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12-0698 (PAT)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA,• CALIFORNIA 92253 Application Number:' 12-00000698Zr Property Address: 4"54776R8UNBROOK LN APN: 604-421-005-5 -23995 - Application description:. PATIO COVER - RESIDENTIAL Property Zoning: LOW DENSITY . RESIDENTIAL ' Application valuation: 2567 TAW BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Applicant: Architect or Engineer: r VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Owner: JANEA DUCHENE 45470 SUNBROOK LANE LA QUINTA, CA 92253 --------------------------------- Contractor: Owner Date: 6/25/12 n1 2 : 2012 ----------------------- r _ LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION I herebyaffirm under penalty of perjury that I am licensed under provisions of Chapter 9 Icommencin with P Y P I Y P P 9 I hereby affirm under penalty of perjury one of the following declarations: ^f, Y P Y P 1 Y 9 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: - CU1111dCLUN - - "_ I have and will maintain workers' compensation insurance, as required by Section .1700 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 pelrson in any manner so as to become 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 become subject to the workers' compensation provisions of Section " License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or700 of the Labor Code, I shall fort ith com ly with those provisions. that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by ///3 2— any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars 15500).: ate: r' plican ( } 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 WARNING: FAILU E 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. It, however, the building or inipruvement is sold within SECTION 3706 OF TMC LABon 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.). 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 restrictionsset forth on this application. property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed l.. 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. f , B.&P.C. for this reason the owner, and the applicant,leach 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. Date: 4� er: - 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 above information 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 building construction, and hereby authorize representatives ` - Lender's Name: of thi o my to enter upon the above-mentioned property for inspect' _ • ate: 19 / nature (Applicant or Agent Lender's Address: } LQPERAI IT Application Number . . . . 12-.00000698 Permit PATIO COVER PERMIT'INV FEE . Additional desc... Permit Fee_ 108.00 Plan Check Fee 35.1`0 Issue Date Valuation . . . 2567 Expiration Date 12/22/12' Qty Unit Charge Per Extension BASE FEE 90.00 1.00 18.0000 THOU BLDG.2,001=25,000' 18.00 Special Notes. and Comments 193: S.F. ALUMAWOOD PATIO COVER TO CLOSE CODE CASE 11-6538. 2010 CODES.INVESTIGATION FEE ASSESSED PER 1997 UNIFORM ADMINISTRATIVE CODE §304.5 FOR WORK BEGUN WITHOUT BUILDING PERMIT. Other Fees . . . BLDG STDS ADMIN (SB1473) .- 1.00 STRONG"MOTION (SMI) - RES .50 Fee summary Charged Paid Credited Due Permit Fee Total 108.00 .00 .00 108.00 Plan Check Total 35.10 .00 00 35.10 j Other Fee Total 1.50 .00 .00 1.50 Grand Total 144.60 .00 .00 144.60 LQPERMIT - moo® i ' C s 1 P.O. Box 1504 . LA QUINTA, CALIFORNIA 92247-1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT PROPERTY OWNEWS PACKAGE (760) 777-7012 FAX (760) 777-7011 Disclosures & Forms for Owner -Ru. lders Applying for Construction Permits Ill_'081i V NOTICE TO )Pgo EVTY 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 P►cknowleclgment and- Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having "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. OFD'S ACKNOWLEDGMV4T AND VE IECATIOIV OF VWORM, 13ON DIRECTI-ONS: Read and initial each: statenrentbehow-10 signify you understand `or verify this in/brmation. 1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder" buttding permit that erroneous) lies Y unP that the property owner is providing his. or her own labor and material persouall ji. 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. 6�n2. I understand building permits are not required to be signed by property owners unless they are responsible for the onstruction and are not hiring a licensed Contractor to assume this responsibility. 11 understand as an "Owner -Builder" I am the responsi6le_party of record on the permit_ I understand that I may protect lffrom potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers or. ermits and contracts. MyI understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value construction is at least five hundred dollars ($500), includinglabor and materials I may be considered an "employer' under state and federal law. Y P-0-6. I understand if I am considered an "employee' 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 ftnanciA risk. G 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. k8. I understand as an Owner -Builder if I sell the property for which this permit is issued, 1 may be held liable for any ancial or personal. injuries summed by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. 4)1_9. I understand I may obtain more information regarding my obligations as an "employer' from the Internet Revenue er ce, 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 1- 800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. qk10_ I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the legally and financially responsible . for proposed construction activity at the following address: 11. I agree that, as the gamy legally and financially responsible for this proposed construction activity, l will abide by all plicable laws and requirements that govern Owner=Builders as well 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 ave 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 issuiug.the<permiL Nate: A copy of theproperty owner's didver's!icensei form notarkatinn, 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 o Date: Note: The following Authorization Forth 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 perjurythat 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 verify the property owner's signature. Property Owner's Signature: Date: utn ff Permit # 1�. �C Project Address < A. P. Number: Legal Description: Contractor: Address: ""I City, ST, Zip: Telephone: ------------- State Lic. # Arch., Engr., Designer: Address: City, ST, Zip: Telephone: State Lic. #: Name of Contact Person: Telephone # of Contact Person: # Submittal Plan Sets Structural Calcs. Truss Calcs. Title 24 Calcs. Flood plain plan Grading plan Subcontactor List Grant Deed H.O.A. Approval IN HOUSE: - Planning Approval Pub. Wks. Appr School Fees City Of La Quinta c -°d' s g Building 8L Safety Division P.O. Box 1504, 78-495 Calle Tampico I La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet LCA_ wner's Name:. 1 V\nrl ► n , IA n, Lic. #: ST, Zip: ject Description: Construction Type: Occupancy: Project type (circle one): New Add'n Alter Repair Demo Sq. Ft.: #Stories: # Units: y`. Ltimated Value of Projec APPLICANT: DO NOT WRITE BELOW THIS LINE 'd Recd TRACKING Plan Check submitted Reviewed, ready for corrections Called Contact Person Plans picked up Plans resubmitted 2"d Review, ready for corrections/issue Called Contact Person Plans picked up Plans resubmitted Jrd Review, ready for corrections/issue Called Contact Person Date of permit issue PERMIT FEES Item Amount Plan Check Deposit Plan Check Balance Construction Mechanical Electrical Plumbing S.M.1. Grading Developer Impact Fee A.I.P.P. Total Permit Fees