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12-0977 (RR)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 12x0,000'0,977 -.tom 0 Property Address: 52145 AVENIDA° RAMIREZ APN: 773-221-024-7 -000000- Application description: RE -ROOF Property Zoning: COVE RESIDENTIAL Application valuation: 4000 Tit!t 4 XP Q" - 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 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: Anycity 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 iscexempt 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 ($500).: 1 I, as owner of theproperty, or my employees with wages as their sole'compensation, will,dothe 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 ow' ner. -of property who builds or improves thereon, and who does the work himself or herself through his or herown'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'ownerof 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°oto 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.&P.C. for this reason X ­__ 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 (Seca 3097, Civ. C.). Lender's Name: Lender's Address: LQPERMIT Owner: ELIANA JARA 52145 AVENIDA LA QUINTA, CA Contractor: Owner RAMIREZ 92253 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 8/23/12 WORKER'S COMPENSATION DECLARATION I hereby_ affirm under penalty of perjury one of the following declarations: _• I have and will maintain aFcertificate of consenrto 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 soas 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 �• 370 of tIi Labor Code, I shall forth fl!i comp .it th ose provi ' ns. ,Date•/�•� / pplicant: WARNING:' FAIL RE TO SECURE WORKERS' COMPENSATION COVERAGE I NLAWFUI 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 uponwtipse 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 agreesfo; and shall defend, indemnity 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 ofthis 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 thisapplication 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 un to enter e/upon property for spectif+p purposes. 06Z ate: /Si ature (Applicant or Agent): Application Number . . . . Permit RE -ROOF Additional desc . . Permit Fee . . . . 30.00 Issue Date . . . . Expiration Date . . 2/19/13 12-00000977 Plan Check Fee . . .00 Valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE 30.00 ---------------------------------------------------------------------------- Special Notes and Comments REMOVE EXISTING TILE, INSTALL NEW PLYWOOD & PAPER. REPLAC ORIGINAL TILE. 2010 CODES. CG61elfIEPR/� ------------------------------------------------------7--------------------- 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 LQPERMIT P.O. BOX 1504 LA QUINTA, CALIFORNIA 92247-1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT (760)777-7012 FAX (.760) 777-7011 PROPERTY OV-M.,NER' S PACKAGE Disclosures &Forms for Owner -' Builders Applying -for Construction Permits Q.f'fi IANT1 NOTICE TO 11'R(lP t�Tv pWnR Dear Property Owner. Aa : application for a building permit has been submitted . in your name listing yourself as the builder of the property impFOreRICUts specified at. We are providing you with an Owner -Builder Acknowledgment a,n. Infotma�en Verifieatma'Form to make you awwx of yewMVQ=ibilities and possible link. }rou may incur by `av ng this"permit issued rn your Warne as the Ownes-Builder. We win not issue a brilding_pecnait untie `you tiave, ratty, io d"ed yotii tmd tandirrg of each prevision, signed, and returned tius.lorm to us.at our oitidal`address indicated: An agent of the owner cannot execute dais notice unless You, the Property owner, obtain the prior approval of the permitting authority. [JfR�T:77�1Vs: R6cd and i+cWd eimda statement be(ativ t® si gn#y you w0witand or, very dlus i>tjorM4110n. . I tnderstand a frequent , practice of unlicensed persons is to have the property . owner obtain an . "Owner -Builder" ding Permit that erroneously.implies that the, property owner is providing his.or her own labor and material personally. [,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 a° willfiilly acting as an Owner -Builder and am aware of the limits of my, insurance coverage for injuries to workers on my property.. understand building permits are not.required .to be signed. bY ProPYowners unless they are responsible for the construction and are not hiring a Licensed Contractor to assume this responsibility. �3. I understand as an "Owner -Builder" L am the responsible party of'record on the permit. I understand that I may protect myself from potential financial risk by hiring a -licensed Contractor and having -the permit filed in his or her name instead of my own. k4. 1 understand Contractors are required, b law eq y to be licensed and bonded in California and to list then license numbers on permits and contracts. 5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total valut of my construction is at, least five hundred dollars ($500); including labor and materials; I may be considered an "employer' understate and federal law. !W 6. [understand if I am considered an "employer" under state and federal taw, I must register. with the state and feden 9 ent, g t, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemploymet compensation for each "employee." .1 also understand my failure to, abide by these taws may subject me to serious fnancii risk. hil 7. 1 understand under California Contractors' State License Law, an Owner -Builder who builds sin le-famil residents g Ysures cannot legally build them with the intent to offer them for sale, unless all work is performed by ticew subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is perform under contract with a licensed general building Contractor. j understand as an Owner- f� financial Builder if I sett the property for which this permit is issued, I may be held liable for any or persona! j4111M. bY.ffiY subsequent owners) thai result from any latent construction defects in the workmanship or materials. t. j 9. I understand I may obtain more dnfomoatioo regarding my obligations as an "employee' from the Internal Revenue Setvice, the United States Small Business Administra ' Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSM at 1- 800-321-CSLB (2752) or www.c.sib.c,&gov for mote information about licensed contractors. _ 10. I am aware of and consent to an Owner -Builder building permit applied for in m name, and understand that I am the / Party legally and financial) Y y _ responsrbk for proposed construction activity at the following address: agree that, as the party legally and finaaciall nsible for applicable laws and Y respo o this proposed construction activity, I will abide by all requirements that govern Owner -Builders as well as employers. 12. 1 agree to notify the issuer of this form immediate) of an addi ' ' ha a provided on y Y. tjoos; deldi+oat, or chpoges to �y of the � 1 this form Ucensod. contractors are regulated by, laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State Lweme Board maybe unable to asset you with any financial loss You may sustain as.a result of a co8iplaint. Yout only remedy against unlicensed Contractors may be in civil nowt It is also iompoctam for you to. undersatnd dW if an `uWkassed Centractor or employee. of that dud YAW or firm is wMed while wodmg yourproperty, you MAY be kse ld liable kms' damages, If you obtain a permit as Owner -Budder and with to hire Coauacsors, You wdl-be .rile for verifjriurg "hub .W or not those Contractors are dation insuraaoe oovenW. pmpah' heeosed and the status of thm workers' Before a building permit can be issued, tWa form must be completed and signed by the property owraer and returned to the agency responsible for .dw.Pa=kL Note: A copy of eke pnsperg* owasr's dWvw 'a fwm notes, or owner's signature. to tier �J' is mqu&ed to be pr+eaearted when the Qemde is ina"'to rarefy die p vp" z :. Signature of property owner 1 Dste S/vim 3/% o� 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 fora construction permit for the Owner -Builder. -- -- •�. �. a vi..�alvCiGiC1I VVV" run u r Excluding the Notice to Property Owner; else eiecution of which I understand ism personal the followwg persons) to ase as m Y Pe responshbility, I hu�eby authorize y agues) 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): permit.is issued to verify the property owner's signature. Date: Total Permit Fees City Of La Quinta Permit # gAVA Building J t Safety Division . P.O. Box 1304,78-40S Calle Tampico a b Quirlta,,-CA 9M-3 -. (760) 777-7012 Building Permit Application and Tracking Sheet X Project Address: �kq� q f A. P. Number: wner's Name: Legal Description: Address: Ili Contractor: �.; (� City. ST, Zip: L• �(/91 tt) ��, Z-,4. �� s v� 40 Address: elephone: 376. v/',4 r �rS Project De iption: City, ST:-Zip: Telephone State Lic. #D: city Arch-, Engr., Designer: , Address: City, ST, Zip: Telephone: State Li Co n s truc - h on Tv- Pe- Oc cu P an c- Name of Contact Person: roject tYpe (circle one): New ' Add'n Alter Repair Demo - Telephone # of,. Contact Person: Sq. Ft.: /..O 7 —0 12 Stories: # Units: / Estimated Value of Project: 000,0 APPLICANT: DO NOT WRITE'BELOW THIS LINE It Submittal Req,'d Recd TRACKING ` Plan Sets, Plan Check submitted , PERMIT FEES Structural Calcs. ready for corrections Itemt ' AmountReviewed, Truss CalcsEGrading - Plan Check Deposit .Called Contact Person Plan .Check Balance Plans picked up ;Plans resubmitted. Construction 2- Review, ready for correctionsrssueElectrical Mechanical Called Contact Person Grant Deed Plumbing. Plans picked up If-O.A. Approval Plans resubmitted' S.M.I. IN HOUSE:-- . . ''' Grading Planning Approval Review, ready for coirectionsrssue Developer Impact Fee Contact Person Pub. Wks. Appr _T_Called Date of permit issue A. LP. P. School Fees Total Permit Fees