08-0797 (RR)P v: BOX 1504 '"
78-495 CALLE TAMPICO 4
LA QUINTA,:CALIFORNIA 922.53 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT .
Application Number: -08-00000797
Property Address: 50021 AVENIDA VISTA `BONITA
APN: 658-260-060-126 -14496 -
Application description: RE -ROOF -
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 5082
Applicant:
~ O�
Architect or Engineer:
Owner:
SANTA ROSA COVE HOA
P.O. BOX 12920
PALM DESERT, .CA 92255
In—
(760)564-8864
Contractor:
WESTERN PACIFIC ROOFI
3462 LA CAMPANA WAY
PALM SPRINGS, CA 9226
(760)'416-5877
Lie. -No.: 235717
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/07/08
MAY o 7 tno� I�,
LA
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 70001 of Division 3 of the Business and Professionals Code, and my License is in full force and effect._
1 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 -
�f�"
.issued.
Date J Contractor: /�
—.1 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 852-0002600
- following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to
_ 1 certify that, in the performance of the work for which this permit is issued, I shall not employ any
construct, ghgr, 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 becume 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, -1 shall forthwith comply with provisions.
_ that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
i �1 t�
-- any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
Date)' /-1 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 ($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, as owner of the property, amexclusively 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.
•. propert'y'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;
- 1 1. I am exempt under Sec. , BAP.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 esentatives
•
of this county to enter upon the above-mentioned property for inspection purpo es.
Lender's Name:
Date% J Signature (Applicant or Agero/�
-• Lender's Address:
✓ —�
f
LQPERAIIT
•
Application Number .08-00000797
_- Permit RE -ROOF
:;,.. Additional desc .
Permit;Fee 30.00
Plan Check
Fee
.00
Issue.Date
Valuation_
0
Expiration Date 11/03/08
Qty Unit Charge Per
Extension
_ BASE FEE
30 . 00
----- -----------------------------------
Special Notes -and Comments
RE -ROOF NEW INSTALLATION OF NEW TILE
UNDERLAYNET 2008 CODES
'
-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