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12-1055 (DSF)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 ceit!t 4 4 Q" BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Application Number: (`12-00001055 ) Property Address: 53275 AVENIDA RAMIREZ APN: 774-081-027- - - Application description: DEMO - COMML/OTHER Property Zoning: COVE RESIDENTIAL Application valuation: 0 Applicant: Architect or Engineer: D 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 (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 or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: / (y_ ) I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and i� 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, 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 contra for the projects with a contractor(s) licensed pursuant to the Contractors' State Licens aw.)• ' (_ 1 I am exempt under Sec. , B.& . . for his reaso Date:' caner: CONSTRUCTION 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: p LQPERMIT I VOICE (760) Ti FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 9/14/12 Owner: LINDSEY SCHNEIDER 53275 AVENIDA RAMIREZ LA QUINTA, CA 92253 --------------------------------- ----------------------------------------------- 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 for which this permit is issued, I shall not employ any person, in any manner so as to,e subject tot ' compensation laws of California, and agree that, if ould b me ubject to the orkers' com ensation provisions of Section Date:�y 3700 of th La r Code, hall f rthwith com y with those provisions. , L` 1� ppttEanr.. - WARNING: FAILURE TO SECURE ORKERS' 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. 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 i tion is co r ree to comply with all city and county ordinances and state laws relating to buil 'ng c strut on, and h.7 auth rize representatives of this county to enter upon he above-mentioned prope f ion purpos pb/. nature (Applicant or Agent): I Application -Number . . . . . 12-00001055• Permit . . . DEMO PERMIT Additional desc Permit Fee . . . . 45.00 Plan Check Fee .00 Issue Date Valuation 0 Expiration Date. 3/13/13 Qty Unit Charge Per Extension BASE.FEE 45.00 -------------------------------------- Special Notes and Comments ------------------ ----- --------- - - - - -- DEMO PERMIT TO REMOVE UNPERMITTED PLUMBING LOCATED IN GARAGE. RESTORE TO ORINGINAL CONDITION. " 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 .00 45.00 raA ra - vA VP k Pdrn wi� mt= P.O. BOX. 1504 LA QUINTA; CALIFORNIA 92247-1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SA.FETY DEPARTMENT PROPERTY OWNER'S PACKAGE (760) 777-7012 FAX (760) 777-7011 Disclosures & Forms for Owner-BaWers Applying for Co»struction Permits M- TA NTT I'IOTICF T P tQ�P1 ,TY 0�'VI R Dear Pl perty Owner. An. application .for a building pmt has been submitted in your ligi g yourself as the builder of lite .property nnpSovents specified at _ a 17 'fie am limyou with an Owner -Builder Acknowled you aware of your ... guient and. Informatien Verification Forth to. -.-.._ possible risk'vou may incur b� ia_vr�g this per�nir i=Pd :n , b as . Os Biulder_ We:will not issue a haildiag.perznH untileui have r y . cad, initWed your understanding of eachprovisioe, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute ",notice unless you, the property owner, obtain the prior approval of the permitting authority. ormaaion. v vfI _ I understand a frequent practice of unlicensed peasons is to have the property owner obtain an "Owner -Builder" building permit that erroneously implies that the property owner is providing his or lien 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 wiHfirllY acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers on y pmPerty- I understand building permits are not required to be signed by property owners unless they are responsible for the conshuction and are not hiring a licensed Contractor to assume this responsibility_ . understand as an "Owner -Builder" I am the responsible.party of record on the permit- I understand that I may protect in If front potential financial risk by hiring a licensed Contractor and having the permit filed in his .or her name instead of my own. v e-11 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. . derstand ifI employ �or otherwise engage any persons; other than California licensed Contractors, and the total value 4ozycrolunnstruction is at least five hundred dollars ($500), including labor and inaierials, I may be considered an "employer" under state and federal law. . gkunderstand if I am considered an "employee" under state' and federal law, I must register with rite state and federal emmerit, 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 risk. under California Contractors' State License Law, an Owner -Builder who builds single-family residential s tur!:understand 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. S I understand as an Oawner-Builder if l.sell the property for which this permit is issued, I nay be held liable for any financial or personal. [nj.aries sustained by any subsequent owner(s) that result from any latent construction defects in the wo anshi r-matenals. I understand I may obtain more information regarding my obligations as an "employer" 5rom the Imeial Revenue Service, the United States Small Business Administration, the California Department of Benefit Pzymehts, and the California Division.of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSL13) at I - 800-32 1 -CSLB (2752) or www.esib.ca.gov for more information about licensed contractors. Iam 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: that, as the party legally and fmaneially responsible for this proposed construction activity,.l will abide by all 4'aplT&le71iand requirements that govern Owner -Builders as well as employers. .411,J2"I agree to notify the issuer of this form immediately of any additions; deletions, or changes to any of the information l _ 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 asset you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors m€y be in`civil court. It is also important for you to understand that if an unlicensed.Contractor or employee of that individual or, 5= is injured while working on your property; you may be held liable f. damages. If.you obtain a permit as'Owner-Builder :end 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 issuing, the .permit. Nate: A copy of the property owner's My.er=.'s home; form notariVstinn; or other verification acceptable to the agency is'.required to be presented when the permit is sued to. verify the property owner's signature. Signature of property Qw! er I Q Date: 02 Note: The following Authorization Form is required to be completed by the property ormer only when designating an agent of the property owner to apply for a construction permit for the Owner -Builder . AUTHORIZATION OF AGENTTO ACT ON PROPERTY OWNER'S BEHALF Excluding.the Notice to Property Owner, the execution of which t understand is my personal rewoiisibility, I hereby authorize the following person(s) to act as. my agent(s)to apply for, sign, and file the documents necessar-_ to obtain an Owner-Buildet Permit for my project. ' 1 I Scope of Construction Project (or Description of Work): U i � t1. "iwt,11 I i x Project Location or Address: Name of Authorized Agent: Tel No / Address of Authorized Agent: I declare under penalty of perjurythat I am the property owner for the address listed above ane. I personally filled out the above information and certify its accuracy. e: A copy of the owner's.driver's license, form notarization, or other verification acceptable to the agency is req ' ed C e'resented when the permit is issued to verify the property owner's sigiiati re.. Property Owner's Signa y ^ Date: O r , 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 -Builders Applying for Construction Permits IWATORTANT! NOTICE�T41P)4tOpEgTy OWNER Dear Property Owner. An. application for a building permit has been submitted in your name listing yourself as the buildeF 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 indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OFD'S AC 40WLEDG NT AND VEftH CAT10N OE II 1 CMN DIRECT7.ONS. Read and initial each.: statement betow to signify you understand or verify this information. 1. 1 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 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 property - 2. 1 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 - 3. 1 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. , 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. y t. 5.1 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. 6. 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 risk. 7. I understand 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 four' within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. C j,vr ysr:.u��+ . sir-.:ri.t 1 ttTSi..-• •rl �. K...t. d.. y} ..+} 4.{;. _• }�,;;a 1�Y? �tf -.� r x { y^et' t(, .:+; Lw � ,.j- 4'. t�.�• E '_ 2 x.r F -� ' .. 7 •'p - '1r .4 t�..rw �' - ,x. cr a ` 1 •,, f _ L1.SY;. •ES � i t ,,�Cr't2� f� tY�,�� R,t �. �, . ��f i�� � �.: ,,,.Y. _ ' yam, t i v +.« .� . r ire t c rs'1':! d2, � :14r y - wE: si. � �'a' t - r{r`:�#�y��r+ yf i4 .i� . �,t 14. F� 3 '1S � ,C ••�' k 'S i t." 'xy C'�'• a3` � � + � t {.: t �x ett�. A 1 .,+ ,.��C .i,.. #�,tr .�iF j 1 r. L.�.E �'t 1,} .''`' r , ' fit' «V -,L - 4! ` '3 a� .tl. r' r,+li r* i..+M y�tY rt' 4 .t �ii it•e. �.y iy.,��Tw�.�ry� 1 �,,` Tf,. � .lar i •.714 '•�: 'r. � ,�„ t . ..Y tr ?' ' w .ris �'. •pr Fes+,,, z fc, i%r =N �'.'-��' 'P00sY - x Bu r s Term and`Condittons cont'd �°�' •�> 4Property Address:- 53.2%5 Ayenlda RatmltreY; 0 Qui 'Cq 92733O APN: 774-081,027 • 1 r ; 1. t r r , i Y �, . d ;The - .` f } property owners) must obtain City of La Quetta+8uilding'and " ,. 1'. �Special inspection permit rior'to commen f ' ' P P cin demolition of garb` conversion. ' 2• Restore garage to building code standard of the original roostruton , ' .. date of 1987. Failure to resolve the violations within the 'time 4frame set forth v+i li #esuk in 1 enforcement action, which may include citation or other legal rerriedy.'}f ,-•""'' you have any questions, please contact George g Munoz at �76fJ) 777=7099, .or en�aR aft gmunoz(a�ta-auinta.ore � r Print Name: ; Dat K tint Name: ••t '•* +•//•�y' it t iy ♦ `r. 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Box 1504,78-495 Calle Tampico La.Quinta, CA 92253- (760) 777-7012 Building Permit Application' and Tracking Sheet Permit # Project Address: do !Y1 Owner's Name:. Address: . A. P. Number. Legal Description: Ci ST Zip: p: Contactor. V� fL � Telephone: M,„�s�r'�s. Address: Project Description: - City, ST, Zip: r Telephone: U- State Lie. 4: City Lie. #; Arch., Engr., Designer. Address: City, ST, Zip: Telephone: StateLic.#: . of Contact Person:Sq. 4),7 • ConstructionType• Occupancy: Project type (circle one): New Add'n Alter Repair DemoName Ft.: # Stories: #Univ Telephone # of Contact Person: o Estimated Value of Proj a",E/ APPLICANT: DO NOT WRITE BELOW THIS UNE # Submittal Req'd 'Rec'd TRACKING PEReLIfP FEES Plan Sets Plan Check submitted Item Amount Strgctural Cales. Reviewed, ready for corrections Plan Check Deposit. . Truss Cairs• Called Contact Person Plan Check Balance Title 24 Calci. Plans picked up Construction' Flood plain plan Plans resubmitted Mechanical Grading plan 2a6 Review, ready for correctionstiissue Electrical Subeontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. ILO -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