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BPLB2017-0077~ 78-495 CALLE TAMPICO Twit D -` `HCl/ uilllt, LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT BUILDING PERMIT Application Number: BPLB2017-0077 Property Address: .51480 AVEN.IDA VILLA APN: 773103006 Application Description: VASQUEZ / SEWER HOOK-UP Property Zoning: Application Valuation: $8,000.00 N t Applicant: FERNANDO VASQUEZ MAY 3 12017, 92253 CITY OF LA QUINTA DESIGN AND 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 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.). q(±�6-1; 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.). (&FI am exempt under Sec. B.&P.C. for this reason 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 L'ender's Address VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 5/31/2017 Owner: FERNANDO VASQUEZ , 92253 Contractor: OWNER BUILDER LIc. No.: WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury oneof the following declarations: I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3X0 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: _ �- 4i 1 certify that in the performance cf 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 :hat, if I should become subject to the workers' compensation provisions of Section: 3700 of the Labor Code, I shall forthwith comply with those provisions. 'nP pPl7n_ . 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 .he Building Official for a permit subject to the conditions and restrictions set forth on tiis 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•iscorrect. I agree to comply with all city and county ordnances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above- mentioned property for inspection purposes. Da V' 1'7 Signature (Ap-p antor�Agent)� Date: 5/31/2017 Application Number: BPLB2017-0077 Owner: Property Address: 51480 AVENIDA VILLA FERNANDO VASQUEZ APN: 773103006 Application Description: VASQUEZ / SEWER HOOK-UP 92253 Property Zoning: ' Application Valuation: $8,000.00 Applicant: Contractor: FERNANDO VASQUEZ OWNER BUILCER 92253 LIc. No.: Detail: ABANDON SEPTIC TANK AND FILL WITH SLURRY OR SAND, HOOK UP TO CITY SEWER. PER 2016 CALIFORNIA PLUMBING CODE. DESCRIPTION ACCOUNT I QTY I AMOUNT BSAS SB1473 FEE 101-0000-20306 0 $1.00 Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 DESCRIPTION ACCOUNT QTY AMOUNT PERMIT ISSUANCE 101-0000-42404 0 $96.27 Total Paid for PERMIT ISSUANCE: $96.27 DESCRIPTION ACCOUNT QTY AMOUNT BUILDING SEWER 103-0000-42401 0 $25.33 DESCRIPTION ACCOUNT QTY AMOUNT BUILDING SEWER PC 101-0000-42600 0 $17.73 Total Paid for PLUMBING FEES: $43.06 DESCRIPTION ACCOUNT QTY AMOUNT TECHNOLOGY ENHANCEMENT FEE 502-0000-43611 0 $5.00 Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00 Bin # City of LA Quinta Buildingw Safety Division 78-495 Calle Tampico. La Quinta, CA 92253 - (760) 777-7012 CC-T7 Building Permit'Application and Tracking Sheet Permit # c3PL��7 Project Address: 06,011 V �� Owner's Name:. A. P. Number: Address: %D/9 ' 1 i_iA Legal Description: City, ST, Zip: M 6Vjh -e a 53 Contr" ac's tor'a ue� 1�s Telephone: ne•laD-a — a� 'S( U 7D � Address: Project Description: City, ST, Zip: • ` �GGV�L. u to - Telephone: hone: State Lie. # : City Lie. #: Arch., Engr., Designer: Address: City., ST, Zip: Telephone: ..<:StateLie.#• .. Name of Contact Person:&AMIf!t/j'Jo V^2, Construction Type:Occupancy: OCcu cY: Project type (circle rcle one • New & Add> Alter Repair Demo Sq. Ft: #Stories: # Units: ('Telephone #_6f Cgntact Persona _-9 (00 — a $9' a im ;Esti a ofProject: y ��[lQ• D v APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req>d Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Title 24 Calcs. .Plans picked up Construction Flood plain planPlans resubmitted Mechanical Grading plan 2°" Review,'ready for corrections/issue Electrical Subcontactor. List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A: Approval. Plans resubmitted Grading IN HOUSE:- 3,d Review, ready for corrections/issue Developer Lnpact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees P. -D. BO,X 1504 LA QUINTA, CALIFORNIA 92247-1504 78-495 CALLS TAMPICO LA QUINTA, CALIFORNIA. 92253 BUILDING &'SAFETY DEPARTMENT ,(760)777-7012 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 permithas been submitted in your name listing yourself as the tuilder of the property improvements specified atf �f d u P1, VT. t/�/i!!jij �t/l jl ry� f as s a We are providing you with—aan-0wner Builder Acc owledgment:and=Information Veiification`Form too'mke 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 understanc.ing of each"provision, signed, and returned this form to us at our official address indicated. An agent of the owner carmot execute this notice unless you, the property owner, obtain the prior approval of the perrnitting.authority: . OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION DIRECTIONS: Read and initial each statement below to signs you understand or verify this information. 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. I, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained b- an unlicensed person and his or her. employees while working on my property. My homeowner's insurance may not prov-,de coverage for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of in on my property. y insurance coverage -for injuries to workers 2. rm 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. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or be>: name instead of my own. 1� 4 I understand Contractors are required by law to be licensed and bonded;in California and to list their license numbers on 4pernmits and.contracts. e S.,I understand if I employ or otherwise.engage any persons, other than California licensed Contractus, and the total value `of'my construction is at least five hundred dollars ($500), including labor and materials, I may be .cons_dered an " eriiployer" under state and federal law: 11`06]. 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 contribLte to unemployment . compensation for each "employee." I also understand my failure to abide by these laws may subject inn- to.serious financial risk. 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. V 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 inancial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. C ry"9I 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 (2152) or www.cslb.ca.gov.for more information about licensed contractors. 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: C'1 L/ C"(1 MWI Pii1 i. /Y Al.,: .w J_ )Jl. 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. J�J1 I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the inforrination 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 to understand that if an unlicensed Contractor or employee of that individual or fum 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 to the agency is required to be presented when the permit is issued to verify the property owner's signature. -Date: 5- V— 17 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 Permi( 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 license, form notarization, or other verification acceptable to the agency is required to be presented when the permit is issued to verify the property owners signature. Property Owner's Signature: Date: z COACHELLA VALLEY WATER DISTRICT P.O. BOX 1058, COACHELLA, CALIFORNIA 92236 (760) 398-2651 INVOICE Date: 5/31/2017 SUBJECT: SANTA CARMELITA, 51480 AVENIDA VILLA, LA QUINTA, LID 681154, "SCC FEE ONLY" ro FERNANDO VASQUEZ Project: 17-8051 51480*AVENIDA VILLA Project Date: 5/31/2017 Amount Due: $4,851.00 LA QUINTA, CA 92253 GEO: 06-06-014 Planner: SANDRA VILLALOBOS TO INSURE PROPER CREDIT, PLEASE RETURN THIS PORTION WITH REMITTANCE AND INCLUDE THE PROJECT ON YOUR CHECK .. ice."& .. . • o • �, a�. . . 1.00 FF SCC -COLLECTION $2,415.00 $2,415.00 1.00 FJ SCC -TREATMENT $2,436.00 1 $2,436.00 $4,851.00 x •--i C-1-1--- 1-1-as a-2-. -:; �� ~ � nr sL c�a tn� -+ CD c co --�-"am ocn cn -, M CL Cn� N{ CQJ S CD C L IG � -0CD CC �� CJin D C7 C3 m ER sza.-+ m� �I-s wo C', CD CD -CCL r_CD m � Ln --I- CD fes-- -0 \OC.) t T M C \ fa -z= � ' D � v C m m o --I . -� T HC ),CD O Or - Z D MM o LO co cn L Z c 20 -r:;D-<ED CD C. . rn m 0-0 m n fO-e3-• m_ O H cn J� �� Z �O iE• CL e9 m .moo v o an M 4f?07CD lD -1-+` !7100 , y aan 1"- 01 �I7-+p0 CJl C_71CD O O O v •1F N 0000 Ln - A 0000 00 v N-+ SUBJECT: SANTA CARMELITA, 51480 AVENIDA VILLA, LA QUINTA, LID 681154, "SCC FEE ONLY" COACHELLA VALLEY WATER DISTRICT P.O. BOX 1058, COACHELLA, CALIFORNIA 92236 (760) 398-2651 • i Page 1