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13-0378 (PLBG)P.O. BOX 1504'• " �" "" VOICE (760) 777-7012. :78-495, CALLE TAMPICO FAX (760) 777-7011 LA'QUINTA;:CALIFORNIA 92253 • BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 3/28/13 Application Number: 13-00000378 Owner: Property Address: 53090 AVENIDA VALLEJO BERNADOTTI, MARIANNE AN: 774-053-004-21 -000000- LA QUINTA, CA 92253 Application description: PLUMBING (760)'399-9527 Property Zoning: COVE RESIDENTIAL - ---=---------------'-------------- " Application valuation: 5000 Contractor: Applicant: Architect or Engineer: Owner -------------------------------- Fn-7 MAR < 2013 ------------------------------------------------------------------ - CLTy_OFLp,QUINTA LICENSED CONT CTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION FINANCE DEPT. I hereby affirm under penalty of perjury that I am licen 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 and5w essionals 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 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, 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 s uld become subject to the workers' compensation provisions of Section ense Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or X700 of the Labor e, I all fbrthwith comp th those provisions. .he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031 .5 by tom` JO L 19I�AY,plicant for a permit subjects the applicant to a civil penalty of not more than five_hundred dollars 155001.: /Dai 2� 3 Appliiani: as owner of the property, or my employees with wages as their Sole compensation, will do the work, and WWW/ the structure is not intended or offered for sale ISec. 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 theworkhimself 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. - - ///,,,111iii .one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.).. , - APPLICANT ACKNOWLEDGEMENT yyy 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. r 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 .cense Law.). whose benefit work is performed under or pursuant to any permit issued as a result of this application, ( I am exempt under Sec. , B P.C. for this. reason ' 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 f performed under or following issuance of this permit. Date: tiiI Ow erg - 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 1 certify that I have read this application and state that the a ve 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 build, construction, and he by authorize representatives of this county to enter upon the above-mentioned property r ri ct6n purpose Lender's Name: Date: Signature (Applicant or`Agent): _ Lender's Address: � LQPERAIIT ' Bina City Of % Qulnta Butift ar Safety Division P.O. Box 1504, 78-495 Calle Tampico La.Quinta, CA 92253 -:(760) 777-7012 Building Pennit'Application' and Tracking Sheet Permit # �' ProjectAddtess: 3 Q q0 V. V V01-L. C v, 's Name:. ivl yl9 c c 1 A. P. Number. L{ " l� 3 O 4' — i-¢ Address: 49 qS -c G f=2S ola S T ! 3 14 Legal Description: City, ST, Zip: I' l C'4 ' Contractor. LJ _ n Telepho eA 3 / S 7 Address: Project Description: City, ST, Zip: : Co 0 �J ` C. Tele hone: State Lic. #: City Lic. #< b tq u t jS E P�n C Arch. Engr., Designer Address: City., ST, Zip: Telephone: ' ' State Lie. #: » : Conduction Type: , Oaupancy: Project type (circle one): New Add'n Alter Repair Derno Sq. FL: # Stories• # Unit Name of Contact Person: Telephone # of Contact Person: Estimated Value of Proj —!� APPLICANT: DO NOT WRITE BELOW THIS UNE _•. 0 Submittal Req'd Reed TRACMG PERWrFEES- Plan Sets Plan Check submitted Item Amount Structural Calm Reviewed, ready for corrections Plan Check Deposit. . Truss Cates. Called Contact Person Plan Check Balance. Title 24 Calci. Pians picked up Construction Flood plain plan Pians resubmitted.. Mecharilcal Grading plan 2a° Review, ready for correctionsrmue Electrical Subcoutactor List Called Contact Person Plumbing Grant Deed Plans picked up W&L FLOAL Approval Plans resubmitted Grading .N HOUSE-- '^' Review; ready for correctionsAssue Developer Impact Fee Planning Approval Called Contact Person AJ-P-P. " Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees k COACHELLA VALLEY WATER DISTRICT + i r t�I P.O. BOX 1058, COACHELLA, CALIFORNIA 92236 (760)'.398=2651 INVOICE + Date:3/28/2013 ` SUBJECT: 'SCC ONLY - 53090 AVENIDA VELLEJO, LA QUINTA, LID 686928° BERNADOTTI MARIANNE - Project: . _ - ' 13-4490r 53090 AVENIDA VALLEJO Project Date: r „ 3/28/2013 - Amount Due: • $4,231.00 LA QUINTA, CA 92253 GEO:' 06-06-12-4' } Planner:. +' CAROL PFANNKUCHE• TO INSURE PROPER CREDIT, PLEASE RETURN THIS PORTION WITH REMITTANCE AND INCLUDE THE PROJECT ON YOUR CHECK' , 1 --------------------- =— -- — — , -BM y,} w. .�_ _ 615 .-' + - ------ ..a...-•_ - 4 .-,;; gam- - 1.00 SCC -COLLECTION $1,836.00 $11636.'00- 1.00 1;836.001.00 SCC -TREATMENT- , $2,395.00 $2,395.00 $4,231,00 i L t PAID ,v 3L P '. - MAR 2;8I?e 2013_ ..COACHELLA VALLEY ^ ` WATER DISTRICT SUBJECT: SCC ONLY -53090 AVENIDA VELLEJO, LA QUINTA, LID 686928 - COACHELLA VALLEY WATER'DISTRICT • +. P.O. BOX 1058, COACHELLA, CALIFORNIA 92236 (760) 398=2651 s IV 011OW FAA. Itv M/M P.O. Box 1504 LA QUINTA, CALIFORNIA 92247-1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT (760) 777-7012 PROPERTY OWNER'S PACKAGE FAX (760) 777-7011 Disclosures & Forms for Owner -Builders Applying for Construction Permits GRZAAW 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 3 -- �j G O 1� U , VA, L' _ (✓'T D LA a U I P T e,) - We are providing you with an Owner -Builder Acknowledgment and I d ormition 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 -Budder. 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. OMWWS ACKNOVMEDGMENT AND YERIMC&MN OE WFORMA )N DfREt>TIONS: Read and initial earfestatement below to signify you understand or verify this information. 1. I understand a frequent practice of unlicensed � p persons is to have the property owner obtain an "Owner -Builder" b g permit that erroneously implies that the property owner is providing his or her own labor and material personally. 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 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- 4t2.1 roperty 42. I understand building permits are not required to be signed by property owners unless they are responsible for the co truction and are not hiring a licensed Contractor to assume this responsibility. JL3. I understand as an "Owner -Builder' I am the responsible party of record on the permit. I understand that I may protect If from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. 4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on e .ts and contracts. 5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value my construction is at least five hundred dollars ($500), including labor and materials, I may be 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 gov rnment, 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 isk. 7. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential tures 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. L h8. I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable, for any cial or personal. kouries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. ELKK9. I understand I may obtain more information regarding my obligations as an "employee' from the Internal Revenue 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.c.sib.ca.gov for more information about licensed contractors. 0. 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: I L I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all cable laws and requirements that govern Owner -Builders as well as employers. 12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I a provided on this form Licensed contractors are regulated by laws designed to protect the public. If you contract with so cone who does not have a license, die 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 wodlang on your property; you may be heed 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 Cofactors 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 is the permdt. Note: A capy of eke property owner's d river's licensg form notarii mown, or other verification acceptable to a agency is required tole presented when the permit is issued to verify the property owner's signature. (I Signature of property owner 444MDate: 41S12-0 %3 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 agents) 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, fora: 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: