05-1382 (RR)Ti4f OF 4 4"
BUILDING & SAFETY DEPARTMENT
�. Box 1504 (760).777-7012
-495 CALLE TAMPICO FAX (760) 777-7011
QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
,tuber . . .
Property Address . . . .
APN:
Application description
Property Zoning . . . . .
Application valuation . .
BUILDING PERMIT
(05-_0000.1382 Date
51740 AVENIDA DIAZ
773 -121 -009 -6 -000000 -
RE -ROOF
COVE RESIDENTIAL
4800
4/12/'05
Owner
Contractor
PHILLIPS GEORGE JOSEPH
PALM DESERT CONTRACTORS
51740 AVENIDA DIAZ
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
-------7 ------------------ ---------------------------
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
-----------------------7----------------------------------------------------
Special Notes and Comments
RE -ROOF 30 YEAR SHINGLES. CLASS
"A"
MATERIALS ONLY
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. Box 1504 alf44a
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Applicant:
Applicant's ailing Address:
BUILDING & SAFETY DEPARTMENT
Architect or Engineer:
Or.
VOICE (760) 777-7012
FAX (760) 777-701 1
INSPECTIONS (760) 777-710'3
Date: 2- 03`
Architect or Engineer's Address:
Lic. No.:
BUILDING 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- 3 1 License No. �f 7 u'N
Date ''t^ "2—"-f—Contractor 412 C—)• `� Tb
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.).
(-.) 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
Owner
WORKERS' COMPENSATION DECLARATION
I 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.
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 �t'r s"—`� A.pplicant
WARNING: FAILURE TO SECURE WORKERS'CO110ENSATION 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
Lender's 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 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 -m rty for inspection purposes.
Date LG — f `,t` ' Signature (Applicant or Agent):
r: PALM DESERT CONTRACTORS/ROOFING
P.O. Box 2.795 Palm Desert
California, 92261 Lic# 477507
760-346-2420 Fax 760-345-3924
DATE: 4-11-05
PROPOSAL submitted to;
George Phillips
WORK to be performed at;
51740 Diaz 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;
PITCH: Install one layer of 15 Ib base sheet, Install Owens Corning 30 year
warranty dimensional shingles, Desert Tan, install standard metal, paint all
roof jaxs.
FLAT: none
Extras; Permit, plywood @$40.00 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, AC/swamp
cooler by other.
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; $ 4800.00
With payments as follows: 10% down, Balance upon completion
Respectfully submitted
ACCEPTANCE O PROPOSAL -
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