11-1191 (RER)P.O.'BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Y4
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: - i1-00001191
Property Address: 47640 VIA MONTANA
APN: 643-120-039-267 -26152 -
Application description: REMODEL - RESIDENTIAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 950
Applicant:
Architect or Engineer:
Owner:
DEMART, CHARLES &
487 LA MARINA DR
CAMARILLO, CA 930'fi
Contractor:
Owner
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
2 2012
1E 1
Date: 3/02/12
pJA
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LICENSED CONTRACTOR'S DECLARATION - - WORKER'S COMPENSATION DECLARATION _
I hereby affirm under penalty of perjury that I am licensed 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 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: Contractor: _ - _ I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
C e, for a performance of the work for which this permit is issued. My workers' compensation
OWNER -BUILDER DECLARATION 'er and polic number are:
1 hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier - Policy Number
following reason ISec. 7031..5, Business and Professions Code: Any city or county that requires a permit to - I certify that, in the erformance 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. 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) or 3700 of the LaborCod�for�co ly withith t�isipns.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by - i -
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars.($ 500).: ate: =� plicant:
(1✓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 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 the work himself or herself through his or her own employees, provided that the DOLLARS ($100,000). 1N 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.
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 _ I 1 am exempt under Sec. , B.&P.C. for this reason)
CONSTRUCTION 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: A
Lender's Address: T
LQPERMIT
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 aboveinformation is correct. I agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby auth fize representatives
offtthiss unty to enter upon the above-mentioned property for inspection pu oses.
ale.
ture (Applicant or Agent !
Application Number . . . . . 11-00001191
------ Structure Information REMOVAL OF COLUMN AT REAR PATIO
[ENG] -----
Other struct'info . . . . . CODE EDITION 2010
----------------------------------------------------------------------------
Permit BUILDING PERMIT .
Additional desc .
Permit Fee . . . . 25.00 Plan Check Fee
16.25
Issue Date Valuation . . . .
950
Expiration Date 8/29/12.
Qty Unit Charge Per
Extension
BASE FEE
15.00.
5.00 2.0000 HND BLDG 501-2,000
1.0.00
- ------------------------------- -----------------------------------
Notes and Comments
REMOVAL OF CENTER COLUMN AT REAR PATIO
[ENGINEERED] THIS'PERMIT DOES NOT
INCLUDE ALTERATION TO MECHANICAL,
PLUMBING OR ELECTRICAL INSTALLATIONS.
2010 CALIFORNIA BUILDING CODES.
March 2,.2012 1:51:21 PM AORTEGA
- -----------------------------------------_--
Other Fees . . . . . BLDG STDS ADMIN (SB1473)
-------.------
.1.00
STRONG MOTION (SMI) - RES
.50
Fee summary Charged Paid Credited.'
Due
Permit Fee Total. 25.00 .00 .00
25.00 "
Plan Check Total ..16.25 00 .00
16.25
Other Fee Total 1.50 .00 :00
1.50
Grand Total 42.75 0.0 .00
42.75
LQPERMIT
�/7
Bin #
City of La. Quints
Building U Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quints, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
nn
l `vl
Project Address: 1 Alb wTA �v,4
Owner's Name: � ,� 1 Wit' oOA
A. P. Number:
Address: y 7 y 6 - v 101 lt7G y 7- N A
Legal Description:
City, ST, Zip: !v T A -0/ Z � S3
Contractor: C N r/('
+::C:.,;.�:.:CCCC: •riiitiS').iiiiNii%:'.��..
Telephoner .�.�/
,
Address: f �. o r
Project Description: ` wjG L 9- <' G C Y,
City, ST, Zip:
A /W G 4 x A Al 19 A
Telephone:
State Lic. # : City Lic. #;
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
:z;>:;::;; s:::>r:;::. ".::> <:: •:<::
€h>:»:`: s.:f•<:<:?::':;.l>:;<;:>:>;':._<
Construction Type: Occupancy.
State Lic. #:
Project type (circle one): New Add'n Alter Repair Demo'
Name of Contact Person:
Sq. Ft.: Q
# Stories: 0
# Units: U
Telephone # of Contact Person: 90 So - 3g - 55 IQ
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Caics.
a
Reviewed, ready for corrections
li (b Plan Check Deposit
Truss Cates.
Called. Contact Person
Plan Check Balance.
Tide 24 Caics.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
9 Mechanical
Grading plan
2°" Review, ready for corrcctio 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 correctionsAssue
Developer Impact Fee
Planning Approval
Called Contact Person
V.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
dl",- 111137 C- /( 141 11
- 4 ► b `'fou -1161 511L 91'f- --3 1, %AC� 9aW&a.47r-tkt, o G
3 2 `'1�t2 - tJ4IST�c.2----�us-r=vQvw4
l
wr® ,
1. Mel,
/ 1
P.O. 'BOX 15'04
LA QvINTA' CALIFORNIA 92247-1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
PROPERTY ONER'S PACKAGE
(760) 777-7012
FAX (760) 777-7011
Disclosures. & forms- for Owner -Rudders Applying for Construction Permits
Z9 ATI P Q. c Tn QunvFu'rsr p
Dear Property Owner.
EUi. application for a building permit has been submitted in your name listing yourself as the builder of the .property
imp✓ eFements specified at G tl d LIM. -r- A4 [ Ka ,.:t/
We arerove.
p ding you with an Owner -Builder Acknowledgment and• Information Verification Form to make you aware :of your
reSPOnsrbilities and possible risk you may incur by having drispermit�igsued in your name as the
Owries-Builder. We will not issue a building permit until you. -have read, initialed your understanding of eaeWpreAsion,
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.
0� S ACNWO 'T AND'VERNWATWN OF W"NWN
D&ECTfONS: !lead a/ref kitiat each: stutenrent $efow—to signify you understand or' der¢{y this information.
1. 1 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 person dlji. 1, as
an Owner -Builder, may be held liable and subject to $�tious_frnancialsial -for-any_injunes_sustained bean 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
flII MY propetty.
2. I understand building permits are not required to 'be signed by property owners unless they are responsible for the
construe on and are not hiring a licensed Contractor to assume this responsibility.
Z,'3.understand as an Owner -Builder' I am the responsible party of record on the permit I understandthat 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
4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on
perIIr` its�nd contracts.
X5.1 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 "employee"
under to 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, 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. /
L/
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•peruut is issued, I may be held liable. for any
financial or -'personal. i .uties sus�fained. by any subsequent owner(s) that result from `any latent construction defects in the.
worlamanship, or materials.
9.: I-' understand 'I may obtain more information regarding my obligations as an "employer" from the Internal, 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 (CS LB) at I-
800-32 1 -CSLB (2752) or www.csib.ca.gov for more information about licensed contractors.
10. 1 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. [.agree that, as the party legally and ftnamially responsible for this proposed construction activity,.l will abide by all
applicable 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 toranY of the information 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 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 inVivil court- It is also
important for you to: understand that if an ualicensed Contractor or employee of that individual or % is injured wbile working
on your property; you may be held &able 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 piope dy licensed and the status of theif workers'
compensation insurance coverages. .
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 [ssgbg,-We perms. Now A copy, of tke propertgowner's Mver's J&Mwei firm notad=4014 or
other verification acceptable to the agency is required to b presented when the permit is isme l to. verify the property
owner's signature.
Signature ofwn Date: — G / Z
!nlenY oDa
Note: Thefollowing 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 BEHAL�
Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize
the followperson(s) to act as my ageat(s) to apply for, sign, and file the documents necessary to obtain anO
ing wner-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: