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BRER2015-011078-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 c&t,, 4 4aw. COMMUNITY DEVELOPMENT DEPARTMENT BUILDING PERMIT 25 VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 11/6/2015 Application Number: BRER2015-0110 Owner: Property Address: 54075 AVENIDA ALVARADO EUREKA KART ESPANOL APN: 774202014 32431 SEVEN SEAS DR Application Description: ESPANOL / REROOF W/ SHASTA WHITE SHINGLE [CRRC: 0890-0002] DANA POINT, CA 92253 Property Zoning: Application Valuation: $7,000.00 Applicant: Contractor: EUREKA KA I ESPANOL ��-- -_ -� KA KARI ESPANOL 32431 SEVEN SEAS DR DANA POINT, CA 92253 `� i __ �� �� I 32431 SEVEN SEAS DR DANA POINT, CA 92253 �J LIC. No.::CONV:140528101254133101 rr`r__4_N`it��e.nR•"i---- __________________________ ______ - c= – --------------------------------------------- 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 Professions Code, and my License is in full force and effect. License Class: _ License No.::CONV:140528101254133101 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 requires 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 jects the applicant to a civil penalty of not more than five hundred dollars ($50 .: (V) 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.). (__j 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 am exempt under Sec. B.&P.Clkd �Ithis reason 4711 Date: Owner: 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 Lender's Address: 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. 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. M workers' compensation insurance carrier and policy number are: Carrier: Polity Number: 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 t workers' compensation provisions of Section 370 of the Labor Code, I sha fort ith comply with those provisions. 'Zlate: S Applicant: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE 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 Building Official for a permit subject to the conditions and restrictions 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 or 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 informat' n i correct. I agree to comply with all city and coup (ordinances and state laws rela n o building construction, and hereby authorize re esentativ of this city to enter on the above-mentioned property for inspe ion pur ses. Date: Signature (Applicant or Agent): FINANCIAL INFORMATION DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE BSAS SB1473 FEE 101-0000-20306 0 $1.00 $1.00 11/6/15 PAID BY METHOD RECEIPT # CHECK # CLTD BY EUREKA KARI ESPANOL DEBIT R10668 AOR Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 $1.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RE -ROOF - FIRST 2,000 SF 101-0000-42404 0 $49.31 $49.31 11/6/15 PAID BY METHOD RECEIPT # CHECK # CLTD BY EUREKA KARI ESPANOL DEBIT R10668 AOR DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RE -ROOF - FIRST 2,000 SF PC 101-0000-42600 0 $98.62 $98.62 11/6/15 PAID BY METHOD RECEIPT # CHECK # CLTD BY EUREKA KARI ESPANOL DEBIT R10668 AOR Total Paid for RE -ROOF: TOTALS: $147.93 $148.93 $147.93 $148.93 Description: ESPANOL / REROOF W/ SHASTA WHITE SHINGLE [CRRC: 0890-0002] Type: RE -ROOF Subtype: Status: ISSUED Applied: 11/6/2015 AOR Approved: 11/6/2015 AOR Parcel No: 774202014 Site Address: 54075 AVENIDA ALVARADO LA QUINTA,CA 92253 Subdivision: SANTA CARMELITA VALE LA QUINTA Block: 254 Lot: 4 Issued: 11/6/2015 AOR UNIT 24 CHRONOLOGY Lot Sq Ft:.O Building Sq Ft: 0 Zoning: Finaled: Valuation: $7,000.00 Occupancy Type: Construction Type: Expired: 5/4/2016 AOR No. Buildings: 0 No. Stories: 0 No. Unites: 0 $1.00 Details: REROOF WITH OWENS CORNING SHASTA WHITE SHINGLE [CRRC: 0890-0002] 2013 CALIFORNIA BUILDING CODES Printed: Friday, November 06, 2015 1:15:02 PM 1 of 2 CRW sysrrnns FINANCIAL ADDITIONAL DESCRIPTION ACCOUNT QTY AMOUNT PAID CHRONOLOGY - BY.. CONDITIONS $1.00 $1.00 11/6/15 R10668 DEBIT EUREKA KARI AOR CONTACTS ESPANOL NAME TYPE NAME ADDRESSI CITY STATE ZIP PHONE FAX EMAIL APPLICANT EUREKA KARI ESPANOL 32431 SEVEN SEAS DR DANA POINT CA 92253 CONTRACTOR EUREKA KARI ESPANOL 32431 SEVEN SEAS DR DANA POINT CA '92253 OWNER EUREKA KART ESPANOL 32431 SEVEN SEAS DR DANA POINT CA 92253 Printed: Friday, November 06, 2015 1:15:02 PM 1 of 2 CRW sysrrnns FINANCIAL INFORMATION DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE. RECEIPT # CHECK #. METHOD PAID BY CLTD - BY.. BSAS SB1473 FEE 101-0000-20306 0 $1.00 $1.00 11/6/15 R10668 DEBIT EUREKA KARI AOR ESPANOL Total Paid for BUILDING STANDARDS ADMINISTRATION $1.00 $1.00 BSA: Printed: Friday, November 06, 2015 1:15:02 PM 1 of 2 CRW sysrrnns INSPECTIONS PROJECTSPARENT REVIEWS REVIEW TYPE REVIEWER SENT DATE DUE DATE RETURNED STATUS REMARKS NOTES DATE ' 1ST BLDG NS (1 AJ ORTEGA 11/6/2015 11/6/2015 11/6/2015 APPROVED DAY) Printed: Friday, November 06, 2015 1:15:02 PM ATTACHMENTS 2of2 SYSTEMS CLTD DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY . BY RE -ROOF - FIRST 2,000 101-0000-42404 0 $49.31 $49.31 11/6/15 R10668 DEBIT EUREKA KARI AOR SF ESPANOL RE -ROOF - FIRST 2,000 101-0000-42600 0 $98.62 $98.62 11/6/15 R10668 DEBIT EUREKA KARI AOR SF PC ESPANOL Total Paid for RE -ROOF: $147.93 $147.93 INSPECTIONS PROJECTSPARENT REVIEWS REVIEW TYPE REVIEWER SENT DATE DUE DATE RETURNED STATUS REMARKS NOTES DATE ' 1ST BLDG NS (1 AJ ORTEGA 11/6/2015 11/6/2015 11/6/2015 APPROVED DAY) Printed: Friday, November 06, 2015 1:15:02 PM ATTACHMENTS 2of2 SYSTEMS 1ov- Qin # city of La Quinta Building 8T Safety Division 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # Project Address: (� Gj . ��. L l_U wner's Name: Eog A. P. Number: Address: C63 S-1 A Legal Description: S F P, City, ST, Zip: t .4 NA rP I Contractor: Telephone: Q -1 'Address: Project Description: City, ST, Zip: N I G-1 l--- Tel h n e o e: P State Lic. # : City Lie. 4.- ;Arch., Arch.,Engr., Designer: Address: City, ST, Zip: TelePh one: MENEM Construction TYe• Occupancy: P cY State Lic. #: Project �P (circle one): New Add'n Alter Repair r Dem o Name of Contact Person: PAUL CQLJ) E'2-01-4 D R I� Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: Ct LH 6.33 t% io stimated Value of Project: b EUS APPLICANT: DO NOT WRITE BELOW THIS LINE H Submittal Req'd Rcc'd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Cates. Called Contact Person Plan Check Balance Title 24 Cates. Plans picked up Construction ' Flood plain plan Plans resubmitted Mechanical Grading plan 2"" Review, ready for corrcctionsrssue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. II.O.A. Approval Plans resubmitted Grading IN I10USE:- Review, ready for corrcctionsrssue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. NVks. Appr Date of permit issue School Fees, Total Permit Fees J OL. 1fdf 4 4 Q" P.O. BOX 1504 LA' QUINTA, CALIFORNIA 92247-1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT PROPERTY OWNER'S PACKAGE (760)777-7012 FAX (760) 777-7011 Disclosures & Forms for Owner -Builders Applying for Construction Permits IMPORTANT! NOTICE TO PROPERTY OWNER 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 at U—l� lS+� til (F>1\46- VAQ�Z� . 1 A U ()'_�A 9 ZZS3 We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION DIRECTIONS: Read and initial each statement below to signify you understand or verb this information. '%�-(/1. I understand a frequent practice of unlicensed persons is .to have the property owner obtain an "Owner -Builder" `� _u_ilding permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. �2.' I understand building pernuts are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. 11 i3. I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect yself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. 4. I understand Contractors are required by law to be licensed and bonded in California and to list their license. numbers on -perrmts and contracts. �Ofmy . I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value construction is at least five hundred dollars ($500), including labor and materials, I may be. considered an "employer" undde�err� state and federal law. "6. I understand if I am considered an "employer" under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject'me to serious financial risk. I understand under California Contractors' State License.Law, an Owner -Builder who builds single-family residential 's ctures cannot legally build them with the .intent to offer them for sale, unless ' all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor.