08-0314 (RR)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: C08-00000314
Property Address: 5222.0 AVENIDA OB EGON
APN: 773-255-001-1 -000000-
Application description: RE -ROOF
Property Zoning: COVE RESIDENTIAL
Application valuation: 7600
Applicant: Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
ISN GRACIE
52220 AVENIDA
LA QUINTA, CA
Contractor:
Owner
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
OBREGON
9225 Q
FEB 19 2008
CITY OF LA QUINTA
FINANCE DEPT.
Date: 2/19/08
-------------------------------------------------------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION. DEC LARATION
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 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 Class: License No.:
_
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
Date: Contractor:
_ 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 hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for theCarrier
Policy Number
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to
I certify that, in theperformance 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 1 should b ome bject to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Coder or
of the Labor Cod I all f h vit amply with those Provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
a�nyl applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
e� A90 cant:
() 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
owl
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The
- WARNING: FAILURE TO SECURE CO PENSATION COVERAGE IS UNLAWF L, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
SUBJECT AN EMPLOYER TO CRIMINAL PENALT.IESAKID rn NES UP TO ONE H RED 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 COMPENSATIO ES 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 notbuild or
improve for the purpose of sale.).
I _ I 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 contract's for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
(_ I 1 am exempt under. , B.&P.C. for this[eason
E
CONSTQUCTION LENOIN6 AGENCY v
1 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:
LQPERMIT
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 and state that the above information is correct. I agree to comply with all
ci�te:
nd county ornces and state laws relating to building co tru .tion, and hereby authorize representatives
os c ty to nt upon [he ab e -mentioned propetty for a [i purposes.
OSi ure (Applicant or Agentl:
Application Number . . .
Permit RE -ROOF
Additional desc .
Permit Fee . . 30.00
Issue Date
Expiration Date 8/17/08
08-00000314
Plan Check Fee
Valuation . .
Qty Unit Charge Per Extension
BASE FEE 30.00
----------------------------------------------------------------------------
Special Notes and Comments
RE -ROOF WITH CLAYMAX LIGHT WEIGHT TILE
(580 LBS/SF)REPLACING COMP SHINGLES
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
LQPEn11T
ter`
Bin #
City. sof La Qui �A)
Building & Safety Division
P:O. Box 1504, 78-495 Calle Tampico
La Quints, CA 92253- (760),777-,7012
Building Permit Application ,and Tracking Sheet
Permit #
`
`
Project Address: x,.
Owner's Name: "
G 4 .
A. P. Number:
Address SQL2
Legal Description:
City, ST, Zip:.,
Contractor: ?u
Telephone
Address:
Project.Desciiphon:
City, ST, Zip:
_
Telephone:
State Lic. # : City'Lic: #:
Arch., Engr., Designer:
E7C1S-�'i .S S
/
Address:
City, ST, Zip:
Telephone:
a.
' Construction Type: Occupancy:
State Lic. #:
Projecttype (circle one): New . Add'n Alter Repair Demo
Name of Contact Person: I I rr ll r(►�
1-t . I'hD� �
S Ft.: s
q• �`�'.
# Stories: sldu 1L.
#Units: �.
Telephone # of Contact Person: 321,
Estimated Value of Proje
APPLICANT: DO_ NOT WRITE BELOW THIS LINE
#
Submittal
Req' d
Rec'dTRACKING
.
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
"Called Contact Person
Plan Check'Balance
Energy Calcs.
Plans picked up
'Construction
Flood plain plan
Plans resubmitted .
Mechanical
Grading plan
2"a 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:-
''" 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
T-iTotal
Permit Fees. '
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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 ihan yourself, you may protect yourself from possible
liability if that person'applies for the''proper permit'in his or, her -name.
Contractors are require&,by law to belicensed and bonded. by. the State of ..California and to have a business license
from the City or County. They are also required bylaw to put their license. number od ail 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 benefit and, protection. .
If you employ or otherwise engage any persons other,than,your, immediate family, and the work (including materials
and other costs) is $200.00 or more for the entire pioject, and such persons are not licensed as contractors or
subcontractors, then you may be an employer.
If you are an employer, you must register with the State and Federal' Government as an employer and you are subject
to several obligations include State and Federal income- tax -withholding, 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 Administration). For more specific information about your obligations under State
Law, contact the Department of Benefit Payments and the'Division of Industrial Accidents.
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 persons professing to be contractors: is to secure an "Owner/Builder" building
permit, erroneously implying that the property. owner is providing his-, or 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, California• 95814.
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
'
X60),777-47011
'OWNER'S SIGNATURE/DATE
PROPERTY ADDRESS
oJ�5 -,g J4
PERMIT NUMBER(S)