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05-0582 (RR)T BUILDING & SAFETY DEPARTMENT P.O. BOx.,1504•- (76.0).777-7012 OF - AMPICo FAX (760) 777-7011 Nom, iIFORNia, 92,253: IN;SP,ECTION REQUESTS (760) 777-7153 FEB 15 2005 B:UILD1NG PERMIT CRYO LA QUINTA . Apr- 1�.r_-at_H A er 05„x,0'0'000582 Date 2/15/05 Property Address 5288"0 AV.ENIDA RUBIO APN: 773-313-"0'07-_20. -'00.0000- Application descri,pt•ion ARE -=ROOF Property ZOrii'ng COVE RESIDENTIAL Application .v . uation ' 3 5'0 0 Owner Contractor DIANA DONATO. OWNER 52880-AVENIDA RURIO LA QUINTA' CA 92253 Permit RE -ROOF Additional desc Permit Fee 3;0.00; Plan Check Fee .00 Issue Date :. Valuation 0 Expiration Date .8/,15/05 .Qty Unit Charge. Per Extension BASE; FEE 30.00 c.. Special Notes.. a.nd� Comments REPLACE EXITS_ TING,. TIDE ROOF; WITH LIGHTWEIGHT`TILE:ROOF'�PER MANUFACTURER SPECS Fee summary Charged; Paid Credited Due ----------------- °-°-------- --------- --_-=------ ---------- Permit Fee Total 3"0._.00 ."0.0 00 30.00 Plan Check .To.tad .00 .•00 :. 00 .00 3 0. 0 0 Grand Total 3 0 ..0 0`' C- P.O. Box 1504 • " VOICE (760) 777-7012 78-495 CALLS TAMPICO FAX (760) 777-7011 La QUINTA, CALIFORNIA 92253 4 4 a INSPECTIONS (760) 777-7153 BUILDING &'SAFETY DEPARTMENT Application Number: �,�—�� 2— Date: 2-6-e;?7� Applicant: 041_14_�ell_ Applicant's Mailing Address: I hereby affirm under penalty of perjury that I am licensed Code, and my License is in full force and effect. License Class Date Contractor Architect or Engineer: Architect or Engineer's Address: Lic. No.: BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals License No. OWNER -BUILDER DECLARATION 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 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 6f Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): (29 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 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.). U 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.). U I am exempt under Sec. , !f� C. for this reason /Dais ,_I S WORKERS' 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 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 Californiad agree that, if I shou ecome subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those visions. f Date i2 / _� Applica� WARNING: FAILURE TO SECURE KERS' 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 employeesfor 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. Date—A f Signature (Applicant or Agent): 4 OWNER/BUILDER 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 ``OwnecBuilder" 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 .perfornied' 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 you 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 subject to several obligations include. State and Federalincome tax. withholding', 'federal social security taxes, worker's compensation insurance, disabiiit-. ance 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: ' 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;'spe&fic information about;yoi r obligations under State Law, contact the Department of Benefit;Paymen'ts'and the Divisior `of 16dustfial 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 oivn'employees,.wi'thout.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 owrier'.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 F) 777-7011 OWNER'S SI NATURE/DATE PROPERTY ADDRESS PERMIT NUMBER(S) '