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BPLB2017-005778-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application Description Property Zoning: Application Valuation: Applicant: I DAVID HAMRY 53190 AVENIDA RAMIREZ LA QUINTA, CA 92253 BPLB2017-0057 53190 AVENIDA RAMIREZ 774052010 HAMRY RESIDENCE / SEWER $500.00 T4'r4lwQ�f DESIGN & DEVELOPMENT DEPARTMENT BUILDING PERMIT �©NNECT n n • D LL1�\ lul 2 2UJ17 CITYOFLAQUINTA ! COMMUNITY DEVELOPMENT DEPARTMENT 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 Professions Code, and my License is in full force and effect. License Class: _ License No.: Date:, �ConVattor: l­� 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 Divisio 3 of.the Business and Professions Code) or that he or she is exempt therefrom and th� basis fthe alleged exemption. Any violation of Section 7031.5 by any applicant for a it bjects the applicant to a civil penalty of not more than five hundred dollars VII)II,'Jisowner of the property, or my employees with wages as their sole 7compensation, 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.). I )1, 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 cont reaso%n icensed pursuant to the Contractors' State License Law.). ( ) I am exemptunder Sec. . B. fNc or this T, CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending aj the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's f Lender's / VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 4/12/2017 Owner: DAVID HAMRY 53190 AVENIDA RAMIREZ LA QUINTA, CA 9253 Contractor: OWNER/BUILDER: Llc. No.: 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. 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 ndb ch this permit is issued, shall not employ any person in any manner so a to becbject to the workers' compensation laws of California, and agr "if I shoome subjecttotheworkersf� compQnsation provisions of Se ion A00 of thCodeI shall forthwith complyjn�ith those proyjslpns. P WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLA F AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES U O 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. APPLICANT ACKNOWLEDGEMENT IMPORTANT: Application is hereby made to the Building Official for a permit subject to the conditions and restrictions set forth on this application. 1. Each person upon whose behalf this appliotion 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. that I have read this app ' ion and state that the above information is correct. to comply with all citylrnd c my ordirrances and state laws relating to building :tion,land hereby aut orize r presentafive,SQf this city to eg4er upon the v A, Date: 4/12/2017 Application Numb , BPLB2017-0057 Owner: Property Address: 53190 AVENIDA RAMIREZ DAVID HAMRY APN: 774052010 53190 AVENIDA RAMIREZ Application Description: HAMRY RESIDENCE / SEWER CONNECT LA QUINTA, CA 92253 Property Zoning: Application Valuation: $500.00 Applicant: Contractor: DAVID HAMRY OWNER / BUILDEF. 53190 AVENIDA RAMIREZ LA QUINTA, CA 92253. Lic. No.: Detail: t l 1. v z*, v•r FINANCIAL INFORMATION DESCRIPTION • .® • BSAS SB1473 FEE 101-0000-20306 0 $1.00 Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: '$1.00 DESCRIPTION ACCOUNT QTY AMOUNT PERMIT ISSUANCE 101-0000-42404 0 $96.27 Total Paid for PERMIT ISSUANCE: $96.27 DESCRIPTION ACCOUNT QTY AMOUNT BUILDING SEWER 101-0000-42401 0 $25.33 DESCRIPTION ACCOUNT QTY AMOUNT BUILDING SEWER PC 101-0000-426000 $17.73 Total Paid for PLUMBING FEES: $43.06 DESCRIPTION ACCOUNT QTY AMOUNT TECHNOLOGY ENHANCEMENT FEE 502-0000-43611 0 $5.00 Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00 TOTA 0 f 0 r , Bin 6 <. City. of Guifdinn & Safety Division ` Permit ;' - 78-495 Calle Tampico La Quinta, CA 92253 --(760) 777-701.2 . rl�'> oject Add,,,,.`, building Permit Application and Tracking beet. [ `O�vI s Na,_n�c' A. P. Number: 0 tiff 2� Address: S t Legal Description: City, ST, Zip: i �Cont �J1�j Telephone: Address: i 'Project Description'.'��� City, ST, Zip: ' Telephone: ^ State Lic. # : City Lic. #c + Arch.,'Engr., Designer: f =• , i Address: City, ST, Zip: e F ne: Telephone: n TY e: Oecu an , Construction P Y S t L State Lic. #:M. Alter Repair d'n A Dem 'r e one), New pro'ect Ad o e cI d o P tyc ) J P !Name of Contact Person: —� S� Ft.: 4 # Stories: . i # Units: �--_ _, , _ Telephone-# of Contact Person: — — -(3NJ 'Estimated Value -of project:_ �- tl Submittal Req'd APPLICANT: DO NOT WRITE BELOW THIS LINE , Rcc'd TRACKING PERMIT FEES ' Plan Sets } Plan Check submitted Item -- Amount- Structural Cafes. 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 S , Grading plan 2°" Review, ready for correclionsfissue Electrical ' Subcontact'orList �, Called Contact Person Plumbing Grant Dced a Plans picked up S.M.I. _ H.O.A. Approval Plans resubmitted 1 Grading .' IN ROUSE:- „' Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.T.P.P. Pub. Wks. Appr Date orpermit issue School Fees, • .1: •• a � 1, - -� .. • , h • i 1 otal Permit Fccs , Tldf 1 4 41 a9w, P.O. Box 1504 LA QUINTA, CALIFORNIA 9.2247-1504 BUILDING &SAFETY DEPARTMENT 78-49.5 CALLE TAMPICo (760) 777-7012 LA QUINTA, CALIFORNIA 92253 i FAX (760) 777-7011 PROPERTY OWNER'S PACKAGE. Disclosures & Forms :for Owner -Builders Applying for Construction Permits IMPORTANT! NOTICE TO PROPERTY OWNER Dear Property Owner: An application for a build:n ` peimit has been submitted inour name listing yourself as the b•iilder of the property improvements specified at / A`t/ (di¢ ,4 j egg t Z 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'issue&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 VERIFICATION20F MFORM•ATroly and initial each statement below to signer you understand or verify this information: I I�..I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder" ui ding permit that erroneously implies that the property'owner is..providing his or her own labor and material personally. I, as an Owner -Builder, may beheld 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 inj s. I am willfully acting as an Owner -Builder and am -aware of the limits of my insurance coverage for injuries to workers o " property. C 2. I understand building permits are not required to be signed by property owners unless they a.e responsible for the o traction and are not hiring a licensed Contractor to assume this responsibility. 3. I understand as an "Owner -Builder" I am the responsibleparty of record on the peranit. I understand. that Imay protect myself from potential financial risk by hiring a licensed Contractor and having the pen''mit it filed in his or her name instead of my Do 4. I understand Contractors are required b law to be licensed and bonded ded m California and to list tlicir license numbers on e •ts and contracts. 5. I understand if I employ or otherwise. engage any persons, other than California licensed Contractocs, and the total value f y construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" r 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 g v mment, withhold payroll taxes, provide workers' compensation. disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure risk. to abide by these laws may subject me to.serious financial 7. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential ctures 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 financial orpersonal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the Vwor anship or materials. P understand I may obtain more .information regarding my obligations as an "employer" from the Internal Revenue 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- 800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. 10. I am 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: :5316f 0 14.r EV 104 RA tot rr -Z J 11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all qpplhave able laws and requirements that govern Owner -Builders as.well as employers. 12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I rovided 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 insurance coverage. Before a building permit can be issu , this form must be completed and signed by the property owner and returned to the agency responsible for issuing thpp mit. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptabl the en is required to be presented when the permit 's is ed 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 as my agent(s) to apply for, sign, and file. the doduments 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: No 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 owners signature. Property Owner's Signature: Date: jp ` E''k, COACHELLA `VALLEY WATER DISTRICT. P:O: BOX -1058, COACHELLA,. CALIFORNIA 92236 (760):398-2651 , INVOICE bate: 4/11/2017 SUBJECT: SANTA CARMELITA, 53190 AVENIDA.RAMIREZ, LA;QUINTA, LOT 15, LID 686898 **.SCC ONLY.**.• g ' HAMRY; DAVID J.• Project: f 17-7926 53190 AVENIDA RAMIREZ Project Date:. Amount Due: , .. $4;851.00 ` LA QUINTA, CA 92253'GEO: 06-06-12-4 +_ Planner: RUBEN MONTIEL" TO INSURE PROPER CREDIT, PLEASE RETURN THIS PORTION WITH REMITTANCE AND INCLUDE THE PROJECT ON YOUR CHECK B,10 • ! • • • • i 1.00 FF SCC-COLLECTION $2,415.00' $2,415.00 1.00 FJ SCC-TREATMENT. $2,436.00 $2,436.00 .. ", • r , $4,851.00' °PAID $G� C7 >.. `Development Services Department ARR 11.. 2017. h f Coachella Valley Water District Y f x 75=515 Hoyley Labe East. <, r >! Palm Desert, CA 92211" , P1.10. 60X -1058, COACHELLA, CALIFORNIA 92236 (760) 398-2651 rt Page 1