06-1941 (RR)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application Valuation:-
Applicant:
-06=00001941
_48130 VISTA CIELO
646-100-067- - -
RE -ROOF
LOW DENSITY RESIDENTIAL
7180
Architect or Engineer:
rte" a lA-
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
LA GUNA DE LA PAZ
48104 VIA HERMOSA
LA QUINTA, CA 92253
Contractor:
WESTERN PACIFIC ROOFING
3462 LA CAMPANA WAY
PALM -SPRINGS, CA 92262
(760)416-5877
Lic. No.: 235717'
VOICE (760) 777-7012
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: - -
of the us
Section 7000) of Division 3iness 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 License No.: 235717
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is -
Date/ -0 L antractor. '- (/
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
- - 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 "
3700 of the Labor Code, I shall forthwit comply with those rovisions. -
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section. 7031.5 by
• -
-r '
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
D ✓ ' -o plicant:
(_ 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: 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 EMPLOYERTOCRIMINAL 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 1$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 contractorls) licensed
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,
(_ 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 Quinti, 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 -
Iis
permit to cancellation. "
I hereby affirm under penalty of perjury that there a construction lending agency. for the performance of the
Icertify 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.).
city and county ordinances and state laws relating to building construction, and hereby authorize representatives -
-
of this my to ente�uponthe(.ab ve-mentioned property for insp=ction�Lender's
Name:
^�licant or Agent):
" Lender's Address:
LQPERMIT
"
Application Number . . 06-00001941
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
Permit Fee Total 30.00 -
.00
.00
30.00.
Plan Check Total.' .0.0
.00
.00
.00
Grand Total 30.00
.00
:00.
.30.00
_ _
LQPERMIT -