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05-1380 (RR)P.O. Box 1504 78-495 CALLS TAMPICO �A QUINTA,'CALIFORNIA 92253 BUILDING PERMIT BUILDING & SAFETY DEPARTMENT (760) .777-7012 FAX (760) 777-7011 INSPECTION REQUESTS (760) 777-7153 \,---Application Number 0:5f00001380-1 Date 4/12/05 Property Address 79950 HORSESHOE RD APN: 649-071-030-27 -2180 - Application description . . . RE -ROOF Property Zoning . . . . . . . LOW DENSITY RESIDENTIAL Application valuation . . . . 17680 Owner Contractor SAM VINCE PALM DESERT CONTRACTORS 79950 HORSESHOE RD, 79945 TRINIDAD LA QUINTA CA 92253 INDIO CA 92201 (760) 346-2420 WCC: EXEMPT WC: EXEMPT 04/30/06 CSLB: 477507 08/31/05 CCC: C39 ------------------------------------------------- Permit• . . . . . . RE -ROOF Additional desc Permit Fee . . . . 30.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 0 Qty Unit Charge Per Extension BASE ---------------------------------------------------------------------------- FEE 30.00 Special Notes and Comments RE -ROOF LIGHTE WAIGHT TILE PER ICBO 4660 Fee summary Charged _ ----------------- Paid Credited Due ---------- Permit Fee Total 30.00 --------------------- .00 .00 ---------- 30.00 Plan Check Total .00 .00 .00 .00 Grand Total 30.00 .00 .00 30.00 P.O. BOC 1504 • �� 78-495 CALLS TAhfPICO LA QUINTA, CALIFORNIA 922$3 BUILDING & SAFETY DEPARTMENT Application Number: Applicant: Applican s Mailing Address: VOICE (760) 777-7012 FAX (760) 777-701 1 INSPECTIONS (760) 777-7133 Date: Architect or Engineer: Architect or Engineer's Address: Lic. No.: UUILUINU PERMIT DECLARATIONS 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 c Z q License No. y Z --O —7_ Date °i ^ 1'i^' O—Contractor _10 OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' 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 Contractors' 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).): U 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 or 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.). U 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.). U I am exempt under Sec. . BA P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I he affirm under penalty of perjury one of -he 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. _ 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 Policy Number 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 ti —t Z — rE aplicant WARNING: FAILURE TO SECURE WORKERS' C ATION 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. 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 Lenders Address 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 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 agrealaxxiM Ily with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enter upon t ve-menti operty for inspection purposes. Date 1—Ir ^«' USignature (Applicant or Agent): w PALM DESERT CONTRACTORS/ROOFING P.O. Box 2795 Palm Desert California, 92261 Lic# 477507 760-346-2420 Fax 760-345-3924 DATE: 2-1-05 PROPOSAL submitted to; Sam Vince WORK to be performed at; o s 79950 Horseshoe dr., L Q Palm Desert Contractors/Roofing hereby proposes to furnish material and perform the labor necessary for the completion of; Total removal of existing roof and re -roof as follows; TILE: Install 40 Ib base sheet, Install Eagle light weight concrete tile #418, Terracotta gold, install standard metal which includes tile pan, saddle, drip edge and roof to wall. Install ridge and trim as needed, use cement as needed. Paint all roof jaxs. FLAT; None Extras; Permit, plywood @$35.00 per sheet, extra painting, custom sheet metal work, extra layers of roofing to be removed @$20.00 per layer per square, taper system @$9.00 per sheet, vents @$75.00 per vent. 5 Year contractor warranty. The work will be performed in accordance with the drawings and specification submitted for the above work and completed in a workman like manner for the sum of; $ 17680.00 With payments as follows: 10% down, Balance upon completion Respectfully submitted ACCEPTANCE OF PROP L . The above price, specification and conditions are satisfactory and are hereby • accepted. Palm Desert Contractors/Roofing is authorized to do the work as specified. Payments will be made as outlined. Date Signature �:�.✓�� ti eco o , �b (--i-�0..,y �. c.��, 3 I / 8 1-H-