Loading...
11-0330 (PAT)a r j P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 _Application Number: Property Address: APN: Application description: Property Zoning: Application valuation: Applicant: bu�ic•'�1? 11-000003301 45090 DESERT HILLS CT 604-280-005-12 -23935 - PATIO COVER -'RESIDENTIAL LOW DENSITY RESIDENTIAL 10241 c&ty/ 4 4Cl" Architect or Engineer: LICENSED CONTRACTOR'S DECLARATION BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Lhereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 70001 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).: 'A (_ 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.). /(_ I I am exempt euender Sec. , B.&P.C, for this reason /Date: 0117- Owner: 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: Lender's Address: LQPM111T VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 9/23/11 Owner: TIAGA EDWARD ARTHUR 45090 DESERT HILLS CT LA QUINTA, CA 92253 --------------------------------- Q Contractor: ; 1 Owner 1 �1 ---------------- - - - - -- - CI'fY O(F LA 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: b /7,/ Applicant: ��Gr9l WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAA 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. a 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 th/is county o enter upon the above-mentioned prope��rt ��fjjo��eer��ins��pection purposes. �d� ///��t��_ Dat[: �Z /(/signature (Applicant or AgentL' LefC,K/ _ Application Number . . . . . 11-00000330 Permit . . . PATIO COVER PERMIT INV FEE Additional desc . Permit Fee 252.00 Plan Check Fee 81.90 Issue Date . . . . Valuation . . . . 10241 Expiration Date . . 3/21/12 Qty Unit.Charge Per Extension BASE FEE 90.00 9.00 18.0000 THOU BLDG 2,001-25,000 162.00 ---------------------------------------------------------------------------- Special Notes and Comments 770 SF OPEN TRELLIS PER CITY STANDARD ATTACHED TO REAR OF RESIDENCE.2010 CODES. "WORK COMMENCING PRIOR TO PERMIT ISSUANCE. INVESTIGATIVE FEES ASSESSED PER CRC SECTION R108.6" --------------------------------------------------------------------- Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) ------•- 1.00 STRONG MOTION (SMI) - RES 1.02 Fee summary Charged Paid Credited ---------- Due ----------------------------------------------- Permit Fee Total 252.00 .00 00 252.00 Plan Check Total 81.90 .00 .00 81.90 Other Fee Total 2.02 .00 .00 2.02 Grand Total 335.92 .00 .00 335.92 LQPER 11T P.O: Box 1504 LA QUIN.TA, CALIFORNIA 92247-1504 78-495 CAL LE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT. PROPERTY OVMER'S PACKAGE (760) 777-7012 FAX (760) 777-7011 Disclosures & Formsfor Owner -Builders Applying for Construction Permits IMPfIRTi�1YT.1 riOTfCE TO PROPERTY OWNER Dear Property Owner' An. application for a building permit has been�ubmitted inyour n me listing yourxelf as the builder of the property impr�ovanentsspecifiedat egfl /7 g��21 kJILL$ CEat//Cl 1 ©�J �I% /Q G'�• We am providing you with an Owner -Builder Acknowledgment arid information Verification Form to make you aware:ofyour spensr'bilities and possible risk you may incur by having this permit issued in your name as .the OwDe"uilder. We will not issue a building permit until yow 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. OVEWS. &C WILED T A,ND 11&�A,TItiNO ) URPRHAk N I,T&A BONS: Read and kitial ea& starenrent-below to signify you ar dw3tand or very this Mformadon. ef 1. t understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Buddee, building permit that erroneously implies that the Property owner is providing his or her own labor and material petsonalljr. 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. 1 am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers 'on MY property- 1 roperty2. I 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 CopUwtor to assume tW responsibility. e l 3. I understand as. an "Owner -Builder" I am.the resp, onsiiile.party of record on the permit. I understand that I may protect myself from potential financial tisk by hiring a licensed Contractor and having thepermit filed in his or her name instead of my own. CT 4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. E`% 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. . Co. I understand if I am considered an "employer" under state and federal taw, I must register with the state and faders government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute toutbemploymet compensation for each "employee." I also understand my faihue to abide by these laws may subject me to serious fmancil risk. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residenti structures cannot .legally build them with the intent to offer them for sale, unless all work is performed by licens, subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is perform under contract with a licensed general building Contractor. V 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. uries tained by any subsequent owners) that result from any latent construction defects in th irsuse worlananship or. materials. I. 9. I understand i may obtain more information regarding my obligations as an "employer:' from the lntcr=l 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 (CSLU) at 1- 800-321-CSLB (2752) or www.csib.ca.gov for more information about licensed contractors. E 1 ` 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: FS- l L I agree that, as .the party legally and financially responsible for this proposed construction activity. I will abide by. all applicable laws and requirements that govern Owner -Builders as well as employers. r� G-� 12. 1 agree to notify the issuer of this form immediately of any additions; deletions, or changes to any 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, tare 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 W Weivit court. It is also important for you to understand that if an umlioensed.Conttwtor or employee of that individual or firm is injured wbile working on your property; you may be field liable for damages. If you obtain a permit as Owner -Builder and wish to him Contractors, you will be responsible fur verifying why or not those Contractors are property licensed and the status of ftm 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 issu.Wg; &a pert, Note: A copy of (ke.N per( owae:'s da ver,'al forret +min; or other verification acceptable to the agency & r qu&a to be presented when dw pomit is issuer to rerFfy the property owner's signature. / Signature of property owner r Date: is ! % 7 - Note: The following Authorization Foran 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 BERaF Excluding.the Notice to Property Owner, the execittion of which I understand is my personal responsibility, I hemby authorize the following persort(s} to act as my agents) to apply for, sign, and file the documents necessary to obtain 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 abo' 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: Total Permit Fees 11 A4 eA?-- %W4 Bin # Permit #P.O. Project Address: �� 0 City of La rota Building a Safety Division Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Owner's Name: A. P. Number: IDa 21-&..C>oj-- Address: p 0 C - Legal Description: City, ST, Zip: — Contractor. WM./-- Telephone: Address: Project Description: /0 Q -7 -7 a S City, ST, Zip: PAYTo Telephone: City Lic. #: State Lic. # : Arch., Engr.,rj IF_' ]�. Address: 912 City, ST, Zip: —rye Telephone: State Lic. #: Name of Contact Person: Construction Type: Occupancy: Project type (circle one): New IaD Alter Repair Demo Sq. Ft.: Q #Stories: # Units: Telephone # of Contact Person: ., Estimated Value of Project: Z o d APPLICANT: DO NOT WRITE BELOW THIS UNE # Submittal Req'd Recd TRACIMG . PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections ''r Plan Check Deposit Truss Gla. Called Contact Person '¢ Plan Check Balance Energy Glcs. Plans Picked up Construction Flood plain plan Plans resubmitted Mechanical Grading.plan 2'' Review, ready for correctio ssue Z 15 Electrical Subcon'tactor List . Called Contact Person Z 7j. Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- Review, ready for.corrections/issueDeveloper Impact Fee Planning Approval Called Contact Person H--tv A.I.P.Y. Pub. Wks. Appr Date of permit issue Q o School Fees 90V G. Total Permit Fees 11 A4 eA?-- %W4