10-0962 (RR)i
r • ,
P.O. BOX 1504
78-495 CALLE TAMPICO.
LA QUINTA, CALIFORNIA 9225.3 BUILDING & SAFETY DEPARTMENT
#_ BUILDING. PERMIT
Application Number:
' Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
en, - -
VOICE (760) 777-7012
FAX (160) 777-7011
INSPECTIONS "(760) 777-7153
Date: 9/20/10
10-00000962 Owner:
54909 SOUTHERN HILLS64 PGA WEST RESIDENTIAL ASSOC.
775-101-081- - 54500 WEST RESIDENTIAL CLUB DR
RE -ROOF s LA QUINTA, CA 92253
LOW DENSITY RESIDENTIAL
23788
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 -B LicenseNo.: 885157
Date: Contractor: R
- - OWNER -BUILDER DECLARATION
I hereby affirm under penalty,of perjury that -1 am exempt from the Contractor's State License Law for the
following reason (Sec. 7031 .5, Business and Professions Code: 'Any city of"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 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 _) 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 Cont?actors' State License Law.). • , .. i
(_ I I am exempt under Sec. B.&P.C. for this reason.
Date: Owner: 1
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: - -
LQPERMIT -
Contractor:
BIENEK ROOFING•CONSTRUCTON INC
9707 PINEWOOD AVENUE
TAJUNGA, CA 91042 .
(760)625-7796
Lic. No.: 885157
WORKER'S COMPENSATION. DECLARATION .
I hereby affirm under penalty of perjury one of the following declarations: -
_ I have andwillmaintain 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 he 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 1889944
I 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 -
-3700 of the Labor Code, I shall forthwith comply with those provisions." - -
+Date: • Applicant:
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-ADOITION-70 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. I # -
1. Each person upon Whosebehalfthis application is made; each person at whose request and for .
r 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 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 hereby authorize representatives
of this county to enter upon the above-mentioned property for inspection purposes.
Date: Signature (Applicant or Agent):
Application Number 10-00000962
Permit . . . RE -ROOF
Additional desc .
Permit Fee 30.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
. . .
. 0
Expiration Date 3/19/11
Qty Unit Charge Per
Extension
BASE
FEE
30.00
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Special Notes and Comments
RE -ROOF VACUUM.ROCK- APPLY SPRAY
FOAM
ROOFING SYSTEM WITH TITLE 24 REFLECTIVE
TOPCOAT.2007 CODES. 54909, 54.891,
54873,
54855 SOUTHERN HILLS.
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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
�+ �• � h v \• -2 ;a 117 11'34, '�= ` ►
LQPERMIT