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BRES2015-004078-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Tr41�4�w COMMUNITY DEVELOPMENT DEPARTMENT BUILDING PERMIT VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 p Date: 2/6/2015 Application Number: BRES2015-0040 Owner: Property Address: 52810 AVENIDA VILLA ROSA HERNANDEZ APN: 773334004 52810 AVENICA VILLA Application Description: OWNER/HERNANDEZ/WINDOW AND DOOR W/LIGHT LA QUINTA, Cm 92253 Property Zoning: Application Valuation: $600.00 Applicant: ROSA HERNANDEZ 52810 AVENIDA VILLA LA QUINTA, CA 92253 A FEB 0 6 2015 CITY OF LA QUINTA COMMUNITY DEVELOPMENT DEPARTMENT 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 Professions 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 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 ( 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 hg or she did not build or improve for the purpose of sale.). J 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 Ole Contractors' State License Law.). ( I am exempt under Sec. . BAP.C. for this reason ate: ' 1 ) 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' Contractor: rMAIKIER BUILDER LIc. No.: WORKER'S COM PENiATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: d— 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 worker_" 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 mannerso as to become subject to the workers' compensation laws of California, and agreethat, if I should become subject to the workers' compensation provisions of Sectirn 37 0 of the Labor Code, l shall forthwith comply with those provisions. rDate: EA— 6 ro ~ t J 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 ($100000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED F=OR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKmUWLEDGEMENT IMPORTANT: Application is.hereby made tic the Building Official for a permit subject to the conditions and restrictions set forth on -.his application. 1. Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result.of this application , the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and employees for any act or omission related t7 the work being performed under or . following issuance of this permit. 2. Any permit issued as a result of this ap 3lication becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to carcellation. I certify that I have read this application_anc state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building . construction, and hereby authorize represe•itatives of this city to enter upon the above• mentioned property for inspection purposes. Signature (Applicz nt or Agent): « FINANCIAL ••• f« s g • DAA nT EAMOUNPAr4DESCRjRTION CITY ID PAID ��$ - -,, n. ,., 'h+ _ E z £k":'K�P«` _,"_:_�P ..t. t n :�atC. c2`."`s. si 1 BSAS 581473 FEE 101-0000-20306 0 $1.00 $0.00 PAID, BY .. a: 4 '�L' "RECEIPT # + °� ' ` .: CLTD BY # CHECK # t a� _ x _.-METHOD"-,x� as o .�., ... ,: 1 Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1:00 $0.00 . `� 'DESCRIFTIOIV ` ¢ A000IJNT�a� QTY AMOUNTr g, .. r . t a E! PAID DATE` a Fa g, Y PAID{ f . DEVICES, FIRST 20 101-0000-42403 0 $24.17 $0.00 PAID;BY r.,� ', 'B `�`, ;METHOD x� R RECEIPT# o-eic_.,...r s. .,.<S r4$B .f« .±. .. -��a k..:;: .�.. ..... 'wrs rP;A+; ['.F f3eE•N Ja, ..g a 0�7i� �£ Nk -• (S. 4a ro. (�`k Y€ S•6 N 3 "pT. y, t i 8°H a DESCRIPTION�c f __ a.` L ', 3 ACCOUNTS `QTY F. 'Y Ts FCk' v Y "° AMOUNT z sgxh '.'C � t T PAID ` "+ y Y :. PAID E.: DATE; T , R , r ,�,� ..n -... -....m - a w . r « 7a n .wi:. Frc.. .w¢ .1.._ r)bd.• Y' 1p .A aN 4wvyeP^:. ' S.. IA -*•.T .. DEVICES, FIRST 20 PC 101-0000-42600 0 $24.17 $0.00 .,t .: z `3' Ri, b£ .p PAIDzBY b.; Y 'T3'f°s m METHOD a; RECEIPT,# CHECK #¢yCLTD BYE e , $ ti Total Paid for ELECTRICAL: $48.34 $0.00 `FDESCRIRTION` _ t ACCOUNT; F QTY ',°AMOUNT Y; `PAID PAID DATE: wIT ` a 4 { p fi iy zti R SMI - RESIDENTIAL 101-0000-20308 0 $0.50 $0.00 x t PAID BY METHOD `A a ' ` { RECEIPT # '« LL��3 r CHECK #Y �t LTD BY< �V ,` . to ... kl ,Yn, Total Paid forSTRONG MOTION INSTRUMENTATION SMt $0.50 $0.00 '>DESCRIPrTION «ACCOUNT `` QTY AMOUNT' '4 Y ``PAID�f PAID DATE: 4. DOOR/WINDOW, REPLACE FIRST 7 101-0000-42400 0 $60.91 $0.00 ' PAID;BY �';� • METHOD y � r'RECEIPT # ••� CHECK# ;DESCRIPTION, ? ACCOUNT QTY AMOUNT PAID PAID DATE`; �"«w w DOOR/WINDOW, REPLACE, FIRST 7 PC 101-0000-42600 0 $110.22 $0.00 `«'i- ��n PAID BY s - ,r '�r 'c.=t METHOD < 1 t, RECEIPT # �{ ' a Y'i£;a" CHECK # 4,x ¢ t CLTD BY k 4 , , a • 4 ; Total Paid for WINDOW/SLIDING GLASS DOOR/FENESTRATION: $171.13 $0.00 ' TOTALS: $220.97 0.00 k " Y 1 FI t � Y r Y 1 Description: OWNER/HERNANDEZ/WINDOW AND DOOR W/LIGHT ADDITIONAL Type: BUILDING, RESIDENTIAL Subtype: REMODEL Status: APPROVED Applied: 2/5/2015 SKH Approved: Parcel No: 773334004 Site Address: 52830 AVENIDA VILLA LA QUINTA CA 92253 Subdivision: SANTA CARMELITA VALE LA QUINTA Block: 148 Lot: 23 Issued: UNIT 15 Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $600.00 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites:.O Details: ADD 1 MAN DOOR & 1 WINDOW TO SIDE OF GARAGE TO INCLUDE 1 LIGHT & SWITCH 2013 CODES Printed: Friday, February 06, 2015 1:19:50 PM 1 of 2 VFWFSTPMS ADDITIONAL CHRONOLOGY TYPE:?, STAFFNAME ., ` , � ACTIONDATE COMPLETION;DATE t;' NOTES PLAN CHECK SUBMITTAL STEPHANIE KHATAMI 2/5/2015 2/5/2015 RECEIVED • • CONTACTS NAME TYPE `% NAME ADDRESSI CITY ;STATE ':. ZIP; : PHNE , FAX' EMAIL APPLICANT ROSA HERNANDEZ 52810 AVENIDA VILLA LA QUINTA CA 92253 CONTRACTOR OWNER BUILDER OWNER ROSA HERNANDEZ 52810 AVENIDA VILLA LA QUINTA CA 92253 FINANCIAL INFORMATION Printed: Friday, February 06, 2015 1:19:50 PM 1 of 2 VFWFSTPMS DESCRIPTION ACCOUNT QTY' AMOUNT PAID PAID RECEIPT# CHECICS METHOD PAID BY LTD. .DATE BY BY BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00 Total Paid forBUILDING STANDARDS ADMINISTRATION $1.00 $0.00 BSA: DEVICES, FIRST 20 101-0000-42403 0 $24.17 $0.00 ' DEVICES, FIRST 20 PC 101-0000-42600 0 $24.17 $0.00 Total Paid for ELECTRICAL: $48.34 $0.00 SMI - RESIDENTIAL 101-0000-20308 1 0 $0.50 $0.00 Total Paid forSTRONG MOTION INSTRUMENTATION SMt $0.50 $0.00 DOOR/WINDOW, 101-0000-42400 0 $60.91 $0.00 REPLACE FIRST 7 DOOR/WINDOW, 101-0000-42600 0 $110.22 $0.00 REPLACE, FIRST 7 PC Total Paid for WINDOW/SLIDING GLASS $171.13 $0.00 DOOR/FENESTRATION: TOTALS:0r0 BOND INFORMATION Printed: Friday, February 06, 2015 1:19:50 PM 2 of 2 cp srsrn.ns Bing V Permit !# of La Quinta. City - Building 8F Sa(ety Division P.O. Box 1504, 78-495 Calle Tampico . La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Project Address: wi A ,, Owner's Name:/ A. P. Number: 7b0 5bL�I 0319 Address: JY \' ,. v 1 C Legal Description: City, ST, Zip:9�Y�1"/hytiCal Contractor: Telephone: N`0 I 00 Afflim Address: a ',_ roject.Description: �' ooR.. • �+- wwDff c✓ City, ST, Zip: , �U l��l -, CLQ . �1.2�3 Telephone: 702. ^ ['>` ,: ,;,.:,,:w,,»:;. Eli;.;.:.. >::< , GA State Lic. # :' City Lie. #; Arch., Engr., Designer: Address: City., ST, ZIP- ip-Tele hone: Telephone: '`^`:`:->:"``:`:':::> > >;%;: "' :::: "` r>' '' ' -= ^" ^= Construction Type: Occupancy: State Lic. #: Project type.(circle one): Ncw Add'n Alter. Repair Demo / Name of Contact Person: �/ J , .l , � Sq. Ft.: # Stories: 1 # Units: Telephone #,of Contact Person: �— Estimated Value of Project: C> APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Rcq'd Rcc'd TRACKING le 01 PERMIT FEES. Plan Sets Plan Checksubmittcd Item Amount Structural Calcs. Reviewed, ready for corrections Plan Click Deposit Truss Calcs. 0 Called Contact Person Plan Ch ick Balance. . Title 24 Cales.Plans picked up .4 Construaion' ' Flood plain plan Plans resubmitted Mechan[cal Grading plan' 2" Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Decd Plans picked up S.M.K. Ii.O.A. Approval Plans resubmitted Grading IN IIOUSE:- '`° Review, ready for eorrcctionsrissue Dcvclop _r Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permlt issue School Fees Total Permit Fees 0 CD . r - M r . r • •✓" . , y.'., �.. - •t - �'F�1�'• J 3 .+ J._ ., ,. .K . Y` i •r .:*' a - .i .tea. t �t •y //•q^ ITY OF QUINTA BUILDING & SAF ; p�". - A PP O E' o ' FOR CONST C, ION. _. DATE 2 0 CD - M "3 . •�t w u��t�cv P.O. BOX 1504 LA QUINTA, CALIFORNIA 92247-1504 BUILDING & SAFETY DEPARTMENT 78-,495 CALLS TAMPICO (760) 777-7012 LA QUINTA, CALIFORNIA 92253• FAX (760)777-7011 PROPERTY •OWNER'S PACKAGE ' . Disclosures & Forms for Owner -Builders Applying for Construction Permits IMPORTANT! NOTICE TO PROPERTY OWNER Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as t_ie builder of the 'property improvements'specified at � � 1 O Awfv%i � h V i i 10, 1 )4 (1A' .-i-c. 4 - 6W53 3 We are providing you with an'Owner-Builder Acknowledgment and Information Verification Forrr to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We will not issue a building permit until you`have read, initialed your under.-tanding 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. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION DIRECTIONS; Read and initial each statement below to signify you understand or verify this information. RkA 1. I understand a frequent practice of unlicensed persons is to ,have the property 'owner,obtain an "Owner -Builder" building perinit that erroneously implies that the property owner is providing his or her ownaabor 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. D Z 1 t 2. I understand building permits are not _required to be signed by property owners unless :hey are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. /Z 14 3. I understand as'an "Owner -Builder" I am the. responsible party of record on the permit. 1 Lmderstand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in hs or her name instead of my own. 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. „ /4* 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. A6. I understand if I am considered an "employer" under state and federal.law, I must register with the state and federal goverment, withhold payroll taxes, provide workers' compensation disability insurance, and -,ontribute.to unemployment compensation for each "employee." I also .understand my failure to abide by these laws may subject me to serious financial' risk. jk_7. I understand under California Contractors' State License Law, an Owner -Builder_ who bolds 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 311 of the work is performed under contract with a licensed general building Contractor. A N 8. 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 injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. ,ej,l 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 (CSLB) at 1- 800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. R0 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: A bf 11. 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. Rj4_ 12. I agree to notify the issuer of this form immediately -of any additions, deletions, or changes to any of the informationI 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 to understand that if an unlicensed 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 will be responsible for verifying whether or not those Contractors are properly 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 the permit. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable gency is required to be presented when the permit is issued to verify the property owner's signature. Signature of property o er Date: 9-6.15 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 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: ';?1'6(L)lU A\R ni akUC �\h LO, ()V ,^, -k t C 2 i S3 Name of Authorized Agent: � 0 VAJ O ��(�`4t(IA Tel No I GO Z 3b .1291 7 Address of Authorized Agent: S21Kly AVV%I A k,\M 6\ 1 L a G� i 4,1 CA f X12 2 S 3 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 req a prese ted when the permit is issued to verify the property owner's signature.- Property ignature.Property Owner's Signature: Date: 2- l � 1 t 5 , - S ' II:l�®iRl�l Il�` DRIVr .. R LIp��7SE J- - S ' II:l�®iRl�l Il�` DRIVr .. R LIp��7SE ,.• ' .. r W -•� �y ,• - ' � � �, � r. .. a r• '• ~ . • + ,. a J – . ] • a • ` � . "♦• s . ' Y • � Y i it a _ - . • ,. J { \ s'+. t i ti ,v .'D ' `! �• i »:r= '-`: » - � r 1- - }, . -. -- . �. Ay: , �. { 4•-J ..{ j • _ .•'rr ,..-3 w err .. Y - ,.. _ .i � '� - - a fir• . �.. � - _ .qtr - . i - - - .. - s y - _ ��« •�\ s •• • '� i, y i. . � w • _ ar t •4 . - 5.;, _ter ,j +l �• -f •T � �.� jM T7 f• 'k • � � 4 rr r _ � ..� a`. l .. a'� _t' • r . �.. i .� . .. • ' r r Ae. .. .. — .f 4 4 _ l t s o ALfv ♦ .. - a J y a _ALIF_O 'Al ExPs06laQ1301.��IK/END=NONE--p •} _ . • FN ONRA lfI - - r a �, 52810JAVENIDA•VILLA L9QUI% � �/i � ,.� , - - _, E,. - - _ . • �_ .. ., , r' 06101986 - !�. 440 �� .�-" � r. - � � - 'q - rdre � tp�S a ' 'Z% i',i1`. � } � • r �dn 1 r t ���M • . A '. ES BRN:�— u'-"�HGT 5 AT�(NC+�148 Ib nS'� '• ' -r..' ' - 4 1J: �C �"�., f�l D�Q:i/znBrzou�7eus/gAFDne �'-. •'['12N8/2013 r• n�.�1Y "•��' �•�`T*,: - y '1. �'p v i'..^ •1 r'i _ L yy". "' _ C. �,:. _ _ _ �}` y r^—.r .M r 1f.� ..8 , y . r _ ,-. aY - { • ,* - .. f 'v - a _ is ._ „4.. r•l .. tk • • L• 4• r i h `X v� ` = t l.. . • Fr..{ . ' •'hr:� �` � w.+. � of , .. ., � � � l� _ � ' i• .I l� .al . �! - � a. . i • , i Y . . l=