13-0589 (PAT)"P.O. BOX 1504
78-495 CALLE TAMPICO
L.,'. QUINT A, CALIFORNIA 92'253
Application Number:
13-00000589
Property Address:
79405 AVENIDA LAS PALMAS
APN:
604-460-004-4 -29563 -
Application description:
PATIO COVER - RESIDENTIAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
4788
Applicant:
iN, T4,ht
��
A�N
BUILDING & SAFETY DEPARTMENT 7�rr
BUILDING PERMIT
Architect or Engineer:
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
an applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
11 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.).
() 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 T' ) I am exempt under Sec. , BAP.C. for this reason
Date: G_ 1 ' Owner:
CONSTRUCTION L DING AG CY
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
C
Owner:
HUONG DANG
79405 AVENIDA
LA QUINTA, CA
(
Contractor:
Owner
LAS PALMAS
92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/06/13
MAY 0 7 2013
CITyOFL-A Otwr-_
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' COMPENSATI 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. 1 agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of this county to enter upon the above-mentioned property for inspection purposes.
Dater Signature (Applicant or Agent):
Application Number . . . . . 13-00000589
Permit . . . PATIO COVER PERMIT
Additional desc . .
Permit Fee 72.00 Plan Check
Fee
46.80
Issue Date Valuation
. . .
. 4788
Expiration Date 11/02/13
Qty Unit Charge Per
Extension
BASE FEE
45.00
3.00 9.0000 THOU BLDG 2,001-25,000
27.00
--------------------------------------------------------------------7-------
Special Notes and Comments
PATIO COVER 10 FT X 36 FT PER CITY
STANDARDS AND APPROGVED PLANS APPPROVED
PER B.H. 2010 CODES
----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG'STDS ADMIN (SB1473)
1.00
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 1.00 .00
.00
1.00
Grand Total 119.80 .00
.00
119.80
LQPERMIT
CityGIS
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Property APN 604480004 M "+ J
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APN: 604460004
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Address: 79405 AVENIDA LAS PALMAS, LA QUINTA CA,
92253
Owner Name: DANG,HUONG THI THU
Owner Address: 79405 AVENIDA LAS PALMAS. LA QUINTA CA,
92253
Owner Phone:
Building SF:1500
Acres (Assessor): 0.18
Acres (Calculated): 0.16
'
Lot Front:
Lot Depth:
Legal Description: .16 ACRES IN LOT 4 MS 294/031 TR 29563
Land SF (Assessor): 6970.0
Land SF 6970.0
(Calculated):
'
Land Use: :SFR
Year Built: 2001
-
Assessed Value: 5176,317
'
TBM Page:
Sales Deed Cat:
,
source: TAX—UPDATE ( 09/23/2009 00:00)
'
Create Markup
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FIRM Panel: 06065C2234G effective 08/2812008
..
U Not In A Flood Zone (Zone X) (zone oer room -
U_ Tax Maps
Markup � ^ 'i C PV 0 Q b 11 Default -
Lon: -116.36382 Lot: 33.69926
1508
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P.O. Box 1504,78-495 Calle Tampico
14-QuInta, CA 92253 -:(760) 777-7012
Building Permit Application'and Tracking Sheet
Pen . nit #
Project Address:
-----------------
Owner's Name: A47
A. P. Number.
Address:
Legal Description:
City, ST, Zip;
Telephone7-& -
Contractor-IfU 6 AL dO
Address:Irb C44
Project Description:
City, ST, Zip: J,41t-' C/ZL
Telephone:76A
State Lic. #: City Lic, 9,
Arch, Engr., Designer:
G0:4 o-10 - Xr 6
Address:
.0 -3
City., ST, Zip:
Telephone:F?
Constructiontypq Occupancy:
State Lic. #: Project type (circle onc): (reDw Add'n. Alter Repair Demo
Name of Contact Person: Sq. Ft: ff Units:
4� /'C— # Stories:
Telephone# of Contact Person: 749 -9 - &i-% Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
N
submittal
Req'd
Recd
TRACIMG
PERMrrFEES-
Pl*n Sets
Plan Check submitted
Rem Amount'
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit.
Truss C21cs.
11'
Called Contact Person
Plan Check Balance.
Title 24 Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted.
MM112filCRI
Grading plan
Review, ready for correctioWasue
Electiicai
Subcontactor List
I Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:.
Wylew, ready for correcdo'ns/issuc
Developer Impact Fee
Planning Approval
Called Contact Person
Pub. Wks. Appr -
Date of permit Issue
School Fees
Total Permit Fees
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 -Builders Applying for Construction Permits
IAWMANT! NOTIC_WNER
-Dear Property Owner.
Ari. application for a building permit been in", your li yourself as the builder of the property
unprawommts specified at 0alc
We are providing you with anowner-Builder Acknowledgment and nformatien Verification Form td make you awam of your
des and possible risk you may incur by having this permit issuedin your name as the
Owner -Builder. We will not issue a building permit until you have read, initiated 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.
OZ'S ACI�NOWLE000" AND VERMCA'I'ION OF WORK-AnON
DIREMONS. head and initial e=h statement below to signify you understand or verify dus information.
IW�11. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder"
b ' ding 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 propenY-
4&2. I understand building permits are not required to be signed by property owners unless they are responsible for .the
cobstruction and are not hiring a licensed Contractor to assume this responsibility.
MT11 understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect
self from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my
own.
ti
I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on
is 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.
A-16- 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
7. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residentia
structures cannot legally build. them with the. intent to offer them for sale, unless all work is performed by licenser
subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performe,
under contract with a licensed general building Contractor.
W8. I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be he'3 liable. W.
financial or personal. i4tiries sustaked.•by any subsequent ownef(s) that result from any latent construction defects in tnJ
woriananship or materials.
9. I understand I may obtain more information regarding my obligations as an ,employee, from the internal Revenue
S &vice, 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.cstb.c.a.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 legal) and , financiaU. &responsible (or pro cons ction activity at the following address:
11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all
app, ficable laws and requirements that govern Owner -Builders as well as employers.
h12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the uifOrmaticm I
eprovided 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 tray be in civil eonrt It is also
important for you to understand that if an unlicensed Contractor or employee of that individual or firm is kotd while worlring
} on your property; you may be hdd. liable for damages. If you obtain a permit as Owner-Buidei and wish to hire Contractors,
You will be rosponskle for verifying whether or not those Contractors are properly licensed and the status of their workers'
conation i>vuranoe oovcmge.
Before a budding permit can be issued, this form must be completed and signed by the property owner rind returned to
the agency responsible for issue: tie permiL.Note. A copy of dies property owner's Myer's i fonn notar*201 , or
other verification aeeeptobk $o die agency is requbW to be presented when the permit is ixftwi to verify: the pt+operty
owner's signature.
Signature of property owner c �(jt�t� 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 understandis my personal responsibility, I hereby authorize
the following person(s) to act as my agent(s) to apply for, sign, and We 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
1 declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the abovt
information and certify its accuracy. Note: A copy of the owner's driver's ticense, 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:
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RECEIVED
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JUN 0 3 2013
CITY OF LA QUINTA
COMMUNITY DEVELOPMENT
{
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1,
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Application Number . . . . . 13-00000589
Permit . . PATIO COVER PERMIT
Additional desc . -
Permit Fee 72.00 Plan Check Fee
46.80
. . . .
Issue Date Valuation
4788
Expiration Date . . 11/02/13
Qty Unit Charge Per
Extension
BASE.FEE
45.00
-
3.00 9.0000 THOU BLDG 2,001-25,000
27.00
Special Notes and Comments
PATIO COVER 10 FT X 36 FT PER CITY
STANDARDS AND APPROGVED PLANS APPPROVED
PER B.H. 2010 CODES
-------------=------.
-
----------•-----•------------->--------------
Other Fees . .. . . . BLDG STDS ADMIN (SB1473).
1.00
Fee summary Charged Paid Credited
Due
107 - Soaa-322 I_
=----<------------'-----------=-----------------------------
Permit Fee Total 72.00 .00 .00
72.00
I&[ -Soe>o -342- 82'00
Plan Check Total 46.80 .00 .00
46.80
Other Fee Total 1.00 .00 .00
1.00
'rand Total 119.80 .00 .00
119.80
LQPERMIT
June 28, 2013
C&f 4.fwa"
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Dang Huong, owner
79-405 Avenida Las Palmas
La Quinta, CA 92253
RE: Permit Refund
Address: 79-405 Avenida Las Palmas
Permit 13-589
Dear Ms. Dang,
Community Development Department
Building Division
PH;(760)777-7125
FAX (760) 777-7011
I have reviewed your letter dated June 3, 2013 requesting a refund to the Patio
Permit 13-589 for a change to pre-engineered patio from a city standard patio.
Under the provisions of the 2010 California Building Code Section109.6 your
request is hereby granted. A 50% (due to inspection performed on 5/21/2013)
refund of the Permit Fee and 100% of impact fee is authorized.
Building Permit of $72.00 x 50% refund ........... _ $36.00
Building Standards Fee of $1.00 x 100% refund._ $1.00
Acct. 101-0000-203.06-00
Total Refund ................................................... _ $37.00
Sincerely,
Burt Hanada
Plans Examiner / Inspection Supervisor
Permit Refund Request
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