13-0034 (PLBG)TA 4`4
F.O. BOX 1504 VOI(:1:('/bU)'/'/'/=JUIl
78-495 CALLE TAMPICO. " FAX (760) 777-7011.
z LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7.153
BUILDING PERMIT
Date: 1/09/13
Application Number:13-00000034-w Owner:
Property Address: 804-56—TORREON WY RICK HUNT
APN: 777-330-028- - -
Property Zoning: LOW DENSITY RESIDENTIAL --------- -------------------------
Application valuation: 400
~ Contractor.
Applicant: Architect or Engineer: Owner
JAN 0 9 2013
---------------=-------- ---------
C1 PY OF lq QUINTA
�" r FINANCE DEPT, '
IV
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LICENSED CONTRACTOR'S DECLARATION - - WORKER'S COMPENSATION DECLARATION•
I hereby affirm under penalty of perjury that 1 am licensed under, provisions of'Chapter 9 (commencing with. t I hereby affirm under penalty of perjury one of the following declarations: - 4
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 -
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 to _ I 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 becom subject 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 ee o the workers' compensation provisions of Section
. License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and -Professions Code) or 700 of the Labor Cod , I all fo c I with those provisions.
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)•: ate: / � of
(_ 1 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
62 the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The WARNING: FAILURE TO SECURE WORKERS' COMPENSATION 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 PENALTIES 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 ($100,0001 IN ADDITION TO THE 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, INTEREST, 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 APPLICANT ACKNOWLEDGEMENT
(_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct fhe project (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a. permit subject to the
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of conditions and restrictions set forth on this application.
property who builds or improves. thereon, and who contracts for the projects with a contractor(s) licensed 1. Each person upon whose behalf this application is made, each person at whose request and for
pursuant to the Contractors' State Lice e'U I I whose benefit work is performed under or pursuant to any permit issued as a result of this application,
(_ 1 I am exempt under Sec. , B.&P. . fo'?•tpi rea n 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.
/ate: /3 Owner: _ 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
CONSTRUCTION LENDING AGENCY permit to cancellation.
I hereby affirm under penalty of perjury that -there is a construction lending agency for the performance of the I certify that I have read this application and state that the abov infor io is correct. I agree to comply with all
work for which this permit is issued (Sec. 3097, Civ. C.). city and county ordinances and state laws relating to bu' i g c t io rid hereby authorize representatives
of this co my o enter upon the above-mentioned pro rty f inspe i ses.
Lender's Name:
` K ate: 3 S• nature (Applicant or Agent): ,
Lender's Address: N '
LQPERMIT ;
Appiicatidn Number . . . . . 13-00006034
Permit . . . PLUMBING
Additional desc .
Permit Fee 18.00 Plan Check Fee
4.50
Issue Date Valuation
0 -
Expiration Date 7/08/13
Qty" Unit Charge Per
Extension
BASE' FEE
15.00
1.00 3.0000 EA PLB GAS PIPE 1-4 OUTLETS"
3.00
-------------- --------------------------------------------------------------
Special Notes and Comments
-
FROM EXISTING 2" GAS @ POOL EQUIPMENT,
TEE OFF 100 L.F. 1 1/2" GAS LINE TO (2)
FUTURE FIRE BOWLS & 50 L.F. 1" GAS LINE
TO FUTURE FIREPIT.& - 20 L.F. 1" GAS
STUB -OUT FOR FUTURE BBQ. 2010 CODES
--- ----------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
--
1.00
Fee summary Charged Paid Credited
Due
Permit Fee Total 18.00 .00 00
18.00
Plan Check Total 4.50 .00 .00
4.50
Other -Fee Total 1.00 .00 .00
1.00
Grand Total 23.50 00 .00
23.50
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Buiidiflg 8L Safety Division
P.O. Box 1504,78-495 Calfe Tampico
ta.Quinta, CA 92253 - (760) 777-7012
Building Permit Application'and Tracking Sheet
Permit #
0
Project Address:
Owner's Name:.
A P. N.tunber.
Address:
Legal Description:
City, ST, Zip: LA+f C�
Contractor. �
�
',•�,,�,�.;r'�'�^
Address:
Project Description: UNIC ril(vite
City, ST, Zip:
E G . V .6AS 0 kZA_ LY(PAWT:
Telephone:
P
p 1
C c0 L N F IT �1� etas L 1 IJ E
State Lie. # :
Ciry Lie. #;
Arch., Engr., Designer
K GF '16k; w Ne .-M fl re F (T
Address:
5Cv `' c -h C .DBQ FVTUF-G)
City., ST, Zip:
�a
Telephone:
A„
State Lic. #: r_ ` �_~`
'
...;w,��»�
Name of Contact Person: �(.A< "Vg T'
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.:
# Stories:
#Univ
Telephone # of Contact Person: '7�i0zj
/nom
Estimated value of project:
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
' Rec'd
TRACKIING
PERMIT FEES'
Plan Sets
Plan Check submitted
Item Amount
S"dural CAM
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Cates.
Called Contact Person
Plan Check Balance
Title 24 Cake.
Plans picked up
Construction
Flood plain plan
Plans resubmitted.
Mechanical
Grading plan
2'' Review, ready for corrections/issue
Electrical
Subcontaetor List
Called Contact Person
Plumbing
Great Deed
Plans picked up
S.M.I.
13.OA. Approval
Plans resubmitted
Grading
IlN IiAI1SE.-
7id Review; ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
AJ.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees '
Total Permit Fees
r
vw,
04M#=t
P.O. Box 1504
LA QUINTA, CALIFORNIA 92247-1504
78-495 CALLE TAMPICO
I -A QUINTA, CALIFORNIA 92253
BUILDING do SAFETY DEPARTMENT
PROPER Y OWNER'S PACKAGE
(160) 777-7912
FAX (760) 777-7011
Disclosures & Forms for Owner -Builders Applying for Construction Permits
1 MOTI EE To punnunTv QTR
Dearp""
ty owns:
iAn' motion for abudding peter has boon submitted in your name Iisting yourself as the budder of toe property
eetsspxifedat _ep c4S_?_1 42=lj;J 3
we we powling youWith--an Oerntx-BOdder A D*wledgment.aud. Ve idieatien Form to make you aware of you
and Posable risk you ®ay incur by having d& pmmit itu- Rd in your naaoe as the
Oeoes'-oodder. We wOl act law a bvVdLg.pemM Until yens -have read, ifled yew Of tack provblon,
signed+ and returned Ob form to us at our official address indicated. An agent of the owner cannot eaecult Wis notice
unless 7ew, the property owner, obtain the prior approval of the permitting authority.
OV'� ACrr-' A
ND
DaWMONS.Readara#
a>s0al .ems ib signify you cwdrmtand or ve rtfy does w ornratum.
understand a froque W practice of unlicensed persons is to have the property owner obtain an "Owner -Builder'
building pmml that ertonoously UnPl= that the property owner is providing his or her own labor and material personLity.1, as
an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustainod by an unlicensed person
and his or hex employees while working on my property. My homeowner's insurance may not provide covusge 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 any property-
L/"2- 1 understand building pemts are not required to be signed by property owners unless they are responsible for the
construction and are not hiring a lieemed Contractor to assume this ttspoust'bihty.
understand as an "Owner -Builder" I am t$e res)ftw_�k party of record on the pumil. i understand that I anty protect
myself front potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name insu ad of m)
own.
4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers o
permits and contracts.
understand if 1 employ or otherwise engage any persons, other than California licensed Contractors, and the total val
of my construction is at least five hundred dollars (5500), including labor and materials, I may be considered an 'employe
under state and federal law.
'1__6. 1 understand if I am considered an " o '
empi yer' under state and federal law, i must register with tlu state and fod�
government, withhold payroll taxes, provide wodms' compensation disability insurance, and contribute to UUM.ployn
compensation for each "employee-" I also understand my failure to abide by these laws may subject me to seri-RU finan
risk.
7. ! understand under California Contractors' State License Law, an Owner -Builder who builds single-family reside
structures cannot legally build them with the intent to offer them for sale, unless all work is performer; by lice
subcontractors and the number of structures does not exceod four within any calendar year, or all of the work is perfo
under contract with a licensed general building Contractor.
8 1 understand as an Owner -Builder if I sell the property for which this pmnt is issued, 1 may be hdd liable for an
financial or personal - sus*dned b an
�� Y . Y subsequent owoe(s) that result Gom any latent construction defects in °bc
worbnanship or materials,
v
V/9- 1 understand I may obtain more information regarding my obligations as an "trnployd' from the Wer681 Ravtnue
Strvioe, the Wood States Smell Business Admkistritiou, the California Depam nmt of Benefit Paymeau. sad the California
Division of lndus %l Accidents. I also understand I Way contact the California Contractors' State License Board (CSLS) at 1 -
....... BM-321-CSLB (2752) or www-cslb.ca.gov for move information about licensed contractors-
. .
�10. 1 aro aware of and consent to an Owner -Budder building permit applied for in my name, and understand that 1 am the
Ply legally and fiaancially responsible for proposed construction activity at the following addr=:
11. I agree that, as the party legally and 4nocially responsible for this proposed co_nstxwAm activity, I will abide by all
applicable laws and mWirwmats that govern Ole w -Benders as yell as employers_
✓12.1 agree to notify the issuer of this form immediately of any additions; deletions, or cbso@u to sny of the iaformitim I
have provided on this form Licensed contradors are regulated by laws designed to protect the public. If you cenuaet with
soi"One who dos sot have a li®onso, the Gootraetors' State License Board may be unable to now you with any tlaasaki loss
you rMY sustaia as a result of a comet Your only remedy against unlicensed Contractm may be in•oivil coort. 11 is also
m°p°� [err you to. and "bbl trot if an uukoea w Contractor,. eaoployec of &d individral-or Jk= is b*w9d wbilc woeiang
on YM ProPcrtY: you may be Meld H*k 1br da =W& If you obtain a permit ssacr
Ow -Banda and wills to him Cooaaotors,
You win be msponsArlo for vu*in 116- for or not those C mviceors arc p aperly 4icamd anA the scions of tfie wo&ue
ooaope tion iaseaaeut ooveram
Before a building pelma can be
the agemey respondbit for
odur weriitoaaion asorpwrbu
owner's signatare.
Signau t of Property owner
tsa�Sdrtldtiorm artist be completed and signed by the prop" owat r Wad rtWrutd to
lliae.l t ofdw prop" ewnw's @ims'W XWOMOMM wNaaiaselrw, K
to be pwuetal wren dw PmKk is isaraal M •m'{fJ► dge p vp"
Note: The following Authorization Form is required to be completed by the property owner only when designatin,
an agent of the property owner to apply for a construction permit for the Owner -Builder.
AU ItI7ATIQN OF A�SP1T TO ACT 4N P�tOirERTY OoNMWs a-EHALF
Excluding the Notroc to Property Owner, the etcectrtion of which I uaderstaad is my pevonal respomsibilitY. I bey amthon
die 165owM4 paaoa(s) to act as my aigenKS) to apply for, sign and file the documents ame ssary to obtain an Owoet-Builds
Pamit for my pmject-
Scope of Cooshuction Project (or Description of Work)'.
Project Location or Address:
Name of fluthorized Agent:
Address of Authorized Agent:
Tel No
I declare under Penalty of perjury that I am the prop" owner for the address listed above and I PcmtLally fdltd out the
information and certify its accuracy. Note: A copy of the owner's driver's tkense. foray notarization, or"other ,Ticati,
acoeptaNe to the agency is required to be presented when the permit is issued to verify the property owner's sanature.
Property Owner's Signature: Date: