04-3600 (RR)R, �e4
V
V �
BUILDING & SAFETY DEPAKTME4T
P.-O. Box 1504 (760) 777=7012
Of'ii�9 .78-495 CALLE TAMPICO . FAX (760).777-7.011
-LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760)777-71:53
:.Application Number BV1L.D1NAe9M1J600 Date 4/2004
Property Address 776.87.-CALLE SONORA
APN: 773 -264 -012 -1 -000000 -
Application description ..RE -ROOF
Property Zoning . . . . . COVE RESIDENTIAL
Application valuation 1500
: • Owner Contractor
-------------------------- ------------------_-----
JESSE LOPEZ OWNER
77-687 CALLE•SONORA
LA :QUINTA . CA - 92253
Permit RE -ROOF.
Additional desc ,
Permit.. Fee 3,O. 00 Plan Check Fee':.... .00
Issue Date. Valuation 0
Qty Unit Charge Per Extension
BASE FEE.30 . 00
Special Notes and Comments
RE-ROOF/CLASS "A" MATERIALS ONLY.
.Fee summary Charged Paid Credited'. -Due
Permit Fee Total 30.00 :00 00.. 330..00
Plan .Check. To.tal.: ...00..
.00 : 04: 00
Grand .Total 30:00 .00 .0.0 30.00
fiA
APR •21.2004
CITY OF LA ®U/NTA
FINANCE DEPT
P.O. BOX 1504cy
78-495 CALLS 'rAMtICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
Application Number. O'f — -3
Applicant: ,j1:5 -S-56 (Ejp
Applicant's MailjhgA dgress: ALLF ONOrt/+—
�
VOICE (760) 777-^x012
FAX (760) 777-7011
INSPECTIONS (760) 777.7153
Date: i
Architect or Engineer. .
—Il€
Architect or Engineer's Address:
Lic. No..
BUILDING PERMIT DECLARATIONS
I hereby slam underR'S LICENSED CONTRACTODECLARATION
Gode. era ray", iense bin Iulfa�oe and dikes
pe�tf Pajay Mat 1 am rear,see ,Baer provisions Of Oh mag0 (oommenan0 with sectai 7000) of Division 3 a the Nainess and ftlessionsls
License Class License No.
Dab • Contractor
I het eby affirm lnder penalty of pa jury that I amER OWNERaUILDDECLARATION
Y « Y That s a permit b oonstrhrct. from the Cerwact0W Stale Lksm Law for the Wowing reason (Sec. 7031.5. Business and Prolessionc Code: Any
slabrssart that the «aha k icensed vve, dernotishm, «repair any structs M prior b Is issuance, also requires the appicent for the peal b iia a signed
and Code) «that he or b Ma D of Ma Carrtraaore Stab License Law (Chapter 9 (oamserscinp with Section 7000) of Division 3 of the Business
appiwnt b a civi esmartpt Mherefrorth and the Desk for the alleged ownipGah. Any violation of Section 7031.6 by any applicant for a penis suf>ieets
penalty of not more than A" hundred dollars (UW00
1, as owner of Ma property. or my employees with wages as their sole oompaaation, will do the work, and the structure k not interhded or ofbrod for sate (Sec. 7044,
Business and Professions Code The ContramAors' stab I#wk does not appy b an owner of property who buids or bmpmves tlbrean, and who doss the work
trmhsel «herself or trough his «her own employees, provided that the improvements are not intended ora teed for sale If, however, the building «improvement is
sold within one year d ooh MW% the owner b Ader will have Mie burden of proving Mhat he or she did not build «improve for the purpose of sale.).
U t, as owner of the properly. am sicknively oontracting with licensed contractors b construct to a*d (Sac 7044. Business and Professions Code: The Contractors'
Stab License Law does not appy to an owner of property who builds or Improves two m, and who om h r s for the projects with a oorstractor(s) sensed pursuant a
the Coneracbre State License Law.}
U lam7/za7;v
_ BA P.C. anis reason
DatecOwner
u
I hereby aurin ser
WORKERS, COMPENSATION DECLARATION
Y d perjury one of Aro lobwirg declarations:
_ I have and will maintain a is pen.ab of sue& b self -issue f« workers' compensation, as provided for by Section 3700 of the Labor Code, for the perbwmahoe
of the wok for wtrch this pertnl k kande.
_ 1 have and oil maintain workers' WmPWMGon 1IMN1100e, as required by Section 3700 of the Labor Code, for the performanced the watt for "lid ► this pemR is
carrier
IssuedIssuedMy workers' corpw=bon Insurance wrier and policy number are:
Number
1 eettily rias, in the peRonnance of ttowork for which this permit is issued. I shall not employ any person in any malar so as to become subject b Mme wakes'
y and spree It 1 should become subject to to workers' compensation provisions of Section 37(10 of Mme Labor Code. I shat
with those
Date APPkerd
WARN04G: FAIWiiE TO SECURETION COVERAGE IS UNLAWFUL, MID SWILL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CML FINES UP TO ONE .HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COWENSATION, DAMAGES AS PROVIDED FOR W
SECTION 3706 OF THE LABOR COOS. WERE*. AND ATTORNEYS FEES. .
I hereby affirm sande CONSTRUCTION LENDING AGENCY
DAY d perjuRy that Mhere k a construction laming agency for to pedon ance of the work for which Ars permit is Issued (Sec. 3097. Civ. C.).
Ledees Name
Lenders Address
IMPORTANT Application is hereby made b the Direcbr ofAPPLICANT ACKNOWLEDGEMENT
1. Each person upWon whose behalf thisthisBuildup and Safety for a Permit s 14W b the conditions and restrictions set forth on Cis application.
Issued es a o of Cris bon is made. each person at whose request and for whose benefit work k performed under or pursuant b any pem*
aWk&5M the owner. and tae applicant, each agrees b. and shall, defend. iaemmnity and hold harmless the CIyof Le Ouinta, its
agents and employees for any act «omission related b the work being performed under Or following Issuance of Cls pennll .
Any pe>ilt Issued as a FORM Of Cls application becomes null and void M work is not cortrrpmoed within 180 drlys from date of Issuance of such pemdL or
cessation of wok for 180 days wti subject permit b cancellation.
1 certify thconstruct .at 1 have road this application and state tat the above in1«mation 1. agree to comply with all til enol
and authorize reprntatives of this Y to Che above
-rhamtioned Y county ordinances and state laws relating b building
for inspection purposes.
�7Date Signature (Applicant or Agent):
OWNER/BUILDER 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 $200.00 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 including 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 not carry 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 Adminstration). For more specific information about your obligations under Stare
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) 777-70
` ,FAX: (760 -70
/ \ O ER' G RE / DATE
17 7 - 6 9 2 cq4c
PROPERTY ADDRESS
off- 0050
PERMIT NUMBER(s)