05-5196 (RR)OWNERIBUILDER 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<1
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 anemplo?er 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.
Formore specific information about your obligations under Federal Law, contact the Internal-Eevenue Service (and;"if
you wish, the US. Small Business Administration). For more specific information about your Dbligations under State
Law, contact the Department of Benefit Payments and the Division of Industrial • Accidents.
If the structure is in for sale, property owners who are not licensed contracts are aliowed'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 "Ovner/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 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: 77-7011
12
OWNER'S SI NATURE/DATE
2) 17' _ , PtUtfv 1 t, -2A Vi(
PROPERTY
1lPROPERTY ADDRESS
PERMIT NUMBER(S)
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
�. `f
Cc . ,Applicant:
05---00005196
52-09'5—AVENIDA VILLA
773-233-026-5 -000000-
RE-ROOF
COVE RESIDENTIAL
2100
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT,
BUILDING PERMIT
--------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 70001 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, alter, improve, demolish, or repair any structure, prior to its issuance, also requiies 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 he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
(�) I, 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
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.).
1 _ 1 I, as owner 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—) I am exempt under Sec. B.&P.C. for this reason
Date -J f AZA &5_ _` Owner_
CONSTRU JION LENDING AG CY -
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:
LQPERMIT
Owner:
FREGOSO FELIPE
52095 AVENIDA VILLA
LA QUINTA, CA 92253
(760)275-4139
Z.
Contractor:
Owner
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
qNC �F�arq
Date: 11/28/05
------------------------------------------------
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
_ I 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. '
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
_Igo� 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 the workers' compensation laws of California,
and agree that, if I should become subject to the workers' compensation provisions of Section
3700 of the Labor Code, I shall forthwith comply with those provisions.
Date: Applicant? `a�jCi(9L�a
WARN( G: FAILURE TO SECURE WORKERS' COMPENSATION RAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($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.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
conditions andrestrictions 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 La Quinta, its officers, agents and employees for any act or omission related to the work being
performed under br following issuance of this permit.
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 will subject
permit to cancellation. .
I certify that I have read this application and state that the above information is correct. I agree to comply with all
city and county ordinances and state laws relating to buildin construction; a ereby authorize representatives
of this county to enter upon the above-mentioned. propeforinspection p poses.
Application Number . . . . . 05-00005196
Permit RE -ROOF
Additional desc .
- Permit. Fee 30.00
Plan Check
Fee
.00
Issue Date
Valuation
. : .
0
Expiration Date 5/27/06
. Qty Unit Charge Per
Extension
BASE
FEE
30.00
----------------.---------------------------------------------
Speclai Nu Les aiul.cumuteilts
REROOF/HOT MOP/CLASS "A" MATERIALS
ONLY
Fee summary Charged
Paid Credited
Due
G
•'
Permit Fee Total 30.00
.00
.00
30.00
Plan Check Total :00
.00 -
.00
Grand Total 30.00'
..00
.•00
.00
30.00
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 Tracki Q Sheet
Perm #
Project Address:
Owner's Name:
A. P. Number:
Address: 5z-,0 5^
Legal Description:
Contractor:
City, ST, Zip: L/�,
Telephone: Z 7,3 41 3 JI -
3c
Address:
Project Description: of — — A f 12 -
City, ST, Zip:
City,
O D(_D LE P)LA6
Telephone:
State Lic. # :
City Lic. #:
Lt
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone: P
Construction Type: I � LA , Occupancy:
State Lic. #:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.: W
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project: -?-O 00
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING .
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check 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