05-5290 (RR)P.O.'BOX 1504
r ' 78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT.
e051-00005290-
80185 WESTWARD HO DR
649-080-005-44 -2190 -
RE -ROOF
LOW DENSITY.RESIDENTIAL
5000
Architect or Engineer:
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 fullforce and effect.
License Class: C39 License No.: 675902
_ �2, 2,
•Date Contractor.
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that.1 am exempt from the Contractor's State License Law for the
following reason (Sec. 7031.5; Business and Professions Code: Any city or couniy 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 applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
(_) 1, 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 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.).
I—) I am exempt under Sec.. B.&P.C. for this reason
Date: Owner:
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:
LQPERMIT
J
Owner:
JACOBS VINCENT A-.
80185 WESTWARD HO DR
LA QUINTA, CA 92253
Contractor:
POPA ROOFING, INC.
13672 ONKAYHA-CIRCLE
LA QUINTA, CA 92253
. (714)•778-6294
Lic- No.: 675902
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 12/02/05
DEC o 2 1005
P)l
Cq of q
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 STATE FUND Policy Number 1579948
_ I certify that,'in the performance of the work for which this peunit 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 sha hwith co ly with those provisions.
Date/1' %' dJ _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.
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 rel>propert
in nstruction, and hereby authorize representatives
of this county to enter upon the above-mentior in ection oses.
Data ; � Signature (Applicant or A
Application Number. . . . . .
05-00005290
-
Permit . . . . . . RE -ROOF
Additional desc .
Permit -Fee, 30.00
Plan Check
Fee
.00
Issue Date
Valuation
- 0
Expiration Date .. 5/31/06
Qty Unit.Charge Per
Extension
BASE
FEE
30.00
Speciai 'Notes and comments
REMOVE EXISTING SHAKES ADD ONE
LAYER
30#..FELT & METRO METAL ROOFING.
CDD OK
PER ,STAN SAWA.
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
LQPERMIT .. - ..
'. .. .. "
Bin #
City of La Quint'a
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
Permit #
n
j -SZ�I v
Project Address:
Owner's Name: f'
A. P. Number:
Address:
Legal Description:
City, ST, Zip::
Contractor: PY�D
Telephone: Z2- 2- % %
Address/36 -7 2 O
Project Description:
City, ST, Zip: —Z:r/!/i r+.e- 9262-0
��A/� S G". �, ,1
Telephone:' i y i 7 0p 4 Z 9 Y
310 Cj - 44 e✓ ✓ Q /cif
State Lic. # : City Lic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lic. #: j
Name of Contact Person:
Construction Type: O.xupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: -?Do d
I # Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project: D 0,0
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Cates.
Plans picked up
Constructicn
Flood plain plan
Plans resubmitted
Mechanical
Grading. plan
2°" Review, ready for corrections/issue
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