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05-1610 (RR)BUILDING &t SAFETY DEPARTMENT P.O. Box 1504 78-495 CALLS TAMPICO (760).777-7012 FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT Application Number . . . 05-00001610 Date 4/27/.05 Property Address . . . . . . 51735 AVENIDA.RUBIO APN: 773-121-017-5 000000 - Application description RE -ROOF Property Zoning , . . . . . . COVE.RESIDENTIAL Application valuation 4000 Owner Contractor --------------------------------- ------------------- ------------- VARGAS, ALEX Owner 51-735 AVENIDA RUBIO LA QUINTA, CA 92253 P.O. Box 1504 VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 4INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: ()-5-- 1610 . Date: 9� - Z 7 -C'S' Applicant: I Architect or Engineer: Applicant's Mailing Address: Architect or Engineer's Address: Lic. No.: BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION 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 -14 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 70.00) 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 the applicant to a civil penalty of not more than five hundred dollars ($500).): U I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structureis 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.). (1Q 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.). r U I am exempt under Sec. BA P.I�for t reason i/ Date d Ownefl�/t' �- RKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following de - arations: 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. Date Applicant 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. 1 certify that I have read this application and state that the above information is matt. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives o/thisunty to enter up the above -m ntioned property for inspection purposes. atD e L Signature (Applicant or -----------------------------------------------------------------=---------- t Application Number . . . . . 05-00001610 ----------------------------------------------------------------------------- Permit . . . . . .. RE -ROOF Additional desc Permit Fee . . . . 30.00 Plan Check Fee 00 Issue Date . . Valuation . . . . 0 Expiration Date 10/24/05 Qty Unit Charge Per Extension BASE FEE 30.00 ----------------------------------------------=----------------------------- Special Notes and Comments' RE -ROOF WITH CLASS "A" MATERIALS. Fee summary Charged Paid Credited Due - ---------- - - - - ------ - - - - ------ - - - - --------- - ------ - - - - - - Permit Fee Total 30.00 .00 00 30.00 Plan Check Total .00 .00 .00 .00 Grand Total 30.00 .00 .00 30.00 Total Permit Fees rJ Demo Amount Bin ;<f CII. O� LQ Y Quinta Building 8t Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # �� /0 Project Address: ` V U Owner's Name: A. P. Number: Legal Description: Address: U"3 ' C-) City, ST, Zip: L_A Q)ui iiJ Contractor: �✓,vP�� Telephone Address: • o, City, ST, Zip: Telephone: ........... State Lic. # : Ciri' Lic. #: Project Description: —' 3 w C --Z� r Arch., Engr., Designer: — Address: City, ST, Zip: Construction on Tv e. . P Occupancy: _ Telephone: P hon e to S toLt• c. #: Project ect —. riPe (circle cls n New e Add'n Alter ia P Name of Contact Person: Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE q Submittal Req'd Rec'd TRACKING PERAfIT FEES Plan Sets I Plan Check submitted Item Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Construction Title 24 Calcs. Plans picked up Flood plain plan Plans resubmitted Mechanical Grading plan 2"d Review, read}, for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S l\1 1 II.O.A. Approval Plans resubmitted Grading IN IIOUSE:- '"' Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees rJ Demo Amount