08-0767 (RR)0.- B* BOX '1 4 VOICE (760) 777-7012
78-495.CALLE TAMPICO FAX (760) 777-7011
LA QUINTA„CALIFORNIA.92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
-Y - «- BUILDING PERMIT 7 x
t Date: 5/06/08
Application Number: X0,8700.0.00.7-6.2----' Owner:,
Property Address: 50042 AVENIDA VISTA' BONITA _ SANTA ROSA COVE HOA
APN: 658-260-A55- - P.O. BOX 12920
Application description: RE -ROOF PALM DESERT, CA 92255 -
Property Zoning: :LOW DENSITY RESIDENTIAL (76.0) 564-8864 ,
Application valuation: 5082
p
Contractor:'
Applicant— Architect or Engineer: WESTERN' PACIFIC ROOFING
3462 LA CAMPANA WAY
t� �C NY PALM SPRINGS, CA 92262
L (760)416-5877
Lc. No.: 235717 F\N
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ --—--——-———————--——————----—---------—— . __ _-________________—_LICENSED CONTRACTOR'S DECLARATION - - WORKER'S COMPENSATION DECLARATION. - -
'1 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 ofahe 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 CI ss: B C39 License o.: 235717 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
_7/ ✓%/Af/ %.�J issued.
to e7 Contractor:..'/��L%,, .. L/� _ 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 -
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 _ 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 worker ' compensation provisions of Section
License Law (Chapter.9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or ' - 700 of the Labor �Ihmplyith o ovisions.
that he or sheds exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 bytttany applicant fora permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500).: Date:- ,.i O Applicant:-
( 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 -
Coritractors' State License Law does not apply to an owner of property who builds or imprdves`thereon, - SUBJECT AN EMPLOYER TO CRIMINAL' PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and -who doesthework 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, 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—) 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 or omission related to the work being -
- performed under or followingissuance 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. -
�1 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 a representatives
of this cou t enter. upon the above-mentioned property for i ee tion s. ,
Lender's Name: J r .. -. _ •-- -. ,�-"�
' + _ 'tDate: % QY 1 Signature (Applicant or Agent . - �-
Lender's Address: - - - -
LQPERMIT ' -
Application Number 08-00000767
Permit RE -ROOF
:• Additional desc
Permit Pee 30.00
Plan Check
Fee
.00
Issue -Date.
Valuation_
0
Expiration Date 11/02/08.
Qty Unit Charge Per
Extension
BASE.FEE
30:00
Special Notes and Comments
RE -ROOF 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
-