06-1899 (RR)X11
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
ApplicatCion Number: 06-00001899" `
Property Address: 48136 VIA-HERMOSA
f' APN: 646 -100 -022 -
Application description:,. RE -ROOF
.'Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 8616 -
Applicant: Architect or Engineer:
IA -
BUILDING & SAFETY DEPARTMENT`
BUILDING PERMIT
Owner:
LA GUNA DE LA PAZ
48300 VISTA DE NO PAL
y LA QUINTA, CA 92253
Contractor:
WESTERN PACIFIC'ROOF
3462 LA CAMPANA WAY
PALM SPRINGS, CA 922
(760)416-5877
Lic. No.: 235717
VOICE (760) 77.7-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/10/06
LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
' I 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 Class: B C39 ense : 235717
���
_
for by Section 3700 of the Labor Code, for the performance of the work for which this permit isdg . -
issued.
'required
'a�te: 0� ractor: _
/
I have and will maintain workers'•compensation insurance, as 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
ith c ply ith th
700 of the Labor Code, I shall fort wo pr ns.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031 .5 by
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anyapplicant for a permit subjects the applicant to a civil penalty of not more than five hundied dollars IS5001.:
ate: ' • scant:
( - 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
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' - 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
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. -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 madeto 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 piujects with a contractors) liconsod
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, '
I—) 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 actor omission related to the work being
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performed under' or following issuance of this permit.
Date: Owner:
2. Any permit issued as a result of this application becomes null and void ifwork isnot 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.). - - -
cityand county ordinancesand state laws relating to building construction, and hereby authorize representatives
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_ - Lender's Name:
- - w •
of this cou nter' upon the above-mentioned property for inspec ion pure es. t
e: J / .S' ture (Applicant or Agent):
Lender's Address: -
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LQPERMIT
Application Number _ 06-00001899
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
j` Special Notes and Comments
REROOF POLYURETHANE FOAM/ACRYLIC
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.
LQPERMIT - -
-