10-0950 (AR)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 10-00000950
Property Address: 52415 AVENIDA BERMUDAS
APN: 773-275-017-7 -000000-
Application description: ADDITION - RESIDENTIAL
Property Zoning: COVE RESIDENTIAL
Application valuation: 24635
c&ht 4 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Applicant: Architect or Engineer:
IKG[. 4::kWA F+S IC�ie4oA/f_--3-
C119 -f/
Owner:
LOPEZ JOSE
52415 AVENIDA BERMUDAS
LA QUINTA, CA 92253
Contractor:
Owner
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 1/11/11
------------------------------------------------------------------------------------------------—
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with I 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: License No.: for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
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).:
(_) 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
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.).
(_ 1 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 contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
( 1 I am exempt under Sec. , B.&P.C. for this reason
Date: x11761201/ 49:"owner:
I hereby affirm under penalty of perjury that there is a cor
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name: _
Lender's Address:
LQPERAIIT
19DING AGENCY
lending agency for the performance of the
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 become subject to the workers' compensation laws of California,
and agree that, if I should become subject to the workers' compensation provisions of Section
3700 of the Labor Code, I shall forthwith comply with those provisions.
Date: Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS 1$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 information is correct. I agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of this co my o enter upon the above-mentioned proper or inspection purposes.
Date;% �A Z01 ignature (Applicant or Age
�i.
LQPER\1IT
Application Number . . . . . 10-00000950
Structure Information
Construction Type . . . . . TYPE V, UNPROTECTED
Occupancy Type . . . . . DWELLG/LODGING/CONG <=10
Other struct info . . . . . CODE EDITION 2007/08 ENERGY
# BEDROOMS 1.00
FLOOD ZONE NO
PATIO SQ FTG 433.00
1ST FLOOR SQUARE FOOTAGE 330.00
----------------------------------------------------------------------------
Permit . . .
Additional desc .
Permit Fee . . . .
Issue Date . . . .
Expiration Date.. .
BUILDING PERMIT
252.00 Plan Check Fee . . 163.80
Valuation . . . . 24635
7/10/11
Qty Unit Charge Per Extension
BASE FEE 45.00
23.00 9.0000 THOU BLDG 2,001-25,000 207.00
----------------------------------------------------------------------------
Permit ELECT - ADD/ALT/REM
Additional desc . .
Permit Fee . . . . 26.55 Plan Check Fee 6.64
Issue Date Valuation . . . . 0
Expiration Date 7/10/11
Qty Unit Charge Per Extension
BASE FEE 15.00
330.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY 11.55
----------------------------------------------------------------------------
Permit . . . MECHANICAL
Additional desc . .
Permit Fee . . . . 39.50
Issue Date . . . .
Expiration Date . . 7/10/11
Plan Check Fee
Valuation . .
9.88
0
Qty
Unit Charge
PerExtension
BASE
FEE
15.00
1.00
9.0000
EA
MECH
FURNACE <=100K
9.00
1.00
9.0000
EA
MECH
B/C <=3HP/100K BTU
9.00
1.00
----------------------------------------------------------------------------
6.5000
EA
MECH
VENT FAN
6.50
Permit . . . PLUMBING
Additional desc . .
Application Number . . . . . 10-00000950
Permit . . . . . . PLUMBING
Permit Fee . . . . 36.00 Plan Check Fee 9.00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 7/10/11
Qty Unit Charge Per Extension
BASE FEE 15.00
3.00 6.0000 EA PLB.FIXTURE 18.00
.1.00 3.0000 EA PLB WATER INST/ALT/REP 3.00
----------------------------------------------------------------------------
Special Notes and Comments
330 SF BEDROOM ADDITION & 433 SF COVERED
PATIO ADDITION TO REAR OF EXISTING SFD
PER ENGINEERED PLANS.
R-3 OCC. TYPE V -B CONSTRUCTION. 2007
CODES. 2008 ENERGY
----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 2.00
ENERGY REVIEW FEE 16.38
STRONG MOTION (SMI) - RES 2.46
Fee summary
-----------------
Permit Fee Total
Plan Check Total
Other Fee Total
Grand Total
LQPERDLLT
Charged Paid
354.05 .00
189.32 .00
20.84 .00
564.21 .00
Credited Due
.00 354.05
.00 189.32
.00 20.84
.00 564.21
cl—n—c0 bc'k
Bin #
Permit # n
10'
A. P. Number:
Address:
City, ST, Zip:
Telephone:
State Lie. #
Arch., Engr., Designer.
Address:
City, ST, Zip:
Telephone: 10
State Lie. #:
Name of Contact Pe i
Telephone # f Contact
It Submittal
Plan Sets
Structural Coles.
Truss Coles.
Title 24 Coles.
Flood plain plan
Grading plan
Subcontactor List
Grant Deed
H.O.A. Approval
M HOUSE: -
Planning Approval
Pub. Wks. Appr
School Fees
City of La Quinta
Bullding 8r Safety Division .
P.O. Box 1504, 78-495 Calle Tampico
La Qlrinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Name:
Project_De§cxiption:
t
City Lic. C �G �' 7
t- G -Ppt- 17r". &91 OLAM-o, .
' L
Construction Type: Occup
Project type (circle one): New tdd' Alter Repair Demo
QL(I(, Sq. Ft: O # Stories: # Units -
RE— ue
nits:Eted1Value of Project: 9 a"
LI NT: DO NOT WRITE BELOW THIS LINE
J'Rec'd TRACKING PERMIT FEES
3 Plan Check submitted ` Item Amount
Reviewed, ready for corrections ID Plan Check Deposit
Z Called Contact Person Plan Check Balance. V
Plans picked up ;v- Construction
Plans resubmltied f Z Mechanleal
2'' Review, ready fo correction ue /) p Electrical
Called Contact Person N Plumbing
Plans picked up �) �ai gni. 00
Plans resubmitted i Z 5
'nd Review, ready fo orrectioa ssue Ai tv Developer Impact Fee
Called Contact Person-�^ ` A.LP.P. w i090
Qf(A tip .�li�l"A 1h.
I '�, 0 1�S5rLaQ_ I r l f
/If t Total Permit Fees
Ate-
/.2116' z/ 21 54V 12 Z I �7
►,�,� �� - � -� JUS � yr
P.O. Box 1504
LA QUINTA, CALIFORNIA 92247-1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
PROPERTY OVNER'S PACKAGE
(760) 777-7012
FAX (760) 777-7011
Disclosures & Norms for Owner -Builders Applying for Construction Permits
'fAmn1 NOTICE 19 PRQI°IMW ovvtv>�R
Dear Property Owner.
An. application for a building permit has been submitted m your name listing yoursetf as the bnilder of the property
inspPovements specified at _
We are ps VKhng you with an Owner -Builder Acknowledgment and Information Verification Forth to make you awm of your
mspow"t►es and possible risk you may incur by having this permit ismd kin your name as the
Owner -Builder. We will not issue a building permit until you -have read, lamed your understanding of each PrOvisiion,
signed, and returned this form to us at our official address indicated. An agent of the owua cannot execute thas notice
unless you, the property owner, obtain the prior approval of the permitting authority.
0YENES ACKWYWLE1DGNMqT AND VER
AMN O MV01MA 17 -N
DMCT M. Read and initial each sratemmt— elbty to signify you undierstand or verify this 00"" 60`
�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 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 unlimscd person
aad 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 mX 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 hiring a licensed Contractor to assume this responsibility.
�3. I understand as an "Owner -Builder" I am fire 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.
t�, - .. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on
permits and contracts.
1�-L5. 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"
wader 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
government, withhold payroll taxes, provide woikcers' 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. 1 understand under California Contractors' State License Law, an Owner -Builder who builds single-family residentia
starctures cannot .legally build them with the intent to offer them for sale, unless all work is performed by licensee
subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performe,
under contract with a licensed general building Contractor.
�L.8. 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 or personal. 4uries sustained. by any subsequent owner(s) that result from any latent construction defects in the
workmanship or materials.
I understand I may obtain more information regarding my obligations as an "employer" from the internal revenue 9.
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( 'LB) at 1-
800-321-CSLB (2752) or www.csib.ca.gov for more information about licensed contractors.
0. 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 financially responsible for proposed construction activity at the . following address:
1. I a&= 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.
Tr 12. 1 agree to notify the issuer of this form immediately of any, additions, deletions, or ciiwws to any Of theinformation I
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 assist you with MY fi mneiak 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 unliowsod.Contractor or employee of that individual or firm is is;pured 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 ver&iing whom or not those Contractors are prope€Iy Iiceand and the status of dick 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 isn" . We. penniL !Yore: A copy of du property owow s diiver.'v fibeftsei ferric not oAo<m or
other verification acceptable to the agency is required to be presented when the permit is issued to verify the ploperty
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 BERALF
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 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: T Acyc r�e Il rv-tudc\
Name of Authorized Agent: 1 2 Tel No r3-7�—
Address of Authorized Agent: tl� 33 70 V('C i A)7) t._J_UV
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, forms 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: %%t Date: �' f ZZ—�2!9111�
'L 8. 1 understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any;,
-("financial or personal. it}jaries sustained by any subsequent owner(s) that result from any latent construction defects in the
workmanship or materials. ,
Sr&. I 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 1-
800-321-CSLB (27 52) or www.csib.ca.gov for more information about licensed contractors.
0. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the
pay legally and financially responsible for proposed construction activity at the following address:
1. 1 agree that, as the party legally and financially responsible for this proposed construction activity, l will abide by all
applicable laws and requirements that govern Owner -Builders as well as employers.
b• 12.1 agree to notify the issuer of this form immediately of any. additions, deletions, or changes to any of the information I
ave 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 lkwse, die Contractors' State License Board may be unable to arm you with 1Y fiaancial 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 unlioesosed Contractor or employee of that individual or firm is injured while working
on your property; You may be Aeld liable for damagas. If you obtain a permit as Owner-Buildei and wish to hire Contractors,
you will be responskle for ver** why or not those Contractors are properly heensed and the status of their workers'
compensation insurenoe 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 is viag do permtt, Note: A copy of dw pvnperg* owner'sei''a hlmnmi famt Win+ er
other verification acaceptable to Eke agency is r+equa+ed to be presented when die permit is i hued 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 BEE ALF
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 agent(s) to apply for, sign, and file the documents nece%ary W obtain an Owner -Builder
Permit for my project.
Scope of Construction Project (or Description of Work): r- C9V ►i r d Re <er - - �' b b �^'� .
Project Location or. Address: 2yr_r-�,
Name of Authorized Agent. ` U�`(h ,c��n 1 Z Tel No
Address of Authorized Agent: j 5 -70 IiC c b47) L, rt t,yAl1�L Z� C for 9 q.2 C11 k
I declare under penalty of perjurythat I am the property owner for the address listed above and I personally filled out the abov
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: �_2 e�ll d
Date
10/22/10
No.
30840
Owner
Jose & Maria Lopez
Address
52-415 Avenida Bermudas
city
La Quinta Zip 92253
Tract #
Type
Residential Addition
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
47950 Dune Palms Road
La Quinta, CA 92253
(760) 771-8515
APN #
Jurisdiction
Permit #
No. of Units
Q BERMUDA DUNES r
Ln RANCHO MIRAGE
N INDIAN WELLS
PALM DESERT .y
LA QUINTA
QINDIO y�
O
773-275-017
La Quinta
1
Lot # No. Street S.F. Lot # No. Street S.F.
Unit 1 52415 Avenida Bermudas 330 Unit 6
Unit 2 Unit 7
Unit 3 Unit 8
Unit 4 Unit 9
Unit 5 Unit 10
Comments
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patiostwalkways, residential additions under
500 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile
homes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason:
Residential Addition 500 Sq Feet or Less
EXEMPT
This certifies that school facility fees imposed pursuant to
Education Code Section 17620 and Government Code 65995 Et Seq.
in the amount of $0.00 X 330 S.F. or $0.00 have been paid for the property listed above and that
building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued.
Fees Paid By Exempt - Julio Muniz Check No.
Name on the check Telephone
Funding Exempt
By Dr. Sharon P. McGehee
Superintendent
Fee collected /exem ed by On ilvrey Payment Recd ;0.00
—Over/IJ. °nder
Signature �o� _ .� .. . ,
M�
NOTICE: Pursuant to Government Code Section 66020(d)(1 thi will serve to notify you that the 90 -day approval period in which you may protest the fees
or other payment identified above will begin to run from the da on which the building or installation permit for this project is issued, or from the date on
which those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID without embossed seal
Embossed Original - Building Department Applicant Copy - Applicant/Receipt Copy - Accounting