13-1442 (DEMO)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
13-00001442
78725 AVENIDA LA FONDA
770-171-006-149 -000000-
DEMO - COMML/OTHER
LOW DENSITY RESIDENTIAL
100
Architect or Engineer:
4.4 Qg(k&
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
PHILLIP & ROSSIE GUTIERREZ
78725 AVENIDA LA FO
LA QUINTA, CA 922539
( �
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.
Li ass: License No.:
Date: Coractor:
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
tfa,'plp�liclml
rshe is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
fora permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500).:
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 novintended 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 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.).
I am exempt under Sec. , B.&P.C. for this reason
Date: L 1 — \ Owner:
CONSTR CTION LENDING AGENCY
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 Name:
Lender's Address:
LQPERMIT
Contractor:
Owner
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 11/13/13
NOV 14 2013 D
OF � QUIM ATAT
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 become subject to the workers' compensation provisions of Section
3700 of the Labor Code, I shall forthwith comply 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 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 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. I agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of t ' county to enter upon t above-mentioned prop ty for inspection purposes.
Date:. Signature (Applicant or A
Application Number . . . . . 13-00001442
Structure Information
Construction Type . . . . . TYPE V, UNPROTECTED
Occupancy Type . . . . . . DWELLG/LODGING/CONG <=10
----------------------------------------------------------------------------
Permit . . . DEMO PERMIT
Additional desc .
Permit Fee 35.75 Plan Check Fee
.00
Issue.Date . . . . Valuation . . .
. 100
Expiration Date 5/12/14
Qty Unit Charge Per
Extension
1.00 35.7500 LS MISC DEMOLITION, EXT
35.75
----------------------------------------------------------------------------
Special Notes and Comments
DEMO - DEMO UNPERMITTED 20FT. X-15FT.
PORCH AND 4FT. X 5FT. WASHROOMS.
RE-ROUTE DETACHED WORKSHOP ELECTRICAL TO
UNIT #1. 2010 CALIFORNIA BUILDING CODES.
----------------------------------------------------------------------------
Other Fees . . . . . . . PLAN CHECK, DEMOLITION
107.25
Fee summary Charged Paid Credited
------------------------------
Due
---------------------------
Permit Fee Total 35.75 .00 .00
35.75
Plan Check Total .00 .00 .00
.00
Other Fee'Total 107.25 .00 .00
107.25
Grand Total 143.00 .00 .00
143.00
C
LQPERMIT
1
Bin #
Qty of La Quinta
Building &r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: l g'12 et A'd v o a4.
Owner's Name:
A. P. Number:
Address: Pv1 F7
Legal Description: LO K,,.k-At— v-
City, ST, Zip: ' v-,,-
Contractor:
Telephone:
Address:
Project Description: MD of C.k 70 A I
City, ST, Zip:
of
Telephone:
%:"�'<. �:?:^ver"<:,::.
•
State Lic. # :
ON Lic. #;F,
Arch., Engr., Designer:
Address:
IF
City., ST, Zip:
Telephone "''"'` '"
State Lic. #• �%::y'>:'ss<f�;�:r.�:<=M:<:>'s>;>:�;::r.;:s::.:;•:.y:
+,.,;:-:::c <h.;>:,«<•+
{L2C:yrr i i::.`fv •i... .. -
Name of Contact Person: ���j l % t {1/i! Z
Construction T e: Occupancy:
,
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.:
# Stories:
#Units:
Telephone # of Contact Person: Gtr — fj`
Estimated Value of Project: 10 Q
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cates.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cates.
Called Contact Person
Plan Check Balance
Title 24 Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
21" 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 HOUSE:-
'"' 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
1
S
-1 0-1 2 S . i, -,A �F o P D�
�v�t��� U. -A �o �'
.--C ITY_OF LA CSU I.NTA
BUILDING & SAFETY DEPT.
APPROVED
FO/R O STRUCTION
~ DATBY-
4
P.O. BOX 1504
'LA QUINTAI* CALIFORNIA 92247-1504 BUILDING & SAFETY DEPARTMENT
78-495 CALLS TAMPIC0. (760J .777-7012
LA.QUINTA, CALIFORNIA 92253 FAX.(760) .777-7011
PROPERTY OWNER'S PACKAGE
,
Dhclo'sures'& Formiiis for Owner-'BuHders Appiylingfor Consiruidlo T erinits
LWOATANV. MICE TQ T FERTY-OWNER
DearTrWerty Owner
AW application y for -a - building Permit - has witted in name, HSI, yourself, as the builder of the.property
LnIpEovemetits specified at '72 c; L—ce A�—d Q k -k "'0,
We are: Providing you with an Owner -Build" Acknowledgment -and Information;of your
fication-Forin.-to make YOU aware
respomibi)ities'and;Pow.blerisk -y- ued.in YW*. f ria ,.a as tht
Owneir-Builder. W ut;wilt not ism�a budding -permit until,,�ou -have read; initialed your. understanding of each'provision,
signed, and returned this form to us at our official address indicated. An agent of thtiowner cannot. execute -this. notice
unless you, the Property owner, obtain the prior approval of the permitting authority.
DIRE: ORead On.
L 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 pe"mon"ally. 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 -
c Q1 understand building permits are not required to be signed by property owners. unless they are responsible for the
ction and are not ".,a, licensedContractor. to assume this
resporisibitity-
i I undertland, as. an."Owner-Builder" i
, I am the responsible party of.re'6orid on the per;fi'iL I understand That I may protect
L Y If from potential ial financial risk by hiring a licensed Contractor and having the permit filed in hisor &r, name instead of my
SIC
4k4. I understand Contractors are required by taw to be licensed and bonded in California and to list their license numbers on
permits and contracts.
f-5. I understand if I employ or otherwise engage any per
sons, 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.
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*pr9yide workers' compensation disabilityinsurance, 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.
7*. 1 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 sustained by any subsequent owners) 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 "employer" from the Intimal Revenue
Service, 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 (CSLI) 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
party legally and, financially responsible .for proposed construction activity at the following address:
11. I agree that, as the party legally and fmancially responsible for this proposed construction activity, I will abide by all
app cable laws and requirements that govern Owner -Builders as well at employers.
,a_ 12.1 agree to notify the issuer of this. form immediately of any additions; deletions, or changes to any -of the information I
ve 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 LicenseBoard may be unable tofiftalwial
you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in�civd court_ It is also
important for you to: understand that if an unlicensed Contractor or employee of that individual or firm is injured while worldng
on your property; you Mile be l_eld. l &W, for damages. If.you obtair= a permit as Owner -Builder and wish to him Contractors,
you wdl be responsible for verifying whether or not those Coutractors are properly licensed and the status of their wotkers'
compensation inwranoe 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 issaing,&e..per tL Note: A copy of Ste property owner's Myers liwe farm irota baa; or
other verification acceptable to the agency is required to be'presented when the permit is inwJ to verify the property
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.
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 followirig 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 the permit is issued to verify the property owner's signature..
Property Owner's Signature : -Date:
Tjt�p 4 4a"
P.O. BOX 1504
LA QUINTA, CALIFORNIA 92247-1504
78-495 CALLS TAMPICO
LA QUINTA, CALIFORNIA,92253 -
BUILDING & SAFETY DEPARTMENT
(760) 777-7012
- - ,.-, FAX (7,60) 777-7011
Considering Becoming an Owner -Builder?
STj
Important information you need to know BEFORE pulling your permit!
The term "Owner -Builder" can mean three different things:
"Owner as Worker", "Owner as Contractor" or "Owner as Employer"
Understand each has Benefits or Risk, and it is possible to combine them!
Hiring a California Licensed Contractor means you do not personally perform any of, the construction work, the permit is not taken
out i ..your name, you are not personally responsible for the construction and you are not an Owner -Builder. Instead, you become a
_. -
"Cu to-m- er" and California law provides you the benefit of protection from poor workmanship. failure to finish the job and financial
risk;iva to worker injury.
B.enefit/Risk: Highest Benefits and the Least amount of Risk
Owner -as -Worker is a type of Owner -Builder where you personally perform the construction work, the permit is taken out in your
name and you are personally responsible for the construction management, knowledge, workmanship, and completion of the job. You
benefit by not paying others to perform this work for'you and your risk depends on your own ability to complete the job successfully.
Benefit/Risk: Possible Benefit with Low Financial Risk
Owner-as-Cantractor is a type of Owner -Builder where. you personally act as your own General Contractor, the permit is taken out in
your name and you hire California licensed sub -contractors to perform portions of the construction work. WARNING: The benefit of
protection provided by law when you hire only California licensed sub -contractors can tam to serious financial risk if you hire
unlicensed contractors to perform any of the work.
BenefitMsk: Possible Benefie and Significant Financial Risk
Owner -as -Employer is a type of Owner -Builder where you pay any unlicensed individual to perform ani, construction work valued at
more than $500.00, the permit is taken out in your name and you are personally responsible for their employment requirements.
supervision, performance, safety and welfare while on your property. WARNING: Cost savings benefit can turn to serious financial
risk if you fail to deduct payroll taxes or provide workers compensation insurance for each worker.
Benefit/Risk: Pussible Bericl'tt with Significant Financial Risk
(Health and Safety Code Section 19827) The California Legislature declares an "urgent and statewide
public interest in assuring" that contractors comply with Contractors' License Law, Business and
Professions Code and Workers' Compensation Insurance requirements to ensure property owners are
informed about, and protected from the following when improving their property as Owner -Builders:
Fraudulent representations - Liability for worker's injuries Liability for material and labor costs unpaid by
'contractors - Licensing requirements - Employers tax liabilities
1
Over 20,000 consumer complaints are filed each year. Many complaints relate to ownerlbuilder projects
and include workmanship and workers' compensation issues Homeowners suffer financial harm due to
defective workmanship and injured employees.
Following are alarming examples of what has occurred with Owner -Builder permits:
Example 1: Homeowner received. insurance money to rebuild burned -down home.
■ Owner/Builder permit pulled to rebuild structure.
■ Unlicensed contractor built substandard structure -- must be torn down and replaced.
■ Estimated financial injury is $225,000. , .
■ Additional financial injury - IRS threatened to tax insurance payout if house not completed by the end of
the year.
Example 2: Brother-in-law had active license but filed an exemption from Workers Comp.
• Owner -Builder hires brother-in-law to install a new roof.
■ Employee falls and sustains multiple spinal and extremity fractures as well as a head injury and
remains in a coma to this day.
- The Owner -Builder, who has sold the home, is now a defendant in a lawsuit for reimbursement for
benefits paid to the injured worker.
Example 3: Employee of contractor without Workers Comp is hired by Owner -Builder to install septic
system and suffers injury that results in permanent disability.
• The Owner -Builder did not have a homeowner's insurance policy on the house against which to submit
a claim.
■ The Owner -Builder is now a defendant in a lawsuit for reimbursement for benefits paid to the injured,
worker.
Did you know — unlicensed persons frequently have the property owner obtain an "Owner -Builder" building
permit which erroneously implies that the property owner is providing his or ; er owns labor a. �d material
personally?
Did you know — your homeowner's insurance may not provide coverage for injuries sustained on your
property by an unlicensed contractor and his/her employees?
Did you know — if you are considered an "employer" under state and federal law, you must register with
the state. and federal government, withhold payroll taxes; provide workers compensation and disability
insurance and contribute to unemployment compensation for each "employee"?
Did you know — that if you fail to abide by these laws you may be subjected to serious financial risk?
OWNERS BEWARE AND CONSIDER THE RISK BEFORE ACCEPTING FULL RESPONSIBILITY FOR
YOUR CONSTRUCTION PERMIT