13-1271 (RR)7rr._
A
P.O. BOX 1504
-78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
13-00001271
Property Address:
54065 AVENIDA RAMIREZ
APN:
774-211-015-3 -000000-
Application description:
RE=ROOF
•Property'Zoning:
COVE RESIDENTIAL
Application Valuation:
4000
JVOICE (760) 777-7012 FAX (760) 777-7011
BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDINGPERMIT
Date: 10/04/13
Owner:
OCHOA CECILIA
*NOT ON FILE
UNKNOWN, CA 99999
---------------------------------
Contractor,
Applicant: Architect or. Engineer: Owner U
OCT 07
2013 1
------------------------ --=-
CITYOF LA QUINTA
'FINANCE DEPT.
.. r - - - - - - - - - - - - - - —
'LICENSED'CONTRACTOR'S DECLARATION' - _ -WORKER'S COMPENSATION:DECLARATION.' -
Qereby affirm under penalty;of perjury'that 14m licensed under"prowsions of(Chapter.9 (commencing with I hereby affirm under penalty, hof perjury one of the following. declarations.
Section' 7000) of Division.3 of theB_usiness and_Professionals Code; and my License is in full force and; eftect. - I have and will maintain a certificate of.consent to self -insure. for workers compensation, as provided
License Class: i4` - license No.: - for. by Section 3700 of the Labor Cotle,-forthe performance of the work'for'which this:permit is
;•issued.
Date: Cont ac�. - - 1 have and will maintain workers' compensation insurance, as requked by Section: 3700: of the Labor,
Code,. for the -performance of the work for whichthis permit is issued. My workers'.compensation
OWNER -BUILDER DECLARATIONinsurance carrier and policy number are
m
hereby affirm under penalty of perjury that I am exemptfrothe•Contractor s State -License Lawfor the Carrier Policy, Number -
following :reason:.ISec. 7031 .5, Business and Professions Code: Any city or countythat. requires a-perrnit to: - I certify that, in the,perf, ormance of the woik�for which this'permit'is issued,[shall nofemploy any
construct, alter ,improve, demolish; or repair any�structure;';prior,to,its issuance, also requires theapplican{for the - person in any manner so'A to:become subject to the workers',compensa6io :laws of California, -
permit to -file 2 signed.statementthat he or she is'licensed pursuant to the provisions.of the: Contractor's -State" ` - and agree that, if l'stiould become subject to the workers' compensabon:provisions of, Section
License•L'aw-(Chapter 9 (commencing: withSection-,7000) ofDivision 3 of -the Business and Professions Code) or 3700 of the Labor;Code,.I.shall'forthwith comply,with those -provision s.
that he•or she isexempt therefrom and the .basis for the alleged exemption. Any violation of'Section 7031 .5 by.
a9p,��?plicant fora permirsubjects the applicant to a civil penalty of not more than five hundred dollars ($50,0).: � Date: Applicant: .
((!.(�_ I, as owner of the property, or my.employees- with wages as their, sole compensation°will dothe work, and
--the structure is not intended'oroffered,for-sale (Sec: 7044, Business-and.Professions Code: The WARNING:' FAILURE TOSECURE'WORKERS',COMPENSATION COVERAGE ISLNLAWFUL, AND SHALL
Contractors' -State License: Law does no{-apply_to an :owner bf'proper{y.who tiuitds orimproves thereon, SUBJECT AN EMPLOYER;TO':CRIMINAL,PENALTIES�AND CIVIL FINES UP -TO ONE -HUNDRED THOUSAND'
-anC who does'.the work himself or, herself' through his'or her owg,employees,.provided that the DOLLARS ($100,000)., IN,ADDITION •TO THE'COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or 'offered for'sale. If, however, the building or improvement is sold:within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
•/) one year Of completion,'the owner -budder will have the burden ofproving that he or she did not build or
•// improve for the purpose of sale.). - APPLICANT ACKNOWLEDGEMENT,
41-
I, as owner of the property, am°exclusively contracti6g with licensed'contractors to-construcf the project (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for apermit subject to the
7044, Business and Professions'Code:The Contractors' State License Lawdoes not apply to'an.owner of " conditions and restrictions set forth on this application.
property who builds or improves thereon, and `who 6ontracts for the projects with a contractor(s) licensed 1 Each person upon whose behalf this application is 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'resultof this application,'
I am exempt under Sec. BAP.C. for this reason 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.
�0ate: /� ��; 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 state laws relating to building construction, and hereby authorize representatives
of this count toe ter upo��
n the above-mentioned property fOr inspection purposes. '
Lender's Name: - -r 1 (/
' Signatu` e(APPlica" nt-oi Agentl: ��c�.�— �B �iL�
Lend er's,Address:
LQPERMIT
•.fix.
LQPERD1IT
Application Number . . . . 13-00001271.'
Permit . . . RE -ROOF
Additional desc .
Permit Fee 48.62 Plan Check Fee
.00
Issue Date . . Valuation
0
Expiration Date 4/02/14.
Qty Unit Charge' PerExtension
1.00 4.8. 6200 LS MISC RE -ROOF, 1ST'2000'SF
48.•62
',
.. -
Special Notes- an df Comments
RE ROOF REROOF'WITH OWEN-CORNING
'DURATION•• SHINGLES SHASTA.,WH'ITE,,,COLOR-
'[CRRC; b -8'9A 0007] 2010 CALIFORNIA ENERGY
-
.CODE .- :- -
'--
•
-- _ --_ -- --- -- --- ----- -----'-------.--
-- -Other
----.-
-Fees _ BLDG $TD$ -ADMIN (SB1473)
.. 1..00
PLAN CHECK; RE -ROOF .
97'_24
M.
Fee -`summary" Charged Paid Credited-•>.
Due
. ------------
"
Permit 'Fee Total' 4b". 62 00. 0;0.
48.62
Plan Check •Total "..00 00 . - '0'0 ..
;U
Other Fee.; Total 98%,24 00' Q0
98 24'-
,.. •
;.
Grand; Total 14;6::.86 00 .00
146:.86
LQPERD1IT
Building BT.Safetybivision
P.O. Box.1504,18-495 Calle Tampico
s.; '
La Quetta; CA 92253 (760j 7777012 .
Building Perrnit,App/icat►on and.Track!' Sheet
Permit. #
7
Project Address.
L�
Owner's Name
".
A. P. Number: S
Address: e t
Legal Description:
City, ST, Zip:. ;
Contractor: �.
, . �f• �3`Q CP
Tel
>t::a .::.;>,;::>-:
Address:
Project Description:
City, ST, Zip:
Telephone:
State Lic. # :
City Lica*..
�
Arch., Engr., Designer:
q.
Address:
City., ST, Zip: `
Telephone:
f . ,
<...... ;�
ConstructionType: Occupancy:
State Lie.- #:
.Pro ect a(circle one : New Add'n Alter Repair Demo
Name of Contact Person:, r @
Sq Ft : .Y q d o
#Stories:
#Units:
Telephone # of Contact Perso : - 'l.. [ ' -e3?
;Estimated. Value of Prglect:, ub
_.
AF?P.LICANT: DO-NOT`WRITE.BEI:OW THIS LINE`:
#
Submittal
Req'd
Aec'd
jRA&MG
PERMIT FEES
Plan Sets
Plan Check spbmitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections-
'PlamCheck Deposit
Truss Calcs.
: Called Contact Person
Plan-Check Balance.
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
+Plans resubmitted
Mechanical
Grading plan
2°' Review,'ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
'Plumbing
Grant Deed
> Plans.likked up,
S.M.I.
H.O.A. Approval
Plans resubmitted'
Grading
IN HOUSE:-
'"' Review; mady.for correctionsfissue.
'Developer. Impact Fee
PlanningApproyal
Called-Contaci Person
A.I.P.P.
Pub. Wks. Appr
Date of permit•isiue
School Fees
Total PermitFees
e
/ 1
,. ,P.O..$Ok,;1,504
L"A'QUINTA; CAUF6047A`92247=1504
78'-495 CALLE TA4fito
LA QUINTA, .CALIFORNIA 92253
'PROPERT'Y OWNER'S. -P
'BUILDING "& SAFETY •DEPARTMENT
(760)'777-1012
FAX (760) 777-7011
]Disclosures &� For fis`f6r0Wheer-Bu ers A 1 for'Constructiaa Permits.
P.P.g
ORTll1'T! NO>TICE._TO )PROPERTY OWNER. '. .
Dear ypwnCI7.
Owner
-
i4n::appLcation for. a: builduig,. t has., submitted Pour :name listing : as bail . of :t�h]e.,�property
improvements sp®cified at �pY�-,`�� �J ' 1Y%'1� �`'"1� 3
We are, vi, w4.,an Owner BuilderAckpowiedgmeat'and'Information-Vaificatxm Form- t�o-make you AWWO of your
r esponslbilities,and possable.nskAY may incur by, 6avtng:this.petmit{issued ig:ryour nage as;tlie , .
Owner -Builder.. We.sill:aoi issuera,btuldiag,peXamt:,unW you.Itave read; iniha d yoar'at derstanWmg;,*Ueach provision,
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.
OZ'S ACI WL-EDGMWW- AN1);)%RMCI -ATIaN'OF'U4'F-O €fi A'>f`ION
DfRDMONS: Redd and WiiaAb"sla[P�xa`ril+hO�liM%•10 tionifv vrnii irii nra lnwii sir �iori�i� Iiiic iiiin»irnriA
1. 1 understand a frequent practice of unlicensed persons is to have .the pcopecty owner obtain an "Owner -Builder"
building permit that erroneously: implies that the Property.owner is;Providing his or herown labor an material personalty. I, as
an Owner -Builder, may be held liable and subject to,serious fnancial:risk.for any injuries sustained byan unlicensed person
and his or,her employees while working oq 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
'on mY Property
...
_12. I understand building permits are not required to be signed by property owners 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" I am the
.responsible pa 4y record, !fiepermit. I understanii that!: may protect
myself G, potential financial"risk by Hiring a'licensed Contractor.and'having the permit filed in his or hec name instead of my
own.
00 4.1 understand Contractors are required by law to be licensed and bonded' in California and,to list their license numbers on
permits and contracts.
eo 5. l understand if 1 employ or otherwise engage any persons, 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. .
W-61-.11 understand if I ani considered an employer" .under state and federal law, I must register with the state; and federal
government, withholdpayroll taxes provide workers' compensation disafiilityinsurance, and contribute to unemployment
compensation for each "employee:" I also -,understand my failure to abide by these laws may subject me to serious financial
risk.
�PT 1 understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential
structures cannot .legally build' them with . the intent to offer them for sale, unless all work is performed by licensed-
, 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 he'd liable, for an.* ,
financial or personal. injuries sustained by any subsequent owner(s) that result from any latent construction defects in the
workmanship or materials.
. I 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 (CSLB) at 1-
800-321-CSLB (2752) or www.csib.ca.gov for more information about licensed contractors.
10. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that 1 am the
party le ally and Tally i for ..proposed ns tivity t>� following address:
as
t
M L
I agree that, as the party legally and futancially responsible for this proposed construction activity, I will abide by all
applicable laws and requirements that governOwner-Builders as well as employers.
L12.1 agree to notify the issuer of this form immediately of any additions, deletions; or changes to any of the information I
have provided 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 tounderstand 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 as Owner -Builder and wish to him Contractors,
you will be.-negxwible for verifying whit her or not those Contractors are propetiy licensed and the status of thsir wotkers'
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 issafltg; &&permit. Note: A copy of tke property owner's Mver'sAcensset fa m no(Ackwdim or
other veri teation acceptable to the agency is required to be presented when the permit is r issued to verify the property
owner's signature.
S tune of
rgna property owner C'1z,1� C a,_ t`x Date: 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 understandis my personal responsibility, l hereby authorize
the following person(s) to act as my agent(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: