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05-0153 (RR)). Box 1504. -495 CALLE TAMPICO QUINTA, CALIFORNIA 92253 BUILDING PERMIT Application Number . . . Property Address . . . . APN: Application description Property Zoning . . . . . Application valuation . BUILDING & SAFETY DEPARTMENT (760) .777-7012 FAX (760) 777-7011 INSPECTION REQUESTS (760) 777-7153 05-00000153 52444 AVENIDA DIAZ 773 -252 -010 -13 -000000 - RE -ROOF COVE RESIDENTIAL 5200 Date 1/18/05 Owner Contractor ------------------------ ------------------------ HEFFLEY MARIAN LEHMAN ROOFING, INC. *NOT ON FILE 12 WATER LILY WAY UNKNOWN CA 99999 COTO DE LAZA CA 92679 (949) 888-1665 WCC: STATE FUND WC: 0000154-2005 01/01/06 CSLB: 499608 10/31/06 CCC: C39 ----------7------------------------7---------------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 - -.-------------------------------------------------------------------------- Special Notes and Comments RE -ROOF WITH CLASS "A" MATERIALS 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 0 P.O. Box 1504 �� VOICE (760) 777-7012 78-495 CALLS TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 4 4INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT G Application Number: OS' /5,3 Date: I O 'OS Applicant: Applicant's Mailing Address: - ----- Architect or Engineer: Architect or Engineer's Address: Lic. No.: BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION I hereby affirm under pe ty erjury that I am licensed under provisions of Chapter 9 (comma i g with Section 7000) of Division 3 of the Business and Professionals Liken and ss Licgr(s� i ftlif force and effect. 5 0 6 /License Class / (.� 1 r �/� cense No. ` (,/ v Date ! r IOContractor v �/ p pw� 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 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. ve and wilJ.!,�kers fain wo rs' compensation insurance, as required by Section 3700 of the -Labor Code, for the performance of the work for which this permit is ' c ensatio rance carrier ani pgl'tt'y�yfibgLare� arcier Policy Number ,, JJ / _ I certify that, in 1he 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 shout ecome subject to the workers' compensation provisions of Section 3700 of the Labor Code, 1 shall forthwith comply with those provisions. rd--' ate 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 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 P't' 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 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 of 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 corr . I g e to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county t nter upon the bo v entioned pro spection purposes. Date ✓ �8 nature (Applicant or Agent): LEHMAN ROOFING INC. 12 WATER LILY WAY COTO DE CAZA, CA 92679 TEL/FAX 949/888-1665 NAME/ADDRESS MRS. HEFFLEY 52-444 AVE. DIAZ LA QUI NTA, CA 92253 PROPOSAL DATE ESTIMATE NO. 01/03f05 1675 ITEM DESCRIPTION TOTAL REROOF TEAR OFF EXISTING ROCK ROOF TO PLYWOOD 5,200.00 NAIL 1 LAYER 30# FELT OVER PLYWOOD INSTALL NEW ROOF SHEET METAL WHERE NEEDED INSTALL 30 YR. DIMENSIONAL SHINGLES OVER COMPLETE ROOF INSTALL TRIM SHINGLES AT RIDGES SEAL AND PAINT ROOF FLASHINGS TO MATCH ROOF CLEAN AND HAUL AWAY ALL ROOFING DEBRIS 5 YEAR LABOR GUARANTEE CONTRACTOR WILL PROVIDE PERMITS EXTRA: $45.00 PER SHEET FOR PLYWOOD REPLACEMENT INSTALL ROOF VENTS @ $50.00 PER PIECE RESPECTIVELY SUBMITTED PROPOSAL ACCEPTED DATE VALID FOR 30 DAYS PLEASE SIGN AND RETURN BY MAIL OR FAX. THANK YOU 4 CALIFORNIA STATE FUND - WORKERS COMPENSATION INSURANCE Total GEMINI - LIABILITY INSURANCE $5,200.00