05-3632 (RER)P.O. BOX 1504
78-495 CALLE,TAMPICO
LA QUINTA; CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description
PropertyZ.,oninq:
Application valuation:
ADDlicant
CU�—;-_O'0'0'0.3-63-2
BUILDING & SAFETY DEPARTMENT.
BUILDING PERMIT
5.2201 AVEIRYD'A' VILLA r
773-233-024-9 -000000. g
REMODEL - RESIDENTIAL
COVE RESIDENTIAL I
300
I
Architect or Engineer: V
AUG 15 2005
CITY OF LA QUINTA
FINANCE DEPT.
Owner:
KARINA SOSA
52-201 AVE NIDA VILLA
LA QUINTA, CA 92253
(76,(1)399-94rn
Contractor:
Owner
VOICE (760) 777-7012 .
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5,/15/05
-------------------------------------------------------------------------------------------------
- LICENSED CONTRACTOR'S DECLARATION
- - WORKER'S COMPENSATION DECLARATION
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:
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
_ I have 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 haveandwill maintain workers'. compensation insurance, as required by Section 3700 of the Labor
.. -
Code, for the performance of the workfor which this permit is issued. My workerscompensation
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 2001 . -Policy Number . - - - - - - - -' - - - - - - '
following.. reason (Sec. 7031.5, Business and Professions Code:, Any city or, county that requires a permit to
�Q I certify that, in the performance. of the work for which this permit is issued; Ishall not employ any
-laws
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
/ person in any mannerso as tobecome subject to the workers' compensation 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 withSection7000) of Division 3 of the Business and Professions Code) or -
3700 of the Labor Code, I hall forthwith comply with thos r isions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of -Section 7031.5 by -
��,� �SS
an applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars 155001.: _
�DBte'11rApolicant:"
(X) 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
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE 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
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 she did not build or
..
` improve for the purpose of sale.).
APPLICANT ACKNOWLEDGEMENT
1—) 1, 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 _ ) I am exempt under Sec. , 6.&P.C. for this reason -
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 or following issuance of this permit. - '
*D�'a1ee�I.�
l S " wner: -
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
CONSTRUCTION LENDING AGENCY
permit to cancellation.,
. I hereby affirm underpenalty of perjury that there is a construction lending agency for the performance of. the
- I certify that 1 have read this application and state that the above information is correct. I agree to comply with all
work for which this permit is issued (Sec. 3097, Civ. C.). •
city and county ordinances and state laws relating to building gonstruction, and'hereby authorize representatives
_
of this county to enter upon the above-mentioned. property f
rRnspection purposes.
Lender's Name:
/�tt
)
Signa re 'Applicantror-AgeMl`
Lender's Address:
LQPERMIT
-Application Number' 05-00003632
t
Permit BUILDINGPERMIT
' Additional,desc
Permit Fee-, 15:00
Plan Check
Fee'.
9.75
Issue Date
Valuation
300
Expiration Date 2/11/06
..
Qty Unit'Charge Per
Extension
BASE FEE
15.00.
Special Notes and,Comments
---------------------------------
.ADD 4 PARAPET WALLS PER APPROVED PLAN
--------------------------------------------------------------
' Other Fees . .'. . . . . . . .ENERGY
REVIEW FEE
.98. .
Fee summary Charged Paid
'--------------------------------------
Credited
Due
Permit Fee Total 15.00
----------
.00
---_-
.00
----
15.00
Plan Check Total -- 9.75
.00
.00
9.75 '
Other Fee Total .98
.00
.00
.98
Grand Total 25.73
.00
.00
25.73
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OFT1 78-495 CALLE TAMPICO — LA QUINTA, CALIFORNIA 92253
TELEPHONE (760) 777-7012 FAX (760) 777-7011 ' ;
OWNER/BUILDER INFORMATION
Dear Property Owner:
An application for a -building permit has been submitted in your name listing yourself as the Euilder of the property
improvements specified. `
For your protection you should be. aware that as "OwnerBuilder" you.are the responsible pary 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 -ourself 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, s
If you plan to.do your owri'work, with the exception of various trades that you plan to subccntract,•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 oi,more•for the entire project, and such persons are not licensed as, contractors or,
sub contractors, then you may be an employer.
If you are an employer, you must register with the State and Federal Government as an employe; and you are subject
jto severalyobligations includeiSiate and Federal income tax withholding, federal social security taxes, worker's.
F' compensation insurance, disability insurance costs•and unemployment compensation contribunions. ,
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 perforning,•their own work-
personally
orkpersonally.
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 ti
FAX
' OWNER'S SIGNATURE/DATE
DZ(^,t
PROPERTY ADDRESS
PERMIT NUMBER(S)