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BRES2016-012578-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 T'+r °� 1wQumr: COMMUNITY DEVELOPMENT DEPARTMENT BUILDING PERMIT Application Number: BRES2016-0125 Property Address: 78470 SINGING PALMS DR APN: 643181012 Application Description: KAREN MUSMECI / GARAGE SHED Property Zoning: Application Valuation: $2,000.00 Applicant: KAREN MUSMECI 205 ATLANTIC AVE HULL, MA 02045 VOICE (760) 777-7125 FAX (760).777-7011 INSPECTIONS (760) 777-7153 Date: 5/5/2016 Owner: KAREN MUSMECI 205 AT H 0204 VA 0 5 Co Facto 20 °.0 KA EN M S 20 ATLANTIC �R0FLAQUINTA HU L, iVIA COMMA DEVELOPMENT DEPARTMENT . (781)773-1405 Llc. No.::CONV:140528101254078268 LICENSED CONTRACTOR'S DECLARATION ` WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter I hereby affirm under penalty of perjury one of the following declarations 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, `. I have and will maintain a certificate of consent to self -insure for workers' and my License is in full force and effect. compensation, as'provided for by Section 3700 of the Labor Code, for the performance License Class: License No.::CONV:140528101254078268 ; of the work for which this permit is issued. I have and will maintain workers' compensation insurance, as required by Date: Contractor: 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: 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 to a civil penalty of not more than five hundred dollars (0• ( I; as owner of the property, or my employees with wages as their sole mpensation, will do the work, and the structure is not intended or offered for sale. ec. 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 h o did not build or improve for the purpose of sale.). ( I, as owner of the property, am exclusively contracting with licensed contractors I 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 thontr eVctors' State License Law.). ( am exempt under Sec. B.&P.C. for this reason —Date: Owner:. " CONSTRUCTION LENDING AG NCY 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: Carrier: Policy Number: _ I certify that in the performance of the work for which this permit is issued, I hall not employ any person in any manner so as to become subject to the workers' ompensation laws of California, and agree that, if I should become subject to the orkers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith I.romply with those provisions. Date: Applicant: 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 =OMPENSATION, 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 Ib blowing 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 information is correct. agree to comply with all city and county ordinances and state laws relating to building onstruction, and hereby authorize representatives of this city to enter upon the above-ment'ned 'operty for inspection purposes. Cate: � Signature (Applicant or Agent): �� ' •• • DESCRIPTION.:, a-p�ACCOUNTk��¢ x :YQTY AMOUNTp pa PAIDt PAID DATE BSAS SB1473 FEE 101-0000-20306 0 $1.00 $1.00 5/5/16 PAID.,BY ' METHOD,:.' z , 3'` ` u RECEIPT # >+ 4 CHECK #�x` .. �; ft c- x.. CLTD BY KAREN MUSMECI CHECK R15286 2474 RSE Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 $1.00 DESCRIPTIONr" " l ACCOU T r QTY F AMOUNT ' ` `' x PAID IPAID DATEk „. �z DEVICES, FIRST 20 101-0000-42403 0 $24.17 $24.17 5/S/16 PAIDBYi #METHOD = CHECK#R CLTDBY,`L t # k KAREN MUSMECI CHECK R15286 2474 RSE DESCRIPTION =. ry r r °mfx 4 AMOUNT. PAID _. PAID'DATE .,ACCOUNT. ,.QTY- DEVICES, FIRST 20 PC 101-0000-42600 0 $24.17 $24.17 5/5/16 eg, o PAID BY METHOD ��RECEIPT# CHECK#.-, . t.CLTDBY.� KAREN MUSMECI CHECK R15286 2474 RSE Total Paid for ELECTRICAL: $48.34 $48.34 ,v.> f t DESCRIPTION ,� i ACCOUNT { QTY 'AMOUNTS x Wr& 4faPA1D.DATE NEW CONSTRUCTION PERMIT 1101-0000-42400 0 $50.71 $50.71 5/5/16 °P: PAID BYE �x r.6E h v^1� METHOD RECEIPT # rt r; a CHECK # CLTD BY KAREN MUSMECI CHECK R15286 2474 RSE Total Paid for NEW CONSTRUCTION PERMIT: $50.71 $50.71 DESCRIPTION '', z ;ACCOUNT `,_c QTY& e, AMOUNTf° i PAID ', PAID DATE,: NEW CONSTRUCTION PLAN CHECK 101-0000-42600 0 $70.99 $70.99 5/5/16 PAID BY Rk'y st t METHOD r ' RECEIPT # CHECK # r CLTD BY �a+ ,� * , KAREN MUSMECI CHECK R15286 2474 RSE Total Paid for NEW CONSTRUCTION PLAN CHECK: $70.99. $70.99 DESCRIPTION } « ' # � 'A000UNTp a !QTY ` Y � AMOUNTa "b � �` PAID PAID DATE'; �` SMI -'RESIDENTIAL 101-0000-20308 0 $0.50 $0.50 5/5/16 .PAID. BY a 0.,k'Y METHOD f n RECEIPT # BiA CHECK # f' 'CLTD BY a az=x KAREN MUSMECI CHECK R15286 2474 RSE Total Paid for STRONG MOTION INSTRUMENTATION SMI: $0.50 $0.50 Description: KAREN MUSMECI / GARAGE SHED Type: BUILDING, RESIDENTIAL Subtype: GARAGE Status: UNDER REVIEW Applied: 5/5/2016 RSE Approved: Parcel No: 643181012 Site Address: 78470 SINGING PALMS DR LA QUINTA,CA 92253 Subdivision: TR 2043• Block: Lot: 24 Issued: Lot Sq Ft: 0 Building Sq Ft:0 Zoning: Finaled: Valuation: $2,000.00 r Occupancy Type: Construction Type:. Expired: No. Buildings: 0 . No. Stories: 0 No. Unites: 0 (781)773-1405 Details: GARAGE SHED WITH SEVEN LIGHTS, 2013 CALIFORNIA BUILDING CODES. KAREN MUSMECI ADDITIONAL SITES Printed: Thursday, May 05, 2016 11:50:49 AM 1 of 2 . SYSTEMS CHRONOLOGY 'NAiMET'YPE �+ �Wlr 8' yff.fNAME�'"' dloonhL uau( e„ aADDRES$1 M,. CONTACTS „4f..�„ i wK )'(!!'N I°rir STATE, __.:"IP lip::-. "" EMAIL 'APPLICANT KAREN MUSMECI 205 ATLANTIC AVE HULL MA 02045 (781)773-1405 CONTRACTOR KAREN MUSMECI 205 ATLANTIC AVE HULL MA 02045 (781)773-1405 OWNER KAREN MUSMECI 205 ATLANTIC AVE HULL '. MA 02045 (781)773-1405 Printed: Thursday, May 05, 2016 11:50:49 AM 1 of 2 . SYSTEMS A 7-, MOUNT'— 'CHECK#_� 'MET CLTD DESCRIPTION ACCOUNT 7 QTY., A PAID, PAID DATE, RECEIPT H ODd PAID BY - BY DEVICES, FIRST 20 101-0000-42403 .0 $24.17 $24.17 5/5/16 R15286 1474 CHECK KAREN MUSMECI RSE DEVICES, FIRST 20 PC 101-0000-42600 0. $24.17 $24.17 5/5/16 R15286 2474 CHECK KAREN MUSMECI -RSE Total Paid for ELECTRICAL: $48.34 $48.34 NEW CONSTRUCTION 101-0000-42400 0 $50.71 $50.71 5/5/16 R15286 2474 CHECK KAREN MUSMECI RSE PERMIT Total Paid for NEW CONSTRUCTION PERMIT: $50.71 $50.71 NEW CONSTRUCTION . 101-0000-42600 0 .$70.99 $70.99 5/5/16 R15286 2474 CHECK KAREN MUSMECI RSE PLAN C HECK Total Paid for NEW CONSTRUCTION PLAN CHECK: $70.99 $70.99 SMI - RESIDENTIAL 101-0000-20308---F 0 $0.50 $O.SO 5/5/16 RiS286 2474 CHECK KAREN MUSMECI RSE Total Paid for STRONG MOTION INSTRUMENTATION SMI: $0.50 $0.50 TOTALS: $171.54 $171,54 INSPECTIONS . .. .... ........ . . PARENT PROJECTS .. ... . . .. ..... Printed: Thursday, May 05, 2016 11:50:49 AM 2 of 2 CB?WYSTEMS P.D. 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)777-7012FAX (760) 777-7011 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. name listing yourself as the builder of the property improvements specified at We are providing you with an Owner -Builder Acknowledgment and Information Verification Form 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' xecute this notice unless you, the property owner, obtain the prior approval of the permitting authority: OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION DIRECTIONS: Read and initial each statement below to signify you understand or verify this information. A -_Tl 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. . 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. liI 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. _d'"I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. /v 5 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 maybe 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 risk. ��71'understand under California Contractors' State License Law, an Owner -Builder whb 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. .ti 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. WI understand I may obtain more information regarding my,obligations as an."employer" from the Internal Revenue eice, the United States Small.Business Administration,the California Department of Benefit Payments, and the p ym California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1- 800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. k10 -am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the p�Iegally , and 'financially responsible for' proposed construction activity at the following address: A- 1.that, as the party legally and financially responsible for this proposed construction activity, I will abide by all app •cable laws and requirements that govern Owner -Builders asmell as employers. 12.1 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. Signature of property owner 41'__ _1/1� /I--- Ir 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 for a 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: 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 thepermit is issued to verify the property owners signature. Property Owner's Signature: Date: Iain # City of La Q uin to Building 8& Safety Division 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # Project Address: -78L(-76 SI11 � Owner's Name: 1 j� ro — Fl��ccv, A. P. Number: Address: l I l� S Legal Description: City, ST, Zip: )0Pq (10 Contractor: o e. 3- TelePhn•3a- 3 J Address:. v' (j—� V Project Description: City, ST, Zip: GtcQ L: l'C�.i+T Telephone: c 7 J State Lic. # : City Lic. #: . Arch., Engr., Designer: Address: City, ST, Zip: . Telephone: . Construction TyP e• Occupancy:aneY : Lic. # State L . Project type (circle r cle one) • New Add'n Alter Repair air De mo Name of Contact Person: �<Ck4� o kj�!)M Lt..... Sq. Ft.: � � # Stories: # Units: Telephone # of Contact Person: (— (a 7 Estimated Value of Prot." . APPLICANT: DO NOT WRITE BELOW THIS LINE 4 Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cafes. 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 2nd 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 ROUSE:- '"! Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of issue School Fees, Total Permit Fees ii f. �. {b�:rx fa {P "��y°"' '�'r' .d� 7 .H'C '1� `a',ry- � Y s',' � r.,, 1'"� �i *•�, �;Fkn i� �,r.17 t�.i�l ��" �'�»• • r �. �y� �y,*►� 1�1� f[:. t'` its ' (� It Nf law io,F *4r l f { ,' ' p'. -• rte^ t r•. +PT.ly ' { 4 - - • 1 ott t,4� CTi=LtUid DATA � _ { 3 may`• � F S � S}�i V � }, __ .{/ eal y.-��_�L.r� '-REC' i MAR 31 2016 E CITY OF LA OUINTA .''IMMUNITY DEVELOPMENT 6 � � �r •: 'r � ,ri .,' ,p �i , . :. S ,.r f Y �- 1 � .,1 , �':� 1 1 y,, ,. y �� b �1 i e� i l 4 CIV O '�9�Ter� BUILOIN G & SAFEV DEPT. � f"ROVE 3 FOR Co�ISI B GTii3N DATE .SIS kcBY