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09-1081 (RR)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Tihf " BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Application Number: .09-00001081. Property Address: 54754 INVERNESS APN: 775-091-084- - - Application description: RE -ROOF Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 20000 Applicant:� J �j Architect or Engineer: ------------------ LICENSED CONTRACTOR'S DECLARATION hereby affirm under penalty of perjury that icense nder provi ' sof Chapter 9 (commencing with Section 7000) of Division 3 of the Busines and ofes as Cod nd my license is in full force and effect. License Class: C39-13 Lic o.: 885157 ill/ /�q��-Contractor: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 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).: 1 _ 1 I, as owner of the property, or my employees with wages as their sole compensation, will dp the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within 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.). (_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). 1 1 I am exempt under Sec. , B.&P.C. for this reason Date: Owner: CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). I Lender's Name: _ Lender's Address: LQPERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 10/08/09 Owner: PGA WEST RESIDENTIAL P.O. BOX 1060 r - LA QUINTA, CA 92253 �I 1 u 0 rT 0 68 Z 59 Contractor: -�,---r-___J BIENEK ROOFING CONSTRUCTIN NC y;';r_ y 9707 PINEWOOD AVENUE "'`t'•'':' _ '. TAJUNGA , CA 91042 (760)625-7796 Lic. No.: 885157 --------------- - - - WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 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 y workers' compensation insurance carrier and policy number are: Carrier STATE FUND Policy Number 18 9944 I certify that, in the performance of t rk for which is permi s is ed, I shall not employ any person in any manner so as to come ubject to workers' C pensation laws of California, and agree that, if I should b ome sub' ct to the orkers' c pensation provisions of Section 3700 of the Labor Code, I II fort it c� wit provisions. Applicant: WARNING: FAILURE TO SECURE MARKERS' COMPENSATION COVEYhAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS 15100,0001. IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application. 1. Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application, 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. . 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 permit to cancellation. I certify that I have read this application anda abo information' orrect. I agree to comply with all city and county ordinances and state law • onstruction d hereby authorize representatives sof this county to enter upon the above -m inspecti urposes. Signat�Applic Application Number . . . . . 09-00001081. Permit . . . RE -ROOF Additional desc . Permit Fee 30.00 Plan Check Fee'. .00 Issue Date . . . . Valuation 0 Expiration Date . . 4/06/10 Qty Unit Charge Per Extension BASE FEE 30.00 ---------------------------------------------------------------------------- Special Notes and Comments RE -ROOF PERMIT REMOVE ROCK INSTALL (1) INCH SPRAY FOAM (4) UNITS 54754-54742 ' INVERNESS.PER 112007" CODES. ---------------------------------------------------------------------------- Other Fees . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged Paid Credited Due ------------------------------------- Permit Fee Total 30.00 -------------------- .00 .00 30.00 Plan Check Total .00 .00 .00 .00 Other Fee Total 1.00 .00 .00 1.00 Grand Total 31.00 .00 .00 31.00 LQPERAIIT Bin # Qty Of La Quinta Building &r Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # Project Address: 7S / X 7 -5/1 -Owner's Name: nY A. P. Number: N�eANoesI Address: Legal Description: AJ z Contractor: �) — / V N T Address:!?D 7 A9 %� (� City, ST, Zip: Tel e h ne. P o Project Description: e City, ST, Zip: (? VVIW Teleph P a s State Lic. # : ! S City Lic. #:...... ' Arch., Engr., Designer: Address: City, ST, Zip: Telephone: ...................... Construction on TY e: Occupancy: P Occu Y• State Lic. #: Project type (circle one): New Add'n Alter Repair Demo Name of Contact Person: f�N Sq. Ft.: # Stories: l # Units: Telephone # of Contact Perso 1 7716 Estimated Value of Project: QQ APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rec'd TRACKING PERMIT FEES Plan Sets Plan Check submitted l 0 Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2°" Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- 7rd Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P,P, Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees vx;e