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05-3606 (PLBG)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: (_05`70 CFO Property Address: 53425 AVEN� ID OBREGON APN: 774-074-021-9 -000000- Application description: PLUMBING Property Zoning: COVE RESIDENTIAL Application valuation: 300 Applicant: itect or Engineer: LICENSED:CONTRACTOR'S DECLARATION BUILDING & SAFETY DEPARTMENT BUILDING PERMIT 1 -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.: Date: Contractor: OWNER -BUILDER DECLARATION I hereby affirmunder penalty of perjury that I am exempt from'the Coritractor's State License Law forthe following.reason 7031:5; Business and Professions Code: Any city orcounty 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 signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter9 (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 fora permit subjects the applicant -to 'a civil penalty of not more than five hundred dollars 1$.5001.: (�),I,*as owner of the property, oi'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 Wildtling'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.). (_ 1 I, as owner,of'the property, am exclusively contracting with licensed contractors to construct the project (Sec. 9044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property vy io builds'or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State.License Law.). ' (_ 1 I am exempt under Sec. , B.&P.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: LQPERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 8/12/05 Owner: DOWLER CHARLES E" 53425 AVENIDA OBREGON LA QUINTA, CA 92253 --------------------------------- --------------- WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations + _ I haveand will maintain a certificate of consent fo'self-insure for workers' compensation, as provided for by,Section 3700 of the Labor Code, for"the performanceof the work for which this permit is .issued _ I have and will maintain workers' compensation insurance, as required by Sectio 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 ..)'certify that, in the performance of the work for which this permit is issued,A 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 shallforthwith comply with those provisions. +Dater% Applicant: WARNING: FAILURE TO SECURE WORKERS'. COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER _TOCRIMINAL PENALTIES AND CIVIL FINES UP"TO ONE HUNDRED THOUSAND DOLLARS ($.100,000).. IN ADDITION TO THE COST'OF COMPENSATION, DAMAGES ASP ROVIDED I FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. " APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made t6 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 andemployees 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. Application Number . . . . . 05-00003606 Permit PLUMBING Additional,desc . Permit Fee 22.50 Plan Check Fee .00 Issue Date . . . Valuation. . . . . 0 Expiration Date 2/08/06 Qty Unit Charge Per Extension BASE -FEE 15.00 1.00 7.5000 EA PLB WATER HEATER/VENT 7.50., --------------------------------------------------------.-- Special Notes and Comments ,. WP:TER• HEATER REPLACEMENT. . '.. Fee summary Charged Paid' Credited Due Permit 'Fee Total 22.50 00 00, -- -2'2 50. _Plan Check.. :00 0.0: 00 00 Grand Total = 22-:50 .00 .00 22,.5.0' LQPERMIT OWNER/BUILDER. INFORMATION Dear Property Owner: An application for a building permit has been submitted':in your name listing yourselfas 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 y':&operty 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 inhis,or'her 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 are also required bylaw to 'put their license -number on all permits for which they apply. If you plan to do your own work, with the exception, o£various'trac16 thaf you -plan t6 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'$200.00or 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 Goverrirrient as an employer and you are subject to several obligations include State and'Feder'al income tax withliolding;=federal social security taxes, worker's compensation insurance, disability insurance. costs and'unemployment compensation.contribuiions. There may be financial risks for you if you.do not carry outthese 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 Paymentsand the_ Division of Industrial Accidents. If the structure is intended for sale; . property owners? who are; not licensed contracts 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 io' 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, Califocinia 95834. . Please complete and return the enclosed owner -builder verification form sothat we can.Onfirm 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 WNER'S SIGNATIJRk/DATf PROPERTY ADDRESS PERMIT NUMBER(S)