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05-0829 (RR)IV V, BUILDING & SAFETY DEPARTMENT Box. 1504 7 (760).777-7012 �'5'CALLE TAMPICO FAX (760) 777-701 1 INTA, CA L'I F 0 kf'4 IX" `'9 2 2 5 3! INSPECTION REQUESTS (760) 777-7153 BUILDINGTERMIT _. L mber . . . —A—pp— 1 cat i 0'5'Lw0�00_0'0 8*2'9. onNu 'Date 3/14/05 Property Address . . . . . . . 52-93-5.;*AV-ENIDA OSREGON­ APN': 773----31420227-9,.t., -000000- Application description Property Zoning COUE',.- .:'RESIDENTIAL Appli*cation valuation 1"0'00 Owner Cont,ractor ----------------------------------- -GILL JOHN C 'OWNER.., - 52935 AVENIDA OBREGON LA QUINTA CA 922'53 ----------------- -------- I -------------------- 7'_,� ------------------------- -- Permit RE, -,ROOF. Additiona.l.de'sc Permit Fee 30 ':',00-. Plan. C eck;. F* e h e .00 Issue Date VaIuation ite 0 Expiration Date r. 9/14/05 Qty Unit Charge* Per Extension.,. BASE*FEE 30.00 ---------------------------- t --------------------------- ------------------------- -- Special.,Not6s'.and.Comments RE -ROOF WITH COMP. -,SHINGLES, CLASS,: ,:'Al," MATERIALS Fee summary 'Char a "Charged ..:p id, Credited Due ----- ---- Permit Fee Total 30.00 &0 ob- ---------- 30.00 Plan Check Total otal .0.0 '00 ob 0,0: Grand Total; .30 .'00 0-0- .00 30.,00j' IP P.O. Box 1504• ��I ��I VOICE (760) 777-7012 78-495 CALLS TAMPICOTv FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: o5_ Date: / O S Applicant: Applicant's Mailing Address: Architect or Engineer: Architect or Engineer's Address: Lic. No.: BUILDING PERMIT DECLARATIONS K LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of 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. Contractor OWNER -BUILDER DECLARATION I hereby affirm under penalty of 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 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 Contractors' 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 applicant to a civil penalty of not more than five hundred dollars ($500).): 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. , BA P.C. for this reason WORKERS' 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 Policy Number I certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Iglo' 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. 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 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 city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enter upon the above-mentioned property for inspection purposes. gnature (Applicant or Agent): OWNER/BU'ILDER.INFORMATION Dear Property Owner: An application for a building permit -has been submitted in'your.name.1isting yourself as the builder of the property improvements specified: . For your. protection,you should beaware 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. ate personally performing their own work. If your work is being performed by'someone other tlian youc'self"you may -protect yourself from possible liability if that person applies for the'proper permit. in .his or h r name. . Contractors are required by: law_ to be licensed, and bonded by the State, of California and, to have a business license from the City or County. They ace also required by -'14w to put their license ynumber on. all permits for which they apply. If you plan to do your own work, with the exception of various,trades.tharyouplan to subcontract, you should be aware of the following information for your •benefit and; protection If you employ or otherwise engage any persons- other your immediate family, and .the work (including materials and other costs) is $200.00 6e more. for.the entire project, 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 taz. withholding, federal. social security taxes, worker's compensation insurance,, disability insurance costs and unemployinent:eompensation 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. coniacrthe 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 licensedcontracts are allowed to perform their work personally or throughtheir own employees, without a licensed contractor:or subcontractor, only under limited conditions. A frequent practice of unlicensed personsprofessing to., be contractors. is to.secure ,an' "OwnerBuilder" 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 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 thavwe.can cdnfirm 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: (760) 777-7011 ER'S SIGNATURE/DATE SL93S Avp--Qbf��,��� 92 PROPERTY ADDRESS os' .�. PERMIT NUMBER(S)