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BSPN2015-0037VOICE (760) 777-7125 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 00 FAX (760) 777-7011 COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 8/13/2015 Application Number: BSPN2015-0037 Owner: Property Address: 52275 AVENIDA OBREGON DENISE PELLEGRINI APN: 773254014. 52275 AVENIDA OBREGON Application Description: PELLEGRINI DENISE SPECIAL INSPECTION LA QUINTA; CA 92253 Property Zoning: Application Valuation: 11 Applicant: U Contractor: DENISE PELLEGRINI 1 OWNER BUILDER 52275 AVENIDA OBREGON AUG 1 2015 LA QUINTA, CA 92253 cm OF IAWNTA �nTuf1 NT 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 (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 forthe permit to file a . signed statement that he or she is licensed pursuant to the provisions of the Llc. No.: 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. My workers' compensation insurance carrier and policy number are: Carrier: Policy 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 to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith cpmply with those provisions. Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division of the Business and Professions Code) or that he or she is exempt therefrom and the te: — 3 '�� Applicant:L11.]., basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for permit subjects the applicant to a civil penalty of not more than five hundred dollars WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, ($500).: AND SHALL SU BJ ECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO SSI, as owner of the property, or my employees_with wages.as their sole ONE HUNDRED THOUSAND DOLLARS ($100;000). IN ADDITION TO THE COST OF mmpensation, will do the work, and the structure is not intended or offered for sale. COMPENSATION, DAMAGES AS PROVIDED, FOR IN SECTION 3706 OF THE LABOR CODE, (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not INTEREST,_AND ATTORNEY'S FEES. apply to an owner of property who builds or improves thereon, and who does the work r 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:)., (� 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(sj licensed pursuant to the Contractors' State License Law.). (_) I am exempt under Sec. . B:&P.C. for this reason /IQ.te: i 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 Na Lender's 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 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 •(ApplicantorA J' .. '^Y::'!3=3Y. �i x I I /. 1- . "t':'.wffi`xT..F^`............. _ _ "¢LSJ.:.:...:...9."i� ...S,iw_'+^ k'v.' 2` G. `. Y ilJ 3Gc Description: PELLEGRINj DENISE SPECIAL INSPECTION ;vae. '• .a* ""..: "..... *:t"P �m '3 . ;t���.ggx .,. * .�+,q.1 Y' v > ., n ... 6 33� .....F ie .rp (?:,.� 'kvf N .� - @T Q' k¢f: .._ h....::.;: .F„ :Yx�""S�. .., HERMM �i..... .. .r: £^ }.. :Y'. 6�1... ie ..... .. .�,,�,>,":t ! - �.k�y.xtfS i Type: SPECIAL INSPECTION Subtype: Status: UNDER REVIEW Applied: 8%13/2015 PJU Approved: Parcel No: 7732S4014.. Site Address: 52275�AVENIDA QBREGON LA QUINTA,CA.92253 Subdivision: SANTA CARMELITA VALE LA QUINTA Block: 11 . Lot: 3 Issued: UNIT 1 Total Paid forCOMPLIANCE SURVEY/SPECIAL INSPECTION: $72.52 $0.00 Lot Sq Ft: 0 Building:Sq Ft: 0 Zoning: Finaled: Valuation: $0.00 Occupancy:Type: 'Construction Type: Expired: No. Buildings: 0, No. Stories: 0, No Unites:, EICALBREAKER APPROVED. PER AJ. Details SPECIAL INSPECTION FOR REPLACE -60F ELCTR APPLICANT DENISE PELLEGRINI 52275 AVENIDA LA QUINTA CA 92253' (760)56471952 OBREGON. CONTRACTOR `OWNER BUILDER . OWNER DENISE PELLEGRINI 52.275 AVENIDA LA QUINTA CA 92253 (760)5641952. OBREGON ;vae. '• .a* ""..: "..... *:t"P �m '3 . ;t���.ggx .,. * .�+,q.1 Y' v > ., n ... 6 33� .....F ie .rp (?:,.� 'kvf N .� - @T Q' k¢f: .._ h....::.;: .F„ :Yx�""S�. .., HERMM �i..... .. .r: £^ }.. :Y'. 6�1... ie ..... .. .�,,�,>,":t ! - �.k�y.xtfS i f. ,. „^. .;<.F. :. af:' :3 kis ::. , a,; RIPTI N h::� .. §�H, -DESC � -ION0.0-0 „,�!ACCOUNT , F QTY AMOUNT a� �: �.�,` i .:_,.,.,sM�•+�.,�h`�::.t....:a:�..El:_.tF;..�RS>,F>.�'�.�'._.__s�?��d�.:._._ss�re�-IT�S,� f&`��eP ..�,3Md�xn�,s.,...Ar»�� f>.�'.�._.._ a SPECIAL -INSPECTION APPLICANT DENISE PELLEGRINI 52275 AVENIDA LA QUINTA CA 92253' (760)56471952 OBREGON. CONTRACTOR `OWNER BUILDER . OWNER DENISE PELLEGRINI 52.275 AVENIDA LA QUINTA CA 92253 (760)5641952. OBREGON Printed: Thursday, August 13, 2015 10:07:59 AM 1 of 2 CRFW.IYSTCMS ;vae. '• .a* ""..: "..... *:t"P �m '3 . ;t���.ggx .,. * .�+,q.1 Y' v > ., n ... 6 33� .....F ie .rp (?:,.� 'kvf N .� - @T Q' k¢f: .._ h....::.;: .F„ :Yx�""S�. .., HERMM �i..... .. .r: £^ }.. :Y'. 6�1... ie ..... .. .�,,�,>,":t ! - �.k�y.xtfS SPENN=, . 3..S'..Y. "B & '. ... ..-. .. ...f.. ^:i?h�uve_W, .. .. ., f4i...§:. M.,..a. p; Tu .. rr �' fig. :. 17' f. ,. „^. .;<.F. :. af:' :3 kis ::. , a,; RIPTI N h::� .. §�H, -DESC � -ION0.0-0 „,�!ACCOUNT , F QTY AMOUNT a� �: �.�,` :..F >C :'.:: r -, r yy. PAID.. PAID DATES f RECEIPT #, +CHECK.#=METFIOD PAID BY -4,11, n .> r > y .SHF: •.> :..:iF —`�N` . .:_,.,.,sM�•+�.,�h`�::.t....:a:�..El:_.tF;..�RS>,F>.�'�.�'._.__s�?��d�.:._._ss�re�-IT�S,� f&`��eP ..�,3Md�xn�,s.,...Ar»�� f>.�'.�._.._ < s. ... exit .. e BY �.��.a:w.,ce. �:e`tah.....i.fa �1`�:X:•i... _r�.�`......Y"k�'Y.4 .���Su.}�a���'�i? L'�v 3<.r6. .,.'�`!n.�:�x. v�.��.'� n. SPECIAL -INSPECTION 101-0000-42404 1 $72.52 $0.00 Total Paid forCOMPLIANCE SURVEY/SPECIAL INSPECTION: $72.52 $0.00 Printed: Thursday, August 13, 2015 10:07:59 AM 1 of 2 CRFW.IYSTCMS INSPECTIONS SEQID � INSPECTION TYPE - = -INSPECTOR , ,. SCHEDULED COMPLETED . . DATE DATE , RESULT '' "-'AEMARKS , NOTES FINAL" BLD RETURNED STATUSREMARKS' REVIEW TYPE,REVIEWER SENT DATE: .DUE DATE, DATE NOTES . ATTACHMENTS Printed: Thursday, August 13, 2015 10:07:59 AM 2 of 2 R sysrenns Din # City of, La Quinta Building SL Safety. Division. Box .1504,'78-495 'Calle Tampico La Quinta, CA 92253.- (760) 777-70.12 Building Permit. Application: and Tracking Sheet Permit #P.O. Project Address: 2�- 7 S' Owner's Name: " 4 A. P. Number: Address: City, ST; Zip: 2Z Legal Description: Contractor: telephone: loo. Address: Project Description: City, ST, Zip: TeleP ho n • e. G State Lie. # : City. Lie. #.: Arch., Engr., Designer: Address: City., ST, Zip: Telephone: `-ConsaneY tructi°on Type: Occupancy: : ie. # S Lie. .ProJe:c' t hPe. (circle one • New Add'n Alter Repair Demo Name of Contact Person: Sq. Ft.: # Sfori # Units: Telephone # of Contact Person: Estimated Value of Project: Q APPLICANT: DO NOT WRITE BELOW THIS .LIN # Submittal Req'd Recd. TRACICINC. PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. ' Reviewed, ready for corrections Plan Check Deposit Truss Cales. Called Contact Person Plan Check Balance Title 24 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 ROUSE:- '"' 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 Fccs Total Permit Fees i P:O. BOX 1504' LA QUINTA, CALIFORNIA 92247;1504 78-495 CF\LLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT- (760)777-7012 EPARTMENT- 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 inour =ting yourself a e uilder of the property improvements specified at �ST-L17 S We are providing you with anOwner-Builder Ackn6Wledgment'aiid Information frcatron Form to make you aware of your responsibilities and possible risk you,may.incur by having this permit issued in your riame?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. Read and initial each statement below to sigiiify. you understand or verify. this information. Z-'1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder" building,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 field 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 illf illy acting as an Owner -Builder and am•aware'of the limits of my insurance coverage for injuries to workers on my pro I unders d building permits are not required to. be signed'by property owners unless they are responsible for the construction are not hiring a licensed Contractor to assume this responsibility. understand as an"Owner-Builder" I:am. the responsible,party,of record.on the.perrn t I understand that I may protect m self from potential financial risk by hiiirrg a licensed Contractor and having the permit filed in his or her name instead of my own I understand Contractors are required by law to be licensed and bonded in'California and to list their license numbers on Wpermitscontracts. erstand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value ruction is at least five hundred dollars ($500); including labor and materials, I may be .considered an "employer" under stale and federal law. g eeunderstand if I am considered an "employer" under state and federal law, I must register with the state and federal mmwithhold payroll taxes, provide workers' compensation disability insurance; and contribute to unemployment compensati n for each "employee." I also understand my failure to abide by these laws 'may subject. me to serious financial ris . 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. Xnderstand as an Owner -Builder if I sell the property for which this permit -is .issued, I may be held liable for any r personal injuries sustained by any subsequent•owner(s) that result. from any latent construction defects in the hip or materials. I understand I may obtain more 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 maycontact the California Contractors' State License Board (CSLB) at 1- CSLB (2752) or www.cslb.ca.gov for more information about.licensed contractors: TT/O, . I 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: A A I agree that, as the party legally and financially responsible for this proposed: construction activity, I will abide by all .e laws -and requirements that gover'Owner-Builders as.well as employers. 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 anr 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 own dr's-driver's: license, form notarization, or other verification acceptable to the agency is required to be presen"ted when the permit is'issued to verify the property owner's signature. Signature of property owner Date: 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. Excluding the Notice to Property Owner,, the execution of which I•understarid•is my personal responsibility, Ihereby 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: �2_7_21- A A—s- � r, _d` C mfr 44 ZZS- 3 v_ Name of Authorized Agent: Tel No. % (o p v Address of Authorized Agent:L2. Cl Z 2f 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: A copy of the. owner's driver's license, form no or other verification acceptable to the agency is required to be presented when the permit is issued to, verify the property owners signature. Property Owner's Signature: Date: ���/�