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06-4157 (RR)P.O: BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: . 006.=-0,0.0.04157_ Property Address: 52740 .AVENIDA OBREGON APN: 773-285-012-11 -000000- Application description: RE -ROOF Property Zoning: COVE RESIDENTIAL Application valuation: 8500 Applicant: Architect or Engineer: 4 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Owner: CARRILLO VICTOR H 52740 AVENIDA OBREGON LA QUINTA, CA 92253 --------------------------------- Contractor: Owner Date: 12/01/06 LICENSED. CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION . hereby. affirm under penalty of perjury that I am licensed under, pro visions of Chapter 9. (commencing with I hereby affirm under penalty of perjuryoneobthe following declarations: " Section 7000) of Divisio6 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: - LicenseNo.: for by Section 3700ofthe 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 underpenalty of perjury that I•am exempt from the Contractor's State License Law for the Carrier Policy Number 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 workers' comp nsation provisions of Section License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3700 of the Labor Code, I shall forthwith comply with thoseXions. that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by an pplicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: te:� -Q VAIficzn�.� OI, as owner'of. the property, or my employees with wages as their sole compensation, will do the work, andthe structure is not intended or offered for sale (Sec. 7044, Business and Professions Code:`The WARNING: FAILURE TO SEC OMPENS TION COVERAGE -IS UNLAWFUL, AND SHALL, . Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO.ONE HUNDRED THOUSAND and who does the work 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 said. 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.). (_ 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 contracts for the projects with a contractors) licensed pursuant to the Contractors' State License Law.). (_ 1. I am exempt under Sec. , B.&P.C. for this reason ..-, te: ' e Q 6 Wner: ` S 101) CONSTRUCTION LE NG AGENCY I hereby affirm under penalty of perjury t at 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, itsofficers, 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 com ly with all city and county ordinances and state laws relating to building construction, and hereby authorize repre natives of this unty to enter upon the above-mentioned property for inspection pur oses. f ate: -o f, Si ture (Applicant or Agent)' Application Number . . . . . 06-00004157 Permit RE -ROOF Additional desc . Permit Fee . . . . 30.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 0 Expiration Date 5/30/07 Qty Unit Charge Per Extension BASE FEE - 30.00 ------------------------------------- Special Notes and Comments ----------------- ------ --------------- REMOVE OLD FLAT ROOF AND RE -ROOF WITH 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 Bin ff City ofLaQuinta Building 8z Safety Division •. Permit 1l (P.O. Box 1504;* 78 49.5 Ca11e Tampico . La Quinta, CA 92253. =' (-760) 777-7012 ` Building Permit Appiicat Aon and Tracking Sheet Project Address:- Owner's Name: ` A. P. Number Address: Legal Description: City, ST, Contractor: Telephone: C7� 0 Address: Projec_ t Description: .City, ST, Zip: pp(cc l�2 .✓teclo Telephone: �!N, State Lic. # : City Lia #: Arch., Engr., Designer: Address: City,. ST, Zip: Telephone: s COnbtiUCttoil Type: Occupancy: State Lie. #: ProJecti type (circle one): New Add'n Alt R. Demo Name of Contact Person: Et : . Sq'i Stories: # Units: 4Estuna(ed �nfprqiect: -# Telephone # of Contact Person: Value t �� . APPUCANT:'DO NOT WRITE BELOW TH(S,UNE It Submittal Id Recd TRACKING. PERMIT FEES Plan Sets Plan Check submitted [tem Amount Structural Cates. Reviewed, ready for corrections . Plaq�eck Deposit Truss Cates. " 'Called Contact Person, Plan, Check Balance Energy Cales. Plans picked up Construction Flood plain plan Plans resubmitted Meehanical Gradiag.plaa 2%' Review, ready for eorrectionsJusue Electrical . Subcontactor I.ist Called Contact Person . -------------------Plumbing " Grant Deed Plans picked up . S.M.I. H.O.A. Approval Plans resubmitted . Grading IN HOUSE:- Review, ready for correctionsl�sue " Developer impactFee.. ; Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date or permit issue School Fees :.: :.:.:..:. .....: .. ,.......:.: ......Permit Fees . ." .. `..; Total. :.>... .. ;:.. a OWNER/BUILDER INFORMATION Dear Property Owner: An application for a building permit has been submitted in your name' -listing yourself as'tlie builder of the property improvements specified. y For your protection you should be aware that as "0 wner/Builder" you 'are the responsible :party of record• on such a permit. Building permits are.not required to be signed bypropetty.owners unless�they.are-.personally performing their own work:. If your work.is being performed by someone othe' Abrin yourself, you .may protect yourself from possible liability if that person applies:forthe proper permit in his or her;name. Contractors are required by law to be licensed and bonded ;Jbk, the State. of .California and to have a business license from the City or County. t• They are also required by: law to putheir. 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 benefiran&protecuon.- If you employ or otherwise engage any persons other than;y'qu.r immediate family, and the work (including materials and other costs) is $200.00 or more for the entire project, and such persons aice 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 Governmentas an employer and you are subject to several obligations include State and Federal income tax,�witl holding, fed'e" ral social security taxes, worker's compensation insurance, disability insurance costs and unempl'oyment.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 Federal1aw; 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,ate ,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 . propiding 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 th'At. ve,can confirm that you are aware of these matters. The building permit will not be issued until the verificationis 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: (760) 777-7011 • T r ER'S SIGNAT /DATE �k 2 7go Woe A!'1z A6A PROPERTY ADDRESS L� D & - 4157 PERMIT NUMBER(S)