05-4507 (RER)P.O.' BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
05-00004507
Pill
Property Address:
5185 -VENIDA MORALES
APN:
773-151-005-5 -000000-
Application description:'
REMODEL -.RESIDENTIAL
Property Zoning:
COVE RESIDENTIAL
Application valuation:
5600
Tay/ 4 s(P Q" '
Applicant: Architect or Engine(
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 77777012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/07/05
Owner:
MILLSPAUGH RONALD M
40725 MEADOW LAND
PALM DESERT, CA 92260
Other struct info .
Contractor:
Owner
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.:
Date: Contractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's 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 Contractor's 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
applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500).:
( 1 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 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.).
(_ 1 1, 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 proje with a contr ctor(s) licensed
pursuant to the Contractors' State License Law.).
(_ 1 I am exempt under Sec. , B.&P.C. for this re on
/ h
wrier.
CONSTRUCTION LENDIN NCV
1 hereby affirm under penalty of perjury that there is a construction len g agency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name: 01
Lender's Address: N
LQPERMIT
C
WORKER'S 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
ia;l certify that, in the performance of the work for which this permit i ' ed, I shall not employ any
person in any manner so as to become sub' ct to the workers' o ensation s of California,
and agree that, if I shouldbecome subje to the work e mp sa ' o- sions of Section
3700 of the Labor Coldd3e r$hall fort cC ply with se o ' ns.
tData•/d
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COV IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINE 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.
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 d ill subject
permit to cancellation.
I certify that I have read this application and state that the above information is correct. I agr c mp i all
city and county ordinances and state laws relating to building constru n and hereby aut ri ent es
of this county to center Won the above-mentioned property 01insp o p as.
Signature (Applicant or Agent):
LQPERMrr
rr ..
Application Number . . . . . 05-00004507
Permit BUILDING PERMIT
Additional desc .
Permit Fee . . . . 81.00
Plan Check
Fee
52.65
Issue Date . . . .
Valuation
5600
Expiration Date .4/.04/06
Qty Unit Charge Per
Extension
BASE FEE
45.00
4.00 9.0000 THOU BLDG 2,001-25,000
36.00
----------------------------------------------------------------------------
Special Notes and Comments
LATH EXTERIOR, CHANGING FROM SHEAR TO
PLASTER
-7 --------------------------------------------------------------------------
Other Fees . . . . . . ENERGY
REVIEW FEE
5.27•
Fee summary Charged Paid
Credited
Due
Permit Fee Total 81.00
.00
.00
81.00
Plan Check Total 52.65
.00
.00
52.65
Other Fee Total 5.27
.00
.00
5.27
Grand Total 138.92
.00
.00
138.92
LQPERMrr
OWNERBUILDER 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 the State of California and to have 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 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 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 su7�ject
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.
r'
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 contracts are allowed to perform their
work personally or through their own employees, without a licensed contractor or subcontractor, only under limited
conditions. 4
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
FAX: (760) 777-70
OWNER'S SIGNATURE/DATE
l
PROPERTY ADDRESS
PERMIT NUMBER(S)