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06-1936 (RR)P.O. BOX 1504 VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 , BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT _ Date: ' 5/10/06 Application Number: 06-00001936 Owner: Property Address:- 48112 VIA HERMOSA LA GUNA DE LA. PAZ APN: 646-100-028- - 48104 VIA HERMOSA Application description: RE -ROOF LA QUINTA, CA 92253 Property Zoning: LOW DENSITY RESIDENTIAL ` Application Valuation: 7180 D n Contractor: Applicant- Architect or Engineer: WESTERN PACIFIC ROOFING CORP MAY 12 ZOOS 3462 -LA CAMPANA'_WAY PALM SPRIr13S, CA 92262 COTy ®F (760) 416-5877 �Qi161VTi0 Lic. No.: 235717 ® T. LICENSED CONTRACTOR'S DECLARATION - WORKER'S COMPENSATION DECLARATION 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 License Cl -ads• B C39 A License No/ 235717 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is s7f /� / / issued. Yate: � ntractor: 'c «/ � _KI 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, 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 700 of the Labor Code, I hall Prth 4th comp wi those provisions. r 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: •� A cant. ( - 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 WARNING: FAIL RE 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, 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 contractor(s) licensed 1., Each personupon 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, Iam 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.. " 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.). c�te nd co ordinances and state. laws relating to building construction, and hereby authorize representatives - - • . _ osy enter upon th ove-mentioned property for ins ctiopurpo s.Lender's Name: C� nature (Applicant or Agent): Lender's Address: LQPERMIT .. , ti Application Number' 06-00001936 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 -a Permit Fee Total. 30.00 ---..0.0 .00 30.00 Plan Check Total .00 .00 .00 '- .00 Grand Total 30.00 .00 .00 30.00 - LQPERMIT -o -