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06-1897 (RR)y Y P.O. BOX 1504 78-495 CALLE'TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Application Number.0 -00001897 Owner. Property Address: 48120 VIA HERMOSA LA GUNA DE LA PAZ APN: 646=100-026- - - 48300 VISTA DE NOPAL Application description' RE -ROOF LA QUINTA, CA 92253 Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: .8616 Contractor: Applicant: Architect or Engineer: WESTERN PACIFIC ROOFING 3462 LA CAMPANA WAY ..� PALM SP,PT-NGS, CA 92262 (760)416-5877 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 LiceriseNo.: 235717 tractor: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor'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 $500).:1 _ 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. - Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the.workhimself 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 t 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.). ' j I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7844, Business and Prot&§sion§ L:6ad! I rte LUIRlaciurs' State Llt,euae Luaa duos ,gat aN)SP; to nn awnar of property who builds or improves thereon, and who contracts for the projects with a contractors) licensed pursuant'to the Contractors' State License Law.). - (_) 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 the performance of the .work for which this permit is issued (Sec. 3097, Civ. C.). _ . Lender's Name: - - - i Lender's Address: LQPERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 5/10/06 ----------------------.------------------------ WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: _ I have 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 insurance carrier and policy number are: Carrier .STATE FUND Policy Number 0457624-2006 I certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner 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 700 of the Labor Code, I shjAall f/or/tyw/ith//��pmplyrw/Y�hprovisions. ' ate: ��.�-." pplicant: ' / �. ` WARNIN :. FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000).1 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 rnnditinns and rPstriminns jet forth on thi; application. - 1 .- Each person upon whose behalf this application is made, each 06ftan at whose request and (ur 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 Quinta, its officers, agents and employees for any act or omission related 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 application and state that the above information is correct. I agree to comply with all city and co ty ordinances and state laws relating to building construction, and hereby authorize representatives of this3`,Z� upon t bove-mentioned property forspe on urposes. /��n//w/te:gnature (Applicant or Agentki*�� "'! 8 x; Application Number 06-00001897 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/ACRYL•IC ROOF SYSTEM Fee summary • Charged ---�,------ Paid Credited ----- ---- Due - --------------------------- Permit Fee Total 30.00 .00 .00 30.•00: Plan Check Total .00 .00 .00 .00 Grand Total 30.00 .00 00 30.00 c LQPERMTT ..