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09-1185 (RR)P.O. BOX 1504 78-495 CALLE TAMPICO k LA QUINTA, CALIFORNIA 92253 BUILDING &.SAFETY DEPARTMENT BUILDING PERMIT Application Number: 09-00001=F,8_5 T Owner: Property Address: 5,3.9.66 AVENIDA: •RAMIREZ SEAN MURRAY APN: 774-162-024-14 -000000- 53966 AVENIDA.RAMIREZ Application description: RE -ROOF LA QUINTA, CA 92253 Property Zoning: COVE RESIDENTIAL ----------=------ - Application valuation: 4000 VOICE(760) 777-7012 FAX (760) 777-7011 INSPECTION& (760) 777-7153 Date: 11/16/09 Contractor: nd Applicant: Architect -.6r Engineer: Owner I(`)v -------------- -------- - G_ 1"sg 1" .l CITYQF - ----- 1 LICENSEDCONTRACTOR'S DECLARATION ' T WORKER'S COMPENSATIOMDECLARATION - - hereby affirm.under penalty of perjury that l am licerised under. provisions,of.Chapi 9'(comrRencing with 'I Hereby. affirm under peri`. y-of;perjury one of the'followmg `declarations •=� a Section 70001 of. Division 3 of the Business and Professionals Code,•,and my L•icense'is in full force: and effect • . _ I have and will maintain :a.certificat i of consentito self insure for workers' compensation, asjprov dad License Class: - - License No.: for by,Section3700 of the Cabor'Cotla; orthe performance of the work for which this permit is - issued. -s •:r, ,.. ' Date: Coritractor. .. _-I have and.will maintain,workers' compensation insurance ;as required by Section 3700 o{ttie Labor,.;. Code, for the performance of the work: I& which,thispermit is issued. My workers' compensation OWNER -BUILDER DECLARATION insurance he and policy number are:. - hereby affirm under penalty of perjury that I am exempt from the Contractor's State License;Law for the Carrier - Policy,Number' following reason (Sec. 7.031..5, Business and_Professions, Code: Any city or county that requires. a, permit to I.cenify that, in the performance of. the work for which this, permit is issL ed, I shall not employ: any construct, alter, improve, demolish, or repair any:structure, prior to its,issuance; also requires the applicant for the person in any,"manner•so as•to become subject to the workeis' compensation laws of California, permit to file a signed statement that he or she.is.licensed;pursuant to the pro-visians of.the Contractor's State and agree that, if 1 should become subject to the workers' compensation provisions of Section License Law (Chapter 9 (commencing, with Section 70001 of,DiGision 3 of the Business and,Professions Code) or 700 of the abor Code shall f • rthwith comply with those provisions. that he or she is exempt therefrom and the basis for theallegedexemption.. Any violation of Section 7031:5 by any%%%%����pplicant for a permit subjects the applicant to a•civil penalty.of not more than five hundred:dollers (S500).: ate: � / .O pplicant: _ ('V) I, as owner of the Property, '& my ernployees with wages as their.sole compensation will do the work; and.f the structure is not intended or offered.for sate'ISec. 7044, Business, and. Professions, Code: The. ' - WARNING:. FAILURE-TO�SECURE;WORKERS'-COMPENSATION. COVERAGE IS UNLAWFOL,'AND SHALL Contractors'. state License Law does not apply to an owner of property who builds or -improves thereon; SUBJECT AN.EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND and who does the work himself or Herself through his or her "n'erttptoyees, provided that. the DOLLARS 1$100;000). IWADDITION•TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN . improvements are not intended og,offered.for sale. If; however, the building or improvement is sold within SECTION'3766 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. - one year of completion, the owner ;builder will have the burden of proving that he orshe did not build or - improve for the purpose.of sale.). • +• .. . _ : •c- APPLICANT:ACKNOWLEDGEMENT .. (_) I, as owner of the property, am exclusively`contracting with licensed contractors to construct the project (Sec. IMPORTANT Application. is hereby made to the Director of Building and Safety for a permit subject to the 7044, Business and Professions Code: The Contractors' State License Law does,not apply to an owner of conditions and restrictions set forth on this application. property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed 1 . Each person upon whose behalf this application °i's made, each person at whose request and for pursuant to the Contractors' State'License Law.). whose benefit work is performed under or pursuant to any permit issued as a result of this application, (_) I am exempt under Sec. , B.&P.C. for this reason the owner, and the applicant, each agrees to; and shall defend, indemnify and hold harmless the City of La ouinta, its officers, agents and employees for any ;act or omission related to the work being // performed,under or following issuance of this permit. /ate: I CJ Own 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 CONSTRUCTION LENDING. AGENCY permit to cancellation. I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the I certify that I have read this application and state that the above information is correct. I agree to comply with all work for which this permit is issued (Sec. 3097, Civ. C.). city and county ordinances and to laws relating to building construction; and hereby authorize representatives of thi cou y to a ter upon t above-mentioned property f in p ti purposes. Lender's Name: ' ate: I (' S` ature (Applicant or Agent): 1� Lender's Address: LQPERMIT .00: LQPERMIT Application Number . . . . 09-0000i185 Permit . . . RE -ROOF Additional desc . Permit 'Fee 30.00 Plan Check Fee Q0 Issue'Date . . . Valuation 0 Expiration'Date , 5/15/1.0 Qty Unit Charge Per Extension BASE FEE 30.00 -------- Special; Notes .and ,.Comments RE ROOF.,WI•TH CLASS "A"' SHINGLES OVER` 70g OF ROOF,. AREA ------.--------- Other Fees -------- - - - --- -------------- BLDG .STDS,ADMIN (SBi473) 1'.00 Fee" summary CYiarged Paid Credited Due: Permit Fee Total 30:.00 .00 .Q0 30::00 Plan Check..jotal 00 .00 .00 00' Other Fee Total 1 : 0`6 .,.00,-.* . 00 1:00 .Grand`Total 31.00 .00 ..00. 31.00 P.O.-BOX 1-504 LA Q6INtA',* CALIFORNIA '92247-1504 BWL'DiNG & SAFETY DEPARTMENT 78-495"CAL ' LE TA.MPIC.0 (7 60) 777-70.12 LA QUINTAI-.CA.LIFO,RNIA 92253 FAX (760) 777-7011 Disclosures & Forms -foi.Owner=B':u"Od'ers Applying ng for Construction Permits IMPMANT! NOTICE TO PROPERTY OWNER Dear Property Owner .An. application -fior-a--building, pernqhas been submitted in y ur name fis-itiri' Yourself as the builder of the property improvements -at 3 6 6 - A specified' We areproviding youwith an Owner -Builder Acknowledghi I 6ni.drid;lnfbimation Ve.4ication Form to make you aware of your responsibilities and possible risk -you may -incur by having,�(h is,periaiit-issue'd4ny'our , name as the I Owner-Bluilder. We will not issue: a buil -.-perxfii(�,unti1 you -.have - ed your understanding of each;provision, dii�g..read, initial erstandm signed, and returned this form to usat our officiaA address indicated. An agent of the owner cannot execute this -notice unless you, the property owner, obtain the prior approval of the permitting authority. DIRECTIONS: Read and initial ea. ch.siatiement below'-"'. td sign'jfy you- understand orwenfy this'Mformation. kI understand a frequent practice of unlicensedpersons is to have the property owner obtain an "Owner -Builder" uild g permit, that erroneously implies that the property . owner is providing his br'her own labor -and material personally. 1, as an Owner -Builder, may be held liable and subject to seriolis.financiaFrisk for any-iniunes -sustained by an unlicensed person and his or her employees while working overage for those g on my,pro erty.. homeowner's insurance p y insurance may not. provide c injunes. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance -coverage for injuries to workers on my property. 2 q- 1 understand building permits are not required to :be signed by proper(y owners unless they are responsible for the , -�construction and are not hiring a licensed..Contractor to-assume...this'responsibility. 13. 1 understand' as an"Owner 7Builder" Liam ,.the,re 'bnsib id'o understand that I may protect sp .,le.part n the permit.. I u y,.ofteco myself from potential financial risk by'hiriii9' a licensed Contractor and having the permit filed in his I or her name instead of my Own. I understand Contractors are required by law to be licensed and. bonded in California and to list their license numbers on permits and contracts. 5. 1 understand if I employ or otherwise engage any pers'ons- other than California licensed Contractors, and the total value of my construction is at least. five hundred dollars- ($500), including labor and materials, I may be considered an "employer" under state and federal.law'. S 6- I understand if I 'am considered' 1.musuregister with the state and federal an ",qmplbyee,. under state and law ax- workeW compensation insurance, and government, withhold'payrgll taxes; e contribute to unemployment compensation on for each "employee:": . . falso " understand . my faiiii I m to abide 'by these* laws may subject me to serious financial tan -risk. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential stru6tur,es cannot Jegally 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. 1 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. injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. 919. 1 understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue Service, the United States Small Business 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 (MR), at 1- 800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. 10. 1 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the following address: 1 L I agree that, as the party legally and financially responsible for this proposed construction activity -1 will abide by all applicable laws and requirements that govern Owner -Builders as well as employers. 4al12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information 1 eprovided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a- license,. the Contractors' State License Board may be unable to assist -'you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in.civil court. It is also important for you to: understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property; you may be held liable for damages. If you obtain a permit asOwner-Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly 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 issuing; the. permit. Note: Acopy of the propertyowner'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 properly 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. AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, .the execution of which I understandis my personal responsibility, I hereby authorize the following person(s) 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: 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 bepresented when the permit is issued to verify the property' 's signature.. Property Owner's Signature: Date: Bin # Qty Of La. Quinta Building 8i' SafetyDivision P.O. Box 1504, A-495 Calle Tampico La Qulnta,.CA 92253 - (760) 777-7012 'Building Permit Application and Tracking Sheet Permit # cb OR, ` Project Address: Owner's Name` A. P. Number: Address: Legal Description: Contractor: (' City, ST, Zip: G' / ya25-3 telephone:` . � 9 5a 3 d s -yv Address: Project Description: E ICQ7F / City, ST, Zip:s J5''L-t rjC - ._ � \ � F IC��J� Telephone: ::i::?:uS:S:;:::i::?:i>.>.?viii:; State Lic. # : City Lic. #: Arch., Engr., Designer: Address: City, ST, Zip: Telephone: `zzPe Construction ton T 'e: Occupancy: Y P ane Y• State Lic. #: 0roJct type (circle one : New Add'n Alter Repair r Dem Name of Contact Person: 69' Tw� Sq. Ft.:f�g # Stories: # Units: Telephone # of Contact Person: Estimated Value,of Project. 0 APPLICANT: DO. NOT.WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Caics. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Confect Person Plan Check Balance Title 24 Calcs. Plans picked up .' Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2°" Review, ready for corrections/issueElectrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- ''" 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