07-0126 (RR)QUA'
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) 777-7153
BUILDING PERMIT \
- — 6 1/16/07
Application NumberiI" ~'07-0.0.0.00126 Owner: D
Property Address: 49311 AVENIDA VISTA BONITA FELL JEROME C
APN: 773-350-033-33' -14496 49-311 AVENIDA-VIS ONI��IIV
Application description: RE-ROOF LA QUINTA, CA 9225
Property Zoning: LOW DENSITY RESIDENTIAL (003) 000-0000 QUINTA
Application valuation: 5706 Cf6Y of p
LA UIN
f
INAN
o Contractor:
Applicant: Architect or Engineer: WESTERN PACIFIC ROOFING CORP
3462 LA CAMPANA WAY
PALM SPRINGS, CA 92262
(760)416-5,877
Lic. No.: 235717
LICENSED CONTRACTOR'S DECLARATION - .. WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury than 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
LicenseClass: B C39 Licens N 235717 - for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
_ _t //y�� C issued.
_ � ,Date: (� -/Contractor: ���/-l/V� _ 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 046001635506
following reason ISec. 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 itsissuance, 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 orthwith comply
''tth,tthhomoose provisions. -
that p li she o exempt therefrom and the basis for the alleged exemption.. Any violation d Section 7031.5 by '- J; . , V ��� �N✓ -
any applicant for permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: Date:.' fit: Applicant:
1 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 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 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, 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 contractor(s) 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—) 1-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 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 - 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.). city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of this co my o enter upon the above-mentioned property, fo sp tion purpose
Lender's Name: -ol
- -Date: /,& Signature (Applicant or AgentL//- -
Lender's Address:
LQPERMIT -
Application Number . . . . . 07-00000126
a•
Permit. RE -ROOF
Additional desc
Permit Fee 30.00'',
Plan Check
Fee
.00•
Issue Date . . . . L.
_ Valuation-
'.
0
Expiration Date 7/15/07
- Qty Unit Charge Per
Extension
BASE.FEE
30.00,
Special Notes and Comments
-------
REMOVE/ REPLACE EXISTIAT. TILfi
UNDERLAYMENT/REPLACE ORIGNINAL TILE.•
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