08-1863 (RR)T4 hfP.O. BOX 1504 ^' VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011.
LA QUINTA,:CALIFORNIA 92253 BUILDING &.SAFETY DEPARTMENT ;y INSPECTIONS (760) 777-7153'
BUILDING PERMIT
_ ' Date-, 11/14/08
Application Number: 08-00001863 J Owner:
Property Address: 51950 AVENIDA VILLA 4 OROZCO ELADIO
~ , APN: 773-183-009-15 000000-. '- --- 51950 AVENIDA VILLA } l
Application description: RE-ROOF LA QUINTA, CA 92253
Property Zoning: COVE RESIDENTIAL (760) 564-0528
Application valuation: 900
Contractor: / D
Applicant: Architect or Engineer: Owner r
1
-------.-_----------------- =---------------------- - - - - -- -- - - ---------- -'- - ------- - - -- --
- LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DE 6A RATION _
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations: a
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. _)�-1'fiave 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
_ issued.
Date: Contractor: _ 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
OWNER-BUILDER DECLARATION insurance carrier and policy number are: _
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier - - - - - - - - - - - - - - - - - - - - - - - Policy Number - -
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to I certify that, in the performance of the work for which this permit is issued, I shall not employ any '
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any manner so as to become subject to the workers' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if I should become subject to the workers' compensation provisions of Section -
License Law (Chapter 9 (commencing with Section 70001 of Division 3 of the Business and Professions Code) or _ 3700 of the Labor Cod aiFfe ith comply with ose provisions. _ _
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by �•{' _ ,
at4y applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500).: - Date: ; :` Applicant: _
( V-T 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERYE'
IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND i
and who does the work himself or herself through his or her own 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-builder will have the burden of proving that he 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 .
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of conditions and restrictions set forth 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 permit issued as a result of this application,
( _) 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 r
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. I
Date: l `l
—owner: 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 wilysubject,
CONSTRUCTION LENDING AGE 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 co ply with all -
work for which this permit is issued (Sec. 3097, Civ. C.). J city and county ordinances and state laws relating to b ' uction, and hereby thorize representatives
• , - - _ of this county to enter upon the above-mentioned prop y for inspecon purpos _
Lender's Name: - _
Date: ,A `!-=Signature (Applicantor Agent):
Lender's Address:
LQPERMIT
Application Number . . . 08-00001863
A .
Permit .. . `. . . . RE -ROOF
Additional desc .
Permit Fee. 30.00 ':
Plan Check
Fee..
.00
Issue Date
Valuation'
0
Expiration Date 5/13/09.,,,
Qty Unit Charge Per
Extension
BASE FEE
30.00
----------------------------------------------------------------------------
Cpeeinh Nvleb and CuunueuLs
RE -ROOF SHINGLES CLASS "'A"'MATERIALS
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
.00
.00
30.00
LQPERMIT
CIAL SERVICES CUSTOMER INVOICE
Notice of Cancellation (see Exhibit A) may be sent to this address:
HOME DEPOT U.S.A., INC. Phone: (760 ) 347-8722
Store 6630 LA QUINTA Salesperson: SES711
79900 HIGHWAY 111Reviewer:
LA QUINTA, CA 92253
This is only atQUOTE for the merchandise and services printed below. This becomes an Agreement upon payment
and an endorsement by a Home Depot register validation.
I
Page 1 of 10 No. 6630-241350
VALIDATION.AREA
6630 C0010, 40370 05/06/0
::ALE 31 NAL01 05a13P PM
CUSTOMER AGREEMENT g 2413501
RECALL AMOUINT 684.5'0
SALES TAY 4`;e:_l1
TOTAL $732:51
:.XXX:::�:YX:YXXX9169 DEBIT 732. `1
RUTH CODE 66'332
tQUOTE is valid for this date: 0510612008
MERCHANDISE AND SERVICE SUMMARY of merchandise right to
limit the quantities
HOME DEPOT DELIVERY. #.`1:
REF #V02
STOCK MERCHANDISE TO BE DELIVERED: �5(
R01
Name Home Phone
1 42.00
OROZCO OMAR (760) 219.0032
TIMBERLINE SELECT 40 BIRCHWOOD
Address 51950 AVANITA VIA Work Phone
$619.50
Company Name
City
LA QUINTA Job Description SHINGLES
$619.50
State CA Zip 92253 County RIVERSIDE .
I
Page 1 of 10 No. 6630-241350
VALIDATION.AREA
6630 C0010, 40370 05/06/0
::ALE 31 NAL01 05a13P PM
CUSTOMER AGREEMENT g 2413501
RECALL AMOUINT 684.5'0
SALES TAY 4`;e:_l1
TOTAL $732:51
:.XXX:::�:YX:YXXX9169 DEBIT 732. `1
RUTH CODE 66'332
tQUOTE is valid for this date: 0510612008
MERCHANDISE AND SERVICE SUMMARY of merchandise right to
limit the quantities
HOME DEPOT DELIVERY. #.`1:
REF #V02
STOCK MERCHANDISE TO BE DELIVERED: �5(
R01
1 841-361
1 42.00
1 BDI
TIMBERLINE SELECT 40 BIRCHWOOD
Y 1 $14.75 1
$619.50
MERCHANDISE TOTAL:j
$619.50
......
..........................................................................................
< < > >
SCHEDULED DELIVERY DATE: 05/10/2008
V02
1 515-663 1 1.00
1 EA
CURBSIDE DELIVERY SERVICE
N565.00
$65.00
DELIVERY SERVICE SUBTOTAL:
$65.00
Hl illi Rl #' t1U1[l .........OU -4 F I IU pSI Q
..................:....:...------.:..........:...........::...:...............
OROZCO, OMAR
-
ADDRESS: 51950 AVANITA VIA
1 : LA QUINTA
STATE: CA ZIP: 92253
COUNTY: RIVERSIDE
\ SALES TAX RATE: 7.750
PHONE: (760) 219-0032
\ V
$684.50
Check your current order status online at
www.homedeoot.com/orderstatus
Page 1 of 10 r No. 6630-241350 Customer Copy
11 1111
(9801) 0100274649
TELEPHONE (760) 777-7012 FAX (760) 777-701.1
OWNERBUILDER 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 protec,_ 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 abusiness 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 include State and Federal income tax withholding, federal social s?curity 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 arc 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
yoti 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 alowed'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 a_ -id material personally.
Building permits are not required to be signed by property owners unless they are perfca•ming 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 confirr 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) 777-7011
OWNER'S SIGNATURE/DA
PROPERTY ADDRESS
PERMIT NUMBER(S)
Bin #
City of La Quinta
Building U Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet -
Permit #,q�j
f
Project Address: �,Il I 1 Iq
Owner's Name: Ze��
A. P. Number:
Address: �' `N r. _ � f l l `A -
I v&A
Legal Description:
Contractor: (Dw }N
City, ST, Zip: .0��,,T� , q -2,7Z-_7
R
Telephon • —) n 1 -eSS 7.1-91-0-191-ml-
Address:
Address:
Project Description: k
City, ST, Zip:
Telephone:NINO
C
State Lic. # :
City Lic. #:
Arch., Engr., Designer:
Address: �.
City, ST, Zip:
Telephone:{
x
Construction Type: Occupancy:
State Lic. #:
Project type (circle one): New Adc'n Alter epair emo
Name of Contact Person:
Sq. Ft.:
#Stories:
#Units:
Telephone # of Contact Person:
Estimated Value of Project: g p O .. 6, d
APPLICANT: DO NOT WRITE BELOW THIS LINE
N
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Chest Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy 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 picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'"' Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees