Loading...
13-0733 (PLBG)� AS .4 P.O. BOX 1504 78-495 CALLE T.AMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Application Number: 13-00000733 Property Address: 52885 AVENIDA RUBIO APN: 773-312-020-7 -000000- Application description: PLUMBING Property Zoning: COVE RESIDENTIAL Application valuation: 1500 Applicant: Architect or Engineer: A)/4 CENSED CONTRACTOR'S DECLARATION - LII,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-BUILDERDECLARATION ' Thereby affirm under•penalty of perjury that 1 am exempt from the Contiactor's-State License.Law;for the 'following reason (Sec.'7031.5, Business . and Professions Code: Any city'or.county.that requires'a permit to- ". . - onstruct, 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 (6hapter'9 (commencing with Section 7000) of Division:3 of the Business and Professions Code) or fhitAd'or she-is`exempt therefrom and the basis for -the alleged exemption. Any violation ofSection 7031.5 by '•any applicant for permit subjects the applicant to a civil penalty,of not more than five hundred dollars ($500).: (jL1,-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 town 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, Erie year of completron,ahe owner -builder will have the burden of provingthat he or she did not build or improve for.the purpose. ' of sale )_ as owner of the property; am exclusively contracting with licensed contractors to:construct the project (Sec. 7044, Business and-Piofessions Code: The Contractors' State License Law does not apply to an owner of propertywho'builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant•to the Contractors' State.License.Law.).Al. - am exempt under. Sec. BAP.C. for this reason ^ _ 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: ROGERS SHIRLEY M 52810 AVENIDA DIAZ LA QUINTA, CA 92253 -------------------- Contractor: Owner VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 JU,q' i.2 2013. Date: 6/12/13 WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjuryone of the following declarations: 1 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 performanceof the work for which this permit is issued. - _ _-A have and will maintain workers-* compensation, insurance, as required by Section, 3700 ofthe Labor Code;. for the performance of the work"for`which this permit is issued. My workers' compensation insurance carrierand 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: Applicant: WARNING: FAILURE.TOSECURE WORKERS' COMPENSATION COVERAGE 1,S UNLAWFUL, AND SHALL SUBJECT -AN. EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UPJO'ONE HUNDRED THOUSAND DOLLARS ($100,000).- IN ADDITION TO THE COST OF COMPENSATION; DAMAGES AS PROVIDED FOR IN SECTION 3706 OE THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT --Application is hereby made to theDirectorof Building and Safety for a per subject tb the conditions and restrictions set forth on this application. 1. Each person upon whose behalfthis 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, -eacli­ agiees 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������uuuuuuthorize representatives of this county to mer upon the above-mentioned property f f irySpectio urposes�r tG! Signature (Applicant or,Ace v N Application Number . . . . . 13-00000733 Permit PLUMBING 2013 Additional desc . . Permit Fee . . . . 11.92 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 12/09/13 Qty Unit Charge Per Extension 1.00 11.9200 EA PLBG BUILDING SEWER 11.92 ---------------------------------------------------------------------------- Special Notes and Comments SEPTIC ABANDON, -SEWER CONNECT. 2010 CALIFORNIA BUILDING CODES. ---------------------------------------------------------------------------- Other Fees . . . . . . . . . BLDG'STDS ADMIN (SB1473) 1.00 PERMIT ISSUANCE M/P/E 90.57 PLAN CHECK, PLUMBING 11..92 Fee summary Charged Paid Credited --------------------------------------------------------- Due Permit Fee Total 11.92 .00 .00 11.92 Plan Check Total .00 .00 .00 .00 Other Fee Total 103.49 .00 .00 103.49 Grand Total 115.41 .00 .00 115.41 LQPERMIT Bin # I� C►ty.. Of La Quint'a Building 8I' Safety Division P.O. Box 1504,:78-.495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # Project Address: !' V i ! Owner's Name: 5 ,` ! ' 1 C r- eG � C� A. P. Number:Address: Legalk cription: r>tb i3 c, c�' p /� n A u e i, 1 �1=� � 4�'i r City, ST, Zip:'1.,� %� ni 2.S 3 C >'L 4 Contractor: ��,;•� Project Description: Address: City, ST, Zip: Telephone: :�Q.::� r' , .iii f:`v::ji]({/' i.'•ftity tij^i: �:' State Lic. # : City Lic #.': , ^ Arch,, Engr., Designer: Address: City., ST, Zip: •j'::; y r?i<: �, 3isE:::r..,.ft: �,:;;yx<; Telephone: State Lic. #::?Ns:;`s•{y?-sn?. wine of Co tact Person: �� r� �� e > _ r �> Telephone # of Contact Person:. , occupancy:,Construction Type: •- %=Project type (circle one): New Add'n Alter Repair Demo Sq. Ft.: #Stories: #Units: Estimated. Value of Prol�ect APPLICANT: DO NOT-WRITE-BELOW THIS LINE . # Submittal Req'd Rec'd., TRACKING PERMIT FEES Plan Sets Plan Check submitted Item 3 Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called'ContactPerson Plan Check Balance Tide 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2°" Review, ready for corrections/issue ElecMcal Subcontactor List Called Contact Person,,,' Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE: '^' Review, ready for correctionsrssue . Developer Impact Fee Planning Approval Called Contaei Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees soy P_O. Box 1504 LA QUINTA, CALIFORNIA 92247-1504 . _ � BUILDING do SAFETY DEPARTMENT 78-495 CALLE TAMOICO (760) 777-7012 LA QUINTA, CALIFORNIA 92253. FAX (760) 777-7011 !ROPERTY .O'WNER'S PACKAGE Disclosures & Forms for Owner -Builders Applying for Construction Permits TAIYTi NOTICR,IM pAnp>rra�ra.OWNSK Dear Property Owoer: - An application for abWdingPam has, been + "emeats specified at 1 ,— subaarttod m Y = : youndf as the builder of the property Weare providing you wide as Owner -H °c�` c anO w _ Veri trop Form to raalm you awns of ew possible rpt you,,may uWW by bovint deispeg, mit inded in yownse ess the Y Ownw-Builder. we pili RQt i5i" a l+ auk 7�ust ktive reed, i led, yams: asdesrstirsdiaa of esa �vbku, signed+ and retained tins form to us at 'dur of8da! address indicated. p agent of use ow�uer cannot a ecyle dtis notict unless you, the property owner, obtain the prior approval of th,_. pamitting autho V- �1. I understand a frequent practice of unlicensed buil pe:aoffi is to have the property owm obtain an "Owner_Builder" �8 Permit -that aroseaislyimplies that; they �,<, S "•) , = property ow tr-is providing lus or;her ov& labor and -r pwMany. I, as an Owner -Builder, may be held liable and subject to.sedious financial risk.:i6r any injuries sustained by an unlicensed person and his or her employees while -wonting on -my prbpertY My homeowner's insurance race not injuries I am willful! ac ' y provide coverage for those Y turg as an Owner -Builder and am on my ProPatY- aware of the limits of my'insucancc.coverage for injuries to workers - .. - understand building permits are not required to be signed by property owners unless they are �espoasible for the construction and are not hiring. a liceasod Contractor to assrma,this, rrspossr 3..I understand as an "Owner -Builder" I am the responsible party.of r000rd.on the permit. I tradastaad that I mz myself from potential Ana cial risk by hiring a ticensed Contractor'and ha ' the y protect own. �g permit filed in his or her name instead of my A4. I understand Contractors are required by law to be Licensed and bonded in Calif m permits and contracts. ora and to fiat thea license numbers on S- I understand if[ employor 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 "employte, under state and federal law. understand if I am consider'd-. an. "employer" under state and federal law, I mutat with government, withhold payroll' taxes, provide woihcers' . oo register the state and federal mpene tion :disability insurance, and contribute to unemployment compensation for each "employe.":I also understand my failure to risk abide by these laws may subject me to serious financial 7: 1 understand under California Contractors' State License Law, an Owner -Builder structures cannot legally build_' them with the intent to offer them for saleunless all work is o builds single-family by license( subcontractors and the number of structures does not exceed four within- any calendar year, or all of the work is performs under contract with a licensed general building Contractor_ z I understand as an Owner -Builder if i sell the property for which this permit is issued, I may be W4 Gable' te,. financial or personal. Wjories sustained by.any subsequent owner(s) that result from any latent construction defects in ter. workmanship or materia k �9. 1 understand I may obtain more information regarding my obligations as an "employer" from the Int rud'Kevenue Service, the United States Small Business Administratio4 the California Department of Benefit Paymexits, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1- 800-321-CSLB (27 52) or www.cslb.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 6nanciali k p construe; activity at the following address: _ . ,std ate".; aL, (L't�'�- Q,� 11. 1 agree that, as the party legally and financially responsible for this proposed construction activity. I will abide by all applicable lays and requirements that govern Owna-BtMers as well as eMPloyen. 12. I agree to notify the issuer of this form immediately of any odditioos, deletions, or Chari@= b my of fibs ia6orroation l have provided on this form Licensed contractors are regulated by laws designed to protect the public. If you cOotract with someone wbo docs not have a Boone, tba Cootractora' State License Bowd may be unable m Mig you with nay 8aaaeira loss you may sustain as a result of a complaint Your only remedy against unlicensed Contractor may be in civil Cowl. It is also impogumt for you to widentand that if an aalieweed Contactor a CaVloyce of that individw or &= is iojueed wbak woftiog on you ley, you may be brdd bi=ble Ax damages If you obtain a permit ss Owner -Banda and wisb to bsm Coatradoa, you wdl be rcapoaaible far verde iog wbatbwzt or not dwst: Contractors are pgopesty licensed and the status of thm wotstus' CompcoM ion im —adoe Q0YCrW- Before a buuldiag permit an be b ied, tbb form most be compkted add tamed by the prepeM oRner and rttaraed to the agency responsible for issol" *A gait. Now. A ce" of ilea p+sV" oWON's e#irerr'rr lierwsei fW= n0& err odder v ry eadow accepetWa w As 09egay is roquk*d a Ger pr@SWWd Wh" db pante is :awed b vwelJj► dw properV owner's signaMrrc. Signature of property owns ./ DaW. Note: The following Authorization Form is required to be completed by the property owner only whin designating an agent of the property owner to apply for a construction permit for the Owner -Builder. AUTHORIZATION OF A(;EK TO ACT ON PROURTY OWNER'S BEHALF Excluding the Notice to Property Owner, the e:xcWtion of which I understand is my personal respoeshiulity, I l""by authorize the following persona) to acct as my agags) to apply for, sign, and file the doaiments neceaary to obtain an Ovnw-Builder Permit for my project- Scope rojectScope of Construction Project (or Description of Work): Project Location or Address: Name of Pkuthorizod Agent: Address of Authorized Agent: Tel No I declare under penalty of perjury that 1 am the property owner for the address listed above and I personally filled out the abov, 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: