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05-2805 (RR)P.0. BOX 1504 78-495 CALLE TAMPICO LA QUINTA,•CALIFORNIA- 92253 -Application Number: 05-00002805 Property Address: 54425 AVENIDA RAMIREZ APN; 774=243-0.21=10 -000000- Application description: RE -ROOF Property Zoning: COVE RESIDENTIAL Applibatior valuation: 1500 Applicant: Architect or. - LICENSED CONTRACTOR'S.DECLARATION�.-- VOICE (760) 777-7012 Tityl 4 AoI FAX (760) 777-7011 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 717-7153 BUILDING PERMIT Date: 7/08/05 Owner: CASTELLANOS, GUILLERMO P 54100 AVENIDA RAMIREZ LA QUINTA, CA 92253 --------------------------------- JUL 112005. - Contractor: Owner -- - - -- - - - - - - - - - - - - - - - - - - - - - - -. -- -- Lender's Name: Lender's Address: LQPERDIIT of this county to upon the above-mentioned property forinspectian purpo s. ,6ateV'0 ignature (Applicant or Agent): - LICENSED CONTRACTOR'S.DECLARATION�.-- WORKER'S COMPENSATION. DECLARATION I hereby affirm under -penalty of perjury thaC9 am licensed under-piovisions-of Chapter 9, (commencing with - I hereby affirm under. penalty of. perjury one of the -following declarations: - Se6tion.7600) of-Division.3,of.fhe Business.Wa Professionals Code,.and my,License'is'in,full force and effect. - '_ 1 have and'will maintain a certificate of consent'to self -insure --for workers'• compensation, as provided " License Class:_ .- _ License -No.: - .... ,.. -.. `. :. for by Section 3700 of the Labor Code, for the performance, of the work'for which this permit is ' ` ,i'. �.... _ .r ._issued. pate: .- Contractor: -' _ - I have and will maintain workers' compensation insurance, -as required by -Section 3700 of the Labor t- .. -' ` • - Code, for the,performance•of the work for.which:this permit is issued. "My -workers' compensation OWNER -BUILDER DECLARATION insurance cairierand policy number are: I hereby affirm under penalty of perjury that Lam exempt from the Contractor's State License Law for the Carrier . Policy Number.. a' - following reason"(Sec. 7031.5, Business and',Profe'ssions.Code:,Any city or. county That iequires a permir'to certify, that, in the performance of the work for which this permit is issued,* I shall not employ any`t' ' - - construct,, alter; improve demolish, or repatr�anystructure,°prior to its issuance, also regtiires-the applicanr4or the -, persn in any manner so as to become subject;to the workers'..compensation Iavis-of.California, " permit to file s signed statement that he or she is licensed pursuant to the provisions -of the Contractor sState.," - . and agree that, if I should beconie,subjectto the workers' compensation provisions of Section ' . License Law (Chapter 9 (commencing;with Section 7000) of�D,ivision 3 of ihi:,Business and-Professioni CW4or 3700 of the Labor Code, I shall: forthwith comply with those provisions.= , that he or she is exempt -therefrom and the basis for the alleged exemption:''Ahy violation of,Section'7031.5 by�//�J for apermit thea hcant to of, more five hundred dollars(S5001.: - . any pplicent subjects acwil penalty not than - ( I:- as! owner of the property or my"employees with wages as their:'sole compensation wilbdgthe'work, and- to scant. """��""" the'siructure is no0 ritended'or offered.forsale (See, =7044, Business and Professions Code: The WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL Contractors' State License Law not apply to an owner of propertywho�builds 6i improves thereon, ., SUBJECT AN EMPLOYER T&CRIMINAL PENALTIES AND CIVIL FINES.UP TO ONE HUNDRED THOUSAND - and%'vhodoes the work.himself or herself through his ocher own employees, provided that the- - DOLL4RS-IS100,000). 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_ --SECT16N'3706 0F.THE LABOR.CODE; INTEREST,'AND-ATTORNEY'S FEES.' . one-year of completion,.the owner -builder will have the burden of proving ihathe or she did`not;build or improve for the purpose of sale.). - 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 =9• 7044, Business and Professions°Code:'The Contractors' State License Caw "does not apply to an'owner of conditions and restrictions set form 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 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 permivissued as a result of this application, - 1_) 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 Quinta, its officers, agents and employees for any act or omission related to the work being cperformed CV2. under orfollowing issuance.of this permit. /ate: wn--a r Any permit issued as a result of this applicationbecomes 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 Lender's Name: Lender's Address: LQPERDIIT of this county to upon the above-mentioned property forinspectian purpo s. ,6ateV'0 ignature (Applicant or Agent): LQPERMIT Application Number . . . . . 05-00002805- 5-00002805Permit Permit. . . RE -ROOF Additional desc . Perinit.Fee 30.00 Plan Check Fee .00 Issue'. ... . . Valuation 0 Expiration Date 1/,04/06 Qty Unit Charge Per Extension BASE" FEE `-----------------= S6.';00 ------------------------ ----------- Spec al Notes•,and,Comments --- -------------------- c,. RE,=ROOF. WITH <5-_5 LB, EAGLELITE TILE, 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. c'00 .00. 30.00... LQPERMIT