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RER (14-0396)76900 Calle Mazatlan 14-0396 P.O. BOX 1504 78-495 CALLE TAMPICO 'LA QUINTA, CALIFORNIA 9225341le BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Application Number: 14-00000396 Property Address: 76900 CALLE MAZATLAN APN: 658-161-048- - Application description: REMODEL - RESIDENTIAL Property Zoning: MEDIUM DENSITY RES Application valuation: 3432 - Applicant: Architect or Engineer: ------------------ LICENSED 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:_!'yV Contractor:+' 410- few 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 r she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by a 10plicant for a permit subjects the applicant to a civil penalty'of not more than five hundred dollars ($500).: () 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 ownemployees, 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 I, as owner of the property, am exclusively contracting with licensed con ractors uct the project (Sec. 7044, Business and Professions Cade: The Contr ctors' State Lice e L does not ply to an owner of property who builds or improves thereon, and w o contracts fort pr ects with a contractor(s) licensed pursuant to the Contractors' State License La 1 _ 1 I am exempt under Sec. B.&P.C. for is reason 9-1 Owner: I hereby affirm under penalty of perjury that there%lk a con work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name:.. Lender's Address: LQPER111IT agency for the performance of the Owner: SUZNEVICH RESIDENCE 76-900 CALLE MEZATLAN 92253 LA QUINTA, Contractor: Owner' VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 U. 253 MAY 0920114 PJ CITY OF LA QUINTA FIN4MCE DEPT. ------------------ WORKER'S COMPENSATION DECLARATION Date: 5/02/14 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. _ ('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 2013 Policy Number --------------- 1 certify that, in the performance . he work f which this permit is issued, I shall not employ any person in any manner so as ecome su ect to the rs' compensation laws of California, j and agree that, if I should a me subje to the grltmpensation provisions of Section 337\700 of the Labo Codell all forth h comp w h those provisions. - fT'TT licant:10 WARNING: FAILURE TO SECUR W KE O P,p4§ATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRI AL PENA WAND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITI N TO TH ST 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 riull and void if wo is not commenced within 180 days from date of issuance of such permit,/ cessation of for 180 days will subject permit to cancellation. / I certify that I have read this application and state that the above iij formation is co t. I afire omply with all city and county ordinances and state laws relating to build ng corfstruction, and r y aut ize presentatives of his c u nty to ente pon the above-mentioned prop✓ett for' coon Durp Sign ure (Applicant or Agent v w'mRMr Application Number ' - . . . . 14-00000396 Permit ' ' . ' ' ' ELocrRzcaL uoza ' Additional deac PermitFee . ' ' ' 23.83 ` Plan Check Fee ' `' .00 zaane Date ' ' ' ' \mLLnatioo ' ' ' ' o Expiration Date ' . 10/29/14 ' Qty Unit Charge Per` 'Extension 1'00 23-8300 -__-__-______-_-__-__- Lo ELEc FIXTURES, FIRST uo ---------------------------------------- 23'83 . Permit . ' ' . ' ' REMODEL 2013 Additional deac Permit Fee 1*3'00 ` Plan Check Fee ' . 'OO ' ` Issue Date ' ' ' ' Valuation ' . ' .o 'Eopizatioo Date ' ' 10/29/14 Qty Unit Charge Per ` ' Extension 1'00 143.0000 EA mzaC oaLcOnmr xuDoN 143'00 ' 'oo 48'6200 La MznC RomonoL, 1ST 100 Gr 'uo . .. ' ' ------------------------------------------------ ------------------- Specialand Comments. . ADDITION or eo oO' FT' OF MEZZANINE AREA ' TO zmo FLOOR HALL. May u, 2014 9:02:27 AM -------------------------------------------------------- -jjobnamo' -------------------- Fees . ' ' . ' ' ' `' HooaLr ez CHECK 87'50 Pz mv csEoK' ELECTRICAL 23'83 PLAN CHECK, REMODEL 167.31 aTouNo MoTzom (SMI) - Roe '50 ` Fee summary Charged ----------- eaid ` credited _--__-- __ oue ---_- -__--_-__-- -eermit Fee Total ---------- 166'u3 'oo 'oo 1.e6'83 Plan Check Total 'no 'uo 'oo Other Fee Total 279'14 ,00 'oo 279'14 Grand Total 44s's7 'oo .00 «4s'y7 ' ` ' u Bin # Permit # I f� 3a City of La Quinta Building &r Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Project Address: L¢r� �`�� Owner's Name: A. P. Number: ��b 1--�� Address: Legal cScription:� City, ST, Zip:,, `� . +��4� �i"-•s�a�'11 Tc3c Izanc�� G�A'1 " = ` Ys':'•• Address: L� �s7 ykoti , Project Description: Telephone: State Lie. # : Arch., Engr., Designer: Y N-,: City Lie. #c�� ! Address:,c� City, ST, Zip: '-70 �'?.;R�'� �„1�`—j �•..: �;°;: State Lie. #: M.Project Construction Type: Occupancy: type (circle one): New Add'n Alter Repair Demo Name of Contact Person: C2,. i�,, C' t —Z rseV L Sq. Ft.: # Units: Telephone #,of Contact Person�n-, ��'� Estimated Value of Project: `� �� C 3 APPLICANT: DO NOT WRITE BELOW THIS LINE H Submittal Req'd Rec'd TRACKING PERMIT FEES Plan Sets ve Plan Check submitted Item Amount Structural Calcs. V" Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person EP;"0 J Plan Check Balance Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted 4 Mechanical Grading plan 2"' Review, ready for correcflo lissu � Z Electrical Subcontactor List Called Contact Person S Plumbing Grant Deed Plans picked up S.M.I. II.O.A. Approval Plans resubmitted Grading IN ROUSE:- 'rd 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 Fees Total Permit Fees _ f�, � � � l Yi1 Date 5/9/14 No. 32084 Owner . Sam Suznevich Address 76-900 Calle Mazatlan City La Quinta Zip 92253 Tract # Type Single Family Residence CERTIFICATE OF COMPLIANCE Desert Sands Unified School District 47950 Dune Palms Road La Quinta, CA 92253 (760) 771-8515 Lot # No. Street Unit 1 76900 Calle Mazatlan Unit 2 Unit 3 Unit 4 Unit 5 Comments S.F. 60 c Q BE MUDA DUNES IA RANCHO MIRAGE J INDIAN WELLS PALM DESERT y LA QUINTA INDIO Qyr O APN # 658-161-048 Jurisdiction La Quinta Permit # No. of Units 1 Lot # No. Street S.F. Unit 6 Unit 7 Unit 8 Unit 9 Unit 10 At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions under 500 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile homes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason: Residential Addition 500 Sq Feet or Less EXEMPT This certifies that school facility fees imposed pursuant to in the amount of $0.00 X 60 S.F. or $0.00 have been paid for the property listed above and that building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued. Fees Paid By Sam Suznevich Check No. 0.00 Bank Name/Recipient of Certificate Telephone 253-569-2493 Funding Residential BY Dr. Gary Rutherford Superintendent Fee collected /exempted by Esp ara Payment Recd a (">" $.o :oo At Over/Under, r Signature NOTICE: Pursuant to Government Code Section 66020(d)(1), this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified above will begin to run from the date on which the building or installation permit for this project is issued, or.from the date on which those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier. NOTICE: This Document NOT VALID without embossed seal Embossed Original - Building Department Applicant Copy -Applicant/Receipt Copy - Accounting P.O. BOX 1504 LA QUINTA, CALIFORNIA 92247-1504 7$-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT PROPERTY OW, NEWS PACKAGE (760) 777-7012 FAX (760) 777-7011 Disclosures & Forms fo.r Owner -Builders Applying for Consiruction Pernuts LWORUNT! NOTICE TO PROPERTY.OWNIER Dear Property Owner A i. application for -a building permit has been submitted in your name listing yourself as the builder of the .property improvements specified at Q" >C O We are providing you with an Owner -Builder Acknowledgment and Information -Verification Form to make you aware of your responsibilities and possible risk -you may incur by having'thispermit issued in your name as the Owner -Builder. We will not issue a building. permit until you -have read, initialed yourunderstanding of eacWprovision, signed, and returned this form to us at our official address indicated. An agent of the owns cannot execute -this notice unless you, the property owner, obtain the prior approval of the permitting authority. Read and initial early statement below C8 signifyyou understand or verify this informaFcon. jai. 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 47es. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers on y property inj . I understand building permits are not required to be signed by property owners unless they are responsible for the c ns ction and are not hiring a licensed Contractor to assume this responsibility.. .d 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 4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on -ts 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' Z6 - state and federal law. I understand if I am considered an "employee' under state and federal law, 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." I also understand my failure to abide by these laws may subject me to serious financial Nk- V. 1 understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential srucures 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 an ial or personal. injuries sustainedby any subsequent owner(s) that result from any latent construction defects in the anship or materials. 9, I understand I may obtain more information regarding my obligations as an "employee' from the Internad RcVenue 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- 21-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. .Mi0. 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. f d i- ,rte i \\ — ` . - — k k -- - --- t , - \ - A erC='7 `7 e- '7 11: I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all cable laws and requirements that govern Owner -Builders as well as employers. ,0- 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 doesnot have a license,. the Contractors' State License Board may be unable to 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 tounderstand 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 revowilAe 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 issdg.&e der Note. A copy, en; of tke property owner's driver'sIkense, farm nor other verification acceptable to die agen required to . e pr when the permit is issued to verify the property owner's signature. Signature of property owner Date: &A 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 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 Ithe property owner for the address listed above and I personally filled out the above information and certify its accuracy. Not A copy of the!er's driver's license, form notarization, or other verification acceptable to the agency is required fo presented wy9„ the pepnit is issued to verify the property owner's signature. AffAl I IFIMFI E -0 - , r "FAM Property Owner's Signature: 5/we W.W—MM301, 4 CITY OF LA QUINTA SUB -CONTRACTOR, LIST JOB ADDRESS Ob l \ b' 9Z PERMIT NUMBER OWNER - 5 -BUILDER horized-to work This form shall be -posted on the job with the rBuilding Inspection Card'at all times in a conspicuous place. Only persons appearing on this list or•the.ir employees are aut h' b An chan es to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance V" t is jo y g " " 's not an acceptable response. ' ermit. For each applicable trade, all information requested below must be completed by applicant. On File i p_ of building p Pp rye c,f .-at,nti .................................. .. . .. ('nntractor .. ......... ,...:..:.... ...... nse a e Contract or s Lice St t ... Workers C P. Co Nam e Company Y P • 'c Classification anon License e Num be r e Exp. Date P Name 'rN e Carrier C ) Policy Nu m ber Y . ies at Varies] F ) Exp. Date P # xx xx x / ) x/ License Number x xx x Exp. Date xx x x • xx/ / 1 1 - B 8 C (e.g. A ) xx x xx x 1 x xx xx x / ( / 1 Fund, aIC om . State F u e. 9 . St , p orm 1. EL1:RT:HIN:O;R:K(:.C:.;7.;. I" ::...............:.........::;:,........: .:;::.:..:. »> CONCR>>:(114 i' •. -W. . `• E STRUCl STEEL (C 81) r MASONR ( ) K ' 'LATHr::.PLASTER<:>l.C.....:)::::::. :DRYWALL r t ,2 ELECTRICAL fC ROOFING (C. 39) .. ' • f " , SHEET METAL (C 43) r -15'><>?><> F O ( f - . GLAZING - INSULAT N ( ) r "51 9 i- j . ' }. PAINTING ( 33) CERAMIC. TILE (C 54) 3, CABINETS ..4 FENCLNG.: C131::::..:..:;:.:::::. . LAN Q. S'"PING:'.'fr F V _