06-1933 (RR)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA .92253
Application Number: 06-00001933
Property Address: 48546 VIA ENCANTO
APN: 646-091-035- - -
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
0
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date
5/10/06.
Contractor:
WESTERN PACIFIC ROOFIN
3462 LA CAMPANA WAY
PALM SPRINGS, CA 92262
(760)416-5877
Lic. No.: 235717
LICENSED CONTRACTOR'S DECLARATION
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WORKER'S COMPENSATION DECLARATION
. I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter•9 (commencing with
Thereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 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 Class: B C39 - License No.: .235717
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is '
�
at e:` ('� • C7 ontracto,: �
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:
1 hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
Carrier STATE FUND 14 '' 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, I 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
3700 of the abor Code, I shall forthwith co m ly 'th those provisions. - -
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).:
ate: 'G Applicant: -
1, as owner of the property, or my. employees with wages as their sale compensation, will do the work, and
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The
WARNING: AILURE 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 UP TO ONE HUNDRED THOUSAND
and who does the work himself or -herself through his or her own employees, provided that the ' .
DOLLARS ($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 LABOR CODE, 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
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.
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
•. . 1. Each person upon whose behalf this application is made, each person at whose request and for
pursuant to the Contractors' State License Law.).
-whose benefit work is performed under or pursuant to any permit issued as a 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 -
_
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..
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"! 80 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 (Sec. 3097, Civ. C.).
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
-
of-th' county to enter upo a above-mentioned property for inspection purposes. - -
- Lender's Name: - -
ate! _P ignature (Applicant or Agent):
Lender's Address:
i
LQPERMIT -
.
Application Number 06-00001933
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 l
BASE -FEE
30.00
-----------------------------
Special Notes "and Comments
------------ ---------
_
REROOF POLYURETHANE FOAM/ACRYLIC
ROOF
..SYSTEM
Fee summary Charged -
Paid Credited
Due
----------
Permit
Permit Fee Totw 3.0":00
----------
.00•
----------
.00
- ------
Do. 00
Plan Check Tota00
l'
.00
.00
.00
,Grand Total 30`.00
..00
.00
30.00 .
• LQPERMIT,