07-0121 (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) 777-71.53
BUILDING PERMIT
Date: 1/16/07
Application Number:X0:7--0000012 Owner:
Property Address: 09277 AVENIDA VISTA BONITA MACIE RICHARD F
APN: 773-350-031-31 "J-14496.- 4'015 HORTON RD
Application description: RE-ROOF r BONITA, CA 91902
r. Property Zoning: LOW DENSITY RESIDENTIAL I
Qr; !'rpplieation voluatian; 5700;75
Contractor: q� f 1 C y Applicant: Architect or Engineer: WESTERN PACIFIC •ROOFIN RP JAI 6 2001
3462 LA CAMPANA WAY
PALM SPRINGS, CA 92262 CITXQFO:A�IJINTA
ti (
760)416-5877 FINANCE 011PT.
Lic. No.: 235717 '
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 ss: B C39 License o.• 35717 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
�iDa �i 1 _Cont-racto _ I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
�f '_,,.�^•• - 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: r
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Cirrier STATE FUND - Policy Number . X046001635506
following reason (Sec..7011 .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 persuit in any manner so as to become subject to the workers' compensation laws of f:alifnrnia,
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 (Chapte(,9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or3700 of the Labor Code, I s I for with comply provisions.
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).: - "Date: L 4Applica �
(_) 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 WAR IN
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
y 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.). r APPLICANT ACKNOWLEDGEMENT
I, 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,
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 act on 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 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.
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.). - city and county ordinances and state laws relating to building construction, and hereby aut ze representatives
` of this c unt to enter u on the above-mentionedpropertyfor i '
y p _ pe tion pur.oses.
�q, /A
Lender's Name: 31 /` �.
(Date: Signature (Applicant or Agent'.
~_ .
Lender's Address: - -
LQPERMTT -
Bin #
City of La Quinn
Building u Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit # zr
Project Address: 9_ 2 7 1Z j f 3 2 9 .7 Y7
A. P. Number: AJ E.J 1 Oti v:) r$
Owner's Name: S�.4r+ !?osR Go�4 hEol�
Address: .
Legal Description:
City, ST, Zip:
Contractor:
Telephone:
Address: ,j jIG.Z �n GQ t,.lA !
Project Description:
City, ST, Zip: f9� : .�.J CA- glli(Z
Telephone: 760 —YA(-, r f 77
State Lic. # : Z T17 / % City Lic. #:
Arch., Engr., Designer:
1^)J PA a -JY✓
V p r
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Construction Type: Occupancy:
Project type (circle one): New. Add'3 Alter Repair Demo
Name of Contact Person: W �,�£
Sq. Ft.: a3 O O
# Stories:
# Units: f
Telephone # of Contact Person: % �� 'J).1—� g G 0
Estimated Value of Project:
APPUCANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd :.
. Reed.
TRACKING .
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready ford' ections
Plan Check Deposit
Truss Coles.
Called Contact Persoa
Plan Check Balance
Energy Calcs.
Plans Picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading, plan
2" Review, ready for correctionvissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S M I
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
''' Review, ready for. corrections/issue
Developer impact Fee
Planning Approval
Called Contact Person1.
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees