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06-1926 (RR)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253. Application Number: 06-00001926 Property Address: 48512 -VIA ENCANTO . APN: 646;-091-046- - Application description: ' RE -ROOF Property Zoning: - LOW DENSITY_ RESIDENTIAL Application valuation: 9334 Applicant: Architect or Engineer: BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: LAGUNA DE LA PAZ HOA" 48300 VISTA DE NOPAL LA QUINTA, CA 92253 Contractor: WESTERN PACIFIC ROOFING 3462 LA CAMPANA WAY PALM SPRINGS, CA•92262 (760)416-5877 . Lic. No.: 235717 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 'Date: 5/10/06 ---------------- - - - --- - 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 6ivision 3 of the Business and Professionals Code, and my License is in full force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided License Cla B C39 License N 235717 - ate: ;< < Co tor: z• for by Section 3700 of the Labor Code, for the performance of the work forwhichthis 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 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 0457624-2006 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,) 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 s II fqhJhwi omply h se provisions. that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by &1/'j! any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: Date: pplicant: .. 1—) 1, 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 . 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 UPTOONE HUNDRED THOUSAND and who does the work himself or herself through his or her own employees, provided that the DOLLARS 1$100,000). 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 LABORCODE, 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 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 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. - is for the projects with.a contractor(s) licensed • property who builds or improvesthereon, and who contracts 1 . -. Each person upon whose behalf application is made, each person at whose request and for _ -- - pursuant to the Contractors' State License Law.).'- p -- Whose-benefitwork is performed under or pursuant permit issuedasa-result of this application, (_ 1 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 •work - - of La*Quinta, its officers, agents and employees for any act or omission related to the 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 this application and state that the above information is correct. I -agree to comply with all ' - work for which this permit is issued ISec. 3097,. Civ. C.). - city and county ordinances and state laws relating to building construction, and hereby authorize representatives • of thii0 - y enter upon the above-mentioned property for in ti pu oses. . ' Lender's Name: - �� Agent): - - Lender's Address: - - ate. ignature (Applicant or LQPERMIT -Application Number . . . . . 06-00001926 Permit RE -ROOF Additional desc , Permit Fee 30.00. Plan Check Fee .00 Issue Date . . . 'Valuation . . 0, Expiration Date ,11/06/06 Qty Unit Charge Per Extension BASE FEE 30.00 Special Notes and Comments REROOF POLYURETHANE FOAM/ACRYLIC ROOF SYSTEM Fee summary Charged Paid Credited Due Permit Fee .Total -= 30.00 00 00 3,0-:-00 Plan Check Total .00 .00 .00 .00 Grand Total 30.00 .00 :00.- 30..00 LQPERMIT -