06-0586 (RR)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:06.00-000586
Property Address: 48518 VIA ENCANTO
APN: -646-091-043-
Application description: RE -ROOF
Property Ltlnilly: LOW DENSITY RESTTIRNTTTAT
Application valuation: 9152
Applicant: Architect or Engineer:
• I - ,11 rr
IJ l
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Dater 2/08/06
Owner:
LAGUNA DE LA PAZ HOA
48300 VISTA DE NOPAL
D n
'/'�u\
LA QUINTA, CA.92253
FES 0 y 2006
Contractor:
CITY ®F L.A QUiNYA
.WESTERN PACIFIC ROOFING
C.QRZ
FINANCE DEPT.
3462 LA CAMPANA WAY
PALM SPRINGS; CA 92262
(760)000-0000
Lic. No.: 235717
--------------------------------------------------
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: B -C39 Lic se No.: 235717
Date: Z - e6 tractor
•. OWNER -BUILDER DECLARATION'
I hereby affirm under penalty of perjury that I am exempt from the Cuntractor'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.).
(_) 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 theperformance of the
work for which this. permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address: p
LQPERMIT - �•
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations: I .
Ihave 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
insurancecarrier and policy number are: '
Carrier. STATE FUND Policy Number 0457624-2005
I certify that, in the performance of the work for which this permit is issried, I shall not employ any
person in anymanner 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
37`00 of the Labor Code, I shall forthwith comply with those provisions. . .
ate: Z— O o Applicant:
l
WARNING:-FAILURETO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND.
DOLLARS (5100,000). 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 Quina, its officers, agents and employees for any act or omissionrelated 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 applica 'on and.state that the above information is correct. I agree to comply with all
city and c unty or
and to laws relating to building construction, nd hereby authorize representatives
of this ountgy to enter upon 'above-mentioned property for inspection rpos -
ate: Z ' /.`a �' nature (Applicant er Agent):
Application Number 06-00.000586
Permit . . . RE -ROOF
t
Additional desc .
Permi•t.Fee 30.00
Plan Check
Fee
.00
-Issue Date . . .
Valuation
0
Expiration Date 8/07/06
Qty Unit Charge Per
Extension
BASE .FEE
30:00
' Special Notes and Comments
RE -ROOF WITH POLYURETHANE FOAM SYSTEM
Fee summary Charged Paid
Credited
Due
-------- ----------
Permit.Fee Total 30.00
-1 ---------
.00
----------
.00
30.00
Plan Check Total .00
.00
.00 -
.00
Grand Total 30.00
00
.00
30.00
LQPERMIT