12-0521 (PAT)P.O: BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description
Property Zoning:
Application valuation:
Applicant:
12-00000521.
51585 AVENIDA RAMIREZ
773-125-017-5 -000000-
PATIO COVER - RESIDENTIAL
COVE RESIDENTIAL
3830
Architect.or Engineer:
0 1 -
�F �w4�rw
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
SERRANO JUAN J
51585 AVENIDA RAMIREZ
LA-QUINTA,-CA-9225IN
Contractor:
Owner
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 7/18/12
LICENSED. CONTRACTOR'S DECLARATION -
WORKER'S COMPENSATION DECLARATION
hereby affirm under penalty of perjury thafl am licensed under provisions of Chapter 9 (commencing with
I hereby affirm under penalty of. perjury one of the following declarations:
Section 70001l of Division_3 of the Business and Professionals Code, and 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: ' '. License No.: -
for by Section 3700 of the Labor Code_forthe performance of the'work for which this permit is
•
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:
hereby. -affirm under penalty of perjury thatam exemptfrom the Contractor's State. License Law for the'
Carrier - Policy Number - -
,l
following ieasori Ism 7031..5, Business and Professions Code: Any city•or county tfi'at iegwre5a permit to
_ I certify that,tin 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
person in any manner so as to become'subject to the workers' compensation Iaws.of, Califor '
permit to: file a signed'statement that he or she is licensed pursuant to the'provisions of the Contractor's State
and agree that, if I should become..subject to the workers' compensation provisionsof
License Caw (Chapter 9; (commencing with Section 70001 of•Division 3 of the Business and. Professions Code) or
3700 of the Labor Code, I shall forthwith. comply with those provisions.
. that he orshe is exempt therefrom and the basis for the alleged exemption. Any violatiomof'Section 7031.5 by
any applicant for a permiisubjects the.applicant to_a civil penalty of not more than five -hundred dollars (5500).:. -
- - `�'�''
k Date: akpplicant: SSP `�f�"�� l
1 — I 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' COMPENSATION COVERAGE IS.UNLAWFUL, AND SHALL '
Contractors' State License Law does not apply to an owner of property„who builds or impro4es thereon,
''SUBJECT AN. EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND -
and.Iwho does the•work himself,or herself through his or her own employees, provided that the .,
DOLLARS (5100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
.1 1: not intende'd�or offered for sale. If, however, the building or improvement is sold within ,
•
SECTION 3706 OF -THE LABOR CODE,,INTEREST, AN FEES.
' one year of completion, the owner -builder will, have the burden of proving that he or she did not build or
,ATTORNEY'S
+ • - - - .
improve for the purpose of sale.)..-
APPLICANT ACKNOWLEDGEMENT -
' 1—), 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'.State.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 cbntractor(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 toanypermit, issued as a result of this application,
( 1 I am exempt under Sec. , B.&P.C. for this reason -
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 actor omission related to the work being
performed under or following issuance of this permit. "
&Date: Owner:
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
" CONSTRUCTION LENDING AGENCY
permit to cancellation.
. -1 hereby affirm under penalty of perjury that there is'a construction lending agency for the performance of -1[5e_
I certify that I have read this application and state that the above information is correct. I agree to comply with all
work for which this permit is issued (Sec. 3097, Civ. C.).
city and county ordinances and state laws relating to building cohstru tion, and hereby authorize representatives
of this county to'enter upon.. the above-mentioned property for inspe i oses.
Lender's Name:
Date: Signature (Applicant or Agent):
Lender's Address:
LQPERMIT
_ N,
Application Number .
Permit . . .
Additional desc . .
Permit Fee . . . .
Issue Date . . . .
Expiration Date . .
. . . . 12-00000521
PATIO COVER PERMIT
63.00
1/14/13
Plan Check Fee . . 40.95
Valuation . . . . 3830
Qty Unit Charge Per
Extension
BASE FEE
45.00
2.00 9.0000 THOU BLDG 2,001-25,000
18.00
---=------------------------------------------------------------------------
Special Notes and Comments
288SF SOLID PATIO COVER AT REAR YARD
[ENGINEERED]. THIS PERMIT DOES NOT
INCLUDE ELECTRICAL, MECHANICAL', OR
PLUMBING INSTALLATIONS. 2010 CALIFORNIA -
.BUILDING CODES.
July 18, 2012 4:57:22 PM AORTEGA _
------------------------------------------------------------------
Other Fees . . . . . . . BLDG STDS.ADMIN (SB1473)
1.00
STRONG MOTION (SMI)• - RES
.50
Fee summary Charged Paid Credited
- =-- - - - - - - - - - - - ------ - - - - ------ - - - - ------ - - - - ----
Due
-- - - - - --
P.ermit Fee Total 63.00 .00 .00
.63.00
Plan Check Total • 40.95 .00 .00
40.95
Other Fee Total 1'.50 .00 .00
1.50
Grand Total 105.45 .00 .00
105.45
LQPERMIT
r
Bln.#
K
Of La Quanta
Bultding 8r Safety Dlvtsl*on
P.O. Box 1504,78-495 Calle Tampico
La.Qulnta, CA 92253 -:(760) 777-7012
Building Permit Applrcatron and Tracking Sheet
Permit #
yI
Project Address:�-1 -9
A
Owner's Name:. uS-31414.
S
A. P. Number.
Address: .57.
Legal Description:
City, ST, Zip:
Telephone: �—
Contractor. /�
Q
Address:
Project Description: one • VMA QPc,{M
City, ST, Zip:
Telephone:
State Lic. # :
r.
City Lic. M
Le
r � it
Arch, Engr., Designer.
Address:
0 6 `t RI)
City, ST, Zip:
-a
j�
Vq sit P rco+
Telephone:
State Lic. #:
w:.
1
, �j�»� '.
Construction Type' Occupcy:
an
o
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
•�
Sq. Ft.:. a
# Stories: i
# Units:
Telephone # of Contact Person:
— (j
Estimated Value of Project: goo. s�
It Submittal Rey'd
APPLICANT: DO NOT WRITE BELOW THIS UNE
'Reed TRACKDNG ' PERMIT FEES -
Plan Sets
3 Plan Check submitted `5�� it.
Amount
Structural Cafes.
p? Reviewed, ready for corrections. Plan Check Deposit. .
Truss Calcs.
RA
Called Contact Person `j Plan Check Balance
Title 24 Calci.
Plans pitked up Z.?! Construction
Rood plain plan
Plans resubmitted.: l Mechanical
Grading plan2s1
Review, ready to recti Cessue Electrical
Subcoutactor List
Called Contact Person b Plumbing
Grant Deed
Plans picked up M.I.
MOA. Approval
Plans resubmitted til Gradlog
•
IN HOUSE:-
1n° Review, ready for eorrectio VDeveloper Impact Fee
•
Planning Approval.
Called Contact Person A.LP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Rot P.
-
Total Permit Fees
511 �'//� 5��? . ,ems.
. Al
. b��'Ld�2 • Ns � � szti . AFt.
P.O. BOX 1504
LA QUdNTA; .CALIFORNIA, 92247=1504 BUILDING & S.AFETY DEPARTMENT
78,-49.5 CALLE .TAMPICO (760) 777-7012
LA QUINTA, CALiFORNIA:42253 FAX (760).777=7011
PR PER' Y O M� -E R'S .PACKAGE
Disclosures &Formslor Owner -Ba lid Applying for..Construction Permits
/MPS. UNTI NOT1€CF T[� L�R01PTtl TY QW�V R°
DMPioPeItY, Owner:., '
Ari. application for: a 6*tdiiig permit has been.. submitted .in your name i g yourself as the buildef of the :property
empr�o�emeatsapecificx#`at . , , ,
: vidmg you'•wWa4 Owner=Budder Aclmawledgmeat AIII&I.Afotinatieti VerifEFation.Form W wake you a .of your
40
ee�ensilulrties and yrossrble tisk you may incur by hgvtng thispermit is$ to jour name:as the
Ouvnes-8#rilder. We aoi Issue a 6iiiidlog permit anti! you have read, inif a y9ti r anderstanding of each provision,
signed,. and returned this form to -us At our otlidal 'address indicated. An agent of the owner cannot execute 1his•:notice
unless you, the property owner,'obtainthe prior approvaf of the. permiiiing.authority.
Read dnd anti ewe: stat�rrrer[t�'eetriev ti's gvufy you uiafei tcinrl' or ve ry d res ei�fon on
l..I understand a frequent practice of unlicensed persons is to .have the property owner obtain an "Owner -Builder"
building permit chat,erroaeo illyiimpl its that the propeity owner is providing his or her own labor and material pets naft.1, as
an Owner -Builder, may beheld liable and subject to 'senous.fmancial risk for.any`injuries sustained by an unlicensed person
and his or her. employees :whiteworking on my Property. 'My homedwrier's insurance niay not provide coverage for those--
injuries. I am willfully acting As.= Owner-Builder'and-ainaware of the limits of my insurance coverage for injuries to workers
on my. Piny.
j.5 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,responijbility.. .
3..I understand as an "O.wner-builder" I am_. * responsi6le.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.
11�5_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.
S S S. 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 "employer"
under state and federal law.
-.3-6. l .understand if I am considered an -employee,, , under state and federal- taw; I must register with the state -and federal
govermnent, withhold :payroll taxes, .provide workers' compensation disability iitstirance, and' contribute. ;to unen>ployment
compensation for each "employee:" t also understand my faihue. to' abide by these laws may, subject me to serious financial
risk
7. 1 understand under California Contractors'_ State License Law, an Owner -Builder who builds single-family residential
structures cannot .legally.,. Fiuild , them with 'the intent to. `off, er 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 ticensed general building Contractor.
8. I understand as an Owner -Builder if I sell the property for which this pernut is issued, I may be held liable for any
financial or personal. 40.gries sustained by any subsequent owner(s) that result from any latent construction defects in the
workmanship or materials.
—.39. I understand I may obtain more information regarding my obligations as an "employer" from the IntmMI ROWnue
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 (CSL13) at 1-
800-321-CSLB (2752) or www.csib.ca.gov for more information about licensed contractors.
IO. I am aware of and consent to anOwner-Builder building permit applied for in my name, and understand that I am the
party legally and 4naneially responsible for proposed construction activity at the following address:
agree that, as the party legally and financially responsible for this proposed construction activity,.[ will abide by all
applicable laws and requirements that govern Owner -)builders as well as employers.
12.1 agree to notify the issuer of this. form immediately of any additions, deletions, or changes to any of the information 1
have provided on this form Licensed contractors are regulated by laws designed to protect the public. U you contract with
someone who does not have a lieemr die Contractors' State License Board may be unable to assam you with any financial: loss
you may sustain as a result of a complaint Your only remedy against unlicensed Contractors may be in,oivil court. It is also
important for you to undmtand that if an w icensed.Centraewr or employee of that individual or firm is injured while working
on your property; you may be hold liable for damages. If you obtain a permit as Owner -Builder and wiih to him Contractors,
you will be reVMwblo for verging v&t&w or not those Contractors, we propcdy [ieensed and 'the status of dMir weAeW
compensation ina mmee oovenW.
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 issui4g 1ltoperrt�. Note: A copy, of the property owner's Mver!V f tent or
other veriTkadon acceptable to the agency is regu a to be presmaed when the pcvmmit is isswd to Va* the property
owner's signature.
Signature of property owner
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 OWNFR'S 13ER •)E<
Excluding.the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize
the following persons) to act as my agents) to apply for, sign, and file the documents necessaFy to obtain ari Owner-Buildet
Permit for my project.
Scope of Construction Project (or Description of Work): Ff4ww ®f
Project Location or Address: S(-sqS Ave vAr, Qq a #&-Z / - L-A OdA J6 CA QA12�3
Name of Authorized Agent:
Address of Authorized Agent:
Tel No(7&D 77-475 �O
I declare under penalty of perjurythat 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 o be ' � ed when -die perntit is issued to verify the property owner's signature..
Property Owner's Signature: � �i� Date: