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06-3956 (RR)P.O. BOX 1504 ,78-495 CALLE TAMPICO ':LA QUINTA, CALIFORNIA 92,253 Application Number: 06-00003956- y -r Property Address: . 80265 WESTWARD HO DR APN: 649-080-009-48 -2190 - Application description: RE -ROOF Property Zoning:LOW DENSITY RESIDENTIAL• Application valuation 8000 Applicant: _ (An�a - IF- &*t °F �Q�w Architect or Engineer: BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: DAVID BLACK 80265•WESTWARD HO DR. LA QUINTA, CA 92253 (760)775-6130 Contractor: WESTERN ROOFING SYS 13672 ONKAYHA CIRCL IRVINE, CA 92620 (714)778-6294° Lic. No.: 675902 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 w Date: 11/13/06 NOV 13 2006 D 401A7 - LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION _ I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with I -hereby affirm under penalty of perjury one of the following declarations: .Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. - I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided _ License.Class: C39 675902 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is 2e'censeNo,: - G. issued. maintain Date1� Contractor: M _ I have and. will 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 �✓ % OWNER -BUILDER DECLARATION - insurance carrier and policy number are: I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier STATE FUND Policy Number 7130015610 - following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to - _ I certify that, in the performance of the work for which this permit is issued, I shall not employ any _ construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any manner so as to. become subject to the workers' compensation laws of California, permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if.I,should become subject to the workers' compensation provisions of Section License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3700 of the Labor Co , I all for 01 h comply with those provisions. that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by y -) •� _ -ate• any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500)-: -will v� - DI - 7 Applica_nv �- ( 1 . I, as owner of the property, or my employees with wages as their sole compensation, do the work, and �� }ov the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL ' - Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND - and who does the work himself or herself through his or her own employees, provided that the * - . DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. - 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.). - APPLICANT ACKNOWLEDGEMENT- (_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of conditions and restrictions set forth on this application. property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed 1 . Each person upon whose behalf this application is made, each person at whose request and for pursuant to the Contractors' State License Law.). whose benefit work is performed under or pursuant to any permit issued as a result of this application, I am exempt under Sec. , B.&P.C. for this reason - - 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. ' Date: Owner: - 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 CONSTRUCTION LENDING AGENCY permit to cancellation. I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the I certify that I have read thisapplication and state that the above information is correct. I agree to comply with all work for which this permit is issued (Sec. 3097, Civ. C.). city and county ordinances and state laws relating to buil g construction, and hereby authorize representatives of upon the above-mentioned-prope 67'185 action purposes.Lender's Name:JDaSignature(Applicant-orA A;uter • Lender's Address: f LQPERMIT Application Number 06-00003956 Permit RE -ROOF Additional desc . Permit Fee 30.00 Plan Check Fee .00. Issue Date Valuation . . 0 . Expiration Date 5/12/07 Qty Unit Charge Per Extension BASE FEE 30..00 - ' _ Rgecial DTQtec .and CQmmente REROOF 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 LQPERMTT Bin # Permit # 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 Trackin.; Sheet Project Address: t b2 rPS l(/Lf/' Owner's Name: I) C/ A. P. Number. Address: Legal Description: City, ST, Zip: Contractor: d /�o -�;�• Telephone: Address:., 6 �� �� A .I , Project Description: City, ST, Zip: U �/ne, Telephone. l 7'% Uj 2-9 State Lie. # City Lie. #: Arch., Engr., Designer: Address: City,. -ST, Zip: Telephone: Construction Type: Occupancy: P cY: State Lie. #: Pro ecE type (circle one): New Add% Alter 'Repair Demo Name of Contact Person: Sq: FL. Stories: # Units: Telephone # of Contact Person: Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING .. PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cales. Reviewed,.ready for corrections Plan -Check beposit Truss Calcs. Called Contact Person ' Plan Check Balance Energy .Calcs. Plans picked up Constraction Flood plain plan Plans resubmitted Mechanicstl Grading,plan 211 Review, ready for correcdonsfissue Electrical Sabcontactor List Called Contact Person Plumbing , Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted.. Grading IN HOUSE:- ''' Rcview, ready for correctionsfissue Developer Impact Fee, Planning Approval Called Contact Person A.I.P.P. " .Pub. Wks. Appr Date of permit issue, School Fees ' :..- Total.Permit Fees ... .