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DSF (13-0281)60755 Living Stone Dr 13-0281 Application description: Property Zoning: Application valuation: 13-00000281 60755 LIVING STONE DR 764-430-015- 7- DEMO - SINGLE FAMILY MEDIUM HIGH DENSITY RES. 400 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: RUSSOMANNO DIANE 60755 LIVING STONE DR LA QUINTA, CA 92253 Other struct info .. N D Q Q VOICE (760) 777-7012 FAX (760) 777-7011.. INSPECTIONS (760) 777-7153 Date: 3/13/13 Contractor: U Applicant: Architect or Engineer: Owner alb 13 2073 OF UNITS 1 0'0""' ��p_ �1 r1' OF CA QUINTA 10PLI&T • !NANC1= ---=--------------------------------•-------------- •LICENSED CONTRACTOR'S DECLARATION - WORKER'S COMPENSATION DECLARATION f hereby affirm under penalty of perjury that I am licensed under provisions of Chapter.9 (commencing with I hereby affirm under penalty of perjury one of the following declarations: . Section 7000) of Division 3 of the -Business and Professionals Code, and my License is in full force and effect. I 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, for the performance of the work for which this permit is. issued.. - - Date: i Contractor: - _ I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor \l. - 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 penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier' - - - - - - - - - - - - - - - - - = - - - - -Policy Number following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to _'1 certify that, in the performance of the work 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 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 of 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 and Professions Code) or - 3700 of the Labor Code, I shall forthwith comply with those provisions. that -he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: Date: Applicant: 1, 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 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL • I Contractors' State License Law does not apply to an owner of property who builds or improves thereon, - SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND 1 �! 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 j I 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 _ I, 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 work is performed under or pursuant to any permit issued as a result of this application, . j 1 am exempt under Sec. .&P.C. for this reason the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City I /fes of La Quinta, its officers, agents and employees for any act or omission related to the work being 1 ` `'� performed under or following issuance of this permit. Date:' 0 nw er 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 1.80 days will subject CONSTRUCTION LE I AGENCY permit to cancellation. " I hereby affirm under penalty of perjury that there is a construction lendingagency for the performance of the I certify that I 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 relati to Id' g construction, and by authorize representatives of this county to enter upon the -above y for inspection purpo e , Lender's Name: %i 3 13 e /�Vy,(,/�__ pw, Da i Signature (Applic�Agen Lender's Address: - LQPERMIT I Application Number . . . . 13-00000281 Permit DEMO PERMIT Additional,desc Permit Fee . .45.00 Plan Check Fee .00 Issue Date . . .' Valuation . . . . 400 + Expiration Date 9/09/13 y Qty Unit Charge Per Extension " BASE FEE 45.00 --------------------------------.----------_ ---------- Special Notes and Comments DEMO UNPERMITTED PATIO COVER APPROX. 64 SQ. FT. AND UNPERMITTED SPA. THIS PERMIT DOES NOT INCLUDE ANY.CONSTRUCTION. 2010 CODES. - -------------------------=---=---------------- - - - - ----------- - - - - -- Other Fees !. BLDG STDS ADMIN (SB1473) 4 1.00 a Fee summary Charged Paid Credited Due - --- ------ - --- -------------------------- ,'. Permit Fee Total 45:00. .00 .00 4 45.00 Plan•Check Total .00 00'` .00' 00 _ Other Fee Total 1.00• .00 _ .00 1.00 Grand, -Total 46.00 00 00 46.00' , LQPERMIT - .. moo® I / 1 P.O. Box 1504 LA QUINTA, CALIFORNIA 92247-1504 BUILDING & SAFETY DEPARTMENT 78-495 CALLE TAMPICo (760) 777-7012 LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011 PROPERTY OWNER'S PACKAGE Disclosures & Forms for Owner -Builders Applying for Construction Permits WPORTANT! NOTICE TO PROPERTY OWNER Dear Property Owner. Ari. application for a building permit hasn submitted ' your list self as a builder of the .property improvements specified at 5 -5 7 t� We are.providing you with an Owner -Bu' Acknovotigmentand Gibimq6dii Verif ation 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 buildingpermit 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. OW NEWS ACKNOwLEI)GMENT AND VERIFICATION OF MORMisI;TION DIRECTIONS: Read and initial eachstatement below to signify you understand or verify this Kormation. W1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder" bu—ilding.perinit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as anOwner-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 amwillfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers Wy property- 2. I understand building permits are not required to be signed by property owners unless they are responsible for the co P3and are not hiring a licensed Contractor to assume this responsibility. P3. I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my WT,ppr'rnils 4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on and contracts. 5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value y construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" der state and federal law. W6. I understand if I am considered an "employer" under state and federal law, I must register with the stati 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 Esunderstand under California Contractors' State License Law, an Owner -Builder who builds single-family residential 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. 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 rkmanship or materials. i - �9. I understand I may obtain more information regarding m obligations as an "employer" from the Internal Revenue Y g� Y g 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- 0-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. L0. 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: OV, L-' 1 L I agree that, as the party legally and financially responsible for this proposed construction activity,.l will abide by all Y �le laws and requirements that govern Owner -Builders as well as employers. . 1 agree to notify the issuer of thisform immediately of any additions; deletions, or changes to any of the information I vided 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 property 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 tkeproperty owner's dr•Fver's.lYcenSe; farm notari¢ation, or other verification acceptable to the agency is required to be presented when the permit is issued to verify the property owner's signature. Q Signature of property owneX Date: C5 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 asmy agents) 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'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: Bin .# City Of LA Qulnita Bullding a Safety Division P.O. Box 1504,78-495 Calle Tampico . La.Quinta, CA 92233 - (760) 777-7012 Building Permit Application and Tracking Sheet -: Pennit # / Project Address -.(,,p0 5. Name:. A. P. Number. �GC �� 53" 77Addr=: Q Legal Description: Contractor. City, ST, Zip: Telephone: / X. Address: Project Description: City, ST, Zip:44 Telephone: -w4` ; State Lic. # : City Lic_ #; Arch, Engr., Designer. g7 q6 Address: City., ST, Zip: Telephone:Construction State Lie. #: Name of Contact Person: Type:. Occupancy: Project type (circle one): New . Add'n Alter Repair Demo Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: � L Estimated Value of Project: . APPLICANT: DO NOT WRITE BELOW THIS UNE k Submittal Req'd Recd TRACKING PERMUFEFS- Plan Sets Plan Check submitted Item Amount Structural Calcs." Reviewed, ready for corrections Pfau Check Deposit. . Truss Calcs. Called Contact Person Plan Check Balance Tide 24 Cales. Plana picked up Construction Flood plain plan Plans resubmitted.. Mechanical Grading plan 2'! Review, ready for correctionstissue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S hLL H.O-A. Approval Plans resubmitted Grading IN HOUSE:. ''" Review; ready for correctionsPrssue Developer Impact Fee Planning Approval. Called Contact Person w AAX-P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees