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10-1292 (RR)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 10-00001292 Property Address: 48731 WASHINGTON ST APN: 646 -150 -002 - Application description: RE -ROOF Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: .9620 7 7q • Qum& BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: VILLAS OF LA QUINTA HOA 42-600 CAROLINA CT STE 101 PALM 'DESERT; CA 92211 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 11/24/10 Contractor: U., /Q Applicant: Architect or Engineer: WESTERN FIC NG RP 3462 LA PA1�T WAY )/ PALM SP IN S, C81�2,26r2 A (760) 4 LiC_ N 23�7�.v� U.-!.- - - - - - - - - - - - - - - - - - - .-.---------------------------- - - - - --- - - -- ---------- - - -- -- - - - - ---- - - - --- - -- --- LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION. I hereby affirm under penalty of perjury that I em licensed under provisions of Chapter 9 icommencing 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 seff•insure for workers' compensation, as provided , License Class: E C39 - _ License No.: 235717 for by Section 3700 of the''Labor Code. for the performance of the work for which this permit is issued. .. ontrecta: _ 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 'OWNER -BUILDER DECLARAT1oN insurance carrier and polity number are- or- " I hereby affirm under penalty of Perjury that I am exempt from the Contract's State License Law for the Carrier CYPRESS INS I Policy Number 33000053308101 following reason (Set. 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 Contractoi s Slate 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 j f Labor.Code, I shall forthwith comply nth Mose rovisions. 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 (85001.: ate: Z/ plicant:��� (_ 1 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 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 15100.000). 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 _ 1 I, as owner of the property. am exclusively contracting with licensed contractors to construct the project (Sea IMPORTANT Application is hereby made to the Director of Building and Safety fora permit subject to the .7044, Business and Professions Code: The Contractors' State License Law doesnot 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 cont(actor(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, -1 _) 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 Quints its officers a ants and em fo ees for any act or omission related to the work being Date: Owner: CONSTRUCTION LENDING AGENCY I hereby affirm under penally 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: Q Lerder's Address: T t LOPERMIT • 9 P v 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. 1 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 construction, end here y authorize representatives of this county to enter u above-mentioned property for inspection purposes. /are�_ S' nature (Applicant or Agent): Application Number . . . . . 10-00001292 Permit . . . RE -ROOF Additional desc . . Permit Fee . . . . 30.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 0 Expiration Date '. 5/23/11 Qty Unit Charge Per Extension BASE FEE 30.00 ---------------------------------------------------------------------------- Special Notes and Comments APPLY POLYURETHANE FOAM & ACRYLIC COATING ROOFING SYSTEM OVER GARAGES (UNCONDITIONED SPACE). 2007 CODES. INCLUDES ADDRESSES:48-755,1,48-774,; - 48-795 & 48-811 ---------------------------------------------------------------------------- Other Fees . . . . . . . . . BLDG STDS ADMIN. (SB1473) 1.00 Fee summary Charged Paid --------------------------- Credited ---=------ Due ---------- Permit Fee Total 30.00 ---------- .00 .00 30.00 Plan Check Total .00 .00 .00 .00 Other Fee Total 1.00 .00 .00 1.00 Grand Total 31.00 .00 .00 31.00 LQvERMuT