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08-1001 (RR)P.O. BOX 1504 VOICE 760 777-7012 -78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 6/12/08 Owner: Application Number: 08-00001001 Property Address: 52770 AVENIDA VILLA KOCHELL- STEVE M APN: 773-334-001-26 -000000' P O BOX 882 Application description: RE -ROOF LA' QUINTA, CA 922 Property Zoning: COVE RESIDENTIAL Application valuation: 7800 O . Contractor: 9 Applicant: Architect or Engineer. WINKLE COMPANY R.D Q1 `oO8 P.O. BOX 476 THOUSAND PALMS, CA 92 (I (760) 343-5144 Ivl Lic. No.: 688062 ----------------------------— _ 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. _ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided License Class' C39 License No.: 688062 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is ( issued. ~Date: /off Contractor. f©,� . _ 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 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 1705642-2008 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 700 of the Labor Code, I shall forthwith comply ith rhos provisions. , 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).: Date: � Applicant: ► �-JC!f� (- 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 r 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 ($100,0001. 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, as owner. of the property, am exclusively contracting with licensed contractors to construct the project ISec. 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. CJ. city and county ordinances and state laws relating to building co truction, and hereby authorize representatives - of this county to enter upon the above-mentioned property for i action purposes. Lender's Name: ,y//.vsey'c/._.� Lender's Address: _ Datii,4' "�'� Signature (Applicant or Agent .���ifi��6�6 ( �_ — LQPERMIIT „Application Number . . . 08-00001001 Permit RE -ROOF Additional desc . Permit Fee . . . . 30.00 Plan Check Fee .00. Issue Date •Valuation 0 Expiration Date 12/09/08 Qty Unit- Charge Per Extension BASE FEE 30.00 Special Notes and Comments. RE -ROOF PERMIT CLASS "A” SHINGLES 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 Bin # Qty of ' La Quint'a Building &r Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # Project Address: 'Sq- Owner's Name: A. P. Number: . .Address: la S = Au Legal Description: City, ST, Zip: Contractor: Address: Telephone: A', Project Description: City, ST, Zip: 1'hQA )SA A A Telephone: 7 a5i State Lic.#: City Lic. Arch., Engr., Designer: Address: U City., ST, Zip: Tele phone:-�—' State Lic.#: .................... ....... Construction Type Occupancy: Project type (circle one): New AdJ'n Alter Repair Demo Name of Contact Person: -A. Sq. Ft.: # Stories: –F#Units: Telephone # of Contact Person f." lue of Project: APPLICANT: DO NOT. WRITE BELOW THIS LINE # Submittal Req'd Rec!d TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural CaIcs. Reviewed, ready for corrections Plan Cheik Deposit Truss Cales. Called Contact Person Plan Cheak Balance Title 24 CaIcs. Plans picked up Construciion Flood plain plan Plans resubmitted Mechanical Grading plan 2"d 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 correctionsfissue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees I I Total Permit Fees I V. 00