13-0935 (RR)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
13-00000935
Property Address:
52810 AVENIDA DIAZ
APN:
773-312-005-22 -000000-
Application description:
RE -ROOF
Property Zoning:
COVE RESIDENTIAL
Application valuation:
2000
T4'!t 4 4v Q"
Applicant: Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that Iam 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).:
1 L/) 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 _ 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
funder
�Sec. , 8.&P.C. for this reason
Date yA ,;&/3 Owner: G�
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
Owner:
ROGERS SHIRLEY M
52810 AVENIDA DIAZ
LA QUINTA, CA 92253
(
Contractor:
Owner
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 7/26/13
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
370000 �of the Labor Cod
I sh. 111 omply with those provisions.
Date: �.205,pplicant:.(✓��G/�[�!/ ix.Qi�
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 I reby authorize representatives
of this county to enter upon the above-mentioned property or inspec '6n pur , s.
Date: / 01 ignature (Applicant or Agent): /
Application Number . . . . . .13-00000935
Permit. . . RE -ROOF
Additional desc . .
Permit Fee 48.62 Plan Check
Fee
.00
Issue Date . . . . Valuation
. . .
. 0
Expiration Date 1/22/14
Qty Unit Charge Per
Extension
1.00 48.6200 LS MISC RE -ROOF, IST 2000
SF
48.62
---------------------- ------------------------------------------------------
Special Notes and Comments
REROOF REPAIR 6 SQ 1/4 ROOF BUILT -UP
300 SQUARE FEET SLOPE 300 SQUARE FEET
TOUCH DOWN 2010 CBC.APPROVED PER J.J.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
PLAN CHECK, RE -ROOF
97.24
Fee summary Charged Paid Credited
---------------------------------------------------------
Due
Permit Fee Total 48.62 .00
.00
48.62
Plan Check Total .00 .00
.00
.00
Other Fee Total 98.24 .00
.00
98.24
Grand Total 146.86 .00
.00
146.86
LQPEIN1IT
Bin #
Qty Of La Quinto
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 -5: g C) teen l _ l c Z
Owner's Name:
A. P. Number:
Address: �� A v(�o ac, DIG, -•L
Legal Description:
City, ST, Zip:
Contractor: �� 1 J:71F
l;
Telephone: �"
;,;Y:?•r.;::3 ;<`<%r '`<€S::'.>'s.::
Address:
Project Description:
City, ST, Zip:
/ V� sg 11. f c) -
Telephone
State Lic. # :
City Lic. #•:
Arch., Engr., Designer:
3C,�r I
E U C CS
Address:
City., ST, Zip:
Telephone:-? (� (� �a�c7
.;:;,.;::::;:;;.:>;>:;;r;:::;>:;< ;::�:;
Construction Type: ("�, c r Occupancy:a w h,<:,
State Lic. #:
Name of Contact Person, r rtF kib h'
Project nPa (circle one): New Add'n Alter a Demo
Sq. Ft.: (od p # Stories: ( # Units:
Telephone # of Contact Person --
Estimated Value of Project: O ,�o
APPLICANT: DO NOT WRITE BELOW THIS LINE
N
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Coles.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
god Review, ready for corrections/issue
Electrical
Subcontactor List.
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
S.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'^' Review, ready for corrections/issue .
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
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
L11WORMTt NOTICE TO PROPERTY -OWNER
Dear Property Owner. ,
An. application for a building permit has been submitted in your naw listing yourself as 14e build of the property
improvements specified at y e Vl lop a I J t G Z- Ca�l.c v174
We are.providing you with an Owner -Builder Acknowledgment and Information Verification Form to make you aware of your
responsibilities and possible risk you may incur by having this permit ismad in your name as the
Owner -Builder. We will not issue a budding' permit until you 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.
OV 'S ACII NN ?Wi:ED6N�M AND VERIFICATION OF -MORKAMN
DIREC7701VS. Read and initial each statement below to signify you understand or ve#ythis information.
3�i1. I 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 personally. 1, 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. property -
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 "Owner -Builder" I am the responsible party of record on the permit. 1 understand that 1 may protect
myself from potential financial risk 6y hiring a licensed Contractor and having the permit filed in his or her name instead of my
own.
_�&4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on
permits and contracts.
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 "employer"
under state and federal law.
6. 1 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 unemp►oyment
compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial
risk.
J7. 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.
'r -8. I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be he'd liable, for any
financial or personal. igiuries sustained by any subsequent owner(s) that result from any latent construction defects in the
workmanship or materials.
P9. 1 understand I may obtain more information regarding my obligations as an "employer" from the bAernal 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 (CSLB) at 1-
800-321-CSLB (2752) or www.csib.ca.gov for more information about licensed contractors.
AMO. 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 proposes cons"kuon activity at the following address:
5-2 �?/.D 4 u 2N 14G rpt
11. 1 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.
AL12_ I 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, 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 civil court- It is also
important for you tounderstand that if an unlicensed Contractor or employee of that individual or firm is injured while wortang
on your property; you may be held liable 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 property licensed and the status of their 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 issuing.6e.permit. Note: A copy of Ake property owner's driver's Avenseo form notatCadons 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:
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 file 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
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 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:
May 22, 2006
COPY
cert�y
P.O. Box 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
Special Inspection Report
RE: 52-810 Avenida Diaz
(760) 777-7012
FAX (760) 777-7011
On May 22, 2006 at approximately 1:00 pm the following field observations were noted
while accompanying Code Compliance Officer Jackie Misuraca investigating several pre-
existing yard structures on site;
• Play House; approximately 8'0" x 8'0" x 12'6" in height. The Owner
reports the yard structure was built in. 1978. The 64 square foot structure is
exempt from requiring a building permit per the 2001 California Building
Code section 106.2. The floor area.does not exceed 120 square feet. The yard
structure as defined by the La Quinta Municipal Code (LQMC 9.60.040) does
exceed the twelve feet in height limit.
• Green House, approximately 24'6" x 10'6" x 8'0" in height. The Owner
reports the combination masonry & wood framed yard structure was built 25
years ago. The 257 square foot structure is constructed in the side yard set
.back against an existing permitted CMU garden block wall. The CMU wall
was raised a few courses along the length of the green house to construct a
roof structure. Evidence of a permitted block wall is -on file; County of
Riverside block wall permit (#302083) issue dated 6/21/77, with no other
documentation on file to support the green house yard structure as
constructed. Per the LQMC 9.60.' 040 and LQMC 9.50.030 the green house
does not comply with side yard setback requirements.
• Lattice Patio structure, approximately 16'0" x 10'0". The Owner reports the
lattice patio structure constructed 20 years ago. The patio structure as
constructed on an un -merged adjacent lot encroaches into the Avenida Rubio
twenty foot front yard set back. Per the LQMC 9.50.030 the lattice patio cover
is not permitted to be.constructed in the front yard set back.
• Electrical receptacles, wiring and fixtures were observed through out the
property in need of maintenance and repair. Per the 2004 California Electrical
Code (CEC) section 370-15, receptacles and fixtures installed in wet locations
shall be listed for use in wet locations and boxes, conduit bodies and fittings
shall be placed or equipped so as to prevent moisture from entering within the
box, conduit body or fitting. Additionally, outdoor receptacles shall be
ground -fault circuit interrupter (GFCI) type for protection of personnel. CEC
210-8.
In summary the green house and lattice patio yard structures should be reviewed for pre-
existing non -conformities to determine if they are permitted.. The electrical receptacles,
wiring and fixtures as observed through out the property are in need of maintenance,
repair, replacement, GFCI protection and/or removal.
Res ctfully;
ame o r.
1
Building. Inspector. I
cc Jackie Misuraca, Code Compliance Officer
File