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06-1934 (RR)BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: D LAGUNA DE LA PAZ HOA 48300 VISTA DE NOPAL - LA QUINTA, CA 92253 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 5/10/06 May � � 10® • w Contractor: iq P.O. BOX 1504 WESTERN PACIFIC ROOFINGCORP 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 06 -00001934 - Property Address: 48554 VIA ENCANTO APN: 646-091-032- - - Application description: RE -ROOF Property Zoning: LOW' DENSITY.RESIDENTIAL- Application valuation: - 9334 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: D LAGUNA DE LA PAZ HOA 48300 VISTA DE NOPAL - LA QUINTA, CA 92253 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 5/10/06 May � � 10® • w Contractor: iq Applicant: Architect or Engineer: WESTERN PACIFIC ROOFINGCORP 3462 -LA CAMPANA WAY PALM SPRINGS, CA 92262 (760)•416-5877 r coo Lic. No.: 235717 - LICENSED CONTRACTOR'S DECLARATION - WORKER'S COMPENSATION DECLARATION " 1 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 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 en a Licss: B C39 License No.: 235717 �J Date: }� c ntractDrr/ / y _ 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 permitisissued. My workers' compensation' OWNER -BUILDER DECLARATION . insurance carrier and policy number are: - I hereby affirm under penalty of perjury that I am exempt trom.the Contraotor'S State License Law for the Carrier STATE FUND Policy Number 04.57624-2006 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 personin 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 that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by 3700 of Code, 1 shall forthwith comply with thh isions. ,. any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: > at"'� `6 ` �/ //✓ 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 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 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 1 _ 1 1, 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 . Eachpersonupon whose behalf this application is made, each person at whose request and for pursuant to the Contractors' State License Law.). whose benefit work isperformedunder 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 180 days will subject CONSTRUCTION LENDING AGENCY permit to cancellation. hereby affirm under penalty of perjury that there is a construction lending agency for the performance of -the I certify that 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.1. , city and c my ordinances and state laws relating to building construction, and hereby authorize representatives Lender's Name: thi aunty toenter upo he above-mentioned property for inspection purposes. '•• '�/" 6 - ignature (Applicant or Agent,—,--7- ate✓ gent fr �� - Lender's - ..Lender's Address: - - • LQPERMIT - Application Number 06-00.001934 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 y + Extension BASE _ FEE 30.00 - --------------------------------------------- Special Notes and Comments ---_--- ----- -.- - - - -----.---- �. 'REROOF POLYURETHANE FOAM/ACRYLIC ROOF „ SYSTEM Fee summary Charged Paid Credited Due 5' Permit Fee Total -4� 30.00 - --- •---------- A.00 .00 30.00— 0.00 Plan Plan Check Total .00 .00 .00 .00 Grand Total 30.00 .00 .00 30.00.• LQPERMIT . • .. -