PLBG (13-0531)60755 Living Stone Dr
13-0531
Applicant:,
13-00000531
60755 LIVING STONE DR
764-430-015- - -
PLUMBING
MEDIUM HIGH DENSITY•RES
400
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT'
BUILDING PERMIT
Owner:
RUSSOMANNO DIANE
60755 LIVING STONE DR
LA QUINTA, CA 92253
(760)777-5219 -
Contractor:
Owner .
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153..
Date: 4/25/13:
'LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION - - -
I hereby affirm under penalty of perjury that I am licensed and 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 o nd 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: _ ae s J '.:
for. by Section 3700 of the Labor Code, for the performance of the work for which this permit is -
1V
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 penalty of perjury that I am exempt from the Contractor's State License Law for the _
Carrier - - - - - :.r - - - - - - - - - - = - - - -Policy Number
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to
ILI-JI'MT711ify 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
V 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 if Ishould become subject to the workers' compensation provisions of Section
License Law (Chapter 9 Icommencing with Section 7000) of Division 3 of the Business and Professions Code) or
3700 of t r Code, I shall forth omply with those provisions.
• t he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
licant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars 1$500).:
Da Applic
,
/) I, 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' COMPE N COVERAGE IS UNLAWFUL, AND SHALL
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
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
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' Slate 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,
I am exempt under Sec. , B.&P.C. for this reas
}
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.
�/1
Date -.174 - D� 3 W � 3 Owner '?
2. Any permit issued as a result of this application becomes null and void if work is not commenced
L",
within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject
' CONSTRUCTION L ING 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 1 have read this application and state that the above information is correct. I agree to comply witti all{
work for which this permit is issued (Sec. 3097, Civ. C.). -
city and county ordinances and state laws relating to building construction, and by'authorize representatives
of tih, enter upon the above-mentioned r inspection purp
Lender's Name:
y
Dat / AI ignature (Applicant or Agen
_
Lender's Address:
LQPFR111IT
Application Number 13-00000531
Permit . . . PLUMBING
Additional desc .
Permit Fee 18.00
Plan Check Fee
4.50
_ Issue -Date
Valuation
0
Expiration Date .. 10/22/13
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 `3.0000 EA PLB GAS
PIPE 1-4 OUTLETS
3.00
-----------------------------------------------------------------------------
Special Notes and Comments
GAS LINE - 58LF OF '/, PIPE FOR THE
BARBEQUE. 2010 CALIFORNIA BUILDING
_
CODES.
Other Fees- 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
LQPEIN1IT
Bin.#
Crty. 0f La Qutnta
Building 8z Safe[y Division
P.O. Box 1504,78-495 Calle Tampico
La.Quinta, CA 92233 -(760)_777-7012
BuildingPermit Application and Tracking Sheet
Perini # .
1T
Project Address:,l0 D 756
Owner's Name:.
A. P. Number.
Address:
Legal Description:
Contractor.
City, ST, Zip:
Telephone: 740 % S -O i
Address:
Project Description: Jj
City, ST, Zip:
Telephone:
State Lic. # : City Lic. #;
Arch., Engr., Designer
Address:
City., ST, Zip:
Telephone:
State Lic. #:
Construction Type:. Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: # Stories: # Unit;;:
Name of Contact Person:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
' Rec'd
TRACKNG
PERMIT FEES
Plan Sets
Pian Check submitted
Item Amount
Structural Cafes.
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Cafes.
Called Contact Person
Plan Check Balance
Title 24 Catcs.
'
Plana picked up
Construction
Flood plain plan
Plans resubulfted, .
Mahatilcal
Grading plan
2'! Review, ready for correetionsfissue
Electrical
Subcontacjor List
galled Contact Person
Plumbing
. Grant Deed
Plans picked up
SMI.
H -0 A- Approval
Plans resubmitted
Grading
IN ROUSE:-
1r° Review; ready for correctionsfissae
Developer Impact Fee
Planning Approval
Called Contact Person
M.P.P.
Pub. Wks. Appr
Date of permit Issue
School Fees
Total Permit Fees
<
Q
-05
�7,
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--------------
iD
SITE REQUIREMENTS
ImER1OR LOT
SIDEYARD: 5 DEET EACH SIDE REAIiYARD: 10 FE "T
hil�iIMUM �'�Q1IMiJM
. � t
FRONTYARD:AREA TO BE `
20 FEET L)VU)SCAPED
MRMAUM
�-- PROPERTY
LINES
CURBLME
i- W14 T,
=I
P.O. BOX 1504
LA QUINTA, CALIFORNIA 92247-1504
78-495 CALLS TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT.
PROPERTY OWNER'S PACKAGE
(760) 777-7012
FAX (760) 777-7011
Disclosures & Forms for Owner -Builders Applying for Construction Permits
ORT'ANT! NOC 'CO gROPERTY OWNER
Dear Property Owner.
Aa. aPPlication for a building permit a been sub m your listing ourself as builder of the propqrty
improvements specified at 'x� -6
We are vvidmg you with an Owner -Builder Ac [nfoimation Verifica ' orm to make you awam of your
responsibilities and possible risk you may incur by having d 6s t issued in, your name as the
Owns -Builder. We will not issue a building permit until you bave read, initiated 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 signify you understand or verify this information.
Pr 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. 1, 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 willMy acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers
nnay P�siy.
2. I understand building permits are not required to be signed by property owners unless they are responsible for the
construction and are not hiring a licensed Contractor to assume this responsibility.
01-/3. I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that 1 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
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.
5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value
of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employee'
der state and federal law.
6. 1 understand if I am considered an "employer" under state and federal taw, I must register with the state and federal
government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment
compensation for each "employee." t also understand my failure to abide by these laws may subject me to serious financial
Nkk-
I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residentia'
escannot legally build them with the intent to offer them for sale, unless all wort( is performed by license(
subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performe4
under contract with a licensed general building Contractor.
ra
eI understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable. le,.
ial or personal. bouries sustained by any subsequent owner(s) that result from any latent construction defects in th."
Rorkmanship or materials:.understand I may obtain more information regarding my obligations as an ,employee' from the Internal Kevenue
rvice, the United States Small Business Administration, the California Department of Benefit Payments, and the California
ivision of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at I-
8 -321-CSLB (2752) or www.cs[b.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 `'� Me for pl°ppo�os��ed �cons�Uv''c��tion activity at the following. address:
\ ►(00-76-.5- 1��_�LJG Ctu.l �n Q� a5�
I. I agree that, as the party legally and ftnaWially responsible for this proposed construction activity, I will abide by all
'lye laws and requirements that govern Owner -Builders as well as employers.
a-- 12.1 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, Bre 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 verd +ing wliedwr or not those Contractors are properly licensed and the status of ft r 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 issue, Me permit. Note: A copy of tks property owner's d4ver's !Manse, Of rrotar*ffidra; or
other verification aeeeptabktodie agency is requbwdd be presmsted when die permit is issued to verify the property
owner's signature.
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 -
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 agettt(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 lluthoriaed 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: