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13-0061 (RR)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application description Property Zoning: Application valuation: Applicant: 13-00000061 51980 AVENIDA NAVARRO 773-184-012-13 -000000- RE-ROOF COVE RESIDENTIAL .500 T4'it 4 w BUILDING & SAFETY DEPARTMENT . BUILDING PERMIT Architect or Engineer: Owner: �VALDEZ JOE ARTHUR 51980 AVENIDA NAVARRO LA QUINTA, CA 92253 -----------------------------------------7--------- • LICENSED C NTRACTOR'S DECLARATION I hereby affirm under penalty of pe that I li n .under provisions of Chapter 9 (commencing with Section 70 0) of Division 3 of the B siness and We i r ode, and my License is in full force and effect. License C s(s: Lic J Contractor• OWNER-BUI DECLARATION I hereby affirm under penalty of pe ury t I am exempt from the Contractor's State License Law for the following reason (Sec. 7031 .5, Business and Professions Code: Any city of 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 pplicant for a permit subjects the 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 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 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 cen Law.l• I ann exemy under Sec. B.; P.C�i r this reason Date: I/ J' %0/l � Owner: . / CONSTRUCTION LENDING AGENCY I here d y 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. _3017, Civ. C.). Lender's Name: w \ I IN Lender's Address: LQPERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 1/18/13 Contractor: IrEiAt. � 1,12013101 . Owner I CITY OF Lg Q- 0 � FINAkgk 0 PT. -_ ----------------------------------------------- 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. 1 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 N tuber I certify that, in the per nce oft wo Ifor which this permit is issued, I shall not employ any person in any mann r so to b o e ject to the workers' compensation laws of California, Ind agree that, if I could eco a sub) to the workers' compensation provisions of Section 700 of the Labor C`o/de, I sh forth' it com those provisions. fie: Applicanj// WARN NG: FAILURE TO SECUE WOR ERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL ' SUBJECT AN EMPLOYER TO C AL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS 15100,0001. 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 performedunderor 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 cessat n of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above infor ati n s correct. I agree to comply with all city and c unty'ordinances and state laws relating to b ' constr tion, d hereby authorize representatives of this co my t enter upon the above-mentioned pr/op y fQ in pe tion p es. Dare: I ignature (Applicant or Agen . G LQPERMIT Application Number . . . . . 13-00000061 Permit . . . RE-ROOF Additional desc . Permit Fee . . . . 10.00 Plan Check Fee .00 Issue Date _ Valuation . . . . 0. Expiration Date 7/17/13 Qty. Unit Charge Per Extension BASE FEE 30.00 Special Notes and .Comments --------- --------------------------- REPLACEMENT OF LESS THAN 11 SQUARE MINIMUM 30LB# FELT REINSTALL SAME 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 Bin.N Petmtt # Project Address C(�/ 0uintd Buttdfig at Safety Division P.O. Box 1504,78-495 Calle Tampico La.Qirinta, CA 92253 - (760) 777-7012 Building Permit' Application'and Tracidng Sheet 11i41e Owner's Name:. IDS A(�Qo.'Z A. P. Number. Address:�j i n v ' Legal Description: Contractor. City, ST, Zip: . A., Telephone: Address: Project Description: 7 city, ST. Zip: Telephone: City Lic. 0, CA Ei State Lie. #: ` r � W Arch., Eagr., Designer. Address: City., ST. Zip: Telephone:Construction State Lta #. Name of Contact Person: Type: • 00c' upancy: - . Project typc (circle one): New Add'n Alt Repair ' Demo Sq. EL: # Stories # Units: Telephone # of Contact Person (- - _ 9 Estimated Value of Project Dv— APPLICANT, DO NOT WRITE BELOW THIS UNE tY Submittal Req'd 'Rec'd TRA47MG PERMTTFEES P(4a Sets . Pian Check submitted Item Amount Structural Cafes Reviewed, ready for corrections Plan Check Deposit. '[fuss Cala. Called Contact Person Pian Check Saleaee Title 24 Cala Plans picked up Construction Flood plain plan Plans resubmitted ' Maharilcsl Grading plan 2'! Review, ready for correctionstissue Electrical Subeonteetor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.L Ii O A Approval Plans resubmitted Grading IN HOUSE:- ''� R;view; ready for correctlo sfissn ( Developer lastp ac. Fee Planning Approval Called Contact Person A.I:P.P. Pub. Wks. Appr - Date of permit Issue School Fees Total Permit Feu i P.O. BOX 1504 LA QUINTA, CALIFORNIA 92247-1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 �r 1� BUILDING & SAFETY DEPARTMENT PROPERTY OWNEWS PACKAGE (760) 777-7012 FAX (760) 777-7011 Disclosures & Forms for Owner -Builders Applying for Construction Permits MANT1 NUTICF Tc) t?unpEM OV1MR 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 at � — . A\1 1PA QAV/VF�- We are providing you with an Owner -Builder Acknowledgment and Information Veri€eeaticn► Form to make you aware of your r+espensibilities and possible risk you may incur by having dds permit -issued in your name as the Owner -Builder. We witl not Umm a budding permit until rou%6ave read, in aW your. understanding of ea&previdon, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. Read a d &ental each stzrtemenr bdlaw,re signify you wderstand or very this information. I understand a frequent'practice of unlicensed persons is to have the property owner obtain an "Owner -Builder" guilding.permit that erroneously implies that the property owner is providing his or her own labor and material personaRy.1, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person a -d 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 6kRay ply ierstand building permits are not required to be signed by property owners unless they are responsible for the and are not hiring a Licensed Contractor to assume this responsibility. I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect F from potential financial, risk by hiring a licensed Contractor and having the -permit fled in his or her name instead of my 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on and contracts. '-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" 4ate,and federal law. nderstand if I am considered an "employer" under state and federal law, I must register with the state and federal it, wi�rhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment ie for each "employee." I also understand my failure to abide by these laws may subject me to serious financial /` 1 understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential s tures cannot .legally build them with the intent to offer them for sale, unless .all work is performed by licensed subcontractors and the number 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. 8. I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any Financial or personal. i4mies sustained by any subsequent owner(s) that result, from any latent construction defects in the wo;kmaasliip or materials. W. I understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue ✓ice, the United States Small Business Administration, the California Department of Benefit Payments, and the California ision'of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at I- �3� 1-CSLB (2752) or www.csib.ca.gov for more information about licensed contractors. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the legally and financially responsible for proposed construction activity at the following address: L I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all able laws and requirements that govern Owner -Builders as well as employers. 12.1 agree to notify the issuer of this form immediately of any additions; deletions, or dW3ges b any of the information 1 ha provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with so who does not have a license, the Contractors' State License Board may be unable to aseM you with any 8naucW loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in 1civil east. It is also important for you to understand that if an unhoensod Contractor or employee of that individual or firm is injured while working on your property, you may be held Ii" for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors, You will be responsMe for v %dither or not those Cotntmctora are property licensed and the status of their workers' compensation insurance coverage. Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issaitrg.ffis perrmtL Nota: A copy of dw property owiw's dairar.'atka. fern r o"bv►q er other verification asceplthe/ ` � s reg % ,ta� bt prtserrttd when the Qcsmit is i�tsretJ to Yrn7ify iiia PMP" owner's signature. t I Signature of property owner Date: ' 1 ir�l 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. AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agcat(s) 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.. Address of Authorized Agent: Tel No I declare under penalty of perjury that 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 driver's 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: