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04-4893 (RR)/4 BUILDING & SAFETY DEPARTMENT P.O. BOX' 1504 (760).777-7012 OFTt9 -495 CALLE,TAMPICQ, s -.I- FAX (760.).777-7011 �"'—� `Q QUINTA, CALIF-oRNtA 92253 INSPECTION REQUESTS (760) 777-7153 11 2004 BUILDING PERMIT JUN ; �U„IP1TA °er . 04 Oj,0004.893 Date 6•/11/04 -erty Address: 52!14=5 AVENI-DA. OBREGON APN: 773-2,14.-02.6-6 7000000 - Application description RE -ROOF° Property Zoning `COVE"'k;ESIDENTIAL; Application valuation 3000 Owner ,Contractor --------------------- --------------- RODRIGUEZ JUAN ELIAS , OWNER 141.q4eWN CA 9 9 1 ------ --- ----------- -------- ° Permit - F RE;-- A'ddi.t"ionaa desc P'e'rmit Fee '30.'00Plan. Check Fee .00 Issue Date Valuation 0 Qty Unit Charge Per �ti ,• Extension _BASE,w FEE' 4' . `” ,> 3 0 . 0 0 - j, `. --------------------- -=------------------------------- .-=- Special Note's ..and Comments REMOVE. EXISTING.BOOR-&::RE PLACE''WITH.`NEW BUILT UPROOF , :USING CLASS A MATER=IALS Fee summary Charged Paid' ,. , Credited Due,-' Permit Fee Total 30.00 :A 00 .00 30.00 Plan Check Total 00 , .00. .'00. 00 Grand Total �30,100�.''.?,.::,, :,,0o.. re .00 30.00 P.O. Box 1504 78-495 CALLS TAMPICO ` VOICE (760) 777-701: LA QUINTA, CALIFORNIA 92253 FAX (760) 777-701 1 INSPECTIONS (760) 777-7153 '�tt BUILDING & SAFETY DEPARTMENT Application Number: �i Applicant: `II . Architect or Engineer: Date: (O _' Applicant's Mailing Address: Architect or Engineer's Address: ala Lic. No.: BUILDING PERMIT DECLARATIONS I hereby affirm under penaltyof LICENSED CONTRACTOR'S DECLARATION perjury that I am licensed under provisions of Chapter'9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License Class License No. Date Contractor I hereby affirm under penaltyof OWNER43uILDER DECLARATION Perjury that I am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires li permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant fort pwmd to file a signed statement that he or she r licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 oft Business and Professions Code) or that he or she is exempt therefrom and the basis fort alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects .thg applicant to a civil penalty of not more than five hundred dollars (5500).): 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 or 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.). U 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.). U I am exempt under Sec. -------- fiB.g P.C. for this reason A c - I herebyaffirm under WORKERS' COAOENSATION DECLARATION 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 t pertormahce 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: Cartier Policy Number I certify that in the performance of the work for which this permit is issued, I shall not employ an compensation laws of California, and agree that, if I should become subject tot workers' any Properson in any visions ons o Sanner so aection 337700 of t s to become subject Code. to the shall forthwith comply with thosevisions^. WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UJAWFUL, 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. I hereby affirm under penalty of perjury that there isa construction lending TION LENDING AGENCY Lender's Name this 9 gen performance Of work for which permit is issued (Sec. 3097, Civ. C.). Lender's Address IMPORTANT APPLICANT ACKNOWLEDGEMENT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this a 1. Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is pe rfoapplication. rmed under a 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 Le Quints, 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 daymi from date is issuance of such permit or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this applicatiori and state that the abovLo:rma�tfiwn is correct I agreeto comply with all city and county ordinances and state lawn relating to buildinconstruction, and hereby authorize representatives of this counon t above-mentioned property for inspection purposes. c to --d ignature (Applicant or Agent): OWNER/BUILDER INFORMATION Dear Property Owner: An application for a building permit has been submitted in.your name listing yourself as the builder of the property improvements specified. For your protection you should+be'aware that as "Owner/Builder'' you are the- responsible party of record on such a permit. Building,permits are.not required to: be signed:by property owners unless they are personally performing their own work. If your work is being performed by.. someone other than yourself, you may -protect yourself from possible liability if that person applies for the .proper permit in his or her name.. Contractors are required by law to be licensed and, bonded by theState of California and tohave a business license from the City. or. County. They are also required by law to put their license number�on all permits for which they apply. If you plan to do your own work; with the exception: of.various -trades that you,plan to subcontract, you should be aware of the following information for your beriefit'and'proiection: If you employ'or otherwise.engage any persons ocher than. your-iinmediate family, and the work (including materials and other costs) is $200:00 or more for .the entire. pro j.ect, and such persons are not licensed as contractors or subcontractors, then you may be an employer: If you are an employer, you:musrregister with-the'State and Federal Government as an employer -and you are subject to several obligations including` State and Federal tncorne tax`withh_olding',. federal 'social security taxes, worker's compensation insurance, disability, insurance costs:and unemployment compensation contributions. There may be financial risks for you if you do not.carry out these. obligations, and these risks are especially serious with respect -to worker's compensation insurance. For more specific information about your.obligations under Federal Law contact the Internal Revenue Service (and, if you wish, -the U.S. Small- Business: Aclminstia'tton)': For more specific: information abou,'t`your obligations under State Law, contact the Department of Benefit'Payments and ihe,Divisionof Iadustrial'Accide'nts. If the structure is intended for sale, property. owners who are not licensed contractors are allowed to perform their work personally or through their own employees, without'a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed,persoris.professiing to be contractors is to secure.an "Owner/ Builder" building permit, erroneously irnplying .that, the property. owner owner his oi: her own labor and material personally. Building permits are not.required to, be signed by '.property owners unless they are performing their own work personally. Information about licensed contractors may be obtained ;by contacting the. Contractors' State License Board in your community or at 1020 N. Street, Sacramento, Califon is 958A. . Please complete and return the enclosed'owner-builder verification.form so that -we can confirm that you are aware of these matters. The building permit will not be issued until; the verification _is returned. Very truly yours, CITY OF LA QUINTA DEPT. OF BUILDING AND SAFETY 78-495 Calle Tampico La Quinta, CA 92253 (760). 777-7012 FAX 0) 7 7-7011 O ER'S IGNATU /DATE PROPERTY ADDRESS PERMIT NUMBER(s)