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BRER2017-0097s 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Permit Type/Subtype: Application Number: Property Address: APN: Application Description: Property Zoning: Application Valuation: . &tit 4 a'� VOICE (760) 777-7125 FAX (760) 777-7011 DESIGN & DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 10/5/2017 RE -ROOF/ Owner: BRER2017-0097 LORENZO GARCIA / FRANCES GARCIA 53855 AVENIDA DIAZ PO BOX 6011 774151018 LA QUINTA, CA 92253 GARCIA / REROOF ENTIRE DWELLING WITH BUILTUP WITH COATING $3,100.00 Applicant: LORENZO GARCIA / FRANCES GARCIA PO BOX 6011 LA QUINTA, CA 92253 QLJ Contractor: OWNER/BUILDER OCT"05 2017 CITY OF LA OUINTA OOMMUNfiYDEVELOPMEMDEPARTMENT Llc. No.: 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.: 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 jSec. 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 b' cts 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 co pensation, 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 he did not build or improve for the purpose of sale.). I, as owner of the property, am exclusively contracting with licensed contractors to con ruct 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 tractors' State License Law.). am exempt under Sec. . B.&P.C. for this reason Date: 10'to 41 owner: l A'b�Gld�— 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 Name: Lender's Address: WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one :)f the following declarations: I have and will maintain a certifirte of consent to self -insure for workers' compensation, as provided for by Section 37)0 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 perfc rmance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Car ri r• Policy Number: _ I certify that in the performance o= the work for which this permit is issued, I shall not mploy any person in any manner s:) 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: 1 �' V t .l Applicant:= WARNING: FAILURE TO SECURE WORKERS' C DMPENSATION 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 the 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, anc the applicant, each agrees to, and shall defend, indemnify and hold harmless the Cityof La Quinta, its officer's, agents, and employees for any act or omission related to :he work being performed under or following issuance of this permit. 2. Any permit issued as a result of this appitation becomes null and void if work is not commenced within 180 days from date of issmance of such permit, or cessation of work for 180 days will subject permit to cancellaticn. I certify that I have read this application and slate that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above- mentioned property for inspection purposes. Date:,�� Signature (Applicant or Agent): r Application Number: BRER2017-0097 Property Address: 53855 AVENIDA DIAZ APN: 774151018 Application Description: GARCIA / REROOF ENTIRE DWELLING WITH BUILTUP WITH COATING Property Zoning: Application Valuation: $3,100.00 Applicant: LORENZO GARCIA / FRANCES GARCIA PO BOX 6011 LA QUINTA, CA 92253 Date: 10/5/2017 Owner: LORENZO GARCIA / FRANCES GARCIA PO BOX 6011 LA QUINTA, CA 92253 Contractor: OWNER/BUILDER t Llc. No.: ----------------- -------------------------------------------------------------------------- Detail: REROOF WITH BUILTUP ROOFING AND COOL ROOF FIELD APPLIED COATING [CRRC: 0770-0001] 2016 CALIFORNIA ENERGY CODE. FINANCIAL INFORMATION DESCRIPTION ACCOUNT QTY AMOUNT BSAS SB1473 FEE 101-0000-20306 0 $1.00 Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 DESCRIPTION ACCOUNT QTY AMOUNT RE -ROOF - FIRST 2,000 SF 101-0000-42404 0 $53.05 DESCRIPTION ACCOUNT QTY AMOUNT RE -ROOF.- FIRST 2,000 SF PC 101-0000-42600 0 $106.11 Total Paid for FE -ROOF: $159.16 DESCRIPTION ACCOUNT QTY AMOUNT TECHNOLOGY ENHANCEMENT FEE 502-0000-43611 0 $5.00 Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00 Biu# City of La Quinta Building & Safety Division 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit# Addres:— r Project s - Address*:753 �6av'tI� oP-2 I � Owner'.sName:_J A.P. Number Address: 5 5 1 1 A f �Z Legal Description: City, ST, Zip: I VITA _C44a� 3 Contractor:. Telephone: , �) Address: Project Descripfion: ,�r _���SI ��(1 City, ST, Zip: Telephone: State'Lic. #: City Lic #: Arch, Engr., Designer: Address: City, ST, Zip: Telephone: Construction Type: Occupancy: State Lic. #: Proj. Type New Add'n Alter Rep;7 Demo Name of Contact: -r ^�� ^ + SgFt: a n p #Stories # Units: Telephone of Contact:-.i 5 7� I g `f 6 Estimated Value of Project: . -S1 D b 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: Title 24-Calcs Plans Picked Up Construction: Flood Plain Plan . Plans Resubmitted Mechanical: ' Grading Plan 2nd Rev, Ready for corrections / Electrical: Subcontractor List Called Contact Person Plumbing: Grant Deed Plans Picked Up S.M.I. HOA Approval Plans Resubmitted Grading IN-HOUSE 3rd Rev, Ready for corrections / Developer Impact Fee Planning Approval Called Contact•Person' A.I•.P.P. .Pub. Wks. Apps Date of permit issue School Fees Total Permi6;Eees::...- .. 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)777-7012FAX (760) 777-7011 Disclosures & Forms for Owner -Builders -A plying for Construction Permits IMPORTANT! NOTICE TO PROPERTY OWNER Dear Property Owner: An application for a building permit, haseensubmitted in your name listing yourself as the guilder of the property improvements specified at.X/� VAI A_ We are providing you with anOwner-Builder Acknowledgment and Inforrhation 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 carrot' 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 verify this informatio . b6l. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder" ur ding 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 permits are .not required to be signed by property owners unless they a -=e responsible for the co truction and are not hiring a licensed Contractor to assume this responsibility. 3. I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect my elf from potential financial risk by hiring a licensed Contractor and having the permit filed in his or h.�r name instead of my own. k4. I understand Contractors are'required by law to be licensed and bonded in California and to list their license numbers on pe 'ts and contracts. . 5. I understand if I employ or otherwise engage any persons, other than California licensed Contractcrs, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under 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 go rnment, 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 ms� to serious financial risk. V4-7. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential structures 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. 1)!q8. I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries. sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. _ I understand I may obtain mote information regarding my obligations as an "employer" from the Internal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1- 80 -321-CSLB (2752) or www.cs1b..ca.gov for more information about licensed contractors. 10. 1 am aware of and consent to an Owner -Builder building permit applied for in my name' and understand that I am the ' party legally, and financially responsible for proposed construction activity at the following address: 11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner -Builders as.well as employers. V 1 12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have provided on this form Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held.liable for damages. If you obtain 'a permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the. permit. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptabto the agency is required to be presented. when the permit is issued to verify the property owner's signature. , Signature of property owner Date: 1 7 Note: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner -Builder.. ' AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF*. Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner -Builder Permit for my project. Scope of Construction Project (or Description of Work): Project Location or Address: Name of Authorized Agent: , Address of Authorized Agent: Tel No I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note:,4 copy of the owner's driver's license, form notarization, or other verification acceptable to .the agency is required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: