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13-1386 (PAT)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 • I BUILDING-& SAFETY DEPARTMENT BUILDIN4d. PERMIT Application Number: 13-00001386A Property Address: 4364.7 SLERNO CT_ APN: . 609-542-015-27 -28457 - Application description: PATIO COVER - RESIDENTIAL Property Zoning: LOW,DENSITY RESIDENTIAL Application valuation: 2554 Applicant:-- Architect or Engineer: OWN(, LICENSED CONTRACTOR'S DECLARATION .- - .-):hereby affir"m untler,penalty of perjury that I.am�licensed under provisions afChapter.g (commencing, with - Section 70001 of,Division 3'of the Business and Professionals Code; and my License is in full force and effect. licenseClass: - License N_o : Date. Contractor: f OWNER -BUILDER DECLARATION,. I hereby affirm under p' nalty of perjury; that.I am exempt from the ;Contractor's' State License Law for the follownj"reason (Sec- 7031 '5„ Busmass`arid Professions Code: Any city.or'county-thatrequires a permit to , ` construct, alter,.improve; demolish:'or repairany structure, prior to its: issuance;".also requires the applicant•for the permitto filea sign" statement that he or. she Ws Icensed.pursuant to the,provisions otthe`Contractor.'s State `a License Law (Chapter 9 (commencing with.section7000) of'Division 3 ofthe`eusines§ and Professions Code) or *F; that he ,or she is exempt therefroni Ad therbasrs for the alleged exemption: f: Any violation oSection.7031.5 by any applicant for a�permit subjects the applicant to a -civil penalty of not more -than fiGe�hundred dollars ($500):: (_) I; as owner of the property, or"niy-employeeswith'wages as.theirsoleLcompensatiori; willdo.the'work, and ' the stiucture is not intended or offered.for sale (Secy 7044 .Business and Profession's Code The ` ,. 'Contractors' State License1aw does not apply to an ownerof property who. builds or improves thereon, " x •`arid'wgo does the work him self'or herself•through,his or her own. employees, provided that the . improvements are notiniended:oi.'offered-fit', •:If however'i .building'or improvementis sold within } - 'one,year'of completion; the owner -builder will: have the$urden of proving thathe or she did not build or -- improveforthe Purpose ofsale:).,- (_ 1 I; as -owner of.the property, am•exclusively contracting with licensed contractors to construct rthe .project (Sec. 7044 Business and Piofassion's•Code: The Contractors' State License.Law floes'not`apply.to an.owner of ` property who builds or.improves thereon, and who contracts forthe projects with`a,coittractor(s) licensed pursuant.to the Contractors' State License Law): 1 1' I am exempt under Sec. B.&P-C. for this reason Date: Owner: CONSTRUCTION LENDING AGENCY I hereby affiim 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: LQPERMIT Owner: KEN HATFIELD 43647 SALERNO LQA QUINTA CA LA QUINTA, CA.9225 Contractor: Owner VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 1/29/14 WORKER'S COMPENSATIONDECLARATION- 1 hereby affirm under penalty. of.perjury:one ,of the following declarations: _ - - _ I have and;will maintain a.certificate'of-consent tolself,insure�for workers'- compensation, as provided - fovby:Section 3700 of. the{abor• Code;- for the performance of the work for whicWthis permit.is . issued. '. I have and will. maintain workers' compensation insurance as.raquired. by Section,3700of the Labor . c Code; Jorthe performance' W the work for which this permit is issued. My, workers' compensation insurance_carner and_pokcy.nuinber arei. ... ' Carrier - - - --- -- --`- ..;= ".--PolicyNumber r^ 4 _ I certify that, inthe..performance-of.thework for which this permitis,issued, Ishall not employ any . person iri-any, mariner sous tobecome 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,tsltall forthwith comply wiih those'pr64isions: Date: Applicant: .. - .- WARNING!*;FAILURE TO SEC URE'WORKERS',:COMPENSATIONF"COVERAGE IS UNL.AWFUL,=AND SHALL SUBJECT+AN EMPLOYER•TO:CRIMINAL PENALTIES AND CIVIL41NES OP:TO ONE HUNDRED THOUSAND ,DOLLARS ($100,000) -'IN -ADDITION TO THE COST OF,.COMPENSATION; OAMAGES`AS PROVIDED FOR IN C 'SECTION 3706 OFTHE'LABOR ODE; INTERESTAND`ATTO.RNEYS,FEES: - ;APPUCANTACKNOWLEDGEMENT IMPORTANT- Application is hereby -made; to the Director of Building and Safety:.for a permit subject'to the conditions and restrictions set forth onthis application:-- 1 _Each person upon whose betialf this application is made, each person at whose request and for whose:benefit: work'is per0medrunder or pursuant'to,any permit issued as a result of this application, the owner;and the applicant; each agrees to; and's_hall'defend;'indemnify and hold harmlessthe City of.La Quinta, its "officers, agents and employees for any actor omission related to the work being performed under or following issuance of this permit: - - - 2. Any permit issued as a resultof 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 1 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 county to enter upon the above-mentioned property for inspection purposes. Date: Signature (Applicant or Agent): LQPERMIT Application Number. 13-00001386 Permit . . . PATIO'COVER 2013 Additional desc . . Permit Fee . . . . 95.81 Plan Check Fee-. .00 Issue Date . . . . Valuation . . . 2554 Expiration Date 7/28/14 Qty Unit Charge Per Extension 1.00 95.8100 EA MISC PATIO COVER, STD 95.81 ---------------------------------------------------------------------------- Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 HOURLY PLAN CHECK 140.00 PLAN CHECK, PATIO COVER 94.38 STRONG MOTION (SMI) - RES .50 Fee summary Charged ---------- Paid Credited ------------------------------ Due ----------------- Permit Fee Total 95.81 .00 .00 95.81 Plan Check Total .00 .00 .00 .00 Other Fee Total 235.88 .00 .00 235.88 Grand Total 331.69 .00 .00 331.69 DX`1) I AR, M1 Bin City OfLa Quanta Building 8z Safely Division P.O.' '. Box 15Q4,,78-4.95. .Caffe Tampico 2 La.Quinta, Ck92253'- (760)177-7012 Co Q17 -y' OP Permit Application and Tracking R�/V, liqu :Jli Tra. gi Permit # ,l /-Building Project Address: AT Owner's Name:. VIQ P A. P. Number: Address: Legal Description: I A - City, ST, Zip- - I P- 7CA 9 Con Contractor: 9 Telephone:, Address: Project Description: City, ST, Zip: Telephone: AN". ...... A a o A State Lic. # ity L'ic,. V w t Arch., Engr., Designer: 0 11� Address: City., ST, Zip: Telephone: K. -I". Construction Type: Occupan*cy: State Lac. #: Name N e of Contact Person: r tie Project type (circle one): Add 'n Alter Repair Demo �S Z es: q.. Ft.: # styri # Units: Telephone #,of Contact Perso Estimated Value of Pr 4 APPLICANT: DO NOT WRITE BtLOW.THISt LINE # Submittal Req'd Rec'd: TRACKING PERMIT FEES, Plan Sets 'Plan'Check submitted Item Amount Z- Structural C*alcs. Reviewed; readyorrec'tions f C L Plan Ch . eck Deposit Truss Cales. Called Contact-Pers.� ,PIahCheck Balance Titleu 24 Calcs. Plans picked p' �Construction Flood plain plan Plans resubmitted. 12 Mechanical Grading plan 2" Review, ready for co . rrecti/issue Electrical.' Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval:Plans resubmitted Grading IN HOUSE:- 3rd Reyiew, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person- A.I.P.P. Pub. Wks. Appr w Date of permit issue Scho6 I Fees —7 Total Permit Fees P.O. -Box 1504: LA QUINTA, CALIFORNTk92247-1504 -BUILDING &'SAFETY DEPARTMENT 78-445 CALLS' T'AMPICO;��.­''­ (760) 77.7-1012 LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011 N Disclosu're's &Tormis'6-ri�Ow"i'i6r'-,U'u"dd"e'r'-'s'A'pyml otis u `4 4' glot'C' ' �d6n Perunits, pti A-MORT'Wr NOME TROPERTY.OWNER Dear' Property Owner. An. application. for ;a building permiu, ha* been .:submitted in your Ii yo =elf builder the bul of the �rw property improvements specified.itt We are pzvviding you. with an-Owher-Buildi6rAckrio.wi6dg"m6niTind'.[Zoirm-ation-Verifisatioir FA& to make youawamof your resportsibiliti's -and len'sk-'.,y.oum'ay"'=ur.-�bylia' is M, Dam as the ,. poss"o this permit, issued Owneir-Builder. -,W�'w'ff.not issue -* Your, b*dAng- �per.ihlt until;yewhave --feadInidalid wyour. understanding of each'prbvision, signed, and returned this form to us at our offilcial� a4dress .'An agent of the -owner cannot'execitte this notice Uce unless you, the property owner, obtain the prior approval' ofthe�;' permitting authority. &%%X7rIXZP"31V .a. 427,-WTO1AM Read 6W vrrtritl each statement Wo I w to - 41541. 1 understand' a.. frequent practice of unlicensed persons is to have the - property owner obtain an "Owner -Builder" building permit that erro"nedbuslytimphim that the property owner,ts providing -his,orhei own labor .and-rnaterrial-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. 'Mrhomeolwner''s insurance may not. provide coverage for those injuries. I am wiUMY acting -as I an Owner -Builder and am' aware ofthe limits of my insurance -coverage for injuries to workers -on my.,pr6perty. �2- 1 understand building' permit's '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 res lity:. po�ibti AhI understand as am the responsible party of, , record on the, pe L I understand that 1 -may protect . e responsible rini myself from potential financial risk by hiring a licensda Contractor an. having -the permit file& in his.or her name instead of my own. �4. I understand Contractors are required by taw to be licensed and bonded in Californiaandto list their license numbers on permits and contracts. . I .:. . : I I . XDOA understand if I employ or otherwise erigage-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"Employer". under state. and- federal law, I- must register with the state and federal government, withhold payroll ta - xes,.�� and contribute to unemployment piovide!- i -k on'disability insurance '1�9 ers� compensation' compensation, for each "employee." I also understand 'my failure to abide by these laws may subject me to serious financial risk- 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. _a8. 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. iryuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. a9. I understand I may obtain more information regarding my obligations as an "employer" from the iuteMI 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. _M10. 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: 11. I agree that, as the party legally and finamially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner -Builders as well as employers. JA 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,. 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 worldrig 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 responsble for veribfing 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 issuiug.the.pez mit. Note: A copy of tke property owner's driver's Jkenset farm notfUltadMi or other verification acceptable to die agency is required to be presented when the permit is issued to verify the property owner's signature. 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 agents) to apply for, sign, and file the documents necessaryto obtain an Owner-Buildet 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 1 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: