13-0151 (PLBG)1,;
P.O_E�OX 1504
78-495,CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 13-00000151
Property Address: 53363 AVENIDA VELASCO
APN: 774-084-017-6 _000000 -
Application description: PLUi4BING'
Property Zoning: COVE RESIDENTIAL
Application valuation: 7o6
Applicant: Architect or Engineer:
Al Ik
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LICENSED CONTRACTOR'S DECLARATION
VOICE (760) 777-7012
FAX (760) 777 -7011
INSPECTIONS (760) 777-7153
BUILDING & SAFETY. DEPARTMENT
BUILDING PERMIT'
Date: 2/11/13
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 a nd Professionals Code, and my License is in full force and effect.
License Class: License No.:
te: e—Contractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalt� of perjury that I am exempt from the Contractor's Statel-icense I Law for tha
following reason (Sec. 7031.5, Business and Professions Code: Any -city or county that requires a p6rmit 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
t�at he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by -
a applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
1, 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. It, however, the building or improvement is sold within
one year of completion, the owner -builder will have the burden of proving hat he or she did not build or
improve for the purpose of sale.).
L 1 1, as owner of the property, am exclusively contracting with licensed contractoirs 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
ig) I'a pursuant to -the Contractors' State License Law.).
m exempt under Sec. _,B.&P.C. for this reason
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 Name:
Lender's Address:
LQPERMIT
Owner:
LUNA ANGEL
53363 AVENIDA VELASCO
LA QUINTA, CA 92253 A
(760)578-0929.
Contractor: FEB I
Owner
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WORKER'S COMPENSATION DECLARATION
I hereby ffirm under penalty of perjury one of the following declarations:
I have and will maintain a certificate of cohsent 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
f issued.
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
insurance carrier and policy number are:
Carri -- - - - - - - - - - L - - - - - - - - - - - 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' comppnsation 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.
CA-Pplicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE 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, indemnity 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 f6r 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_buildiA� construction, and hereby authorize representatives
of this county to enter upon the above-mentioned - property for i2pec , . yonpur oses,
-//-/-3 Signet
Da'te:',2'� 6.—(.pplc.nt or AiE
LQPERMIT
Application Number . . . . . 13-00000151
Permit PLUMBING SEWER
Additional desc
Permit Fee 30.019 1 Plan Check Fee
.'00
Issue Date . . . . Valuation . . .
. 0
Expiration Date 8/10/13
Qty Unit Charge Per
Extension.
BASE FEE
15 �.00
1.00 15.0000 EA PLB BUILDING.SEWER
I
15.00
- -
- - - - - - - - --- - - - - - - - - - - - - - - - - - --- - - - - - - - - - - - - - - - -
Special Notes and Comments
- - - 7 - - - - - - - -
SEPTIC ABANDONED. SEWER CONNECT. 2010
CODES.
---------------------------------- 7 ----------------------------------
Other Fees . . . . .. . . . . BLDG STDS ADMIN'(SB1473)
1.00
Fee summary Charged Paid Credited
---------- ---------- ----------
Due
----------------- -----------
Permit Fee Total 30.00 .00 .00.
30.00
Plan Check Total* .00 .00 .00
.00
Other Fee Total 1.00 .00 .00
1.00
Grand Total 31.00 .00
31.00
LQPERMIT
Bin. #
of- U Quinta
Buffcft ff Safe i:y DW6n
P.O. Box 1504,78-495 Catte Tampico
LaQuinta, CA 92253 -:(760) 777-7012
Building Petmit -Applicadon'and Tracking Sh'eet
permit #
Project.Address: AV C- Ve/4S.6 0
Ower", Ne:. L
A! UN K
A- P. Number.
Addrcss:53-3� �Avrz-vp'--Msen.
Legal Description:
Contractor CJ -0 CU N F— X�'
City, ST, Zip:
ielephone: 760 �579'-09,R-9
;N;
Address:
--..PrqjectDescription:
City, ST, Zip:
Telephone: 766 -6.7tf- 0 %P
State Lic. #: Lic,
Arch, Engr., Designer
Address:
City., ST, Zip!
Telephone:
State Lic. #:
Name of Contact Person:
Construction Type: Occupancy:
Project type (circle one): Now Add'n. Alter Repair Demo
Sq. Ft.; # Stories: its:
0 TJru–.
Telephone of C ontact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
it
submittal
Reqld
Reeld
TRACMG
PERMU FEES
Pip Sets
Plan Check submitted
item Amount'
Structural Cates.
Reviewedready for corrections
Plan Cht& Deposit.
Truss Cales.
Called Contact Person
Plan Check Balance.
Mde 24 Cales.
Plans plaid up
Construction
Flood plain plan
Plans resubmitted.'.
Mech2filcal
Grading plan
Z� Review, ready for correciionslb;sue
Electrical
Subcoutactor iist
Called Contact Person
Pitimbing
Grant Deed
Plans picktd up
&IVLL
H.OA. Approval
Plans resubmitted
Grading
134 110USE-,
Review, ready for torrccdonsAssuc
Developer Impact Fee
Planning Approval.
Called Contact Person
AXP.P.
Pub. Nyks. Appr
Date of permit Issue
School Fees
Lot., Permit Fees
P.O. Box 1504
�A QUINTA, CALIFORNIA 92247-1504
78-495 CALLE TAMPICO'-*
LA QUINTA, CALIFORNIA 92253
BuILDING & SAFETY DEPARTMENT
(760) 777-7012
FAX (760) 777-7011
PROPERTY OWNER'S PACKAGE,
Disclosures & Forms for Owner -Builders Applying for Construction Permits.'
IMPORTANT! NdTICE TO PROPERTY OWNER
Dear Property Owner:
An application -for a buildinj ierrhit has been submi'tted 'in your name listing yourself as the builder of the property
improvements specified at -6 _:� -3 63 A V e- V F_ I A 5 C Q
Weare providing yoti with an Owner -Builder Acknowledgment and Information Verification Form to make you aware of your
responsibilities and possible risk you may incur. b� having this permit. issued in your name as the
Owner -Builder. We will n'ot 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 ANDNERIFICATION OF INFORMATION
�5[R CTIOIVS: Read and initial each statement below to signify you understand or verify this information.
I understand 'a frequent p!�actice of unlicensed persons is to have th� property owner obtain an "Owner -Builder"
building permit that errone*ly implies that the property owner is providing his her own labor and material pe
or ersonally. 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 orher employees while working on my property. My homeowner's insur.ance 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.
&L2. 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.
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 insiead of my
own.
L 4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on
permits and contracts.
A -L-5. I understand if I employ or otherwise engage any persons, other than California licensed Co&rictors, 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 f6deral law.
-L-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
risk.
I understand under California Contractors' State License Law, an Owner -Builder who b uilds single-family residential
structures cannot legally build them with the intent to offer them for sale, unless all work.is petfornied by licensed
.subcontractors and the number of structures does nof exceed four within any calendar year, or all of the work is performed
under contract with a licensed general building Contractor.
4—L8. 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.
A1- 9. 1 understand I may obtain more information regarding my obligations as an "ernployer" 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 California Contractors' State License Board (CSLB) at I-
800-32 1 -CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors.
4L-40. I am aware of and consent to an Owner -Builder building perrrdt applied for in my name, and understand that I am the
party legally and Pnancially responsible for proposed construction activity at the following address:
T-3363 AVE- VE(4SCO
k—L- 11. 1 agree' that, as the party legally and financially responsible for this proposed construction activity, I will abide by all
applicable laws and requirements that govem Owner -Builders as well as employers. -
AUL-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 verift'the property
owner's signature. A .4
Signature of property owner 6MZ2U144 Date: 'd,
Note: Diefollowing Authorization Form is required to be completed by theproperty owner only when designating
an agent of the property owner to applyfor a construction permitfor the Owner -Builder.
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding th7e 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 pedury 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 ofthe 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 ver6 the property owner's signature.
Property Owner's Signature: Date:
z
a
COACHELLA VALLEY WATER DISTRICT
P.O. BOX'1058, COACHELLA:'CALIF.ORNIA-92236,(760)-398-265-l'
INVOICE-.� Date,: 2/11/2013.
UBJECT:, SANTA CARMELITA,-6363 AVENIDA VELASCO, LA QUINTA, LID 687656. "SCC FEE ONLY"
ALFREDO LUNA
Project: 13-4391.
53363 AVENIDA VELASCO Prqject Date:
�2/7/2013
-231.00
Amount Due: $4,
LA QUIN�A, CA, 92253 -GEO: 06-06 1 -12-4
Planner:, SANDRA VILLALPBOS
TO INSURE PROPER CREDIT, PLEASE RETURN THIS PORT16N WITH
I . I 'A. - . . .. , I ..
REMITTANCE AND INCLUDE THE PROJECT ON YOUR CHECK
---- - - -------- - ------------
SUBJECT: SANTA CARMELITA, 53363 AVENIDA VELASCO, LA QUINTA, LID 687656, "SCC FEE ONLY"
COACHELLA VALLEYMATER DISTRICT
P.O..-BOX 1058,�',COACHELLAF CALIFORNIA 92236 (760) 398-2651