06-1689 (RR)-, :s
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
06-00001689
Property Address:
49095 CALLE FLORA
APN:
658 -210 -002 -
Application description:
RE -ROOF
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
17000
T4ht 4 4 Quik&
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Applicant: Architect or Engineer:
--------------------------------------------------
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 License is in full force and effect.
License..Clla�/ss: B -C10 -C20- License No.: 458005
ate%,O ntractor:-
OWNER-BUILDEy ARATION
I hereby affirm under penalty of perjury that I am exempt fro a 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 70001 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 ($500).:
(_ 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
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.).
(_ 1 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 contractor(s) licensed
pursuant to the Contractors' State License Law.).
1 1 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
Owner:
MEL LEVINE
49095 CALLE FLORA
LA QUINTA, CA 92253
Contractor:
BILT-WELL ROOF & MATERIAL CO
3310 VERDUGO ROAD
LOS ANGELES, CA 90065 _
(323)254-2888
Lic. No.: 458005
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/02/06
D°
MAY 0 ? Z006
------------------
WORKER'S COMPENSATION DECLARATION
LA
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.
1 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
insurance carrier and policy number are:
Carrier STATE FUND Policy Number 1783600
_ 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 Code, I shat hwith comply with those provisions.
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION RAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIV INE, UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION 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 building construction, and hereby authorize representatives
of this county to enter upon the ove-mentioned property for in p ion purposes.
ate �-1-Si ture (Applicant or Agent):
k„ '1.
Application Number . . . . . 06-00001689
Permit . . . RE -ROOF INV FEE
Additional desc . .
Permit Fee . . . . 60.00
Plan Check
Fee
.00
Issue Date
Valuation
. . .
. 0
Expiration Date .. 10/29/06
Qty, Unit Charge Per
Extension
BASE FEE
60.00
----------------------------------------------------------------------------
Special Notes and Comments
RE -ROOF WITH PVE 40 ML
FIBERTITE.INVESTIGATION FEE ASSESSED
PER 1997 UAC SEC. 304.5 FOR WORK BEGUN
WITHOUT A BUILDING PERMIT
Fee .summary Charged Paid
-------------------------------------
Credited
--------------------
Due --
Permit Fee Total 60.00
.00
.00
60.00
Plan Check Total .00
.00
.00
..00
Grand Total 60.00
.00
.00
60.00
LQPERMIT
05/01!2006 11:46 7607777011
LA QUINTA PAGE 01/01
Bin #
City of La Quints
Building at Safety Division
P.O. Bax 1504, 78-495 Calle Tampico
Permit #
La Quinta, CA 92253 - (760) 777-7012
Building Permlt Application and Tracking Sheet
Project Address:
f �� Owncr's Name:Kel
A. P. Nurobex:
Address: 3 0
%gal Desctiption:
City, ST, Zip: S d(�y�
Contractor. r ^".
I / ;
Telephone:
Description:
Address:Project
City, ST, Zip: A—
4C.J
Teleph_one:
x �
State Lic.'# :
(� City Lie. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
Construction .Type: ! Occupancy: ^ • /
State Lie. #:
Project typo (circle one): New Add'n Alt Repair 'Demo
Name of Contact Person:
Ft. Q #Stoniest # U>uits:
Telepironc # of Contact Person: Estimated Value of Project:
APPLICANT* DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACMG .
PERM• FEES
Plan Sets
Plan Check submitted
Item Amount
Structural Cal".
geviewed, ready for correctlons
Klan Check, Deposit
Truss Calcs.
Called Contact Person
Klan Check Balance
Energy Calcs.
Plans Picked up
Construction
Flood plain plan
Plans resubmitted
Mcchanieal
Grading plan
V gcview, ready for correctionstissue
Electrical
Subcontactor.List
Called Contact Person
Plumbing
GrantAeed
Plans picked up
S.M.I.
H.O.A. Approval'
Plans resubmitted
Grading
IN ROUSE:-
'"d Review, ready for corrections/Issue
Developer Impact Fee
Planning Approval
Called Contact Person
.Pub. Wks. Appr
Date of permit issne
School Fees
'Total Permit trees