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05-0790 (RR)r , 44P m BUILDING & SAFETY DEPARTMENT P.O. Box 1504 (760).777-7012 78-495 CALLS TAMPICO FAX (760) 777-7,011 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS .(760) 777-7153 BUILDING PERMIT Application Number. -0..0.0.07=9-0 Date 3/08/05 Property Address . . . . . 53580 AVENIDA VILLA APN: 774-134-004-21 000000 Application description RE -ROOF Property Zoning COVE RESIDENTIAL Application valuation . 2000 Owner Contract Dr HORENSTEIN DOUG OWNER 53580 AVENIDA VILLA LA QUINTA CA 92253 - (760) 564-0014 Permit. RE -ROOF Additional desc Permit'F;ee . . . 30.0.0 Plan Check Fee .00. Issue Date Valuat--on 0 Qty Unit Charge Per Extension BASE FEE 301:00 f, Special Notes and Comments REMOVE EXISTING ROCK ROOF/REROOF•WITH 3` TAB COMPOSITE SHINGLES. CLASS "A" `MATERIALS ONLY. Fee summary Charged Paid Credited Due ~ Permit -Fee Total 30.00 00 00_M .30.00. ,Plan Check Total 00 .... ..00 . 00"' .00. Grand Total 30.00 .00 .00- 30.00 P.O. BOX 1504 • 'GC��� VOICE (760) 777-7012 78-495 CALLS TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: 0,1-: Date: 8 as - Applicant: V Applicant's Mailing Address: CJ Architect or Engineer: Architect or Engineer's Address: Lic. No.. BUILDING PERMIT DECLARATIONS 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 rm under penalty of perjury that I am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any city or unty that requires a permit to construct, alter, improve, demolish,,or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed state ent that he or she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business an rofessions Code) or that he or she is exempt therefrom and the basis forPe alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects I p licant to a civil penalty of not more than five hundred dollars ($500).): s owner of the property, or my employees with wages as their sole co p nsation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The C n ractors' State License La do s not apply to an owner of property who builds or improves thereon, and who does the work himself or herself or through his or her o n employees, provided that he improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the er-builder will have the bu de of proving that he or she did not build or improve for the purpose of sale.). U I, as owner of the property, am exclusively o tracting with licensed con ractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an er 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 am exemp4'under Se� BA P. Ir this reason O ORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following decla ationE I hav and will maintain a certificate consent to se -insure for orkers' compensation, as provided for by Section 3700 of the Labor Code, for the performance the work for which this permit ' i sued. _ I ave and will maintain workers' c mp nsation i rance, as q 'red by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compen sat n i surance carrier and p lic number are: Carrier _ P licy Number e rtify that, in the performance of he ork for which t is pe it i iss I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, an agree that, if I hould be a sub'eci•to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith co a ply with those provi io s. �✓ ��� p WARNING: FAILURE TO SECURE WORKERS' COMPENS ION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLA ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name Lender's Address APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to conditions and restrictions set forth on this application. 1. Each person upon whose behalf this application is made, each person at whose request a d for whose benefit work is performed under or pursuant to any permit issued as a result of this application, the owner, and the app'cant, each agrees to, and s II, defend, indemnify and hold harmless the City of La Quinta, its officers, agents and employees for any act or omission relat to the work being perform d under or following issuance of this permit. 2. Any permit issued as a result of this application becomes nu nd void if work is not com enlced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancella ' _ I certify that I have read this application and state that the above 'nforinat o is correct. I agre to co ith all city and county ordinances and state laws relating to building construction, and hereby uthorize representatives of this county to enter on the above en'o r perty for inspection purposes. 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 FederalGovernment 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 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 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 'contracts 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 ETY 78 4 Calle Tampico La ntXnta, CA 92253 (760 77-7012 ti ` FAX: 0) 777-7A11 OWNER'S SIGNA URp/DATE PROPERTY ADDRESS PERMIT NUMBER(S)