10-1292 (RR)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
•
� I
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: 10-00001292 Owner:
Property Address: 48731 WASHINGTON ST VILLAS OF LA QUINTA HOA
APN: 646-150-002- - - 42-600 CAROLINA CT STE 101
Application description: RE -ROOF PALM DESERT, CA 92211
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 9620
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 11/24/10
Contractor: u, /4 1
Applicant: Architect or Engineer: WESTERN FIC NG R'®
3462 LA PANT WAY
PALM SP IN S, .2 6r2
(760) 4
i^ LiC. N 23�'T�. rr ur.
-- - - -- ---= -------- - - - - -- - - - - --- - - - - -- -- - - -- - -- L_ - - -- - -
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION -
1 hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 icommencing with I.hereby affirm under penalty of _
pe y perjury one of the louow�ng declarations:
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. - _ t have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class:{/B C39 License No.: 235717 " for by Section 3700 of•the Labor Code, for the performance of—he work for which this permit is
���Z / �� issued.
Date: ontractor / — / �� _� 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
OWNER43UILDER DECLARATION insurance carrier and policy number are: '
I hereby affirm under penalty o1 perjury that f am exempt from the Contractor's Stare License Law tot the 1 Carrier CYPRESS INS Policy Number 33000053308101
following reason (Sec. 7031.5. Business and Professions Code: Any city or county that requirese 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, of 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 1 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 t Labor Code, I shall forthwith co�rth those 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 more than five hundred dollars ($5001.: ate: �— 2y/� plicent:.
(_ 1 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 _ - WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who buildsor 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 16100,000). 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 sob 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 _ 11, 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 theprojects with a contractorls) 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 I am exempt under Sec. . B.&P.C. for this reason the owner, and the applicant, each agrees to, and shall defend, indemnity and hold harmless the City
I d he k b0
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 ISec. 3097, Civ. C.). -
Lender's Name:
Lender's Address:
LQPERMIT
of La Quints, its officers, agents and employees for any act or omissiton re ate towon ng
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 1 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, and here5y authorize representatives
of this county to enter u above-mentioned property for inspection purpose -
ei<Zy-1. 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, 48-774,
`
48-795'&- 48-811.` ,
-------------7--------------------------------------------------------------
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
LQreRucr