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12-1318 (RR)C P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application -Number: Property Address: APN: Application description: Property Zoning: , Application valuation: -12-00001318 55340 SOUTHERN HILLS -;r 775-190-055-1, - - RE -ROOF LOW DENSITY RE IDENTIAL 7500 Tiht44Q".. BUILDING & SAFETY DEPARTMENT ' BUILDING PERMIT Owner: DANGOTT MORRIS 55340 SOUTHERN HILLS LA QUINTA, CA 92253 Contractor: VOICE (760)i-,�._� FAX (760) INSPECTIONS (760) 777-7153 Date: 11/061112 11�� a6 2o�z Applicant: Architect or Engineer: BERRY ROOFING 1� p�p1_ 3226 KLUK LANE 0�1�E RIVERSIDE, CA 92501 (951)905-5116, LiC.'No.: £91947 t LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty'of perjury that I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations: Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided License Class: C39 -C43 License No.: 691947 for by Section 3700 of the LaborCode, for the performance of the work for which this permit is r issued. K I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor uate: ommctor: -40�' // j Code, for the performance of the work for which this permit is issued.' My workers' compensation OWNER -BUILDER DECLARATION insurance carrier and policy number are: - 1 hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier CASTLEPOINT . Policy Number WSLTHPE09245901 following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires, a permit to _ I certify that, in the performance of the work for which this permit is issued, I shall not employ any construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any manner so as to become subject to the workers' compensation laws of California, permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if I should become subject to the workers' compensation provisions of Section - License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or . 3700 of the Labor Code, 1 shall fo hwith comply with those provisions. that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by five hundred �— any applicant for a permit subjects the applicant to a civil penalty of not more than dollars (5500).: ate: plicant: �..- (_ 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 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 Coder 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 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.). N Lender's Name: A Lender's Address: - LQPERMIT WARNING: FAILURE TO SECURE WORKERS' 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. - 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 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 thi ount/y'to enter upon the above-mentioned property for mspecti purposes. ate: �/7i'% �� gnature (Applicant or Agent): ' qi LQPERMIT Application. Number . . . . . 12-00001318 Permit . . . RE -ROOF Additional d_esc . Permit Fee . . . . 30.00 Plan Check Fee .00 Issue Date Valuation . . . . 0 Expiration Date 5/05/13 Qty Unit Charge Per Extension BASE FEE 30.00 ---------------------------------------------------------------------------- Special Notes and Comments REMOVE -21 SQUARES.TILE,REFELT AND INSTALL O.C.-DURATION SHINGLES." REINSTALL ORIGINAL TILES AROUND ARRAY.' 2010 CODES. ------------------------------------------- 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 Sin.# Crty 0f Lel Qi!(htd Building ff Safety Division P.O. Box 1504,76-495 Calle Tampico 14.Quinta, CA 92253 - (760) 777-7012 Building Permit -Application and Tracking Sheet Permit #0\11 Project Address: �' ai/ / �S Owner's Name:.D 1 /i�7✓�O A. P. Number. Address: a s _ Legal Description://YAG // j % l �� City, ST, Zip: Contractor./j�L:�2/z / /`✓G Telephone: �` f�SS 9y c•.d. :uy Address: Z Zt /�(f�� /� ^ Project Description: City, sr, zip:7 i1 l�/S✓�it� DsG.:. Telephone: -Res"'&flL State Lic. #: .� �% City Lic. #, Arch., Engr., Designer: Address: City., ST, Zip: Telephone: y ... '• �` State Lic. #: Name of Contact Person: ConstructionType:4j�Go4:1 Occupancy: Project type (circle one): New Add'n Alter Repair Demo Sq. FL: # Stories: #Univ Telephone # of Contact Person: Estimated Value of Project: -7,5'00 APPLICANT: DO NOT WRITE BELOW THIS UNE # Submittal Req'd'Rec'd TRACKING PERMIT FEES - Plan Sets Plan Check submitted Item Amount Structural Cafes. 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 2iQ Review, ready for correctionsfiissue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.L H.O.A. Approval Plans resubmitted Grading IN HOUSE:- 7i6 Review; ready for correctionsl4ssue Developer Impact Fee Planning Approval Called Contact Person A.LP.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees