05-1814 (RR)AD
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
05-00001814
Property Address:
79645 CORTEZ LN
APN:
649-063-016-76 -2180 -
Application description:
RE -ROOF
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
17400
Applicant: Architect'or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
-------------------- -------------------------------
LICENSED CONTRACTOR'SDECLARATION
I hereby affirm under penaltyofperjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Divisionr3.of the Business and Professionals Code, and,my License is in full force and effect..
License Class: B License No.: 819833
vete: ttractor:
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 structure;. prior to its issuance, also requires theapplicant for the
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State.
License Low (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 fora permit subjects the.applicant to a civil penalty of not.more than five hundred dollars (8500).:
(_) 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 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 _ 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 Lew 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:tunder penalty of perjury that there is a.construction lending,egency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
LQFERMJT
Owner:
LENART PAT ANN
Contractor:
M D FIXALL
79645 CORTEZ IN
LA QUINTA, CA 92253
(760)613-4231
Lic. No.: 819.833
VOICE (760) 777-7012
FAX (760) 777-7011.
INSPECTIONS (760) 777-7153
Date: 7/08/05
u
DEC 13 2005
CITY OF LA OUINTA
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.
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 29566-2005
I certify that, in performance of the work.forwhich 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
700 of the Labor a, I shall forthwith comply with those provisions.
ata (cant:
WARNIN/:FAILURE TO'SECURE WORKERS' COMPENSATION CO - C11N�WFUL;ANDSHALL
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 subjecrto the
conditions and restrictions set forth on this application.
1. Eaeh'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 permitissued as a result of this application,
theowner, andthe applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La 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 applicationand 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 t enter on the above-mentioned property for inspection' purposes.
e:
re (Applicant or Agent):
,r.
.Application Number . . . . . 05-00001814
Permit . .
. RE -ROOF
Additional desc .
Permit Fee . . .
. 30.00
Plan Check
Fee
.00
Issue Date . . .
.
Valuation
. . .
. 0
Expiration Date
1/04/06
Qty Unit Charge Per
Extension
BASE FEE
30.0'0
------------------------
Special Notes and
---- ------
Comments
RE -ROOF WITH LIGHT WEIGHT TZLE AFTER
REMOVING EXISTING
ROOFING MATERIALS.
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
30.0.0
LQrF.RMrr
f
Bin #
City of La Quints
ild( ing 8t Safety MOM
Box 1504, 78-495 Calle Tampico
La (NMta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
PeM* #P.O.
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Projcd Mwress: -
Cp , G
Owner's Name:
A. P. Number
Address: ,3 �% Ty1;e-T D Y
Legal Description:
Contractor.
Address:
GO
City"ST, zip: i t0 0% 2 3
Telephone:
Project Description: G �
City, ST, zip:
Telephone: _
State Lie. #:
a
,3
3
G A
City Lie. #:
Arch., Engr., Designer.
Address:
City, STT, Zip:.
.
Telephone:
State Lic. k
Name of Contact Person:
S
Construction Type: Occupancy:
Projdct type (circle one): New Add'm Alter cpair Demo
Sq. Ft : `f d
# Stories:
# Units:
Telephone # of Contact Person:
0—
Estimated Value of Project: D D . O
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal.
Req'd
Rec'd
TRACIMG
PERMIT FEES
Plan Sets
Plan Check submitted
item
Amount
Structural Coles.
Reviewed, ready for corrections
f L,
Plan Check Deposit
Tram Calm
Ca1ledComtact Person
fr
PlanCbeek.Ralsuce
Title 24 Coles.
Plans picked up
j /7
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
V Review, ready'f corretli e`
IVJ
eat
Subcoutactor List
Ca11ed:Cootact Pe
Plumb log
Grant Decd
up e
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
Di HOUSE:-
Review, ready for correctb
7-1-0
Developer impact Fee
Planning Approval
Called Cootact•Person IA
A.LP.P,
Pub. Wks. Appr
Date of Meme
School Pees
Total Permit Fees
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