04-3923 (RR)LOP-
°�°
BUILDING& SAFETY DEPARTMENT
c w� P.O. Box 1504 (760).777=7012
OFTl9 78-495 CALLE.TAMPICO FAX (760) 777-701.1
LA QUINTA; CALIFORNIA 92253 INSPECTION REQUESTS- (7.60) 777-7153
BUILDING PERMIT.
Application Number (04�-00003923 Date 5/06/04
Property Address 80105 VISTA GRANDE
APN,: 649-143-003'-14 -3505 -
Application description RE --ROOF
Property Zoning LOW DENSITY.RESIDENTIAL
Application.valuation ,:; 3270:
=Owner Contr'acto'r'.
h
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MULLENEAUX JOSEPH W CASTRO ROOFING INC
80.10:5 VISTA GRANDE P O BOX 122.
LA .QUI NTA, CA' 92253..: THOUSAND PALMS' CA 92276
(7.60), 343=00.42
WCC HRH .INS
WC: 170546903. 12/01/04
CS'tB:. 8284`78 12/31/05
CCC: C-39
Permit RE7,ROOF
Additional desc
Permit Fee 30.00 Plan Check.Fee .00
Issue Date Valuation .: 0'
Qty Unit Charge: Per Extension
BASE FEE:30.00
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Special Notes and Comments..
RE'ROOF'.CLASS.."A" MATERIALS
Fee summary Charged Paid Credited; _ Due
-------------------
Permit Fee Total. 30.00 .:00 0:0 . 30.00
Plan Check .Tot a1 .00 ..00_ 00 00
Grand Total 30.0.0: 0:0 ^-y -- _._0_0 30'..0 0
PAY 05,
SEP-:
P.O. BOX 1504 "
VOICE (760) 777-7012
78-495 CALLS TAMPICO FAX (760) 777-7011
LA QulNrp, CALIFORNIA 92253 4.44
INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number:
Applicant:
Applicant's ailing A d
Date: S'l - 01
Architect or E g*
Architect orEngineer's Address:
Lic. No.
BUILDING PERMIT DECLARATIONS
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_ —3 9 License No.
Date Contra
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' 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 Contractors' 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).):
U 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 Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who.does the work
himself or herself or 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 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.).
U I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (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 contracts for the projects with a contractor(s) licensed pursuant to
the Contractors' State License Law.).
U I am exempt under Sec. , BA P.C. for this reason
Date
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
_ 1 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.
-_oI 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
issue' . My workers' compensation insurance carrier and policy numbs are:
Cartier Policy Number r-tj �Q 2j
_ I certify that, in the performance of the work for which this pe�ii u�halrnot employ any person in any manner so.as to become subject to the workers'
compensation laws of Californoat, if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those pr
Date "7 ' Appli
WARNING: 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), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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
Lender's Address
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application.
1. Each person upon whose behalf this application is made, each person at'whose request and for 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 inform on i I agree to comply with all city and county ordinances and state laws relating to building
constructio , a hereby authorize representatives of th' the above-mentioned property for inspection purposes.
Date e ! Signature (Applicant or Agent): '