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12-0637 (RR)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 T,444Q "- Application Number: 12-00000637, Property Address: 51980 AVENIDA NAVARRO APN:' 773-184-012-13 -000000- Application description: RE -ROOF Property Zoning: COVE RESIDENTIAL Application valuation: 500 Applicant: Architect or Engineer: BUILDING & SAFETY DEPARTMENT BUILDING PERMIT -------------------------------------------------- LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with • Section 70001 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 a y pplicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: ( 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 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 projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). (_ I I am exempt under Sec. , B.& �or this rea�on t Date: (dl11 0 ner: C STRUCTI ENDING AGENCY I hereby affirm under penalty of perjury th a is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.I. Lender's Name: Lender's Address: LQPERM1IT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 6/08/12 Owner: JOE ARTHUR 51980 P 51980 AVENIDA NAVARRO _ LA QUINTA, CA 92253 ---------------------------FJU,N 0,5 2012 Contractor: j CITY OF L4-4u- owner 44UOwner FrWkNcE OFI ----------------------------------------------- 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. X 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 mannr s to become subject to the workers' compensation laws of California, and agree that, if, IId - me subject to the workers' compensation provisions of Section %3700 of the Labore- hall fogghwith c Ii with those provisions. WARMING: FAILURE TO SEC RE RKERS' 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. 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 abonspect tion is correct. I agree to comply with all city and co ty dinances and state laws relay g to build n, and hereby authorize representatives �te: is cou t enter. up r the above-mentio ed prope - o purposes. ignature (Applicant or Age LQPERMIT Application Number . . . . . 12-00000637 Permit RE -ROOF Additional desc . . ' Permit Fee . . . . 30.0.0 Plan Check Fee .00 Issue Date Valuation 0 Expiration Date 12/05/12 } '' Qty Unit Charge Per Extension BASE FEE 30.00 Special Notes and Comments REMOVE 8-9 SQUARE OF TILE AT SOUTH SIDE AND REPLACE UNDERLAYMENT. RE -INSTALL EXISTING TILE. 2010 CODES. ---------------------------------------------------------------------------- Other Fees . . . . . . . BLDG STDS ADMIN (SB1473), 1.00 Fee summary Charged Paid Credited Due Permit Fee Total 30.00 .00 .00 30.00 Plan Check Total .00 .00 .00 .00 Other Fee,Total 1.00 .00 .00 1.00 Grand Total 31.00 .00. .00 31.00 r0a _!PV, Pdrt - wl� M= / I P.O. Box 1504 LA QUINTA; CALIFORNIA 92247-1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT PROPERTY, OWNER'S PACKAGE (760) 777-7012 FAX (760) 777-7011 Disclosures & Forms for Owner -BUB' dens Applying for Construction Permits km f�R�VT! l�1QT1€ F Tn eR(iP TV OWI> Dear Property Owner. Ari. apglication .for a building permit has been submitted in your name listing yourself as the builder of the .property 114pPe VC10eats specified at We are providing you with an Owner -Builder Acknowledgmeat and. Information Verification Form to make you avim of your eesponstbilities and Possible risk you may incur by having ddspermit•issuedin your name as .the Owns -Builder. We will not issue a building -permit until you have react, initiated youranderstauding of eadr'provislon, signed, and returned this form to us at our ofilcial address indicated. An agent of the owner cannot execute tbis:notice unless you, the property owner, obtain the prior approval of the permitting authority. "VJWLJ G— T AND VE CATI N 01P.RWO1 iN Read and initial each stutenren —Mow to signify you w derstan&or very this informadon. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder" b i ding permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner -Builder, may be held liable and subject to serious. financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner -Builder and am' aware of the limits of my insurance -coverage for injuries to workers rtructi7on stand building permits are not required to be signed by property owners unless they are responsible for the c d are. not hiring a licensed Contractor to assume this responsibility,.. I I understand as. an "Owner -builder" I am the responsible.party of record on the permit. I understand that I may protect from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name 'instead of my I understand Contractors are required by taw to be licensed and bonded in California and to list their license numbers on - and contracts. I understand if I employ or otherwise engage any persons; other than California licensed Contractors, and the total value construction is at least five hundred dollars ($500), including labor and materials; I may be considered an "employer" fate and federal law.. [ understand if I am considered an "employee" under state and federal law, I must register with the state and federal ernment, withhold payroll taxes, provide workers' compensation disability insurance, and' contribute _to unemployment compensation for each "employee." I also understand 'my failure to abide by these laws may subject me to serious financial F=cnderstand under California Contractors' State License Law, an Owner -Builder who builds single-family residential S.cannot .legally build them with the .intent to offer them for sale, unless all work is performed by licensed tors and thenumber of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. lnderstand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any r personal. 4uries sustained byany subsequent owners) that result from any latent construction defects in the hip or materials. nderstand I may obtain more information regarding my obligations as an "employe' from the Internal Revenuee United States Small Business Administration, the California Department of Benefit Payments. and the California f Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CkT3) at 1- 800riegally CSLB (2752)or www.cslb.cagov for more information about licensed contractors. Iamaware ofand consent to an Owner -Builder building permit applied for in my name, and understand that I am the and Wumially responsible for proposed construction activity at the following address: I agree that, as the party legally and financially responsible for this proposed construction activity,.l will abide by all 6 laws and requirements that govern Owner -Builders as well as employers. 2.1 agree to notify the issuer of this form immediately of any additions; deletions, or chimes toany of the information I ve rovided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with o e who does. not have a licetrsa, tate Contractors' State License Boar may be enable to assbt.you with any finandd loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be inicivil court. It is- also ihWtant for YOU toy understand that if an tutlicens0d.C©ntractor of employee of that individual or fern is i*ted while woddag on your property; you may be kdd liable for damages. If you obtain a permit as Owner -Builder and wish to hire Conuaetam, you wifi be responsible for vajeying v&e w or not those Contractors are prope y licensed and the status of theif wottcers' commotion insuranee coverage. Before a building permit can be issued, this form must be completed and signed by the property owner and returned to tate agency responsible for tsst .bg.tlte ,pwmit. Now A copy, of d properiV o."er's dWyerf'vl ssl forum #0tadZadw4 or other verification aeceptabl ag required to be presented when the pgvmk is jaued to verify the property owner's signature. ' Signature of property owner Date: Note: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner -Builder. AUT$ORIZATION OE AGit`1V`I TO ACT ON IPROPERTY QWNWS B -RM F Excluding.the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following persons), to act as my agents) to apply for, sign, and file the documents necessary to obtain an Owner -Builder Permit for my project. Scope of Construction Project (or Description of Work): Project Location or Address: Name of Authorized Agent: - _ _ Tel No Address of Authorized Agent: I declare under penalty of perjurythat I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note: A copy of the owner's drivers license, form notarization, or other verification acceptable to the agency is required to be presented when the permit is issued to verify the property owner's signature.. Property Owner's Signature: Date: city. i r of La Quinta Building 8t Safety Division P.O. Box 1504,"78-495 Calle Tampico 4.Quinta, CA 92253 - (760) 777-7012 Building Permit Application' and Tracking Sheet Permit # ` �- Project Address: >1 —W(/ Owner's Name:. A P. Number. Address: — EtO AVINIPA Legal Description: Contractor.. City, ST, Zip. Telephon S2 u Address: Project Description: City, ST, Zip: ' Telephone: -s- F. '3 i `r. State Lia # : City Lia k Engr., Designer.ress: J., , ST, Zip. Telephone: State Lia #: k ' Name of Contact Person: Construction Type:_30 Occupancy: " j Project type (circle one): New Add'a AlterRepair Demo Sq. Ft.: #Stories: # Units Telephone # of Contact Person: Estimated Value of Project. APPLICANT: DO NOT WRITE BELOW THIS UNE N Submittal Req'd Recd TRACENG PERMIT FEES - Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Pian Check Deposit. . Truss Cates. Called Contact Person Plan Check Balance Title 24 Calm picked up Construction Flood plain plan Pians resubmitted.". Mecharilcal Giading plan Z'� Review, ready for correctionslissue Electrical Subeontactor List Called Contact Person Plumbing Grant Deed Pleas picked up &r*LL H.O.A. Approval Plans resubmitted Grading IN HOUSE:- 7jd Review, ready for eorreetionsAmc Developer Impact Fee Planning Approval Caked Contact Person A.LP.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees