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11-1039 (PLBG)T4ht 4 P.O. BOX 1504 VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 9/27/11 Application Number: Mr11=_0000103 Owner. Property Address: 5!ee8;"�A NIDA RAMIREZ MICHAEL. MOJARRO APN: 773-165-024-12 -000000- 51987 AVENIDA RAMIREZ Application description: PLUMBING LA QUINTA, CA 92253 Property Zoning: COVE RESIDENTIAL n 1 Application valuation: 1000 ! il' Contractor. eW (0q 1 Applicant: Architect or Engineer: B B & . L INC. e `� t �} P O, BOX 6299 LA QUINTA, CA. 92248 CITY ,)FLA QiliiJ A (760).360-6631 €1i�ra?E:. r� . Lic. No.: 927558 Ak- --------_----- -- LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION . I herebyaffirm under penalty.of perjury that I am licensed under provisions of Chapter .9 (commencing with I hereby affirm under penalty of `perjury one of the following declarations: ' - Section 7000) 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: A License No.: 927558 - for by. Section 3700 of the Labor Code,. for the 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 whicWthis. permit is issued. My workers' compensation OWNER -BUILDER DECLARATION insurance carrier and policy number are: ' I hereby affirm under penalty of perjury that I am"exempt from the Contractor's State License Law for the Carrier STATE FUND... - Policy Number :_2380011160 - followingreason (Sec.,7031 .5, Business and Professions Code: Anycity or couhty that requires a permit to - I certify that,'in 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 fne•applicant for the � � person in any manner so: as to become subject to the workers' compensation laws :of California,. permit fo 14,i -signed statement that he or she is licensed pursuant to theprovisions of the Contractor's. State p - and agree that; if (should becdme;subject.to the workers' compensation provisions of Section License Law. (Chapter.9 (commencing with Section 7000) of Division 3• of the Business,and Professions Code) or 3700 of the Labor ode, I shall forthwith comply with.those provisions. that he or she is exempt therefrom;and the basis for the alleged exemption. Any wolation.of Section 7031.5 by any applicant fora permit subjects the applicant to acivil penalty of not more than five hundred dollars (5500).:. A -cant: 1 1 1, as owner,of the property, or my•employees.with wages as their sole compensation, will do the work, and 10 the structure is nor intended or offered for sale (Sec. 7044, Business and Professions Code: _The - WARNING: FAIL RE TO SECURE WORKER$'°COMPENSATIONCOVER EIS UNLAWFUL, AND SHALL. Contractors' State License Law does not apply to an owner.rof property who builds or improves thereon; SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND.CIVIL FINES UP TO ONE HUNDRED THOUSAND and who does the work himself or herself through his or her own employees, provided that the - DOLLARS ($100,000)., IN ADDITION TO THE COST OF. COMPENSATION, DAMAGES AS PROVIDED FOR IN improvements are not intended or offered for sale. If, however, the building orimprovement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND;ATTORNEY'S FEES. ' 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`.). - - - 'APPLICANT ACKNOWLEDGEMENT ( I; as owner'of the property, am exclusivelycontracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety fora permit subject to the 7044, Business:and Professions Code: The Contractors' State License Law does not apply to an owner of conditions and restrictions,ser.forth on this application. `r property who builds or improves thereon, and who contracts for the projects with a contractors) 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 to any permit issued asa result of this; application, 1 _ I 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'act or omission related to the work being �— y _/•/� _ performed *under. or following issuance of this permit. - - te: C O e 2. Any permit issued as a result of this application becomes null and void if work is notcommenced 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. hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the I certify that I have read this application and state that the above iriformation is correct. I agree to comply with all work for which -this permit is issued (Sec. 3097, Civ. C.I. city and county ordinances and state, laws relating to building construction, and hereby authorize representatives of this c ty to enter upon thea ve•mentioned pro spec[ionpu oses. Lenders Name: � _/ e: 'Jig' re (Applicant or Ag nq: «G Lender's Address: PC /01 LQPERMIT Application Number . . . . . 11-00001039 Permit . . . PLUMBING SEWER Additional desc . Permit Fee 30.00 Plan Check Fee .00. Issue Date Valuation . . . . .1000 Expiration Date 3/25/12 Qty Unit Charge Per Extension BASE" FEE 30.00 ------------------------------------------ Special Notes and Comments --------------------------- SEPTIC ABANDON, SEWER CONNECT. 2,010 CODES. ---- ---- - -----Other,-Eees ,, BLDG-.STDS ADMIN:-(SB1473) Fee summary. Charged Paid Credited' Due Permit .Fee` Total. 30,.00 00. .0.0 3.0•.;00 Phan Cheek, Total 00..00 00 :00 '.Other.Fee'Total 1.00 .00 1.00 _.00. ,. Grand Tota.l .31.00 :00 ..00 31.O0 LQPERMIT COACHELLA VALLEY WATER DISTRICT pt�STtik P.O. BOX 1058, ­COACHELLA, CALIFORNIA 9.2236 (760) 398-2651 INVOICE ''Date: 5/26/2011 SUBJECT: 51987 AVENIDA RAmIREZ, LA QUINTA MICHELE MOJARRO Project: 11-2958 51987 AVENIDA RAMIREZ Project Date: 5/26/2011 Amount 'Due: $4,231.00 LA QUINTA, CA 92253 GEO: 06-06-01-4 Planner: REBECCA MILWARD TO INSURE PROPER CREDIT, PLEASE RETURN THIS PORTION WITH REMITTANCE AND INCLUDE THE PROJECT ON YOUR CHECK - -=----------------------- 0 .SUBJECT: 51987 AVENIDA RAMIREZ, LA QUINTA COACHELLA VALLEY WATER DISTRICT P.O. BOX 1058,.COACHELLA,',CALIFORNIA 92236 (760) 398-2651 Pagel W P.O. Box.,J'504 LA QUINTA"%CALIFORNIA 92247-1504 BUILDING & SAFETY DEPARTMENT 78-495 •CALLE TAMPICO (760) 777-7012 LA QUINTA, CAOFOPMA 92253 FAX. (760) 777-7011 PROPERTY OWNER'. S PACKAGE Disclosures & Forms for Owner-B.uil'ders Applying for Construction Permits !11lPfliK�ANT! NOTIG� O IPRO OEM QV�°NER Dear Property Owner. Ag. application for a building Permit', has been submitted . in your name yourself as ,the builder of the property improwements.specified at �C—' moi: ln.rC�, riles L U2 c y., tc �.1 We are providing you wrth'an Owner Builder AcknaW[Wgml nt and;Infotmati©n Veiifieation Foran to make you avvane of your r+espaasrbilities and possible risk you may incur byhaym . this permit issaed in your na�e.as the. Owner -Builder. We •�vi11 not issue.a buil per rit:unti[ you strive read, hddaW:your. understanding of each provision, signed, and returned this form to us at our ofliciai. addreis indicated. An agent of the owner cannot execute this notice unless you, the ProPeih' owner, obtainthe prior approval of the. permitting authority. MAECi70NS. Read.ai d dniiial eack statement below tv signify you understated or veitfy diis it fonmadon. I understanda frequent practice. of unlicensed persons. is to .have the property owner obtain an "Owner -Builder" building permit that erroneously'implies that..the.pr'operty owner is providing his or�her own labor and material personalty. I, 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'homeownerIs 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 pooperty. �. 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 Conuwtor-lto assume this responsibility. I understand as an "Owner -Builder" I am theresponsible patty of record on the permit i understand that I may protec myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of m. own. ' -. 1 understand Contractors are required by. taw to be licensed and bonded in California and to list their license numbers e permits and contracts.. P' 5. 1 understand if 1 employ or otherwise engage any, persons, other'than California licensed Contractors, and the total va i of my construction is at. least five hundred dollars ($500), including labor.and materials, II may be considered an "employ under state and federal law. lL ►' • 6.% c understand if I am; considered' an ." , . 10 vin- the stake a� fed emp yer" under state and federallaw, i must. register government, withhold payroll taxes,. provide woriEers' compensation disability insurance, and contribute to uaemployn compensation for each "employee." I also understand my failuie to abide by these laws may subject me to serious final risk. &)L7. 1 understand under California Contractors' State License- Law, an Owner -Builder who builds single-family reside structures cannot legally build them with the intent to . offer them for sale, unless all work is performed by lice subcontractors and the number of structures .does not exceed four within any calendar. year, or all. of the work is perfo under contract with a licensed general building Contractor. 8. I. understand as an Owner -Builder if I sell the property for -which this permit is issued, [may be held liable for any fin cial or personal igjaries sustained. by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. a 4.9. 1 understand I may obtain more, information regarding' my obligations as an "employee `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 I. 800--321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. O,,I0. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the ply legally and financially responsible ' for proposed construction activity at the following address: 1 t I mise 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..f agree to notify the issuer of this form immediately of any additions, deletions, or [Manges 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, 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 umlioensed Contractor or employee of that individual or fine is injured while worlang 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 whedw or not those Contractors aie..ptope ly limed and the status of their workers' compensation iWtuanoe 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 issuirig.Me.permiL Note: A copy of the properV owner's drirer'z< fes' no n3 or other verification acceptable to the agency is reequimd to be pieeserrted when tke permit is in ued to verify the property owner's signature. Signature of property o �� 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_OVVNXWS BIMMLF Excluding the Notice to Property Owner, the exewtion of which I understandis my personal responsibility, I hereby authoriz dhe following person(s) to act as my ageat(s) to apply for, sign, and file the doctiments necessaFy 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 a accuracy. e: A copy o e owners drivers ticense, farm n 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: 8. Lunderstand'as an Owner Builder_if I 'sell the,property;: for which this "pernut is issued I may be held liable for: any fin al or peisonal p�orres: sustained by, any subsequent ownei(s)"that result from any latent construction defects in the worlamanshtp or`matenils: r 9. I. understand l may obtain more mfor'mation regarding' my obligations as an "employer" `from the [ateraal',Itevenue : Service, the Uriited States Small."Business-Admi istration, the Cahfomia Dep Service, Payments, and the California Division of Industnal,,Accidents ' l also understand I may contact the: California Contractors' State License Board (CSLB) at I- S (2752) or www.csib.ca.gov'for more info"rmation.about licensed contractors. (//" lo. I am aware of and consent to an Owner-6uifder buildirigepermit applied. for in my name, and understand that lam the .party . legally and financially responsible _fore. proposed construction activity at the following address: l I U.`I agree that; as the party'1�gally and' financially respgnstble forjthis proposed construction activity, I will abide by all applicable laws and requirements.that govern Owner Builders as wellas 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 •contiactors are ,regulated-by:la'ws. designed to protect the public. If you contract with someone who does'not have a lice e, the Cont actors'_State License &o 'mon aybe unable to assist ywith' any financial loss you may sustain as •a iwult of a, complaint Your only remedy against unlit OW& ontractors may be in civil court It is also important for You to: urideistand that if an tuthceased Cccintractoi or eanployce'of thaR:individual or frim is injured while wortang on your property you,may be BeM liable for damages: If you�obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible for,verif i whether or rM,'&Ose Contractors are.om' exty`_liceased 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 -prop" owner "d returned to the agency responsr6ie for issait g.,dW permit.I.Note:"A. copy of the;proper;y ow►ier's rer'atiflert farm notadoa rA m other, verifu anon acceptable td. -&0 agency"%s regi reQ to 'be' prdsente'dY whang tfie permit is greed m reFify ;the property owner's signature. Signature of property Date: Note: The following Authorization Form is required to be cgrrrpleted by the property owner only when designating an agent of the property'owrier to apply for a construction permit for. the Owner -Builder. AUTHORIZATION'OF AGENT TO ACT -TONJ? OWNER'S BXH�F Excluding die Notice to Property Owner the'execution of which I understaiiii is:iny personalresporisibihty, I hereby authoriz the following persons) to act as my agent(s)'tis apply for,,sign,,and Ale the documents necessary to obtain an Owner=Builder Permit verify the property owner's signature. Propert Date: Bin. # • .. City of La- Who ' Buiiding'g Safety Divition. P.O Box 1504,78495 Galle Tampico, La.Quinta 04 92253 - (760) 777-7012 . Buildrng Perm t:MD11tation-and Tracking Sheet Permit # Froject,Address: = Owner's Name:: r r o A. P. Number. AddcOSS: Legal Description:. -City, ST, Zip: Contractor: lez— 14 C' Telephone: 66 2o eo r Address: 1?O If'o �i Z Project Description: 1 � City, $T, Zip: r e0� Telephone: leo ,30 9gY/ 1 e-zv - � State Lie. # : Z 7. S'"_: City Lic. #c Arch., Engr., Designer: Address: City., ST, Zip: Telephone: State Lic. #: Name of Contact Person: GonstruWoti Type; Occupancy: Project type (circle one): Now.,Add'n Altei. Repair Demo Si. F,: # Stories: # Units: Telephone # of Contact Person: P G •Estimated, Value ofProjeefi APPLICANT DONOT.WRITE BELOW THIS LINE N •Sobmlttal Req'd Recd � �' IRAG PEPJAW FEES' Plan Sets Plan Check submitted' Item Amount' Structutal calm. Review, ed, ready for correcdoas� . Plan Check Deposit, . Truss Cake. Called.Cantact Person Plan Check Balance Mde 24 Cales Plans picked up . Construction ' Floodplain plan Plans. resubmitted.. Mechaelcal Grading plan 2i6 Review, ready tot corrcetioumssue Electrical Subeoatactor LisE Called Contact Person Plumbing, Grant Deed Piens"picked up Approval Plans resubuiltted .. `. Grading IN HOUSE- '`° Review, ready for correetionsAssue Developer Impact Fee Planning Approval.Called, ontact`Penon AA.P.P. Pub. Wks. Appr ' Date of permit issue School Fees 4 Total Permit Fees