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10-1198 (PAT)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 10-00001198 Property Address: 79886 INDEPENDENCE WY APN: 6b4-501-025-6 -24197 - Application description: PATIO COVER - RESIDENTIAL Property Zoning: ' LOW DENSITY RESIDENTIAL Application valuation: 6823 Tiht 4 4 Q" Applicant: Architect or Engineer: BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: GEE DOUG 79-886 INDEPENDEN LA QUINTA, CA 922 ----------------- Contractor: Owner _VOICE (760)'777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 11/04/10 ° D r+ov zo,o ------------------------------------------------------------------------7------------------------ 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 hereby affirm under penalty of perjury that there is 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. C.) _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided License Class: License No.: Lender's Address:�� 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 which this 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 Policy Number following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit toI 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 the applicant for the person in any manner so as to become bject to the workers' compensation laws of California, permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if I should become su act 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 Lab de, I shall fo it comply with those provisions. that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by an applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: 11 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and 44700a ate: cant: the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The WARNING: FAILURE TO SECURE WO ERS' OMPENSAT16N COVERAGE IS UNLAWFUL, AND SHALL Contractors' State License Law does not apply to an owner of property who builds or improves thereon, - • SUBJECT AN EMPLOYER TO CRIMINAL PE LTIES 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 T E COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INT REST, 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.). (_ I 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.). F _ I I am exempt under Sec. , B.&P.C. for this reasonA ate: caner: ���`T��TTT�7����� CONS UC ON LENDING AGENCY I hereby affirm under penalty of perjury that there is con ruction lending agency for the performance of the ' work for which this permit is issued (Sec. 3097, Ci . C.) Lender's Name: ' Lender's Address:�� LQPERMIT 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 inform n is correct. I agree to comply with all city and county ordinances and to laws relating to building construc n, and hereby authorize representatives ofOis coun to enter upo a above-mentioned y for inspe ori purposes. Date: ��- • nature (Applicant or Agen Application Number . . . . . 10-00001198 Permit . . . PATIO COVER PERMIT Additional desc . Permit Fee . . . . 90.00 Plan Check Fee 58.50 Issue Date . . . . Valuation . . . . 6823 Expiration Date 5/03/11 Qty Unit Charge Per Extension BASE FEE 45.00 5.00 9.0000 THOU BLDG 2,001-25,000 45.00 ---------------------------------------------------------------------------- Special Notes and Comments 513 S.F. LATTICE PATIO COVER, PER APPROVED PLANS (ST)2007 CODES ---------------------------------------------------------------------------- Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 STRONG MOTION (SMI) - RES .68. Fee summary Charged Paid Credited ----------------------------------------------------- Due - --- Permit Fee Total 90.00 .00 .00. 90.00 Plan Check Total 58.50 .00 .00 58.50 Other Fee Total 1.68 .00 .00 1.68 Grand Total 150.18 .00 .00 150.18 LQPERMIT. u� ,;2-0v 1�b�(,=� IN P�A- 1) z,�cF, `wNy _ _ tpN t & oq- 5o( - 02--5 L LA QUINTA SAFETY R®NSTRUCTION BY -- v .® P.O. BOX 1504 LA QUINTA, CALIFORNIA 92247-1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT PROPERTY O"ER'S PACKAGE (7'60) 777-7012 FAX (760) 777-7011 Disclosures & Forms for Owner -Builders Applying for Construction Permits : 0H_TAiW,! NOTICE TO Il'R4 EI;,TY 4VV1�1EIt Dear Property Owner. .An. application for a buildii .rmit has been submitted .in your name listing yourself as the builder of the .property �impraovements specified at `- 1Mg.8 _ Nd1CA ev, i . CA - We are providing you with an Owner -Builder Aclozovvledgment and Informs n Veri�teation Form make you aware of your r�sporrsibilities 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. OZ'S AMOMUEDGM21 AND NE CATION of VOORMMN D .IAMIONS. Read and initial each statement below Ei signify you understand`orvedfy this information. . 1. I understand a frequent practice of unlicensed persons is to`have the property owner obtain an "Owner -Builder" ".uilding permit that erroneously implies that the property owner is providing his. or her own labor and material pers6nilfy. 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. 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.tlte 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 instep of my own. - V4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. X5. 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" under state and federal law. R6. L 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 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 stfuctures I 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. 8. I understand as an Owner -Builder if I sell the property for which this pertiut is issued, I may be held liable for any mancial or personal. 4uries sustained. by any subsequent owner(s) that result from any latent constriction defects in the worlananship or materials. ' 9. I understand I may obtain more information regarding my obligations as an "employer" from the Internal Re*enue 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 (CSLR) at I- 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: -��o®i_ --7.- _i - .1 . __ . _._ _ _ __._ .,,._ _ ....... _.. r i 11. I agree that, as the party legally and financially responsible for this proposed construction activity,.' will abide by all aplicabi.6 laws and requirements that govern Owner -Builders as well as employers. 2.1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to Any of the information I hav 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 financialloss 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 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 with be .responsible for verifying 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 issu ttg; ffie.permit. Note: A copy of tke property owner's dklver. &1k5p sea farm notadaadvn3 or other verification acceptable to the agency is utred to be presented when the per=mit is inued to verify tie pmpert owner's signature. Signature of property Date: If./,/, 0 - 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 OWNEWS BEHAF Excluding the Notice to Property Owner, the eaewtion of which: I understand is my personal responsibility, I hereby authorize the following persons) to act as my ageut(s) to apply for, sign, and file the documents necessary to obtain ani Owner -Builder Permit for my project. Scope of Construction Project (or Description of Work): Project Location' or Address: Name of ?lathorized 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: Bin # Qty of La Quinta Building &r Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # Q O Project Address: Tn e % e, W Owner's Name: O Ge A. P. Number: G O y— o Q Address: D 0 d Why Legal Description: Contractor: , (' — City, ST, Zip: C CjZ2 s 3P Telephone ' f Address: ' t Project Description: City, ST, Zip: 12 e-• i It> co J r ' Telephone: �`�� r��>::.�:...�ryy,,�:� � • '��A State Lic. # : City Lic. #; Arch., Engr., Designer. i Address: City., ST, Zip: Telephone: :. `:: • '"� . ' < .w.•.>i:. 'h4•,c:^L:y� iv:{>: js awn. ,. nrr..»....... 5.. .s:ic f>"<% ' " Construction Type: 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 Truss Calcs. Called Contact Person Plan Check Balance Title 24 Cales. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2°" Review, ready for corrections/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:- 'id Review, ready for correctionstissue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees