05-4143 (RR)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
cw
Application Number:
Property Address:
APN:
Application description
Property Zoning:
Application valuation:
Applicant:
"`05-00004143
53140 EISENHOWER DR
774-061-007-18 -000000-
RE-ROOF
COVE RESIDENTIAL
12540
Architect or
Td4t 4 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
--------------------------------------------------
LICENSED CONTRACTOR'S DE
CLA ATION
I hereby affirm under penalty of perjury that I am licensed under pr isions hapter 9 (commencing with
Section 7000) of Division 3 of the Business. and Professionals Co , a d icense is in full force and effect.
License Class: C39 n N 4410707
Date: ���� Contractor:
` y .
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury 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 ($500).:
1 _ 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 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:
ESQUIVEL FRANK/NORMA
53140 EISENHOWER DR
LA QUINTA, CA 92253
(760) 564-.9255
Contractor:
PETRONELLA ROOFING COMPANY
68314 KIELEY ROAD
CATHEDRAL CITY, CA 92234
(760)324-5482
Lic. No.: 460707
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/15/05
-----------------7-----------------------------
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following 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 performance of the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier STATE FUND Policy Number 1801579
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 work s' compensation laws of California,
and agree that, if I should become subject to the w rker ' c mpensation provisions of Section
c�r7�
3700 of the Labor Codlall fo hwith c ly i h o provisions.
Date: Applicant:
WARNING: FAILURE TO SEC WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES 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 Ouinta, 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 corre t. I a e to comply with all
city and county ordinances and state laws relating to building onstruction, and her au o ze representatives
of this county to enter upon the above-mentioned property f ins p ction ose
Date: —/r—,P gnature (Applicant or Agent): -
Application Number . . . . .• 05-00004143
Permit . . . RE -ROOF
Additional desc .
Permit Fee . . . . 30.00
Plan Check
Fee
.00
Issue Date
Valuation
. . .
. 0
Expiration Date 3/14/06
t Qty Unit Charge Per
Extension
BASE
-
FEE
30.00
----------------------------------------------------------------------------
Special Notes and Comments
REMOVE ALL EXISTING ROOFING
MATERIALS/REPLACE WITH EAGLELITE
TILE
Fee summary Charged
------------- - --- ----------
Paid Credited
Due
----------
Permit Fee Total 30.00
----------
.00
----------
.00
30.00
Plan Check Total-, .00
.00
.00
4 .00 `+
Grand Total 30.00
.00
.00
30.00
LQPERMIT
THE R ER, •,OFING SPE C° ALISTS, INC.
Corporate Office:
2626 Newport Blvd.
Costa Mesa, CA 92627
949.548.1645 /Fax: 949.548-2617
ROOFING
Desert Office:
68-314 Kieley Road
Cathedral City, CA 92234
License 9460707 760.324.5482 / Fax: 760.328.4612
PETRONELLA ROOFING hereinafter called "Contractor and/or "Seller" aerees to provide the following listed labor materials and construction:
NAME / OWNER: NORMA ESQUIVEL
REROOF PROJECT ADDRESS 53140 EISENHOWER DRIVE
CITY, STATE & ZIP CODE LA QUINTA, CA. 92253
BILLING ADDRESS:
CITY, STATE & ZIP CODE:
ADDITIONAL PHONE NUMBER:
DESCRIPTION OF LABOR MATERIALS AND MISC.:
Petronella Roofingwill furnish all labor anal material to install a
ROOFING COST
OPTION #1
LIGHTWEIGHT TIME ROOFING SYSTEM (On Pitched)
Petronella Roofing will issue a 10 Year "Weathershield" Warranty
PHONE NO: (
FAX NUMBER:
COST...............................................................................................$12,540.00
SPECIAL INSTRUCTIONS:
1. Replace damaged plywood at $2.50 per S.F.. as required by city inspector.
2. Any electrical or plumbing work will be billed at $75.00 per man per hour.
3. Replace fascia at $ 6.50 per L.F.
a S
CONTRACT TERMS:
10% Upon Award of Contract
40% Upon Tear Off
50% Upon Completion
TIME FOR STARTING AND COMPLETING PROJECT: Work Shall commence within ten (I0) days from the date of sale unless specified otherwise
and be substantially completed in approximately ten (10) working days with additional time to be as detailed in Paragraph 9. of the
Terms. conditions and `Notice to Owner" on the back hereof: Substantial Commencement of work shall be defined as the installation of am- materials and/or labor.
Contractors failure, to substantially commence work. without lallftil excuse, within twenty (20) days from the date specified, above is a violation of the Contractors
License Law.
NOTICE TO.BUYER: (1) Do not sign this agreement before you read it. (2) You are entitled to a completely tilled in copy of this agreement. (3) Owner /
Authorized Responsible party acknowledges that Ile / she has read and received a legible copy of the this agreement signed by Contractor. including all Terms.
Conditions and `Notice to Owner' on the reverse side, before any work was done and that he / she has read and received a legible copy of every document that Owner/
Authorized Responsible parthas signed during the negotiations. (4) YOU. THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO
MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION BY NOTIFYING THE SELLER. IN WRITING. AT THE ABOVE
ADDRESS. IN THE EVENT YOU THE BUYER FAILS TO EXERCISE THIS RIGHT AND SUBSEQUENTLY ATTEMPTS TO CANCEL THIS CONTRACT
AFTER THE EFECTIVE DATE IF :RECISION. THE CONTRACTOR SHALL BE ENTITLED TO RECOVER ALL COSTS AND LOST PROFITS ASSOCIATED
WITH THIS CONTRACT. (5) YOU, AS OWNER OR TENANT, HAVE THE RIGHT TO REQUIRE THE CONTRACTOR. TO HAVE A PERFOMANCE AND
PAYMENT BOND OR.FUNDING CONTROL.
OWNER / RESPONSIBLIE PARTY
Owner /Responsible Party: Pr& Name
yL(,9,.. 6 eq3'tjj
Owner / Responsible P Signature
O
Date of Sale
CONTRACTOR (SELLER) CONTRACT PRICE
klike Scheid A $ 12,540.00
PetronellaIfing Print Name
$ 1,254.00
Petr to RNling Authorized Rep esentative: Signature
.august 02, 2005
Date of Sale