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12-0904 (DSF)4 P.O. BOX 1504 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: 8/10/12 Application Number:,. _ 12-00000904- Owner: Property Address: 52135 AVENIDA CARRANZA CASSEL LLORA LEE APN: 773-215-024-8 -000000- 52135 AVENIDA CARRANZA Application description: DEMO - SINGLE FAMILY LA QUINTA, CA 92253 Property Zoning: COVE RESIDENTIAL ( I1 Application valuation: 0 D k' U Contractor: VJT �L y �0�2 Applicant: Architect or Engineer: Owner L ! �lA4- CITY OF LA QUINTA FI{ IkgCE CEPT. 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 ISec. 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 any ay licant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($5001.: 1 J) 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 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 am exempt under Sec. , B.&P.C. for this reason e:Date:. Ow er. ONSTRUCTION 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 WORKER'S COMPENSATION DECLARATION _ 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. . 1 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 1.00 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 " of theLt:e od all forthwith cwith those provisions. Date: - Appli WARNING: FAILURE TO SECURE RKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN. SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. r 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 co ty to a ter upon the above -mention arty r inspection purposes. Data. I�i nature (Applicant or gent): CIA. LQPERMIT Application Number Permit . . Additional desc . . Permit Fee . . . . Issue Date . . . . Expiration Date . . . . . 12-00000904 DEMO PERMIT 45.00 Plan Check Fee . Valuation . . . . 2/06/13 .00 0 Qty . Unit Charge Per Extension BASE FEE 45.00 ---------------------------------------------------------------------------- Special Notes and Comments DEMO PERMIT TO REMOVE FLOORING UNPERMITTED LAUNDRY ROOM CODE CASE # 12-2641. APPROVED B.H. , 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 .0.0 45.00 x LsI" 11• City of La Quinta Building 8i Safety Division F.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # Project Address: wner's Name: A. P. Number: Address: cCJa e Legal Description: City, ST, Zip: nr r Co t acto .eleP hone: Address: Project Description: City, ST, Zip: Telephone: State Lic. #: City Lic. #: Arch., Engr., Designer: Address:20* City, ST, Zip: Telephone: Construction Type: Occupancy: StateLic. #: Project type ne Nev Add'n Alter Repair Demo Name of Contact Person: Sq. Ft.: #Stories: #Units: Telephone # of Contact Person: 1 Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Title 24 Calcs. 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.1. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- '" 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 �>J S-e— ODA f 20. op- CI -Ty OF L _A QUINTA lDEPT. 13 JILDING R®V E1ED FORJ FORcoNSTRkCTION D kTEAP �,BY ars 176 a Ave, r- a 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=Bullders Applying for Construction Permits JJ W-TANT! NOTICE TO PROPERTY OWNER Dear Property Owner. An. application for a building permit has been submitted in your name listing yourself asthe builder of the property improvements specified at 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 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 indicate(L An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OV R'S AC1Q40-WI E1)O1 T AND VERMCATION 011 EWOR V1tiA'i'i N Dl'RECTIONS. Read and initial-eack statement betow to signify you understand or verify this information. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder" wilding 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 willfully acting as an Owner -Builder and am aware of the limits of my insurance -coverage for injuries to workers on my p�rty- 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. 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 own. J 4!I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on ermits and contracts. 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, 1 may be considered an "employer" under state and federal law_ understand if I im considered an "employee' 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." 1 also understand my failure to abide by these laws may subject me to serious financial risk. deist and 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 fourwithin any calendar year, or all of the work is performed under contract with a licensed general building Contractor. understand as an Owner -Builder if I sell the property for which this peru' u -t is issued, I may be held liable for any financial or personal. injuries sustained by any subsequent owners). that result from any latent construction defects in the wo hip or materials. ; C: I understand 1 may obtain more information regarding my obligations as an "employee' from the Internal Revenue CL, 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 (CSI -9) at I - J SLB (2752) or www.cslb.ca_gov for more information about licensed contractors. C: 0. aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the . legally and financially responsible for proposed construction activity at the following address agree that, as the party legally and financially responsible for this proposed construction activity,.l will abide by all ap licable laws and requirements that govern Owner -Builders as well as employers. 12. I ee to notify the issuer of this form immediately of any additions, deletions, or changes to any of the informatioe 1 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, the Contractors' State License Board may be unable to assi* you with any frnaneial 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 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 responsible for verifying whether or not those Contractors are properly 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 issnirig. &e.permiL Nate: A copy of the property owner's dsiver's.ticen=4 form rrotarr tt, or other verification acceptable to the agency is required to be presented when the permit is Witted to verify the property owner's signature- Signature Signature of p owner Date:1011 Note: Thefollowing 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, l hereby authorize the following person(s) to act as my 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 frlied 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' 'd understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any LI/financial or personal. "'Urm sustained by any subsequent owner(s) that result from any latent construction defects in the wo hip or materials. , I understand I may obtain more information regarding my obligations as an "employer" from the Ill Revenue e United States Small Business Administration, the California Department of Benefit Payments, and tht California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at I - 800- 1-CSLB (2752) or www.cstb.mgov for more information about licensed oontractors. C:�J10. aware of and consent to an Owner -Builder building permit applied for in my name, and understand that 1 am the legally and financially responsible for proposed construction activity at the . following address: agree that, as the party legally and financially responsible for this proposed construction activity,.l will abide by all �J ap licable Paws and requirements that govern Owner -Builders as well as employers. 12. I 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, 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 inIcivii court- It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while woriang on your property; you may be held liable for damages. If you obtain a pernut-as Owner -Builder and wish to hint 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 issu.i.&e.permit. Nese: A copy of the property owger's dsiver'sAkenset f"m "tackadM or other verifwation acceptable to the agency is required to be presented when the permit is issued to verify the P"PertY owner's signature. l Signature of property owner Date: L 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 1 understand is my personal responsibility, l 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 1 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, fonn 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.