13-1556 (PLBG)P.O. BOX 1504 VOICE (760) 777-7012
. c:i� �-,
78-495 CALLE TAMPICO �� FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 12/02/13
Application Number: 13-00001556 Owner:
Property Address: 54085 AVENIDA RAMIREZ JAVIER MAGALLON
APN: 774-211-016'-4 -000000- 5.4085 AVENIDA RAMIREZ
Application description: PLUMBING LA QUINTA', CA 92253
PropertyZoning: COVE'RES.IDENTIAL (760)777-9723
Application- valuation: 2.500
a _ Contractor:
Applicant: Architect•�or Engineer: Owner DEC
„= C17Y OF' l Pr QUINTA
_
FINANCE DEPT. • .
�b_ _ -- _ _ _- s ---------------- - - - ------- , •_ _
" y LICENSED CONTRACTOR'S DECLARATION-` .. - �rJr - - _ - : • _ WORKER'S COMPENSATION DECLARATION
hereb affirm under � pe, of'- er ur that I'am licensed:under- rovisions of Cha ter 9•Icommencin with. ,..- - I-hereb affirm"under7penalt of er'ur .one of.the-followin declarations
..y. P Y .P 1 V ,. P P _ 9 Y P Y,• P I V, 9 +�-=,
'•. - Sect{on-700%of Divisiom3 of(the Business_hand-Professionals Code;.and my License is'iri,fulH'G a and effect. _ _ 1 have and:will maintain'a certificate'of consent to self-in'su je for -workers' compensation, as provided
License Class: •-666nse.No -- ' - for tiy,Section'3Z00 of -the Labor-CoAe, for the performance-of.the:wark for which this permit is
r •issued
Date • ' :Contractor ' - - - 1 - Ii Piave and wdl maintain ;workers `compensation msurance,`as required b9Se6bon 3700 of.the-Labor'
Code foi ihe$p'rftrmance:of the work focwhich this permit is'issued. fvty, workers' compensation'
'OWNER -BUILDER -DECLARATION insurance carnerand-Policy,numberare: - - �,•-''
I hereby affirmunder�,penalty of-peryury that i:am exempt from theContractor?sState License law foithe .Carrier - - - - - - ------- - - - - -Policy Number
following. reason.ISec.-7031.5;'Business and`Professiohs Code: Any aty or,county that. requires.a.per&t to '.I certify that :in the performance of=the work for whicfi.this permit is issued Iahall not employ any'
. - ' - -.,
..;;construct 'alter improve ;demolish; or -repair any. structure .prior. to its issuance; also. requires the. applicant for..the - \�•' •person in -any manne;;so asto become subject to the workers compensation"lawsof. California, '
rr
- _: .-.
r - r' - n' r' ,,. h rf-li- I' me ub' t t '.the workers coin ensation rovisions ofSection•
permit to:file a signedstatementthat he•or she is�l�icensed pursuant�to the_prowsions of;fhe Cont acro, s,5tate and ag ee t at j ,•ws ; u d,beco-., s ler o _ p -. p
:-6 libw (Chapter9.,lcommencing with Section .700.0) of Division 3-of;the Business and Professions Code) or. _ 3700 -of t Labor;, o e-I:shalGforthwith comply with those, prov-isions.
' -tfiat he-or-,she.is exempt therefrom and the basis for the la leged exemption EAny wolation:of Section 7031 .5 by - - ', �. a,' ',r _� +., �' - •,-
-.'a yapplicant fora permit subjects the applicant to a civihpenaltyXof normoieahan five hundred dollars ($500G: t .w Date 0_1 ' �'Applicanr.-
"11 I;as
ow
of _the property; or my:employeeswith wagisas;therrsolecompensation wdl do-.the-work,-
.�; - ,.
,the structure is Pot me or offered forsaleiSec 7044 Business and Professions Code. -The WARNING FAILURE TO`SECU, ORKERS COMPENSATION COVERAGE:IS.,UNLAWFUL,..AND SHALL y -
- 'Contractors' State License Law does not apply to an'owner of"property who builds orimproves thereon,-. SUBJECT AN EMPLOYEil, G - INAL PENALTIESANO GIVIL.FINES:UP TO.ONE HUNDRED THOUSAND -
s�.;.,. .
�-
an h.
does the work:himself or �herself;thrdughthis' ocher own employees ;provided that the r DOLLARS ($100,000).- IN ADDITION TO'THE-;COST.OF COMPENSATION; DAMAGES AS PROVIDED FOR IN
improvements are not intended orioffered-for sale°-�If, however, th'e building or improvement is.,sold:within - SECTION3706 OF fHE:LABOR",CODE, INTEREST, AND ATTORNEY'SFEES. -
one'year of completion, the owner -builder. wili' have the burden of proving that he or sha did.not build br'-
. mprove.ffor•the.purpose of .sale,): , -, _ � , _ .. °.- .: -.., -a .,,. APP,LICANTsACKNOWLEDGEMENT:r„ a, _
I, as.owneuof the property;'am_exclusively contracting with licensed contractors to" construct the project (Sec. IMPORTANT Application is hereby made to_t, a 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 orimproves thereon, and who contracts for the, projects with a contractor(s) licensed 1 ., Each person upon whose behalf this application is made, each person at whose request and for
pursuantto the Contractors' Ste License Ldvw4.- - - whose benefit work is m
perfored under or pursuant to any permit issue& s a result of this application,
_&) 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
W 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.
Date:• Owner.'sy�` .. ../"tom 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 A NCY - permit to cancellation.
I hereby affiim under penalty of perjury a here is a construction lending agency for the performance of the I certify that I have read this application and state t t, e abormation is correct. 1 agree to comply with all
work for which this permit is issued (Sec.. 097, Civ. C.). city and county ordinances and state laws relating bu ove ding coninfstruction, and hereby authorise representatives
of this county to enter upon the above-mentioned, ope y for inspection purposes.
Lender's Name:- _ 4/��, % \1
Date�,(�� Signature (Applicant or Agent)
Lender's Address:
LQPERN11T
LQPERMIT
Application Number . . . . . 13-00001556
Permit PLUMBING 2013
"
Additional desc .
Permit Fee . . . . 11.92 Plan Check Fee..
.•00
Issue Date . . . . Valuation . . .
. 0
Expiration Date .. 5•/31/•14
Qty Unit Charge Per
Extension
1:00 11..9,200 EA PLBG BUILDING -SEWER
11.92
Special Notes ,aiid Comments
-
SEPTC ABANDONMENT"AND'SEWER CONNECTION:
_
2010_ICALIFQRNIA BUILDING CODES:.
•---------------------------- - - -- ---------- - - - - -- ----
Other Fees . . . . . . PERMIT.ISSUANCE�.;M/P/E
-------------
.. 90.57
PLAN CHECK;` PLUMBING..
4.77
Fee summary .- Charged' Paid Credited..
Due
Permit -:Fee Total 11.92 -00 .00
13.'92
-
Plan Cheek Total.00: :•00 ,.00
.00.
Other Fee 'Total 95:34: .00 00
95-34
- Gra 'a Total 107,..26. '. 00 . .,o,0
107...26..
LQPERMIT
M
Bin #
06' Of ` : a�Qyinb
Biiilding 8T Safety Division
P:O:`BOX 1504, 78 495 -'Calle Tampico
Permit #
J. I.
,SLP
{ La Quinta, CA 92253 ff 777 7012
,. ,
Building Permit°Application. andSheet
:Tracking
roject Address: 5' -Ib 95- A,V EP. l'P a .. 1 bwner's.Name U
A. P. Number: fi M 1 7L E .L. �'Address: LA h ( I
Legal Description:' City,7,21p: LA`v 1 CA . / Z ZS
Contractor. *" elephone '76 b.,, .7%7 7 57 2
Address: y.'" •6jOctDeseription:
/
City, ST, Zip: -00"5 % , A& A 14 0 /,j
Telephone:
P
<>:.<'s::>:#;s:>.::>;:; :;:: rg'
: :< <<; CO ,, NYS G
State Lic..# : ,•
p;,
City Lie # "
Arch., Engr., Designer: =
Address: a.
i
City., ST, Zip:
Telephone: Cons"Occupancy:
State Lic. #: E;:?it !fh•/. 1 .
{,:, F Project type (circle one) :,New . Add'n Alter Repan Demo
ane of Contact Person: /9 1/,j Q t''/�-( /-� �p f'f p ;Sq Ft.: #Stones: #Units:
Zeltphone #;of•Contact 'Person' : 7 --f
' 7 «7 ': �j� % Z fstimated Value of Project: Q
APPLICANT DO NOT WRITE BELOW THIS'LINE
ii
Submittal
Req'd
Recd ;
n "k -TRACKMG.
�' PERMIT. FEES.
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs:
Reviewed, ready•forcorrections ''
Plap Check Deposit
Truss Cala.
Called ContactTerson..
y
PIan*Check Balance.
Title 24 Cala.
Plans picked up
Construe_ tion
Flood lain; plan ...
P p
�'
Plans resubmitted
„Mechanical
Grading plan
20°.Review; re£dg forcorrections/issue
Electrical
Subcontactor List.
Called ContactPerson
Plumbing
Grant Deed
Plani picked up
S.M:L
H.O.A. Approval
Plans resubmitted'•`
;
`Grading
IN HOUSE: -
3rd Review, ready";for corrections/t
Developer Impact Fee
Planning Approval
Called Contact Person._. , •
A.LP:F:'
Pub. Wks. Appr
Date of.permit issue
School Fees
Total'PermitFees
}
.... .. .Y,_w - .. s..
J. I.
.. �... ._.... .. ..._ ...
.:1504
LA QUtNTA CALIFORNIA,92241-4504 $ ILDING 8i' SAFETY DEPARTMENT
78-495 CAtiE TAMP[Co.. (760)'117-7012
LA QUINTA, CALIFORNIA 92253 FAX (760) 7.77-7011
PROPER "YOWNER'ST KAGE
Disclosures. & Forms for Owner-BQild_ers Appi" 14 for Coastritc.0 ,Permits
RMOT'AIM — NUTIC� TQ gRQPERTi� OWhI�R
Dear'k?inperty Owner
Aa.: agplicatron for a building permit has been subautted; in your name ting .yourself as builder of the..property
impr�avenients specified at :...�. /O 5- ..}{ l/ r9 > -t 1,n E' Z /�- : :�'). ,�, C . CA 5— 2- LS 1
We are providing you with an Owner Buildcr:Aclknuwled
gment and Iaformatron Veli catrou Forrn to mike -you awam .of your
respowsbilifles:and posaable risk you mayincur•by laavug ih�s°.peraut issued' yot+rnaaie as;the
Q.Wnec•Builder. We will not -issue a braiding„perarit uutil;you have read; ihidaled your' uuderstanding 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.
O '� ACI i ED 2YT AND VE ATON b -WORM. N
CI_1_1. I 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 hei. own labor'and material persbnally.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, oR.my.propeity::My, homeowner',s•insuranoe may not. provide coverage. for those
mjudes• I am willfully acting as an Owner -Builder and ala aware of the limits of my insurance -coverage for injuries to workers
'on my property -
2. I understand building permits are not required to be signed by property owners unless they are responsible for the
construction and are.not.hirmg a licensed Contractor to assume this,responsibility..
understand as an. Owner Builder' I am the r risible of record on the rmrt ,I understand that I may protect
espo Party. pe_ .. , . y
myself from potential' financial risk by hiring a licensed Contractor `and having the permit`hi in lus of~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. ` ..
0-5. 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.
I, understand if I am considered, an "employer' under state1. and federal law, I must register with,the.state and federal
overnmen wr "
g t, • thhold payroll ;taxes, provide woiicers' .compensation. disabrhty :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 t e' 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 contractwith a licensed general building Contractor.
Ji!�__8. I understand as an Owner -Builder if I sell the property for which this permit is issued, I .may be he'd liable, for any
financial or personal. injuries sustained by any subsequent owner(s) that result from any latent construction defects in the
workmanship or materials.
(� -- 9. I understand I may obtain more information regarding my obligations as an "employer" from the I *=Rl 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.csib.ca.gov for more information about licensed contractors.
0 •^ 10. I 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 financi y responsible or proposed constructionactivi at the following address:
A /,I Lzr�
11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all
applicable 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
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, Bre Contractors' State License Board may be unable to i -you with any financial loss
you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in-avil 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 bell. liable for damages. If you obtain a permit as Owner -Builder and wish to hire COnb*ct r8,
You will be responsible for verifying whether or not those Contractors are properly licensed and the status of thtir woriccrs'
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. Ow permit. Note: A copy of tkc property owner's driver's l?eaaeset farm notarkat%rrt or
other verification acceptable to the agency is required to be presented when the permit is issued 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 conduction 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 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 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 owner's signature.
Property Owner's Signature: Date:
COACHE.LLA' VALLEY WATER DISTRICT
�QfSr�; P.D. BOX .10,58, COACHELLA, CALIFORNIA 92236 (760) 398-2651
INVOICE Dat6"112/2/2013
SUBJECT: SANTA CARMELITA, 54085 AVENIDA RAMIREZ, LA QUINTA,.LID 689886, "SCC FEE ONLY"
JAVIER MAGALLON . Project: 13-5051
54085 AVENIDA RAMIREZ Project Date: 12/2/2013
Amount Due: $4,851.00
LA QUINTA, CA 92253 GEO: 06-06-13-1
Planner: SANDRA VILLALOBOS
TO INSURE PROPER CREDIT" PLEASE RETURN THIS PORTION WITH
REMITTANCE AND'INCL'UDE THE PROJECT ON YOUR CHECK
1.00 FF SCC -COLLECTION
4$2,415`00 $2,415.00
1.00 FJ SCC -TREATMENT $2 436.001 $2,436.00
$4,851.00
DECO 2 2013
SUBJECT:SANTA CARMELITA, 54085 AVENIDA RAMIREZ, LA'QUINTA, LID 689886, "SCC FEE ONLY"
COACHELLA`VALLEY-WATER.DISTRICT
P.O. Box 1058, COACHELLA',.CALIFORNIA 92236"(760) 398-2651
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