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06-3017 (RR)1 TA P.O. BOX 1504 _ 78-495 CALLE TAMPICO LA QUINTA,' CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT" ti BUILDING PERMIT Application Number: c06-00003017 Property Address: 80060 VISTA GRANDE APN: 649-141-003-3 -3505 - Application description: RE -ROOF Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 7000 Owner: KOHFELD JEFFREY DEAN 80060 VISTA GRANDE,. LA QUINTA,'CA 92253 ------------------------ Contractor: Applicant: Architect or Engineer: Owner VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 8/17/06 , AUG -1 7 2006 ----------------------- ----- �ITY O�LA NTAAPT. ' LICENSED CONTRACTOR'S DECLARATION - WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that.l am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations: - c Section 7000) of Division 3 of the Business and Professionals Code, and my License is infullforce and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided ti 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 penaltyof perjury that.l am exempt from the Contractor's State License Law for the - Carrier Policy Number '�. following reason (Sec. 7039.5, Business and Professions Code: Any city or county that requires a permit to /1R 1 certify that, in the performance of the w k 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 beco e s le t 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 1 should b o bje the workers' compensation provisions of Section •. License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or - .3700 of the Labor Cod s fo h omply with those provisions. ,I • .. 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).: - �� " t7 Q6 Date: applicant: , ,1 g1 ; as owner of the property, or my employees with wages as their sole compensation, will do the work, and i..t the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The WARNING: FAILURE TO SECURE WORKE(S' C ENSATION COVERAGE IS UNLAWFUL, AND SHALL - Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYERTO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUN DRED: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 or she did not build or improve for the purpose of sale.). - -APPLICANT ACKNOWLEDGEMENT .. (_ ), 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 workis performed under or pursuant to any permit issued as a result ofthis application, 1 I am exempt under Sec. , B.&P.C. for thi ea - the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City 1 of La Quinta, its officers, agents and employees for any act or omission related.to the work being - !''� _ • •7 �� r,_ - performed under or following issuance of this permit. r Date: C 0wrier: _ 2. Any permit issued as a result of this application becomes null and void if work isnot commenced C within 180 days from date of .issuance of such permit, or cessation of work for 180 days will subject CON RU LENDING f1GENCY-• permit to cancellation. - I hereby affirm under penalty of perjury that there is construction lending agency for the performance of the I certify that I have read this application and state that s rrect. I agree to comply with -all work for which this permit is issuedISec. 3097, Civ. C.1. - - - city and county ordinances and state laws relating to bhereby authorize representativesof dove,ofatio this county to enter upon the above-mentioned propeoses. - ' Lender's Name:_ 1 � CC-= • Date: - Signature. (Applicant or Agent): . . Lender's Address: - i LQPERMIT Application .Number . . 06-00003017. Permit . . . RE -ROOF Additional desc . Permit Fee..,. 30.00 Plan Check Fee .00 Issue".Date Valuation 0 Expiration Date 2/13/07 Qty. Unit Charge Per Extension BASE ,FEE 30.00 Special Notes and Comments ------------------------- - REMOVE EXISTING ROCK ROOF/REPLACE WITH LIGHTWEIGHT TILE. ; Fee summaryCharged__ ----- �• -__Paid-_- Permit Fee Total •30.00 -Credited ----Due :00 .00" --- 30.00 ' Plan Check Total .00 .00 .00 00 " Grand Total" 30.00 .00 .00 30.00 i LQPERMIT ' - Bin.# City of La QUinta . Building a 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 • . O Project Address: bO��� 1 l -r, A. P. Number: Owner's Name: k I Lv7@C Address: 00060 fz,-kG, r..Q vi. '� Legal Description: City, ST,.Zip: V t A-zti 77 Z5 Contractor: Telephone: '"760 8 j 2 - `(6 Project Description: etvd&of Address: City, ST, Zip: � k Ojet' ,i , Telephone: State Lic. # : City Lic. #: Arch., Engr., Designer: Address: City, ST, Zip: Telephone: State Lic. #: r Name of Contact Person: Construction Type: Occupancy: Project type (circle one): New Add'n Alter Repair Demo Sq. Ft.: # Stori s: # Units: Telephone # of Contact Person: Estimated Value of Projec J V APPLICANT: DO NOT'WRITE.BELOW THIS LINE # Submittal Req'd Reed 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"d Review, ready for correctionsfissue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up II.O.A. Approval Plans resubmitted Grading IN HOUSE:- 7rd Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P.. Pub. �Yks. Appr Date of permit issue School Fees Total Permit. Fees TELEPHONE. (760) 777-7012• FAX (760) 777-7611 OWNERJBUILDER 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 Federal Government 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 structures 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 SAFETY, 78-495 Calle Tampico La Quinta, CA 9225 (760) 777-7012 FAX: (760) 7 7 1 OWNER'S G ATURE ATE foo 16 o PROPERTY ADDRESS PERMIT NUMBER(S)