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04-7464 (RR)BUILDING & SAFETY DEPARTMENT P.O. Box 1504 (760).777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT Application Number . . . . . 04700'007464 Date' 11/24/04 Property Address . . . . . . 51680 AVENIDA HERRERA APN: 773-133-009-16 -000000- Application description RE -ROOF Property Zoning . . . . . . . COVE RESIDENTIAL Application valuation 5000 Owner ---------------- - ------- RICHARD KNUDSON JR 51680 AVENIDA HERRERA LA QUINTA CA 92253 Contractor ---------------- - ------- OWNER ---------------------------------------------------------------------------- Permit . . . . . . RE -ROOF Additional desc Permit Fee 30.00 Plan Check Fee .00 Issue Date . . . . Valuation 0 Qty Unit Charge Per Extension BASE FEE 30.00 -------------------------------------------------------�--------------------- Special Notes and Comments RE -ROOF WITH SHINGLES -CLASS "A" MATERIALS ONLY Fee summary Charged -..Paid Credited Due .x ----------------- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ---------- Permit ---------Permit Fee Total 30.00 .00 .00 30.00 Plan Check Total .00 .00 .00 .00 Grand Total 30.00 00 •00„ 30 00 P.O. Box 1504• �� VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: 0!�- % Y iC Date: Applicant: G)L/Nell` Architect or Engineer: Applicant's Mailing Address: Architect or Engineer's Address: Lic. No.: BUILDING PERMIT DECLARATIONS 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 Class License No. Date Contractor OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' 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 Contractors' 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. Arry violation of Section 7031.5 by any applicant for a permit subjects thgapplicant to a civil penalty of not more than five hundred dollars ($500).): 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 or 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 h ve the burde f proving that he or she did not build or improve for the purpose of sale.). U 1, as owner of the property, am exclusively contracting wit ' en con rs to nstruct the project (Sec. 7044, Business and Professions Code: The Contractors'. State License Law does not apply to an owner of p y o b s imp s thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). U I am exempt under Sec. , BA P.C. f hi e Date Owner W KERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the fol wing declarations: 1 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. I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the perfornance of the work for which this permit is issued. My workers' compensation insurance canjelvand olicy numb are: Cartier Policy Nu bei ertify that, in the performance of the work r w ch'As erm 's is ed II not employ any person in any manner so as to become subject to the workers' compensation laws of California, and ree a I o ec a to the workers' compensation provisions of Section 3700 of the Labor Code, I shall fort with comply with those provi ' s. Date Applicant WAR ING: FAILURE TO SECU ORKERS' COMP SATION OVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DO RS ($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. CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perl'ury 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 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, anO shall, defe indemnify and hold harmless the City of La Quinta, its officers, agents and employees for any act or omission related to the wo ng p reed u r r follow issuance of this permit. 2. Any permit issued as a result of this application becomes null and voi rk i t com n within 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 informs ' is re I ree co ly w' ity and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to er u n t bo - do pr or inspection purposes. Date 7 Signature (Applicant or Agent .