10-0537 (RR)I
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
.Application Number: 10-00000537; Owner:
Property Address: 77876 CALLE SONORA DURBIN TOM
APN: 773-233-022-11 -000000 77876 CALLE SONORA
Application description: RE -ROOF' LA QUINTA, CA 92253
Property Zoning: COVE RESIDENTIAL
Application valuation: 3900
—-------- -- --- - --------Contractor:_
Applicant: Architect or Engineer: SOUTHWEST ROOFING
P.O. BOX 126
��
A r 2 )/► INDIO, CA 92202
/V /CVT— (760) 578-3735
Lic. No:: 787029
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 th usiness YP Professionals Code, and my License is in full force and effect.
License Class: C39 Licen , No.: 787029
Date:.(% I �� Contrec[8 -
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 fora permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
(-_•) I, as owner of the property, or my employees with- wages as their sole compensation, will do the work, and
the structure isnot 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.).
1-1 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:
LQPERN1IT
PJ
.VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/21/10
JUN 2 12010
CITY OF !.A LIUINTA -
WORKER'S COMPENSATION DECLARATION
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.
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 2380008906
I certify that, in the performance of the work for which this permit is issued, I shall not employ any
person in any mann so as to become subject to the workers' compensation laws of California, .
and agree that, if uld beco subject th workers' compensation provisions of Section
3700 of the Lab de, I sh orthwi(om y wi h th a provisions.
.Oate44- Applican
WARNING: FAILURE TO SEC RE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO RIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,0001. 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 t bove information is correct. I agree to comply with all.
city and county ordinances and state laws relating to b it ng constructi , and here uthorize representatives
of this county to eennter.upon the'above-mentioned pr for inspecti purpose
Date tel/ f Signature (Applicant or Agen
Application Number 10-00000537
Permit RE -ROOF
Additional desc .
Permit "Fee 30.00 Plan Check Fee
.00.
Issue Date Valuation . . .
. 0
Expiration Date 12/18/10
Qty Unit Charge Per,
Extension -"
BASE FEE
30.0.0
Special Notes and Comments
RE -ROOF SOUTH SIDE OF ROOF USING 130 MPH
PREMIUM DURATION SHINGLES. EXEMPT FROM
---------------------FORM-"COOL-FOF-LESS`THAN-50---s PER..A_J_—_---- .__.........__..._.__...._........._._..._.
................... ...._....._._.._.._......_ —_
----------------------------------------------------------------------------
OtherFees . . . BLDG STDS ADMIN (SB1473)
--- -Other
.1.00
Fee summary " Charged Paid Credited
----------
Due
Permit-Fee Total 30.00 .00 .00
30.00
r+ Plan Check Total.': .00 .00 .00
.00
3. Other(Fee Total.•. 1.00 .00 .00
'c
1.00
Grand -,'Total 31.00 .00 .00
31.00
Bin #
City of La Quinta
Building 81 Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta CA 92253 - (760) 777-7012 .
Building Permit Application and Tracking Sheet
Permit #
V
Project Address: �%� . 87 N�
Owner's Name:� v r e til'
A. P. Number:
Address: -7 7--5 C4 -
Legal Description:
Legal
City, ST, Zip: I 5 -
Contractor: —�C�UT �'
Telephone:
Addressq, 0 (2
Project Description: 'q%QA ®� V
City, ST, Zip: ti I C> 9 ZZ p Z
O RLLU Q— �•! (N c1
Telephon
State Lic. # :7A 70.z-
City Lic. #:
.q. ®.p (�' T /—jD Gvl 414
Arch., Engr., Designer:
--V^
f 1 U t�� A— L t9� IN
Address:
City, ST, Zip:
Telephone:
State Lic. #:r:ity;"
w{' i \v}.vwlM <.n;M.:•:ijw:i:}j� }'}}:�j
Construction Type: Occupancy:
Project type circle one): New Add'n Alter a_ air Dem
Name of Contact Person:
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project: 3 cnqv
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
Jn° Review, ready for correctionstissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees