09-1078 (RR)44aP.O. BOX 1504. ,' VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777=7011
LA QUINTA CALIFORNIA 92253 " BUILDING & SAFETY. DEPARTMENT INSPECTIONS (760) 777-7153
— - BUILDING PERMIT -
Date: 10/07 ,99
Application Number: 09-00001078 Owner: I�1I
Property Address: '54783 -SOUTHERN HILLS r PGA WEST RESIDENTIAL --�,.
APN: 775-101-074- - `P.O.-BOX 1060
Application description: RE -ROOF LA QUINTA, CA 92253 ",fl J
Property Zoning: LOW DENSITY RESIDENTIALOCT Q" 2-3131
Application valuation: 20000
-.-
Contractor:
Applicant: Architect or Engineer: BIENEK ROOFING CONSTRUCTIN INC
9707 PINEWOOD AVENUE
TAJUNGA, ° CA ,91042
(760)625-7796 '
Lic. No.:,885157
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LICENSED CONTRACTOR'S DECLARATION - - 'WORKER'S COMPENSATION DECLARATION -
I hereby affirm under penalty of perjury that license 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 Busin and -rofe onals Code d my License is in full force and effect. _ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
Licensee Clllass�s::: C739 -B Licens : 885157 - for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
Contractor: .1 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
OWNER -861 ER DECLARATION - - insurance carrier and policy number are:
hereby affirm under penalty of perjury that I am exempt from the Contractor's.State License -Law for the ' - Carrier STATE FUND _ Policy Number 1889944 •
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to_ I certify that, in the performance 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 a o b 0 bject to the orkers' 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 shoul becom ub' t to the rs' 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 Cod I shall ith comp) h those provisions.
that he or she is exempttherefrom 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).: ... Applicant:
(_ 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 •- WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves°thereon, , SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND—
. and who does the work himself or herself through his or her own employees, provided that the - ` - DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, -DAMAGES AS -PROVIDED FOR IN "
improvements are not intended or offered for sale. If, however, the building or improvement is.sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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.). ' ' '- APPLICANT ACKNOWLEDGEMENT, -
• (_ 1 I, asownerof the property, am exclusively contracting with licensed contractors to construct the project ISec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the.
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of conditions and restrictions set'forth on this application. -
property who builds or improves thereoA, and who contracts for the projects with a contractor(s) licensed - 1. Each person upon whose behalf this application is made, each person at whose request and for
pursuant to the Contractors' State License Law.)'. - - whose benefit work is performed under or pursuant to any permit issued as a result of this application,
(_ 1 I am exempt under Sec.. , B.&P.C. for this reason '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.
Date:- Owner: - 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 -
• - - - CONSTRUCTION LENDING AGENCY _ permit to cancellation.
hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the I certify that I have read this application and state that th bove informatioJd
e to comply with all
work for which this permit is issued (Sec. 3097, Civ. C.). city and county ordinances and state laws relating to riding onstructio ize representatives
of this county to enter upon the above-mentioned p party for nspecti '
' Lender's Name:
Signature (Applicant or Ag tl: -
• Lender's Address:
LQPERMIT
.4 _ . -
.Application Number . . . . . 09-00001078
Permit RE -ROOF "
. . .. ... ..::. . Additional desc .. _
- Permit Fee 30.00 ..
Plan Check Fee
.00
Issue Date
Valuation
0
Expiration Date 4/05/10
Qty Unit Charge Per
Extension
BASE:,FEE
30.00
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Special Notes and Comments
RE -ROOF PERMIT REMOVE ROCK INSTALL (1)
INCH SPRAY FOAM (4)UNITS 54783-54837.
SOUTHERN HILLS. PER 112007 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
'
Bin #
City of LaQuinta
Building 8£ Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit # �C)
Project Address: 713 " 5Y g'3 7
Owner's Name: . G &-'eS Y, q�
A. P. Number: j ``,f
Address:
Legal Descrip '
City, ST, Zip:
TeleP hone:
Contractor: N 0 % s
1 �
Address: 7(, 7 %A1r—ztJ�fad
Project Description: .
City, ST, Zip:
ele ho
TP
e
State Lic. # :19 0 f 5,7 City Lic. #;
Arch., Engr., Designer:
A%S' j V
Address:
City, ST, Zip:
h .
Telephone: �>
P
State Lic. #: :.
Name of Contact Person: �}'f%,6 j �%
Construction T e: ccu
Type: Occupancy:
P Y•
Project type (circleo e): New Add'n Alter Repair Demo
S Ft.:LJA
#Stories:
Telephone # of Contact Person: �7 7 G
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
}.
' V
Item
Amount
Structural Cates.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cates.
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:-
3a Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees