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