10-1293 (RR)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 10-00001293
Property Address: 49191 WASHINGTON ST
APN: 646=170-022- - -
Application description: RE -ROOF
Property Zoning: LOW DENSITY RESIDENTIAL
'Application valuation: 9620
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
VILLAS SOF LA QUINTA HO.
42-600 CAROLINA CT.STE
PALM DESERT, CA 92211
VCE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 24/10
o NOV 242
�
C1T'Y OF LAA Q1J1N'TrA
Contractor:
Applicant: Architect or Engineer:.
WESTERN PACIFIC ROOFING CORP
•
3462 LA CAMPANA WAY
PALM SPRINGS, CA 92262
(760)416-5877
/1
LiC . NO.. 235717
LICENSED CONTRACTOR`S DECLARATION
. - WORKER'S COMPENSATIONDECLARATION.
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 infull force and effect..
_ I have and will maintain a certificate o1 consent to self -insure for workers' compensation, as provided
License Class: B C39 Lice'No.:. 235717
for by Section 3700 of the Labor Code, too the performance of the, work for which this permit is
fI� %rD
issued.
I have and maintain insurance, as required by Section 3700 of the Labor
ate: ontractor:
will workers' compensation
Cade, 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 CYPRESS INS Policy Number 33000053308101
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 Code, I shall forthwith�wirovisions.
'
that he or she is exempt therefrom and the basis for the alleged'exemption. Any violation of Section 7031.5 by -
y
v
' any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (8500).:
ate: it-ty pplicant: ! -
(_ f 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 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 (8100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
' improvements are not intended or offered for sale. If, however, the Wilding 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 contractors) licensed
_ 1 . Each person upon whose behalf this application is made, each person at whose request and for
pursuant to the Contractors' State License Lew.).
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
' I hereby affirm under penalty of perjury that there is a construction lending agency for, the performance of the
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
'
work for which this permit is issued (Sec. 3097, Civ. C.I. - -
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
'
of this county to enter upon the above-mentioned property for inspection purpo"-/.
Lender's Name: .• - -
Z r' -�%' w /.�
�� r �D Sign re (Applicant or Agenq' �_ / �/
Lender's Address:
Application Number
Permit
Additional desc .
Permit Fee
Issue Date . . .
Expiration Date . .
10-00001293
RE -ROOF
30.00
5/23/11
Plan Check Fee .00
Valuation 0
Qty Unit Charge Per
Extension
BASE FEE
30.00
-------------------- 7 ---------------------------'----------------------------
Special Notes and Comments
APPLY POLYURETHANE FOAM & ACRYLIC
COATING ROOFING SYSTEM OVER GARAGES
(UNCONDITIONED SPACE). 2007 CODES.
INCLUDES ADDRESSES:49-185,• 49-171,;
49-165 & 49-151.' ""
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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