12-1414 (SOL)•1 P.O. BOX 1504
78-495 CALLE TAMPICO ,
LA QUINTA, CALIFORNIA 92.253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
- r
•12-00001414 '
54040 AVENIDA VELASCO
774-215-002-2 -000000-
SOLAR -
COVE RESIDENTIAL
800
Applicant: Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
GRANADO JOEL ANTHONY
54040 AVENIDA VLEASCO
LA QUINTA, CA 92253
------------------------------
Contractor: ,
Owner
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
I
Date:• 12/07/12
DrEC 0.7 2012
----------------------------------=--------------
LICENSED CONTRACTOR'S DECLARATION r
-----------------------------------------------—
_ 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 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.
_ 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
• + I
. 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 become subject to the workers' compensation laws of California,i
- 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 subject to the workers' compensation provisions of Section ,
-C
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
- 3700 of the Labor e, shallf�complyhose provisions.
that he 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).:
- ( 1, as owner of the property, or my, employees with wages as their sole compensation, will do the work, and.
ate: pplicant:
the structure is not intended or offered for sale ISec. 7044, Business and Professions Code: The
WARNING: FAI URE 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 ($100,000). 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 t urden of proving that he or she did not build or
improve for the purpose of sale.).
APPLICANT ACKNOWLEDGEMENT '
. (_) I, as owner of the property, am exclusively contracting with licensed contractors to construct the 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 License Law.).
. whose benefit work is performed under or pursuant to any permit issued as a result of this application, ,..
I am exempt under Sec. , BAP.C. for this reason
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..
-7
/ate: Z `• / Z Z Owner-. M/' -
2. Any permit issued as a result, of this application becomes null and void if work is not commenced
71 •
within 180 days from date of issuance of such permit, of 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 above information is correct. I agree to comply withall
work for which this permit is issued ISec. 3097, Civ. C.).
city and county ordinances and state laws relating to building construction,and hereby authorize representatives
•
of is county to enter upon he above-mentioned properly.for instion purposes.
IAUI
Lender's Name:
.1 'll
Z • 7- ZOl Z .nature
-
Date: (Applicant or Agent):
Lender's Address:
"
LQPERMIT
Application Number . . . . . 12-00001414
Permit PLUMBING
Additional desc .
Permit Fee -21.00 Plan Check.Fee
5.25
Issue Date . . . . Valuation
0
Expiration Date.. 6/05/13
Qty Unit Charge Per
Extension
BASE FEE
15.00,
1.00 6.0000 EA PLB FIXTURE..
6.00 -
Permit SOLAR PERMIT
Additional desc'.
Permit Fee . ... . 19.50 Plan Check
Fee
4.88
Issue Date. Valuation
800 .
Expiration Date 6/05/13
Qty Unit Charge Per
Extension
BASE FEE
15:00
1.00 4.5000 EA SOLAR COLLECTOR < 1000
4.50
Special Notes and Comments
INSTALL SOLAR WATER HEATER ON GARAGE
ROOF - PANEL SIZAE 4' X 81. 2010 CODES.
- ----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1:00
Fee summary Charged Paid Credited
Due
Permit Fee Total 40:50 .00
.00
40.50
Plan Check Total 10.13 .00
.00
10.13-
0.13Other
OtherFee Total 1.00 00
.00
'1.00
Grand Total .51.63 .00
.00
51.63
r
•off
- VV! 1P, 76 W_� M. 0 a � nA.,
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
fA����s11V�7 I�IOTI('� T[t PRnPF � OVVIuIF�
Dftr Pv0perty Owner.
An. application for a budding permit has been in yoW name,listing yourself as the builder of the propmty
nmpr+Oveareats specified at _ ,r`(C-L I e 1 C,
We aro ProvidingYOU with an Owner -Builder Admowlodgsnent and lnf mnatien Verification Forret to make you awam of your
mobilities and possible risk you may incur by haWn dtispermit•i=*W in your nano as the
Ownm4guitder. We vrill not issue a batilding pe" untilhave read ifided
>�' :. Y'oltr ► of each privisien,
signed, and returned this form to us at our offlcial address indicated- An agent of tk owner cannot execute this notice
unless you, the Property owner, obtain the prior approval of the permitting authority.
�1. 1 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 personalty. 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 or her employees while working on my property. My homeowner's insurance may not provide coverage for those
mJuAes- 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.
P2. 1 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 responmbility.
JL3. I understand as an "Owner -Builder'• I am file responsible party of record on the permit. I understand that 1 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
o�/wn..
V 4. 1, understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on
permitsand contracts.
, J 5. I understand if I employ or otherwise engage any Persons, other than California licensed Contractors, and the total Yalu(
of my construction is at least five hundred dollars (5500) including labor and materials, I may be considered an "employer'
under state and federal law. '
&L6. 1 understand if I am considered an -employee, under state and federal taw, I must register with the state and feden
government, withhold payroll taxes, provide woikers' compensation disability insurance, and contnbute to unemploymet
compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious frnanci
n�
7. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family resident
structures cannot legally build them with the intent to offer them for sale unless all work is performed by keens
subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is perform
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
tinancial or personal. iffowies ursMaked by any subsequent owner(s) that result from any latent construction defects. in the
I IT lmmnship or materials.
9. I understand I may obtain more information regarding my obligations as an "employer" from the Intemid Rownue
"vice, the United States Small BusinAdministration, the California Department of Benefit Payments, and the California
ess
Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (C SLB) at I-
800-321-CSLB (2752) or www.csib.ca.gov for more information about licensed contractors.
r� 10. 1 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the
per' legally and feanciiylly r�o for proposed construction activity at the 'following address:
64 o
Z—Vl L I agree that, as the party legally and fmaaciaUy responsible for this proposed construction activity, I will abide by all
applicable laws and requirements that govern Owner -Builders as well as employers.
l� 12.1 agree to notify the issuer of this form immediately of any additiorw; deletions, or ch4ne" to ffiy of the information t
have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If YOU contract with
somooue who does not have a license, the Contractors' State License Board may be unaMe to assist you with any financial loss
YOU may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may bo in civil oowL It is also
bWOEUM for you to Un*rsWA that if an unlicensed Contractor cc employee of that individual or firm is irtjurod wtdc vrorlang
on your property; you may be held liable for damages. If you obtain. a permit as Owner-Bmider and wilb to hire Contractors,
you will be responsjo for verBjring WhQ&tF or not those Contractors are prepedy lkeenstd and the status of their wwkus'
oon>peasstion imsuranoe coveram
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 inuiog IM.penniL Nett; A copy of da p vperW o"w's MvWx i fi' n"'***�M er
other verification acceptWe to die aggency ' requ red to be pr+eseatcd what the pemdt is iuueJ to M* die prQPCM
owner's signature.
Signature of property owner pate: Z / Z d
Note: 7lie following Authorization For7n 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 B1�HALA
Excluding.the Notice to Property Owner, the execution of which I understand is my personal respom-bility, I hereby authorize
the following persons) to act as my ag=Ks) to apply for, sign, and file the documents rtecessary to obtain an Ownet-Builder
Permit for my project.
Scope of Construction Project (or Description of Work):
Project Location or Address:
Name of Authorized Agent:
Address of Authorised 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 aM
information and ocr ify 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 sigruiture.
Property Owner's Signature: . Date:
ofla Quin,ta
Building 8t Safety Division .. .
Permit # P.O. Box 1504,76-495 Calle Tampico
1 ` U.Quinta, CA 92253 -:(760) 777-7012
Building Permit Application' and Tracking Sheet
Project Address: -457yQy 0 Vey t q CU Owner's Namc:.7 77 6C C, L, e, .9.
A P. Number.
Address: .S 0 70 6� YC" i t,ci C. CSC v
Legal Description:
Contractor:
City, ST, Zip: L4 ZZ S' 3
�c
Telephone: - `srs x'
6 0 —� 19 S 0::b:.
Address:
Project Description:
City, ST, Zip:
- A 51 a 6 Sol
G. e—
Telephone:
��: ' ?y
a? m
State Lie. # :
City Lie'. #!Coo
Arch., Engr., Designer.
Address:
City., ST, Zip:.
Telephone:
State Lie.#:
Name of Contact Person:
"
i > �~
..:�;w�i,'
Construction Type:. Occupancy:
Project type (circle one):ew Add'n Alter Repair Demo
Sq. Ft.: # Stories:
#Unita
Telephone # of Contact Person:
Estimated Value of Project Ts 00 0
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Reed
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item Amount
Structural Cafes.
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Catcs.
Called Contact Person
Plan Check Balance.
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2id Review, ready for corrections/issue
Electrical
Subeontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.L
H.O.A. Approval
Plans resubmitted
Grading
M ROUSE:-
1i° 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
Total Permit Fees