11-0149 (PAT)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description
Property Zoning:
Application valuation:
Applicant:
11-00000149
54600 AVENIDA JUAREZ
774-263-005-20 -000000-
PATIO COVER - RESIDENTIAL
COVE RESIDENTIAL
1782
T4ht 4 4 Q"
Architect or Engineer:
dA
r -
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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 a or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
any pplicant 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.).
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 1 I am exempt under Sec. , B.&P.C. for this reason
1 Date: '2 / Owner:
�• \\ + CONSTRUCTION LENDING ENCY
I hereby affirm under penalty of perjurhat 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:
t
LQPERMIT
Owner:
SCHUTZ JOHN & JOYCE A
54600 AVENIDA JUAREZ
LA QUINTA, CA 92253
Contractor:
Owner
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS. (760) 777-7153
Date: 2/11/,11
�/ WORKER'S COMPENSATION DECLARATION
n r y of perjury one of the following declarations:
a and dl maintain a certificate of consent to self -insure for workers' compensation, as provided
for by ection 3700 of the Labor Code, for the performance of the work for which this permit is
_ I hb%W5nd 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
w.
sZ 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 Cod sh orthwith co ply tho B provisions.
Date: ��r �4Applicant:
WARNING: FAILURE TO SEC WORKERS' COMPENSATION COV GE 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 information is correct. I agree to comply with all
city and county ordinances and state laws relating to building construction, and her y au onze representatives
of this county to enter upon the above-mentioned propert inspe n purposes
Pate:2— 1(^(I`ntSignature (Applicant or Agent):
Application Number . . . . . 11-00000149
Permit . . . .
. PATIO COVER PERMIT
Additional desc .
.
Permit Fee
41.00 Plan Check
Fee
26.65
Issue Date
Valuation
. . .
. 1782
Expiration Date
8/10/11
Qty Unit Charge Per
Extension
BASE FEE
15.00
13.00 2.0000 HND BLDG 501-2,000
26.00
----------------------------------------------------------------------------
Special Notes and
Comments
134SF PATIO COVER
AT FRONT OF DWELLING
[CITY STANDARD] CODE CASE NO: 11-0266
[EE] 2010 CALIFORNIA BUILDING CODES.
February 11, 2011
2:41:55 PM AORTEGA
----------------------------------------------------------------------------
Other Fees
. . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary
Charged Paid Credited
----------------------------------------
Due
-----------------
Permit Fee Total
41.00 .00
.00
41.00
Plan Check Total
26.65 .00
.00
26.65
Other Fee Total
1.00 .00
.00
1.00
Grand Total
68.65 .00
.00
68.65
LQPERMIT
1
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EXISTING POST
27" x 27"
ROPOSED NEW BEAM LOCATION
10'-3"
EXISTING 2x6 FIR 16 O.C.
13-4 S,!;- . r -r.
EXISTING BEAM LOCATION
13'-0"
PEN LATTICE
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AV"
10'-2-2" "
ED NEW OVERHANG
l'-6"
5"
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TY OF LA QUINTA
LD114G & SAFETY DEPT.
PROVED
OR ONSTRUCTION
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PROPOSED NEW OVERHANG
OPEN LATTICE
EXISTING 2X6 FIR 16 O.C.
PROPOSED NEW 48 FIR---/
OCATION
POST LOCATION
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A
CITY OF LA QUINT
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BUILDING& SAFETY DEP
APPROVED
04 M, lot, M, 9
DATE Fly
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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
I1bITORT'A'Tt NOTICE TO PROPERTY OWNER
Dear Property Owner.
Anapplication for a building permit has been submitted in your name listing yourself as the builder 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.
OAR'S ACIQq4Wi:EDGWW AND YERMCATWN OF IIWCHD�W
DfRECTTONS. Read and initial each statement below to signify you understand or verify this information.
1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder"
ding permit that erroneously implies that the property owner is providing his or her own labor and material personally. 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 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.
arty
2. I understand building permits are not required to be signed by property owners unless they are responsible for the
nstruction and are not hiring a licensed Contractor to e this responsibility..
3. I understand as an "Owner -Builder" I am theresponsrble party of record on the permit. I understand that I may protect
yself from potential financial risk by hiring a tic used Contractor and having the permit filed in tris or her name instead of my
own.
4. 1 understand Contractors are uired by law to be licensed and bonded in California and to list their license numbers on
routs and contracts.
5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value
my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer"
under state and federal law.
14 6. I understand if I am considered an "employer" under state and federal law, I must register with the state and federal
gpVtrnment, 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
tures 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 performer
under contract with a licensed general building Contractor.
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
nancial or personal. 4uries sustained. by any subsequent owners) that result from any latent construction defects in the
worlananship or materials.
9. I understand I may obtain more information regarding my obligations as an "employee' from the Interr d Revenue
rvice, 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 (CS -LB) & 1-
800-321-CSLB (2752) or www.csib.ca.gov for more information about licensed contractors.
10. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the
legally and financially responsible for proposed construction activity at the following address:
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,. 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 fum is injured 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 verifying whether or not those Contractors are properly licensed and the status of their wetkers'
coition 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 tlhe pernikL Note: A copy of dw property owner's driver'slkwese, form, nen; 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: _�2 — /l — /(
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 BERAL
Excluding the Notice to Property Owner, the execution of which I understandis 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: .5- q 6O D /19. Ve IV dr J U A fl5 f Z
Name of (Authorised Agent:
Address of Authorized Agent:
Tel No 2
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
accgptable 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:
�s
N
Bin #
City of La Quinta
Building & Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quints, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address; . wo i7ww
Owner's Name:
A. P. Number:
Address: A Y-N!��
Legal Description:
City, ST,
Contractor•
Telephone:`?
Address:
Project Description: '? &Itld
City, ST, Zip:
4w 6A212
Telephone:
P
State Lic. # :
City Lic. #;
Arch., Engr., Designer:
Address:
o
Coos
�C
City., ST, Zip:
P>.nY
Telephone:
:OYv'N.•:ti•i::: �i}iii:�l:i3�}i:{rd:}j': r4�
.., ::; .>•:<»:i:a>N >:<:>sc �:.:{ :z
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>;;:; :; .:'s .. ;;....:;> <
r.. ....:.. f..<...,..:.:.. ..:.
Construction Type:
YP Occupancy:
project type (circle one): New Add'n Alter Repair Demo
State Lic. #:?
Name of Contact Person:
Sq. Ft.:
# Stories:
#Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
r'
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2” Review, ready for corrections/issue
Electrical
t.
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
0-1
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:
''d 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
rl
Total Permit Fees