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14-0826 (PLBG)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application description: Property Zoning: Application valuation: A7:t4;51� 14-00000826 52215 AVENIDA DIAZ 773-211-022-11 -000000- PLUMBING COVE RESIDENTIAL 400 T4ht 4 4 Q" Architect or Engineer: 04— BUILDING & SAFETY DEPARTMENT BUILDING PERMIT -------------------------------------------------- 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 any applicant for a permit subjects the applicant to a civil penalty.of not more than five hundred dollars ($500).: 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 _ 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.). (_ 1 I am exempt under Sec. , BAP.C. for this reason J Date:_ 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: LQPERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 6/11/14 Owner: BURT HOROWITZ 52215 AVENIDA DIAZ LA QUINTA, CA 92253 ( D ��s r{9,9i� Contractor: Owner- ��U►Ni'A ------------------ 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 33/700 of the Labor Coe 1 shall fo hwith comply ith those provisions. Date:G-),[- I i Applicant: WARNING: FAILURE TO SECURE WORKERS' COrIENS ION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTICIVIL 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. Date. Signature (Applicant or Agent): Application Number . . . . . 14-00000826 Permit . . . . PLUMBING*2013 .Additional desc . Permit Fee . . . . 11.92 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 12/08/14 Qty Unit Charge Per Extension 1.00 11.9200 LS PLBG GAS SYS, 1=4 OUTLETS 11.92 ---------------------------------------------------------------------------- Special Notes and Comments CONNECTING GAS LINE TO BARBEQUE 68 LN FT X 3/4" PIPING MUST BE SLEEVED PER APPROVED PLANS & 2013 PLUMBING CODES APPROVED PER JJ. -------------------------------------------------------------------------=-- Other Fees . . . . . . . . . BLDG STDS ADMIN .(SB1473) 1.00 PERMIT ISSUANCE M/P/E 90.57 PLAN CHECK, PLUMBING 23.83 Fee summary Charged Paid Credited ----------------- Due --------=------------------------------- Permit Fee Total 11.92 .00 .00 11.92 Plan Check Total .00 .00' .00 .00 Other Fee Total 115.40 .00 .00 115.40 Grand Total 127.32 .00 .00 127.32 LQPERMIT Bin ;r City 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: ZZ) j 1�v2 �.� a Owner's Name: �. 2 A. P. Number: i n Address: S ZZ 1 vlZy�` c( --cl -Z— Legal Description: City, ST, Zip: L4 u 1 Contractor: Telephone: . •:3.:;xs:;y;�>>;.;:;:;<;:;:. Address: Project Description: j'Ohre City, ST, Zip: 3 't Q �. e- Telephone- elePhone:State StateLic. # : City Lie. #•: Arch., Engr., Designer. Address: City., ST, Zip: Telephone: _`:'!%liry :`:}:;3:.!`yS: L:i:: yn `.jy:S`v}iiii -.:.::.:n.:y.:.!::;::;.::.:�:>:�s<:<:>::;::>:: Construction Type: Occupancy: Project type circle one): New Add'n Alter Repair Demo State Lic. # i `-%'yi'I}Yy::tiii:!in::. yyii:(iy:!i::ii: is }::i •:.. :: y': ?iM%;i::•irv'ii✓;:;i::.':?: !'^"'y::'_.,°"''~" '°""'`` ' Name of Contact Person: Sq. Ft.: # Stories: *Units: Telephone # of Contact Person: Estimated Value of Project: d ro APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Rcq'd Rec'd TRACKING PERMIT FEES, Plan Sets Plan Check submitted Item Amount Structural Cates. Reviewed, ready for corrections Plan Check Deposit Truss Cala. Called Contact Person Plan Check'Balance. Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2'' Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Dced Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN IfOUSE:- 3" Review, ready for correctionsfissue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees WAO i t t ,. u,t � 1 BUILDING & SAFETY DEPARTMENT 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 PROPERTY O'WNER'S PACKAGE. (760) 777-7012 ie FAX (760) 777-7011 Disclosures & Forms for Owner -Builders Applying for Construction Pern its l'GIRTANZ7 NOTICE TO PROPERTY OWNER Dear Property Owner An application for a building permit has been submitted in ur name listing yourself as the builder of the property improvements specified at _ �' 1. y!.. A 2�1 c, q Z We are providing you with an Owner -Builder Ackriowledgmeat•and Information Verification Form to make you aware of your responsibilities and possrble risk you may incur by having this permit isv&edin your name as the Own, r -Builder. We Will not Issue a building:permtt until your have read, i» idaW your understanding of eacli'provWon, 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. Read dii446iidl.'eiicii•slaletiieri't'below to signify you iinderstand VV / _ 1. 1 . understand a frequent practice of unlicensed persons is 'to .!lave the property owner obtain an "Owner-tuildee, bur ding permit, that erroneously implies that the property owner is providing his or her own .labor arid. material. Pcm. aHy- L as; an Owner -Builder, may be held liable and subject to serious financial,- risk for any sri'uries: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•coveragc for injuries to workers on property. 2. I understand building permits are not required to be signed by property owners unless they are responsible for the c nstruction and are not hiring a licensed Contractor to assume this responsibility. IjI understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect If Gom potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my F . 1 understand Contractors are required by law to be licensed and bonded in California and to List their license numbers on f�ts and contracts. 5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value 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 rnment; withhold-payroll-taxes;-provide-workers=compensation-disability--insurance,—and-contribute-to-unemployment )enation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial 7. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential lures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed )ntractors and the number of structures does not exceed four within any calendar year, or all of the work is performed r contract with a licensed general building Contractor. oma' 8. 1 understand as an Owner -Builder if I sell the property for wbich this permit is issued, I may be 1101d liable. for any oial or personal,.4urics sustained by any subsequent owner(s) that result from any latent construction defects in the f9- anship or materials. I understand I may obtain more information regarding my obligations as an "employer" from the Interutal ILcxcnue , theUnited States Sall 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 Licensc Doard (CSLB) at I- -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 P legally and financially responsible for proposed const�pctton activity at the following address: r2W-I I- 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. 12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the informatickh 1 h e 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 in`6vil court- It is also innportant for you tounderstand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property; you may be held litrblc' for damages. If you obtain a permit as Owner -Builder :and wish to hire CoawAors, You will be respousiMe for verifying whoth r or not those Contractors are properly licensed and lire status of their workers' compensation istsuranee coverage. Before a building permit can be issued, this form must be completed and signed by the property owner sad returned to the agency responsible for issuift,01K,perrntt. Note. A copy of tl[e property owner's d4ver 'u Amose, fon" notadonOm or other verification acceptable to die agency isyqu, ed to be presenter when the permit is d to Ver* the prop" owner's signature. n _# — Signature of property owner / Date: E7 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 execguon of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agents) to apply for, sign, and file the documents necessary to obtain an Owner-Buildet Permit for my project. Scope of Construction Project (or Description of Work): _ Project Location or Address: Name of eAuthorized Agent: Address of Authorized Agent: Tel No I declare under penalty of perjury that 1 am the property owner for the address listed above and I personally filled out the above information and certify its accuracy..Nole: 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: