zip:.
-- 2 05ill,
Telephone:
State Lic. #:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
O
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Sq., Ft: 17' 1
# Stories:
# Units: r
Telephone # of Contact Person:
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Estimated Value of Project: .,p q
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Reed
TRACMG .
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cales.
Reviewed, ready for corrections
Plan Check'Deposit
Truss Cala.
Called Contact Person
Plan Check Balance
Energy Cales.
Plans ticked up
Construction
Flood plain-plan
Plans resubmitted
Mechanical
Grading plan
V Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact PersonPlumbing
.Grant Deed
Plans picked. up
S:M.I.
FLO.A.,Approval
Plans resubmitted
Grading
INHOUSE-,
3W Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
AXP.P.
Pub. Wks. Appr
Date of permit June
School Fees
Total Permit Fees
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