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06-0273 (RR)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 06-00000273 Property Address: 52780 AVENIDA DIAZ APN: 773 -312 -004 -23 -000000 - Application description: RE -ROOF Property Zoning: COVE RESIDENTIAL Application valuation: 0 �s r T4ht 4 4 Q" Applicant: Architect or Engineer: ------------------ LICENSED CONTRACTOR'S DECLARATION BUILDING & SAFETY DEPARTMENT BUILDING PERMIT JAN 2 6 2006 CITY aP LA nli..= 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: License No.: Date: Contractor: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's 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 Contractor's 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 plicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500).: 7( ) 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 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.). (_) 1, 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.). 1 _ ) I am exempt under Sec. , B.&P.C. for this reason /f Date: Owner: I hereby affirm under penalty of perjury that there is a co work for which this permit is issued (Sec. 3097, Civ. C.) Lender's Name: _ Lender's Address: LQPERMIT lending agency for the performance of the VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 1/25/06 Owner:. ROGERS SHIRLEY M --------------------------------- Contractor: Owner ----------------------------------------------- WORKER'S 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 t orkers' compensation provisions of Section 3790 of the Labor Cod , I hall fo with co y with those provisions. Date: Y_A_04&1& plicant:- WARNING: FAILURE TO SECURE WORKERS' C PENSATI COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (5100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. 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 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 const uction, nd5herzbuthorize representatives of this counter upon the above-mentioned property far 'sectio urP Date: �ignature (Applicant or Agent): Application Number . . . . . .06-00000273 Permit . . .. RE -ROOF Additional desc . Permit Fee 60.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 0 _ Expiration Date 7/24/06 Qty Unit Charge Per Extension BASE FEE 60.00 ---------------------------------------------------------------------------- Special Notes and Comments RE -ROOF WITH TILE PER APPROVED STRUCT CALLS. INVESTIGATION FEE ASSESSED PER 199'7 UNIFORM ADMINISTRATIVE CODE §304:5 FOR WORK BEGUN WITHOUT BUILDING PERMIT. ---------------------------------------------------------------------------- Other Fees . . . . . . HOURLY PLAN CHECK. 35.00 Fee summary Charged Paid Credited --------------------------------------------------------- Due Permit Fee Total 60.00 .00 .00 60.00 Plan Check Total .00 .00 .00 .00 Other Fee Total 35.00 .00 ..00 35.00 Grand Total 95.00 .00 .00 95.00 LQPERMIT Bin m City of La Quinta- Building U Safety Division P.O. Box. 1504, 78-495 Calle Tampico La Quinta, CA 92253 -.(760) 777-.7012 Building Permit Application and Tracking Sheet Recd Permit # �1r9 Project Address: r _ L CJl L*2Y1 D Z Owner's Name:I I r iS A. P. Number: Address: { �� Legal Description: City, ST, Ziip: Contractor: Q �• e e Telephone: - Plan Check Deposit" Address: lcs. Project Description: City, ST, Zip: tib. ev e. ► s t n t` o 0 Telephone: LAState Plans.picked up Lic. # Construction Arch., Engr., Designer: Plans resubmitted Address: Mechanical Grading.plan City, ST, Zip: Telephone: State Lic. #: J Construction Type: Occupancy: Project type (circle one): New Add'n Alter Repair Demo Name of Contact Person: Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: G � Estimated Value of Project: 00 APPLICANT: DO NOT WRITE BELOW THIS UNE , #Eubnmtiyttra' Req'd Recd TRACKING -,PERMIT FEES Plan Check submitted { �� Item Amount l Calcs. Reviewed, ready for corrections Plan Check Deposit" lcs. Called Contact Person PlanCheck Balance Cities. Plans.picked up Construction Flood plain plan Plans resubmitted Mechanical Grading.plan J 2e° Review, ready for correctio sCssue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- ''' 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 AWN& &It� 0-110b �/A3 SIR zv. B.G. Structural Engineering, Inc. 45-535 Via Corona Indian Wells, CA 92210 BILL TO Forrest Grubb Invoice DATE INVOICE NO. 1/14/2006 800.0106 P.O. NO. TERMS REP PROJECT Net 15 BG 800.0106-Roge... ITEM DESCRIPTION QTY RATE AMOUNT Eng - 150 52-780 Residence Re -roof Engineering - 3 150.00 450.00 It's been a pleasure working with you! Total $450.00 'B.G. STR.UCTURAL ENGINEERING,. INC. LIC. NO. C33047 . BRIAN GOTTLIEB - CIVIL ENG.INEER N0. S&D. of o ATTENTION 45-535 VIA CORONA (760) 568-3553 INDIAN WELLS, CA 92210 (760) 568-5681 FAX TO rLU�3 6 LETTER Of TRANSMITTAL DATEJOB r4 seaCv N0. S&D. of o ATTENTION RE: 3 'C5 WE ARE SENDING YOU V -ATTACHED ❑ UNDER SEPARATE COVER VIAbri4n4 THE FOLLOWING ITEMS: []SHOP DRAWINGS Dk�RINTS ❑ PLANS ❑ SAMPLES []SPECIFICATIONS ❑ COPY OF LETTER [:]CHANGE ORDER ❑ COPIES DATE NO.. DESCRIPTION 3 'C5 THESE ARE TRANSMITTED AS CHECKED BELOW: JAOR-APPROVAL El-APPROVED AS SUBMITTED ❑OR YOUR USE APPROVED AS NOTED S REQUESTED ❑ RETURNED FOR CORRECTIONS ❑ FOR REVIEW 8 COMMENT[-]. ❑ RESUBMIT COPIES FOR APPROVAL ❑SUBMIT COPIES FOR DISTRIBUTION ❑ RETURN CORRECTED PRINTS ❑ FOR BID5 DUE ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS COPY TO--- _.- ---------- IF -.._...._.._..._.....:....._: _........._ ..__._�.I.�NED 1 1F ENCLOSURES ARE NOT AS NOTED. KINDLY NOTIFY US AT'ONCE.