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BP 08-0645P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 08-00000645 Property Address: 52174 AVENIDA ALVARADO APN: 773-214-008-15-000000- Application description: RE -ROOF Property Zoning: COVE RESIDENTIAL Application valuation: 5900 ADDlicant: T4'v1 4 4 Q" Architect or Engineer: OW BUILDING & SAFETY DEPARTMENT BUILDING PERMIT --------------------------------------------------- LICENS CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am li nsed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business an Pro ssionals Code, and my License is in full force and effect. License Class: C39 License No.: 859337 2 ( ( C actor. 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).: (_) 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 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.). (_) 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 am exempt under Sec. , BAP.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.). Lender's Name: Lender's Address: VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 4/21/08 Owner WRIGHT JAKE 52174 AVENIDA ALVARADO LA QUINTA, CA 92253 Contractor: ABOVE AND BEYOND ROk20­0 5ApR212008 78676 CASCADIA DRIV BERMUDA DUNES, CA 9(760)702-5984 Lic. No.: 859337FINANCI:DEPT. CITY OF LA QUINTA •---------------------------------------------- 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. 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 insurance carrier and policy number are: Carrier STATE FUND Policy Number 0030697-2007 _ I certify that, in the performance f the work for which this permit is issued, 1 shall not employ any person in any manner so as to ecome subject to the workers' compensation laws of California, and agree th , if I should bec a subject to the the compensation provisions of Section �Y3ee700 of Labor CodeMhwith comply with those provisions. Date: Zi v�3 Applicant WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). 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 applicati becomes null and void if work is not commenced within 180 days from date of issuance of su permit, or cessation of work for 180 days will subject permit to cancellation. - I certify that 1 have read this application and state that th a ve information is correct. I agree to comply with all city and county ordinances and state laws relate o nstruction, and hereby authorize representatives of th' county Jo enter upon a above -mentioned prop pection purposes. at> e It 2 t Ord 3 gn> a�(Applicant - LQPERMIT Application Number . . . . . 08-00000645 Permit . . . RE -ROOF Additional desc . . Permit Fee . . . . 30.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 10/18/08 Qty Unit Charge Per Extension BASE ---------------------------------------------------------------------------- FEE 30.00 Special Notes and Comments REMOVE OLD ROOF AND RE -ROOF WITH 30 YR. COMPOSITION SHINGLE, CLASS "A" MATERIALS 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