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05-4496 (RR)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 c&1it 4 stP Q" BUILDING & SAFETY DEPARTMENT BUILDING PERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 %;iTY OF LA Applicant: Architect or Enineer: FINANt-c ------------------ LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my Li n I fo1ce and effect/ License Class: License No.: % 1 7 O(.. Date: —0 Contractor: OWNER -BUILDER DECLARATION I hereby affirm under penalty of Lriury that I am exempt from the Contractor's State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 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 (5500).: (_) 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 Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within 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.). (_) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractors) licensed pursuant to the Contractors' State License Law.). ( ) I am exempt under Sec. , B.&P.C. for this reason 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 (Sec. 3097, Civ. C.). Lender's Name: _ Lender's Address: LQPERMIT Contractor: L/,) AtPOFi.✓G;� co owoe— -------- 131o0A1IAIQ'V/V- CA --- 923/6 WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ii I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Y� Code, for the performance of the work for which this permit is issued. My workers' compe sat'on 5Tsurany�carrier /nd policy number are: / Carrier s C—L. — Policy Numbery I certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Cod shal Drthwith comply with )hose provisions. Date: Q Applicant: .� WARNING: FAILURE TO SEC WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO IMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN A ITION TO THE COST OF COMPENSATION, DAMAGES -AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application. 1. Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application, 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. 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. I 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 buildingynstructip , and hereby authorize representatives of this county to enter upon the above-mentioned property ins p �o purpose Date/04-05—'-Signature. (Applicant or Agent): Date: 10/06/05 Application Number: r 05-00004496 __ Owner: Property Address: 79850 FIESTA DR NORMAN MARVIN C APN: 649-062-018-47 -2180 - D 79850 FIESTA DR Application description: RE -ROOF LA QUINTA, CA 92253 Property Zoning: LOW DENSITY.RESIDENTIAL --------------------------------- Application valuation: 5800 OCT 0 6 2005 %;iTY OF LA Applicant: Architect or Enineer: FINANt-c ------------------ LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my Li n I fo1ce and effect/ License Class: License No.: % 1 7 O(.. Date: —0 Contractor: OWNER -BUILDER DECLARATION I hereby affirm under penalty of Lriury that I am exempt from the Contractor's State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 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 (5500).: (_) 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 Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within 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.). (_) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractors) licensed pursuant to the Contractors' State License Law.). ( ) I am exempt under Sec. , B.&P.C. for this reason 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 (Sec. 3097, Civ. C.). Lender's Name: _ Lender's Address: LQPERMIT Contractor: L/,) AtPOFi.✓G;� co owoe— -------- 131o0A1IAIQ'V/V- CA --- 923/6 WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ii I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Y� Code, for the performance of the work for which this permit is issued. My workers' compe sat'on 5Tsurany�carrier /nd policy number are: / Carrier s C—L. — Policy Numbery I certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Cod shal Drthwith comply with )hose provisions. Date: Q Applicant: .� WARNING: FAILURE TO SEC WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO IMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN A ITION TO THE COST OF COMPENSATION, DAMAGES -AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application. 1. Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application, 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. 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. I 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 buildingynstructip , and hereby authorize representatives of this county to enter upon the above-mentioned property ins p �o purpose Date/04-05—'-Signature. (Applicant or Agent): Application Number . . . . . 05-00004496 Permit . . . RE -ROOF Additional desc . Permit Fee . . . . 30.00 Plan Check Fee .00 Issue Date Valuation . . . . 0 Expiration Date 4/04/06 Qty Unit Charge Per Extension BASE FEE 30.00 ----------I--------------------------------------------------------- Special Notes and Comments REMOVE WOOD SHINGLES/REPLACE WITH 30 YEAR COMP SHINGLES. CLASS "A" MATERIALS ONLY. 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 f LQPERMIT M P.O. BOX 1504 APPLICATION ONLY Building 78-495 CALLE TAMPICO Address LA QUINTA, CALIFORNIA 92253 Owner Boa, ®°Y BUILDING: TYPE CONST. OCC. GRP. Mailing Address A.P. Number City Zip Tel. Legal Description y Contractor Project Descrtion Address �tkteic. Zip el. it Sq. Ft. No. p No. Dw. & Classif._ Lic. # Size Stories ( Units Arch., Engr., New Add ❑ Alter ❑ Repair ❑ Demolition ❑ Designer Address Tel. City Zip State Lic. # LIC SED CONTRACTOR'S DECLARATION I hereby aHir that I a ens!��er 9 (commencing with Section 7000) of Di ' Ion 3 of usind my Ilcense is in Lull force and effect.-�® SIGN DATE OWNER -BUILDER DECLARATION ereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, or that he 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). ❑ 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 Profes- sions Code: The Contractor's License Law does not apply to an owner of property who builds ort mproves thereon and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or im- provement is sold within one year of completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law) O 1 am exempt under Sec. B. & P.C. for this reason Date Owner WORKER'S COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Worker's Compensatio Insur n� e, r certified copy tl reo (Sec. 3 �0 ,Labor ode.) Policy No.� ompanyc C �IA— ❑ Copy. is filed with the city. IrCertified copy is hereby, furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) valuation or less). I certify that in the perform an of t work for which this permil is issued, I shall not employ any person in any manner is comes bject to Worker ompensation Laws of CallaJJn�}'��� �✓ ���� Dat �� Owner - NO CE TO APPLICANT. er making this Certificate of Exemption you should become subject to the Workers' mpensation provisions of the Labor Code, you must forthwith comply with such provisio or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Lender's Name Lender's Address This is a building permit whenproperly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. 1 certify that I have read this application and state that the above information is correct. I agree to comply with acounty ordinances and state laws relating to building construction, and hereby�authzeep entativesof thi city to enter the above-mentioned property for inspectio�pu Signature of applicants Date Mailing Address City, State, Zip ' WHITE = BUILDING DEPARTMENT Estimated PERMIT Plan Chk. Dep. Plan Chk: Bal. Const. Mech. Electrical S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS AMOUNT /0 W ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validation: YELLOW = APPLICANT PINK = FINANCE 1U/U3/LUU0 nil) 1UAI CAA 100000d00H 11U it t, 11VINt SUDI 5 --)-j Jllll Branch: g�{ i�leg�Z ROOFING SPEC SHEET Branch It: CQ DESCRIPTION OF WORK WJ UU4/ UUP _ f Spec sheet M R'221809 Job #: 'M� ?s5'EIW14N':' g:. : u v; ,. •,NyA : ,pm :p99,N:.1�Blr' v "'+ ' Nome Phone #: Customer Name, ? �}2v �� 1s ar-?-marJ Cell Phone #: + ) lis b !Ek0< ,W P9— • Work Phone #: ± ? Job Address; l �7 streatAddress Email Address: S jDol i+v `g c., cq�S 7 Drop Location: City Stele Zip Cade Dumpster Location: •Sr . IS,64—. — ' r OldJl .. SHINGLE SPECIALTY ROOFING REMOVAL METAL FLASHING Product Color Product Color meek at/ hat,PWy Timberline 30 ei Royal Sovereign aid Law Slope Flat Asphalt Wood Shingles Step. Counter or Base Timberline Ultra Grand Slate Tile Metal Tile Modified Chimney Grand Sequoia Class IV Tar & Gravel Skylight Price Ineludeel shiroes (lad, starter, hip s ridge), Leak Barrer and undertagmant _ Other" _ 'Name: `"# Layers_ Drip Edge Other Peace of Mind Installation® "�° System: " sea ado alereea below A^ Color. W�11� Exhaust Intake Product Color soffit a Fascia Cricket Ridge Vent Soffit Vent Wrap Fascia Only Addl. Slo Turbine Vent Low Profile Vented Drip E e Cover Frieze Board Gutter & Downspout Poor ass Stee rga with: Tuck Fascia under Gutters: res = No 0 Color: %� Colo . Cover Frieze Bo PVC Trim 1 R ee Fascia Vertices t t1 'AL°EAl l N, NOTES . List uxaaas ur metal dashtngrguhc wrcRt a t3"- to bo o-Xk�ned and any other soecwi considareaons. o .trdm vty pre ezioim ptm iwrr, (etchta on coinme, bent or damaged gulters. etc.) and 6fdlocstiona bekml: Wa'Is Ceilings Windows Sidin Gutters Driveway Landscaping A r; If rotted or damaged wood Is cliscoyprto AFTER removing the existing roofing, or could ript be idcrttified at the time of sale, there will be an additional charge of $7 -LC—.— per sheet of 4x13 sheathing and/or bier linear foot of dimensional lumber, "If additional layers of roofing are discovered AFTER removing the first layer, or could riot be identified at time of sale, there will be an additional charge per square to remove each additional layer based on product to be removed: s t for composition shingles, $ for wood shingles arld $�3.0- rot low slope roofing. I hove reviewed and agree with the job specifications described above: Customer Si nal Ge, Date; g4 0 1).174)4 :FGR License Detail California Home Page 1 of 2 octol License Detail CALIFORNIA CONTRACTORS STATE LICEN Contractor License # 786931 DISCLAIMER A license status check provides information taken from the CSLB license data base. BeforE on this information, you should be aware of the following limitations: . CSLB complaint disclosure is restricted by law (B&P 7124.6). If this entity is subject tc complaint disclosure, a link for complaint disclosure will appear below. Click on the tin button to obtain complaint and/or legal action information. . Per B&P 7071,17, only construction related civil judgments reported to the CSLB are disclosed. • Arbitrations are not listed unless the contractor fails to comply with the terms of the arbitration. . Due to workload, there may be relevant information that has not yet been entered ont Board's license data base. Extract Date: 10/06/2005 * * * Business Information * * * J L M ROOFING CO 18449 LA CANADA CT BLOOMINGTON, CA 92316 Business Phone Number: (909) 220-0933 Entity: Sole Ownership Issue Date: 11/03/2000 Expire Date: 11/30/2006 * * * License Status * * * This license is current and active. All information below should be reviewed. * * * Classifications * * * Class Description C39 ROOFING * * * Bonding Information * * * CONTRACTOR'S BOND: This license filed Contractor's Bond number WCL1206988 in the of $10,000 with the bonding company http://www2.csIb.ca.gov/CS.LB_LIBP,ARY/License+Detai1.asp 10/6/2005