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14-0247 (DSF)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application description: Property Zoning: Application valuation: Applicant: 14-00000247 51325 AVENIDA DIAZ 773-043-022-8 -000000- DEMO - SINGLE FAMILY MEDIUM DENSITY RES Twit " BUILDING & SAFETY DEPARTMENT BUILDING PERMIT �? Owner: TORNAMBE PAUL E & DEBORAH E111 Architect or Engineer: Contractor: Owner VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 3/07/14 MSR 0`'� AUINTA F1WAM E DAV I. vette-------------- 0 ----------------------------------------------------------------------------------- LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION 1 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 Code, for the performance of the work for which this permit is issued. My workers' compensation OWNER -BUILDER DECLARATION insurance carrier and policy number are: I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier - - - - - - - - - - - - - - - - - - - - - - - Policy Number following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to _ I certify that, in the performance 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 Labor Code, I shall forthwith comply with those provisions. that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by a�ny{,applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: 1, 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 f, property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.l. I am exempt under lSe'c. , BAP.C. for this reason Date_ d tt q ow ei: \ f �« CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performana of work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name: _ Lender's Address: LQPERAI IT 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 this W"D county toenter upon the above-mentioned pr rty for�spection Date: �4Signature-(Appl�t or Agent): r a e Application Number . . . . . 14-00000247 Permit . . . DEMO PERMIT Additional desc . . Permit Fee . . . . 24.31 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 9/03/14 Qty Unit Charge Per Extension 1.00 24.3100 LS MISC DEMOLITION, FULL 24.31 ---------------------------------------------------------------------------- Special Notes and Comments DEMO - DEMO (1) TOP COURSE OF BLOCK WALL ON ONE SIDE AND TOP (2) COURSES OF BLOCK WALL ON OTHER SIDE PER ATTACHED PHOTOS, CODE CASE #14-313. 2013 CALIFORNIA BUILDING CODES. ----------------------------7----------------------------------------------- Other Fees . . . . . . . . . PLAN CHECK, DEMOLITION 85.80 Fee summary Charged Paid Credited ---------=------------------------------------------------ Due Permit Fee Total 24.31 .00 .00 24.31 Plan Check Total .00 .00 .00 .00 Other Fee Total 85.80 .00 .00 85.80 Grand Total 110.11 .00 .00 110.11 LQPERMIT Din# City of La Quinta Building U 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 Mdress: % ?� a.N�j Owner's Name: p� _�o V VAC � A. P. Number:. Address: Legal Description City, ST, Zip: • Contractor: Address: Project Description: \,tCoLe, �W'✓ City, ST, Zip: t.ta! S Y.T Y� _ .., lf7fl�t(ly •J%.���L v'%%f':Y:Li�{5E -- State Lie. #: City Lie. Mcl S Arch.,.Engr., Designer: ���YL 1ti6� IN e- W Address: J City, ST, Zip: �'An G E p C.MR•5 es As— L4Q—UCO Telephone: State Lie. #: y* 5 �£r�%' ,{ � ,rafk t a" Construction Type: Occupancy: Project typ�(circle one): New Add'n T Alter Repair Demo Name of Contact Person: C TO . Sq. Ft.;Stories: Ucttts: ~� Telephont #,of Contact Person: 2LEstimated 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 Cala. Reviewed, ready for corrections Plan Check Deposit Truss Cala. Called Contact Person Plan Check Valance. Title 24 Coles. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 211 Review, ready for corrections/issue Electrical SubcontaUor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN IiOUSE:- snd Reylew, ready for correetionstissue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fccs Total Permit Fees MN I 46 9 rf NJ A P.O. BOX 1504 LA QUINTA, CALIFORNIA 92247-1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT (760),777-7012 FAX (760) 777-7011 T PROPERTYOWNEWS PACKAGE Disclosures & Forms for Owner -Builders Applying for Coi3strudion Permits IMA ORTANT! NOT CE TOPERTX OWNE�t Dear -Property Owner 3 . An. application for -a building permit has been submitted in your name li yourself as. -the builder of the .property improvements specified at (- _ � bi wz, LrL, We arero p _ viding you with an Owner -Builder Acknowledgment and Inforination� Verr€ication-Form to mance you aware of your respansrbilities and possible risk -you may incur by hiving dits-permit issued in your name as the - Owner -Builder. We vsifl not issue a building permit until,you !lave 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. L1tx Iif C'� A/'!i71�i!•1X3"F.i liTL''I[A YTr A. ILTWW:i.�_t�rr+rte Read and &rkial eeich staieiirent below -to u �i signify yoderstared "or`veiify this iiiforriratcon. AE1. I understand a frequemt,practice of unlicensed persons is to have the property owner obtain an "Owner -Builder" building permit that erroneously.,implies that the property bwaer ii providing liis 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 willfiffly acting as an Owner -Builder and am aware of the limits of my insurance -coverage for injuries to workers 'on my. property. T 2. 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 Contractor to assume this responsibility.. 3. I understand as an "O.wner-Builder" I am the responsible 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 tier: name instead of my own. %�K-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. TC5. 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 free 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, 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' StateLicense Law, an Owner -Builder who builds single-family residential s etures 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. I understand as an Owner -Builder if I sell the property for which this permit is issued, I ,may be he'_3 liable. for any menial or personal. Wjuries sustained by any subsequent owner(s) that result from any latent construction defects in. the workmanship or materials. �9. I understand I may obtain more information regarding my obligations as an "employer" from the Internal ICe.VMue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand 1 may contact the California Contractors' State License Board (CS -L13) at 1- 800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. W10. 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 groposed construction activity. at the following address: /101 I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and required that govern Owner -Builders as well as employers. ,Z12C12. 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 _doesnot have a license,. the Contractors' State License Board maybe unable to assisysu with aaasriai loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you tounderstand that if an urtlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit -as Owner -Builder and wish -to hire Contractors, You widl be resPonsble forverifying whether or not those Contractors are properly licensed and the status of their woiiccrs' compensation imtuame 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, isstst.die lmrniiL Note. A copy of d ke property owner's. driver'sUmnsej farm xo n; or other verification acceptable to the agency is. required to be presented when the permit is issued to. verify the property owner's signature. Signature of property owner Date: d Ot 3 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 followirip persons) to act as my agents) to apply for, sign, and file the documents necessary to obtain an Owner -Builder Permitfor my project. Scope of Construction Project (or Description of Work): Project Location or Address: Name of Authorized Agent: Tel No Address of Authorized Agent: 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: