BSPN2014-002478-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application Description:
Property Zoning:
Application Valuation:
Applicant:
ELIA TERRONES
78810 SON ESTA WAY
LA QUINTA, CA 92253
BSPN2014-0024
78810 SON ESTA WAY
` 4 449mro�
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
604151016 y
SPECIAL INSPECTION FOR'FUTURE PATIO COVER
SEP 0 2014
L61—Ty UIWA
COMMUNfTY DEVELOPMENT DEPARTMENT
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 Professions 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 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 a civil penalty of not more than five hundred dollars ($500).:
00 rl, 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
` o0�h, did not build or improve for the purpose of sale.).
as owner of the property, am exclusively contracting with licensed contractors to
/1 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.).
AVI am exempt under Sec. , B.&P.C. for this reason
Dat /
Dat Own er-.'14
CONSTRUCTION LENDING AGENCY
I hereby affirm 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
Lender's Address:
VOICE (760) 777-:125
FAX (760) 777-:011
INSPECTIONS (760) 777-x;153
Owner:
ELIA TERRONES
78810 SON ESTA WAY
LA QUINTA, CA 92253
Contractor:
OWNER / BUILDER
Llc. No.:
Date: 9/5/2014
SEP 0 5 201
CITY OF LA QUINTA
COMMUNITY DEVELOPMENT DEWTMENT
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certificate of consent to self -insure for workers
compensation, as provided for by Section 3700 of the Labor Code, for the performance of .
the work for which this permit is issued.
I have and will maintain workers' compensation insurance, as required bre
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 UNLAWFJL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TC 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 Building Official 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 w-Jrk
for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is torr=-ct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this city to enter upon the abeve-
mentioned property for inspection purposes.
Date Signatures (' Applicant or Agent):
FINANCIAL 1 •
DESCRIPTION* A� 'rte +'�r� ACCOUNTS QTY" AMOUNT=
�' PAID ^ '
rP.AID CATS
..A ,.n..•%.k� .t. �',t r Li.; .n r .,r ;. .rr. !
rrle.
SPECIAL INSPECTION 101-0000-42404
l $71.50
$0.00
RECEIPT#�.;zzn
s`CHECK#_
CL D B
T Y+a
s
Total Paid,forCOMPLIANCE SURVEY/SPECIAL INSPECTION $71.50. $0.00
TOTALS:• 00
Permit Number: BSPN2014-0024 Description: SPECIAL INSPECTION FOR FUTURE PATIO COVER
Applied: 9/5/2014 Approved: 9/5/2014 Site Address: 78810 SONESTA WAY '
Issued: Finaled: City, State Zip Code: LA QUINTA, CA 92253'
Status: APPROVED r "Applicant: ELIA TERRONES
Parent Permit: Owner: ELIA TERRONES • ,
Parent Project: Contractor: OWNER / BUILDER
Details:
SPECIAL INSPECTION OF FOOTINGS FOR FUTURE PATIO COVER. 2013 CALIFORNIA BUILDING CODES.;
r
K
Bin #
Permit #
_
Projectdros— s� )-o
Qty Of La Quinta
Building 8l: Safety Division
P.O. Box 1504, 78-495 Calle Tampico .
La Quinta,CA 92253 - (760) 777-7012
Building PermitApp/i_cation and Tracking• heet
y� �� Owncr'sName:
e
O r
A. P. Number: 11
Address: f 0
Legal Description:
l
1 City, ST, Zip:
Contractor:
Telephone: b
Address:_P-roject.D`escription:
� C
City, ST, Zip:
2 # °
Telephone:
r
State Lic. # :
City Lie. #;
Arch., Engr., Designer.
Address:
City., ST, Zip:
Telephone:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair
Demo
State Lic. #:
of
Name Contact Person
Sq- FL:
# Stories:
#Units:
`Telephone #,of Contact Person: 6 6
-- —
`E;Z itiat V - o£ Project
— —
# Submittal Req'd
APPLICANT: DO NOT WRITE BELOW THIS LINE
'Rec'd 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 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Review, ready for corrcctionsrssue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN If OUSE:-
'`" Review, ready for correctionstiissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permIt issue
School Fees
Total Permit Fees
4.
P.O. Box 1504
LA QUINTA, CALIFORNIA 92247-1504 BUILDING & SAFETYDEPARTMENT.-
78-495 CALLE TAMPICO (760) 777-7012
LA QUINTA, CALIFORNIA 92253 FAX. (760) 777-7011
PROPERTY OWNER'S PACKAGE
Disclosures & Forms for Owner -Builders Applying for Construction Permits
IMPORTANT! NOTICE TO PROPERTY OWNER
Dear Property Owner:
An application for a building permit has been submitted in your n e listing yourself as the builder of the property
improvements specified at O o 8 5 _C,3��
We are providing you with an Owner -Buil er Acknowledgment andd I 6mution Verification o 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.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
ERECTIONS: Read and initial each statement below to signify you understand or verb this information.
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 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. I understand building permits are not required to be signed by property owners unless they areresponsible for the
construction and are not hiring a licensed Contractor to assume this responsibility.
fak
-75�3. I understand as an "Owner -Builder" I am the 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.
4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on
permits and contracts.
7P
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.'
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 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
7. 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.
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 injuries sustained by any subsequent owner(s) that result from any latent construction defects in the
workmanship or materials.
9. I understand I may obtain more information regarding my obligations as an "employer" 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 Califomia Contractors' State License Board (CSLB) at 1-
800-321-CSLB (2752) or www.cslb.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
party le ally and financially responsible f r •pro osed construc 'o activity at the following address:
1° o �- e S -� 0- 2 2
`11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all
plicable 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 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 will 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 issuing the permit. Note: A copy of the property 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. A A
N.
Signature of property
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 fora 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 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:
Name of Authorized Agent: _ Tel No
Address of Authorized Agent:
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 verb the property owner's signature.
Property Owner's Signature: Date: