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07-1202 (RR)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT ` VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Application Number: 07-00001202 Owner: Property Address: 53605 AVENIDA CORTEZ VEZO MICHAEL/LOAR NANCY APN: 774-101-,004-4 -000000- 53605 AVENIDA CORTEZ Application description: RE -.ROOF LA QUINTA, CA 92253 Property Zoning: COVE RESIDENTIAL ------------------ ------------------ Application --- ------------------,--- Application valuation: 2000 Applicant: Architect or Engineer: ------------------ 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: Any city or county that requires a permit to construct, alterJmprove, 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? or: she is exempt therefrom-andthe basis for the alleged exemption. Anviolation.of. Section.7031,.5 by rpplicant for a permit- subjects -the applyicant.to.a civil penalty of not more than five hundred dollars.($500).: ) 1, as owner of the property, or my employees with wages as3heirsole compensation, will do the work, and. the structure isnot intendedor 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 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.). (_) I, asowner 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.). I_) 1 am exempt under Sec: B:&P.C. for this reason Date: Owner: CONSTRUCTION LENDI AGENCY I.hereby affirm under penalty of perjury that there is aconstruction lends agency for the pefformance of the work for whichahis permit is issued (Sec. 3097, Civ. C.).. Lender's. Name: Lender's Address: LQPERMIT Date: 4/19/07 Contractor: Owner F e ---------------------AN-19 2007 CITY OP U QUINTA ---------------A ----------------------------------- WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: _ 1 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 he workers' compensation laws of California, and agree that, if I�becom Idbject to [h workers' compensatjon,provisions of Section' 3 00 of the Law' ly with those provisions. Date: Applicant: WARNING.TILURE TO SECURE WORKERS' COMPENSATIONVERAGE IS UNLAWFUL, AND.SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL iNES UP TO ONE HUNDRED THOUSAND DOLLARS 01=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°&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 Le Quina; its officers, agents and employees for 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 voidif 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 ieformation isrect. 1 agree to comply with all city and county ordinances and state laws,relating to building con ion,.& ereby authorize representatives of this,: - My to enter upon the above-mentioned Pr r for in tion es. Date: 7 Signature (Applicant or Agent): Application Number . . . . . 07=00001202 Permit . . . RE -ROOF Additional desc Permit Fee . . 30.00 Plan Check Fee .00 Issue Date . . . Valuation 0 Expiration Date 10/16/07 Qty Unit Charge Per Extension BASE FEE 30.00 ------=------------------------------=----------------------------------------- Special Notes and Comments REROOF-ASPHALT SHINGLES. CLASS "A" MATERIALS ONLY. Fee summary Charged Paid Credited, Due Permit Fee Total 30.00 .00 .00 30.00 Plan Check Total_ .00 .00 .00 .00 Grand Total 3.0.00 .00 .00 .30.00 LQPERMrr Bin 1f . Pty Of La Quiff Building 8t Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-70.12 -Building Permit Application and. Tracking Sheet - Peanit, Project Address:' 3 6 a �C IU7 ^Z. owner's Name:. Ye q N (, A. P. Number: Address: 6o r /�1 *vj1 A - Legal Description: Contractor: City;, ST, Zip: N CA Telephoner' � Address: Project Description. City, ST, zip: 2c� UOCc: a Sh�Ac r N t Telephone: State Lic. # : City Lic. #: Arch„ E w., Designer: Address: City., ST, Zip: Telephone: State Lic. #: Name of Contact. Person: Construction Type: Occupancy: Ptoject,type (circle:one): New 'Add'n . Alter Repair Demo Sq. Et.: 3 Soo # Sto 'es: # Units: Telephone:# of Contact Person: F.sfimated Value oProject: APPLICANT: DO NOT WRITEr BELOW THIS LINE # Submittal - Req Id Recd TRACKING. PXRMrrFEES Plan Sets Plan Check submitted Item Amount Structural Cates. Reviewed, ready for corrections • Plan Check Deposit Train Coles. Called Contaet Person Plan Cheek Balance Energy Cala. Plans nicked up Construction Flood .plain plan . Plans resubmitted Mechanical Grading plan V Review, ready for corroetions/issue Electrical Subcontaetor List Called Contact Person Plumbing Grant Deed Piaui picked up S.M L H.O.A. Approval Plans resubmitted Grading INHOUSE:- 3W Reyiew, ready for correcdouslisaae Developer Impact Fee Planning, Approval Called.Contaet Person AXP.P. Pub. Wks. Appr Date of permit issue School Fan Total Permit Fees TELEPHONE (760) 777-7012 FAX (760) 777-7011 OWNER/BUII DER '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 "Owner/Builder" 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 performed 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 your 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 16200.00 ,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 Federal income tax withholding, federal social security taxes, worker's compensation insurance, disability insurance costs and unemployment compensation contributions: There may be financial risks for you if you. do notcarry 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 specific information about your obligations under State Law, contact the Department of Benefit Payments and the Division of,Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally or through their own employees, without 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 owner 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 FAX: (760) 777-7 11 ER'S SIGNA /DATE. 57? 60 PROPERTY ADDRESS 07- f 2-oZ PERMIT NUMBER(S)