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10-0003 (RR)P.O. BOX -1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 ;t Application Number: '10-00000003 Property Address: 52295 AVENIDA VELASCO . APN: 773-264-014-3 -000000- Application description: RE -ROOF Property Zoning: COVE RESIDENTIAL Application valuation: . 7700 T4iV1 4 4a Q" - BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Applicant: Architect or Engineer: ------------------ LICENSED CONTRACTOR'S DECLARATION 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 LicenseNo.: 336547 ! Date:Contractor! /jam y c � J/— OWNER -BUILDER DECLARATIONt/ 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 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 oroffered 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 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: LQPEEMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 1/04/10 Owner: D GARRIGUES MARY, 52-295 AVENIDA VELA LA QUINTA, 'CA 92253 (760)899-8421 fly 042010 Contractor: CITY OF LA gtUINTA MILLER & SONS ROOFIN 68760 SUMMIT DRIVE CATHEDRAL CITY, CA 92234 (760)328-6616 Lic. No.: 336547 ----------------------------------------------- WORKER'S COMPENSATION DECLARATION ' I hereby affirm under penalty of perjury one of the following declarations: . _ I have and will maint6in 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 238002574 _ 1 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 ��,�,,,,��jj 3 y --��700 of the Labor shall f rthwith coM211with those provisions. Date: 1 1. •Applicant: 1 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWF ,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.. 1 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 hereby authorize representatives of this county to enter upon the above-mentioned propGHy'iv 'nspe ion purposes ' "Date: r Signature (Applicant or Agent): LQPERMIT Application Number 10-00000003 Permit RE -ROOF Additional desc Permit.Fee . . . . 30.00 Plan Check Fee .00. Issue Date . . . Valuation . . . . 0 Expiration Date 7/03/10 Qty Unit Charge Per. Extension BASE FEE 30.00 Special Notes and Comments RE -ROOF INSTALL 30 DIMENSIONAL SHINGLE (2)LAYERS #40 FELT MECHANICALLY ATTACHED . OVER•EXISTING ROOF. ---------------------------------------------------------------------------- Other Fees . . . . . . . BLDG.STDS ADMIN (SB1473). 1.00 Fee summary . Charged Paid Credited -------------------- Due ----------------- Permit Fee Total ---------- 30.00 ---------- .00 .00 30.00 Plan Check Total. .00 .00 .00 .00 Other Fee Total 1.00 .00 .00- 1".00 Grand Total 31.00 .00 .00 31.00 LQPERMIT Bin # Permit # Project Address: 5L A. z — A. P. Number: Contractor: & m 1l.1.a+ 5" Address: 6S -160 S�PAPK r City, ST, Zip: 6 urK4L Telephone:: State Lic. # : l(j S Arch., Engr., Designer. Address: City, ST, Zip: Telephone: State Lic. #: Name of Contact Person: Telephone # of Contact Person: # Submittal Req'd Plan Sets Structural Calcs. Truss Calcs. Title 24 Calcs. Flood plain plan Grading plan Subcontactor List Grant Deed H.O.A. Approval IN HOUSE: - Planning Approval Pub. Wks. Appr School Fees City of La Quinta Building a Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet iF_LA3c•0. Owner's Name: fAAU 6A1Ek1 Ak4F,.5 Address:' 52 -2 q Avg,, oA Qr_L_A-3<-0 City, ST, Zip: tA 9.44 � � q z 25' 'f-0cFF#A16 telephone: Iq 2 - Project Description: 1 # 14o FeLr Lic. #.: Al Total Permit Fees ,..:.,:>: : r..4c>. { •. Construction T e: Occupancy: Project type (circle one): New Add'n Alter Repair . Demo 11A0-Jic Sq. Ft.: # Stories:. # Units: 1 't y Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE TRACKING PERMIT FEES T eck submitted Item Amount ed, ready for corrections Pian Check Deposit Called Contact Person Plan Check Balance Plans picked up Construction Plans resubmitted Mechanical 2•" Review, ready for corrections/issue Electrical Called Contact Person Plumbing Plans picked up S.M.I. Plans resubmitted Grading Review, ready for corrections/issue Developer Impact Fee Called Contact Person A.I.P.P. Date of permit issue Total Permit Fees