12-0629 (PAT)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:. 12-00000629
Property Address: 78845 LA PALMA DR
APN:" 604-163-017-117 -23269 -
Application description: PATIO COVER - RESIDENTIAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 5000
Ta�/ 4 4 Q"
Applicant: Architect or Engin
D
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
KUCHYT, CHRISTOPHER
78845 LA PALMA DA
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Contractor:
Owner
e
JT
---------------7-----------------
JUL1' 2012
LICENSED CONTRACTOR'S DECLARATION
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 and Professionals Code, and my License is in full force and effect.
License Class: License No.:
Date: Contractor:
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 ($500).:
(_ 1 I, 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. If, however, the building or improvement is sold within
• 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.).
(_ 1 I, as owner of the property, am exclusively contracting with licensed contractors 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
pursuant to the Contractors' State License Law.).
1 _ 1 I am exempt under Sec. , B.&P.C. for this reason
xDate: �°�%" /� Owner:
I hereby affirm under penalty of perjury that there is a con
work for which this permit is issued (Sec. 3097, Civ. C.):
Lender's Name:
Lender's Address:
LQPERMIT
AIDING AGENCY
lending agency for the performance of the
Date: .7/17/12
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
_ I have and will maintain a certificate of consent 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
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:
Carrier 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' compensation laws of California,
and agree that, if I should beco si ject to the workers' compensation provisions of Section
3700 of the Labor Code, I Ifo h c • 9 with rhos rovisions.
,Date: r_/V_/1__Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPEN ON COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000)• IN ADDITION TO THE CO 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, 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.
2. Any permit issued as a result of this application becomes null and void if work is not cdmmenced
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. I agree to comply with all
city and county ordinances and state laws relating to building constru n, and hereby authoriz resentatives
of this county to enter upon the above-mentioned property for i ec ' s1�s
Date' 405& nature (Applicant or Agent):
Application Number . . . . . 12-00000629
Permit . . . PATIO COVER PERMIT
Additional desc .
Permit Fee 72.00 Plan Check Fee
46.80
Issue Date . . . . Valuation . . .
. 5000
Expiration Date.. 1/13/13
Qty Unit Charge Per
Extension
BASE FEE
45.00
3.00 9.0000 THOU BLDG 2,001-25,000
w
27.00
------------------
Notes and Comments
176SF FREE -STRANDING PATIO COVER AT REAR
YARD [ENGINEERED] DESIGNED 5PSF ROOF
COVERING ONLY. THIS PERMIT DOES NOT
INCLUDE ELECTRICAL, MECHANICAL OR
PLUMBING INSTALLATIONS. 2010 CALIFORNIA
BUILDING CODES.
July 17, 2012 2:03:26 PM AORTEGA
----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
STRONG MOTION (SMI) - RES
.50
Fee summary Charged Paid Credited
Due
--------------------=------------------------------------
Permit Fee Total- 72.00 .00 .00
72.00
Plan Check Total 46.80 .00 .00
46.80
Other Fee Total 1.50 .00 .00
1.50
Grand Total 120.30 .00 .00
120.30
wog wl�
Me#1"19
e
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-Buflders Applying for Construction Permits
ORO .. I�iQTICF Tn eitnp>�u-ry OW1V R_
Dear Property Owner:
Ari. application for a building permit has been submitted m your name listing yourself as the builder of the .property
Imp.specified at
We are Pmvding you with an Owner -Builder Aclmowledgment and Information Verification Form to make you awm of your
responsibilities and lrossible risk you may incur by having this permit issued in your name as .the
Owner -Builder. We w(B not issue a buRding.pennit unt6 ywAave read, initialed your understanding of eaeLproAslon,
signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute "...notice
unless you, the property owner, obtain the prior approval of the permitting authority.
OVRQW3 Ale XOGNENT ANDYERMCATWN OF FOW">1` ON
tA&M1USdead and htitiat each: statement -heti w -m signify you unidurswn&or very dds iiuformadon.
�. I 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 persorielfy. 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 Party.
Z2. a 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.
1._,-?. I understand as. an "Owner -Builder" I am the responsiiile,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.
If4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on
permits and contracts.
�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 may be considered an "employer"
under state and federal law.
_,CIC I understand if I am considered an "employer" under state and federal taw, I must register with the state and federal
government, withhold payroll taxes, provide workers' compensation disability imstrr-ance, 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-
/X7.
is// 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.
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_ 4uries WvWned by any subsequent owner(s) that result from any latent construction defects in the
workmanship or materials. '
�9. 1 understand I may obtain more information regarding my obligations as an "employe' from the Internal ReNenue
Service, the United States Small Business Administration, the California Department of Benefit P,aymel ts, and the California
Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (C%Z) at 1-
800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors.
(/10. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the
Ply legally and financially responsible for. proposed construction activity at the following address:
agree that, as the party legally and fwaucially responsible for this proposed construction activity, 1 will abide by all
applica
ble laws and requirements that govern Owe -Builders as well as employers.
12. I agree to notify the issuer of this form immediately of any additions; deWans, or changes to 4ny of the infMm6 ioh 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 limnsec, the Contractors' State License Board may be unable to assts you with any dnaueW loss
You may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be inie wd court. It is also
important for you to understand that if an .Contractor of employee of that individual or firm, is bqurW while wort ing
on your Property, you may be hoU liable €or damage& If you obtain a permit as Owner -Builder and wish to hire ConUactors,
you will be respossMo for verifjring v&dhw os not those Co tractors are pmperty anti the staEtts of their weWeW
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 issrrib dw.p =it, Noter: A copy of the property otyow's dWYees 4M.Maj f ate 00ft oa A"4 or
other verification acceptable to the agency is ,wired to be presented when the pe.vmit is laaa to varify the PmperrY
owner's signature.
Signature of property owner 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.
AUTRQRVATION OF AGENT TO ACT ON PROPERTY OWNEWS BMW
Excluding -the Notice to Property Owner, the execution of which I understand is my persond responsibility, I hereby authorize
the following perms). to act as my agent(s) to apply for, sign, and file the documents necessary to obtain ani Owaet-Builder
Permit for my project.
Scope of Construction Project (or Description of Work):
Project Location or Address:
Name of Authorised 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 bepres cited when the permit is issued to verify the property owner's signature..
Property Owner's Signature: Date:
71-780 San Jacinto Dr. Ste. E2; Rancho Mirage;, Ca. 92270 ph. (760) 83478860 fax (760) 834-8861
Letter of Transmittal
To:
City of La Quinta Today's Date:
7-13-12
78-495 Calle Tampico City Due Date:
7-12-12
La Quinta, CA 92253 Project Address:
78-845 La Palma
Attn:
Kay / AJ Plan Check #:
12-629
Submittal: ❑ 1st
❑
4th
® 2nd
❑
5th
❑ 3`d
❑
Other:
We are forwarding: ® By Messenger ❑ By
Mail (Fed Ex or UPS)
❑ Your Pickup
Includes: # Of Descriptions: Includes:
# Of
Descriptions:
Copies:
Copies:
®
1 Structural Plans
❑
Revised Struct. Plans
®
1 Structural Calculations
❑
Revised Struct. Calcs
❑
Truss Calcs w/Ltr.
❑
Revised Truss w/Ltr.
❑
Soils Report
❑
Revised Soils Report
❑
Structural P/C Comments
❑
Approved Structural Plans
❑
Redlined Structural Plans _
❑
Approved Structural Calcs
❑
Redlined Structural Calcs
❑
Approved Truss Calcs
❑
Redlined Truss Calcs
❑
Approved Soils Report
❑ Redlined Soils Reports ❑ Other:
Comments: Structural content is approvable.
Please note roof structure designed for asphalt roof shingles.
Structural Plan Review Time =1.0 Hrs.
This Material Sent for:
❑ Your Files ® Per Your Request
❑ Your Review ❑ Approval
❑ Checking ❑ At the request of:
Other: ❑
By: John W. Thompson
Rancho Mirage Office: ® (760) 834-8860
Other: ❑
I JUl- � � 2012
71 780 San Jacirto Dr.: Ste. E2; Rancho Mirage,;C,a. 92270 ph. (760) 834-8860: 1
Letter of Transmittal
To: City of La Quinta ,
Today's Date:
6-13-12
78-495 Calle Tampico
City Due Date:
6-13-12
La Quinta, CA 92253
Project Address:
78-845 La Palma Drive
Attn: Kay
Plan Check #:
12-629
Submittal:
® -15t-- ❑
4th
❑ 2nd ❑
5th
❑ 3`d ❑
Other:
We are forwarding: ® By Messenger ❑ By Mail (Fed Ex or UPS) ❑
Includes: # Of
Copies:
® 1
El
El
Descriptions:
Structural Plans
Structural Calculations
Truss Calcs
_ Soils Report Update
Structural P/C Comments
Redlined Structural Plans
Redlined Structural Calcs
Redlined Truss Calcs
❑ Redlined Soils Reports
Comments: Structural content is approvable.
Structural Plan Review Time =.75 Hrs.
This Material Sent for:
❑ Your Files
❑ Your Review
❑ Checking
Other: ❑
By: John W. Thompson
Rancho Mirage Office: Z (760) 834-8860
Other: ❑
Includes: # Of
Copies:
Descriptions:
Revised Plans
Your Pickup
Revised Struct. Calcs
Revised Truss w/Ltr.
Revised Soils Report
Approved Structural Plans
Approved Structural Calcs
Approved Truss Calcs
Approved Soils Report
Other:
® Per Your Request
❑ Approval
❑ At the request of:
� 0 T ,
14 201
?Our.
Bln.#11P. ��
C��/ Of La trim
Q
BulkUng 8T Safety Division
Box 1504,78-495 Calle Tampico
La .QLdnta, CA 92253 - (760) 777-7012
Building Permit Applicadonand Tracking Sheet
Permit #P.O.
s.b V
��
Project Address:
Owner's Name:.
A. P. Number.
Address: 7e &?,5 5��f
Legal Description:
Contractor. O�y
City, ST, Zip: Z J—
Telephonl8 �
Address: 76? or
Project Description:
City, ST, Zip:
State Lic. #: City Lia #;
Arch., Engr., Designer o e
Addt+ess: O �Qt�[L� s�lsCp �l�Z
City, ST. Zip: .9
Telepho 7 � f 1*97
State Lia #:
Construction Type:. Occupancy:
Project type (circle one): New Add'n Alter Repair. Demo
Name of Contact Person
Sq. Ft.: 33 p
# Stories:
# unit$:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT:
DO NOT WRITE BELOW THIS LINE
N
Submittal
Req'd
Recd
TRACMG PERMfT FEES
Plan Sete
Item
Plan Check submittedRn
Amount
Structural Cales.
Reviewed, ready for correctives b itiPlan Check Deposit_Truss
Calcs.
Called Contact Person PlanCheckBalance.
Title 24 Cato.
Pians pickaA up Construction
Flood plain plan
Plans resubmitted. _ Mechanical
Giadiog plan
2' Review, ready for correctio9. nI Electrical
Subeontactor List
Called Contact Person Plumbing
Grant Deed
Plans picked up S.M.I.
H.O.A. Approval
Plans resubmitted Grading
IN ROUSE:-
3" Review, ready for correctionsAssee Developer Impact Fee
Planning Approval
Called Contact Person p,
Pub. Wks. Appr
Date of permit issue
Schodl Fees
Total Permit Fees
'S "Ilrlle sea A&lcrL
!0`111'30�R. - Ns� Qr'c. I.StR- �>� � P�►x'p�c� 'Co ISSw+�
_.... ........---- ...............__._.
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