12-0338 (PLBG)s ' •
P.O. BOX 1504-4^ VOICE 760 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
�;�=- Date: 3/30/12
Application Number: 12]:!
2 00000:338 Owner:
Property Address: 53,12-1 AVENIDA OBREGON CORY HEMMERLING
APN: 774-'044-018-6 . -000000- 53121 AVENIDA OBREGON
Application description: PLUMBING LA QUINTA, CA 92253
Property Zoning: COVE .:RESIDENTIAL
-----------=--------------------=
Application valuation: 200
Contractor: 4
Applicant: Architect d-r Engineer:. Owner
: MAR• 30 2 12
---------------- - - - - --
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CITV OF !.A CAUIMA :
FIItA) JX
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LICENSED CONTRACTOR'S DECLARATION ' WORKER'S COMPENSATION DECLARATION - -
'1 hereby'affirm under penalty ofperjury that I am licensed under provisions of Chapter 9 (commencing with - I hereby, affirm under penalty of perjury one of the following declarations: .
Section7000) of"Drvision3 of the Business�arid Professionals�Codeland my License is in full forcejand'effect. _1 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, the performance of the workfor which`this permit is
issued.
Date Contractor. _ I. have "and will maintain-workers"compensation insurance, as required by Section 3700 ofithe Labor -
Code; for the performance of. the work,forwhich this permit is issued. My workers' compensation °
OWNER-BUILDER DECLARATION "•insurance carrier and policy number are: -"
hereby, affirm under penalty of perjury that I am exempt from:the. Contractor's State License Law for'the - Carrier - Policy Number
following ieason,ISec. 7031.5, Business and Professioris Code: Any city or.county that requires a permitto I certify that, in t_heyperforrtmance of the work for which this permit is issued, Itshall not, employ any
construct, alter: improvef demolish; or repair any structure, prior to its issuance, also requiresthe'applicant for the person in any manner so as to become subject to the workers''compensation laws of California,
permit to file a signed statement that he or she is. licensed pursuant to the provisions 'f the Contractor's State and agree that, if I should become subject to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing:with Section 7000) of Division 3 of the Business land Professions Codel or 3700 of the Labor Code a11`.forthwith compl• wi - those r ' ' ns:,
tNat'he or she is exempt therefrom and the basis for ttie alleged exemption. Any. violation of Section 7031.5 by-
pplicant for a-permit subjects the applicant to a civil penalty of not more than five hundred dollars IS5001.: ate:
1. I; as owner of the property,, or.my employees with wages as"their sole compensation, will do the work, and
. the structureis'not intended.or'offereo 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 ao-owner'of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL'PENALTIES AND-CIVIL FINES UP TO:ONE"HUNDRED THOUSAND--',
' and;who doas;the work himself or. through his or her own employees, provided that the. .,DOLLARS ($i 00,000). IN ADDITION TO.THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
. improvements are not intended or offered for sale- If,'nowever, the building or.improvement.is sold within DOLLARS
3706 OF THE'LABOR.,CODE, INTEREST, AND ATTORNEY'S FEES. -
one;year otcompletion, the owner-buildei'will have the burden ofprovindihat he' or she'did not build or
improve for the purpose of sale.). APPLICANT ACKNOWLEDGEMENT
1—) 1, as owner of the propertym, aexclusively 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 contractors) 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 woik is`performed under orpursuant to any permit issued as'a result of this application,
(_ 1 I am exempt under Sec. , B.&P.C. for this reasonthe owner, and:the*applicant, each agrees to, and shali'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
'r ��,•� y performed under or following issuance'of this permit:
Date:y ` caner.oe
2. Any permit issued as a'result of this application becomes null and.void dwork is not.commenced
Within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject
CON STRU ON LENDING AGENCY _ •permit to cancellation.
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the_ I certify that l 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 construction, and hereby guthor'ze represent i s
zat
county to enVupo the above-mentioned propert nspection purposes: Lender's Name:3 ��—�ure (Applicant or Agent):
Lender's Address:
LQPERMIT - - i
Application Number . . . .
12-00000338
Permit . . . PLUMBING
Additional desc .
Permit Fee . . . . 18.00
Plan Check Fee
4.50
Issue Date . . . .
Valuation . . .
. 0
Expiration Date 9/26/12
Qty Unit Charge Per
Extension
BASE
FEE
15.00
1.00 3.000.0 EA PLB
GAS PIPE 1-4 OUTLETS
3.00
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Special Notes and Comments
INSTALL WATER SHUT-OFF VALVE &
REGULATOR. 2010 CODES.
Other-Fees .. . . . . . .
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BLDG STDS ADMIN (SB1473)
1.00
Fee summary. Charged
Paid Credited
Due
Permit Fee Total 18.00.
:00 .00
18.00
Plan Check Total 4.50`
.00 .00
4.50
Other Fee Total 1.00
.00 .00
1.00
Grand Total 23.50.-
.00 .00
.23.50
LQPERMIT
P1.0 , -Box •1504
LA QU[NTA, '.CALIFORNIA ,922;47-1504
78-49S-.CALLE TAMPICO-
LA QUINTA, CALIFORNIA. 92253
0WN, ER''
BUILDING & SAFETY DEPARTMENT
(760) 777-7012
FAX (760) 777-7011
Disclosures & Forms fo.r•.Owner"Bullders Applying -for Construction'Po rinis
l.....�ft�AIY'i'1 l�1QTIGF TCI pR'[1�ER,'i'u.OW1V>�� .
Dear Property-ownet -
E�ri. application. .for a builFlin9 permit' has been submitted. in youi name listing yourself as the builder of tine :property
0
impr+ovements'spe¢ifieEl at • ,
We me.pmvidmg you with ait O.caner-BWkier'Aclmo y lee lg&ent.artd infotmation V titin:Form to maIke you avmw of your
Ina s�nsibilities and pessrble rislt you may`incur by hiwig tidsperm t �sstt6d. rzf yoaur name as .the,
Owner -Budder. We will soi issue a buildii� ped_ t until-yeA Rave reaCITd, hdamg of eadt:0ovision,
signed, and returned this form to us at our' official 'ad'dress indicated.An agent of'the. owner cannot execute. this. -notice
unless you, the Property owner; ,obtain` the prior approval of die permitting autlior►ty. .
()WMWS UCKN0-Wr E��TVrRMCA'TWN- 4F' o�-WON
a' ' ��:.Idead irk initial �h>srdte�nenrbeE-viv t� siSnrfY 3'ou arrderstarrd'or ver�y'tkes'eitforneg6ion.
l: I understand a frequent_ practice of unlicensed persons, is to have the property,,, owner obtain an ``Owner -Builder"
building permit that erroneously implies thatthe property:owner is providing his or her own labor and material peisoriaft: I, as
an Owner -Builder, may be held'liable and subject to serious:,finarieiaf risk for; any injuries-, sustained by an unlioeised person
and his or her employees while rvorldng on my property.;My'homeowner's insnrasce Jmay not provide coverage for those
mlunes I am}' acting as.an Owner -Builder and•am aware'of the limits of my insurance coverage for injuries to workers
•0
on my. Party.
2. I understand building permits are not required to be signed by propertyowners unless they are respordible for the
construction and are. not hiring`licensed Contractor to assume thisxesponsibility. .
C43. I. understand as an".Owner-Builder" I am.tlie: responsi6le,,party of record on' the permit:;l understand that I may protect
elf 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
permits and contracts.
Go �c 5. I understand if .1. employ or otherwise engage any persons; other than California licensed Contractors, and the total value.
my construction is at leasf five hundred dollais �. ($500), including labor and materials, I may be considered as employer"
under state and federal law.
.6. I understand. if I am considered an "e io ; _.
mp yer' under state and f®deral [aw,"I must register with the state and federal
government, Withhold payrvll..taxes, provide. workers' .:comperisatron 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.
��ii
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."
8. 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. iroaries sustained by any subsequent owners) that result from any latent construction defects in the
workmanship or materials. "
9. 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 may contact the California Contractors' State License Board (CSLB) at 1-
800-321-CSLB (2752) or www.csib.ca.gov for more information about licensed contractors.
10. 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:
11. I agree that, as the party legally and financially responsible for this proposed construction activity,.[ will abide by all
applicable laws and requirements that govern Owner -Builders as well as employers.
12. 1 agree to notify the issuer of this form immediately of any additions; dsietions, 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 licenser the Contractors' � State License Board may be unable to assb;t you with any financial loss
YOU may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be inVivil Court. It is also
.important for you tounderstand"if antwiicensbd.Contractor or employee of that individual orfirm is injured while woddng
on your Property; you may be Held liable for damages. If you obtain a permit as Owner -Builder and wish to him Contractors,
you will be responsible for verdymg MwAhes or not those Contractors are praopedy Neensed and the status of tlt iz WO&Us'
compensation insurance oover4ge.
Before a building permit can be issued, fids form must be completed and signed by the property owner and returned to
the agency responsible for issultg0A perms. Nate: A copy, of the property owner's dWverf'albertsey fears notadza&N or
other verification acceptable to the agency is regui3r+ed to be presented when the pgamil is meted 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.
AUTRORIZATION OF AGENT TO ACT ON PROPERTY OWNEWS BEHaF
Excluding the Notice to Property Owner, the cxewtion of which I understand is my personal responsibility, I hereby authorize
the following persons) 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: A copy of the owner's driver' form notarization, or other verification .
acceptable to the agency is required presented h lti is " to verify the property owner's signature..
r
Property Owner's Signature: Date:
Bin. #
o
QiiMta
-Rule
14•BL:Safety•Ulvttion
�P.O//IBro'z.150e47rr8495'TC/a�11e;Tamplco
• • b. {.d.Qurnta, .CA•9�Lj�i4{%�} 70I2--.. u
- Bu��ding PenmitApplcation and Tracking Sheet
Permit # '
I��
`�'
Project Address:. .
Ownef's,Name , y� i�rli� L ti.
A. P. Number
Address
Legal Description:.
Contractor.
City; ST,'Zip: 2 5
Telephone: ,�a6ra.
Address:
Project Description: ,
City, ST, Zip:
Telephone:
State Lie. #:
City Lia
Arch., Engr., Designer
Address:
City., ST, Zip:
r ..
Telephone:
State Lia #:
Name of Contact Person:
truchon Type • �� Occupancy:
Proje;et.type (oircto one): New' Add'n Alter Repa Demo
Sq. K.
#pStories:
# Uctits:
Telephone* of Contact Person:
G�
Estimafed Value; of Project: t • ;ZQQ
ti
:.'. APPLICANT: DO NOT:WRITE.BELQW,THIS UNE
#.
Submittal
Req'd
Recd •..
TRACKING
PERNMFEES
Plan Sets
Plan Check submitted
Item Amount
Structural Cale$.
Reviewed, ready for'cottections
PIan,64 Deposit. .
Tress Cates.
•
Called Contact Person,
Plan Check Balance..
Tide 24 Calcs.
Pians picked up,. -
Construction . -
Flood plain plan
Plans resubmitted.' :
Mechanical •: .
Grading plan
2id Review, ready for correctionsfissde
Electrical
Sabeoatactor List
Called Contact'Person
Plgmbing
Grant Deed
Pians picked up r
S.M L,
H.O.A. Approval
Plans resubmitted
ading
IN FIOIISE:-
Review;'ready for correctionslissiie`. ; .
Developer Impact Fee, .
Planning Approval
,6141 Contact Person
A:LP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
TotalTermit Fees
Nl`ATI E,q
ESTABLISHED IN 1918 AS A PUBLIC AGENCY
0/STRI�
COACHELLA VALLEY WATER DISTRICT
POST OFFICE BOX 1058 • COACHELLA, CALIFORNIA 92236 • TELEPHONE (760) 398-2651 • FAX (760) 398-3711
DIRECTORS
JOHN W. McFADDEN, PRESIDENT
PETER NELSON, VICE PRESIDENT
TELLIS CODEKAS
RUSSELL KITAHARA
PATRICIA A. LARSON
September 30, 2003
Tina Airey
Sands Realty
72-605 Highway 111, Suite B
Palm Desert, California 92260
Dear Ms. Airey:
OFFICERS
STEVEN B. ROBBINS,
GENERAL MANAGER -CHIEF ENGINEER
JULIA FERNANDEZ, SECRETARY
DAN PARKS, ASST. TO GENERAL MANAGER
REDWINE AND SHERRILL, ATTORNEYS
File: 1112.
Subject: Account No. 606123,533.0.9
53-121 Avenida Obregon, La Quinta
In response to your inquiry, all sewer requirements for the above -referenced
property have been met. It will be the homeowner's responsibility to
connect their pipeline to the sewer lateral.
If you have any questions please contact Rosie Anacleto, Customer Service
Representative, extension 2420.
Yours very truly,
/^G�' Steve Robbins
General Manager -Chief Engineer
RIA:ra
bc: City of La Quinta
Post Office Box 1504
La Quinta, California 92253
TRUE .CONSERVATION
USE WATER WISELY