DEMO (09-0196)52840 Avenida Martinez
09-0196
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 09-00000196 ,
Property Address: _ 52.840 AVENIDA MARTINEZ
APN: 773-332-006-21 -000000-
Application description: DEMO - COMML/OTHER
Property Zoning: COVE RESIDENTIAL
Application valuation: 500
A pl. ant:
Titvl 4 4 Qu&I
Architect or E gineer:
BUILDING & SAFETY DEPARTMENT
. BUILDING PERMIT
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 Professionals 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 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
a^p' Pplicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
16 () 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
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 she did not build or
improve for the purpose of sale.).
1 _ 1 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(s) licensed
pursuant to the Contractors' State License Law.).
I _ 1 II am.
__exempt
under Sec. , B.&P.C. for this reason
,Date: _r/r "/" l - - ' Own D lt 2ii_ "rt1.,Y_.es
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:
LQPERMIT
Owner:
THERESA PALACIOS
52840 AVENIDA MARTINEZ
LA QUINTA, CA 92253
(760)485-8809
Contractor:
Owner
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/02/09
p wFu
MAR 0 3 2x09
CITY OF LA QUINTA
FINANICE DEPT
WORKER'S COMPENSATION DECLARATION
hereby affirm under penalty of perjury one of the following declarations:
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 comply with those provisions.
Date: —q , Applicant:--lqa;t
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,0001. 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 Director of Building and Safety 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 county to enter upon the above-mentioned property for inspection purposes.
Date:' 9%-4q Signature (Applicant or Agentlg 9-P /
Application Number . . . . . 09-00000196
Permit . . . DEMO PERMIT
i Additional desc .
.Permit Fee . . . . 45.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
. . .
. 500
Expiration Date 8/29/09
Qty Unit Charge Per
Extension
BASE FEE
45.00
----------------------------------------------------------------------------
Special Notes and Comments.
DEMO PERMIT GARAGE CONVERSION BACK TO
GARAGE KNOCK OUT WALL PULL OUT
TOILET/SHOWER, CAP HOLE IN SHOWER PER
AJ
Fee summary. Charged Paid
--------------------
Credited
--------------------
Due
-----------------
Permit Fee Total 45.00
.00
.00
45.00
Plan Check Total .00
.00
.00
.00
Grand Total 45.00
.00
.00
45.00
LQPERMIT
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OUT
T-Vf 4 4 QuArdi
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) 777-7011
Disclosures & Forms for Owner -Builders Applying for Construction Permits
IMPORTANT! NOTICE TO PROPERTY OWNER
Dear Property Owner:
An. application for a buildma permit has bee bittedryour name listing yourself as the builder of the property
improvements specified at C XQt c . d ^( , p
We are .providing you with anOwner-Builder Acknowledgment and Information 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 cannot 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 signs you understand or verify this information.
C1. I understand a frequent practice of unlicensed person's 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 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 are responsible for the
c struction and are not hiring a licensed Contractor to assume this responsibility.
IX3. I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect
if from potential financial risk by hiring 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
ae its and contracts.
A
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"
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 ernment, 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
-risk.
7. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential .
s cures 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.
A8. I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any
fin cial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the
workmanship or materials.
Cvi9. I understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue
ce, 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 (CS`LB) at 1-
800-321-CSLB (2752) or www.csib.ca.gov for more information about licensed contractors.
0. I amllaware of and consent to an. Owner -Builder building permit applied for in my name, and understand that I am the
p legally and financially responsible for proposed construction activity at the following address:
I. agree. that, as the party legally and financially responsible for this proposed construction activity, .1 will abide by all
a4pp laws and requirements that govern Owner -Builders as well as employers.
de12. I agree to notify the issuer of this. form immediately of any additions, deletions, or changes to any of the information I
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 insurancecoverage.
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 acceptable to the agency is required to be presented 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.
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 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: Tel No
Address of Authorized Agent:
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 Qu►nta
Building U Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
kNt I
Project Address:
Owner's Name: (✓
A. P. Number:
Address:
S9-19, u O t7 M t ilcv
Legal Description:
City, ST, Zip: / c
tom/---►- (\x
Contractor: —C,
Telephone: L4 9
Address:
Project Description: Q to
City, ST, Zip:
_
P-
Telephone.
City Lie. #:
State Lie. # :
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lie. #:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.:
# Stories: # Units:
Telephone # of Contact Person: Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Plan Sets
Req'd
Recd
TRACKING PERMIT FEES
Plan Check submitted Item Amount
Structural Calcs.
Reviewed, ready for corrections Plan Check Deposit
Truss Cales.
Called Contact Person Plan Check Balance
Energy Cates.
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 HOUSE:-
3'" Review, ready for corrcetionsfissue Developer Impact Fee
Planning Approval
Called Contact Person A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees