BDEM2015-000278-495 CALLE.TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application Description:
Property Zoning:
Application Valuation:
Applicant:
GERRY REINGOLD
53220 EISENHOWER DR
LA QUINTA, CA 92253
4Iw
Qil.
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
BDEM2015-0002
53220 EISENHOWER DR
774061011 ^iR
GERRY REINGOLD DEMOLITION CODE CASE
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 Bus' ess and Professions Code) or that he or she is exempt therefrom and the
basis for a alleged exemption. Any violation of Section 7031.5 by any applicant fo, as
permiy§ubjects the applicant to a civil penalty of not more than five hundred dollars
($500.:
( V) 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 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.).
(� I amexempt under
Sec. B.&P.C. fo this reason
ate: 1 � � J Owner: 1,� �0.. .t J�l
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
Lender's Address:
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/9/2015
Owner:
GERRY REINGOLD
P 0 BOX 1998,
LA QUINTA, CA 92253
Contractor: 0 N
Llc. No.:
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 worko hich this permit is issued,
shall not employ any person in any manner s to bec me bject to the workers'
compensation laws of California, and agree th t, if I sho d be me subjectto the
workers' compensation provisions of Sectio 0 of the bo Code, I shall forthwith
comply with t se pr visions.
at Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENS TI N C VERAGE I (AWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PEN IES A D CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,000). INA DITION 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 Building Official 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 I s relating to building
construction, and hereby authorize representatives of this c' to _ter upon tZJ4 ove.
mentioned rope y for inspection purposes.
Ote: Signature (Applicant orAgent):
i f4
DESCRIPTION x:"
FINANCIAL INFORMATION
" "ACCOUNT .r'" '' QTY' , AMOUNT, ..
PAID
PAID DATE
DEMOLITION, FULL PC
101-0000-42600
0
$87.02
$0.00
PAID BY
x .. J METHOD
RECEIPT # '
CHECK #
CLTD BY
DESCRIPTION
"F ''- 'ACCOUNT . =
rC!TY„
� AMOUNT;
PAID
PAID DATE
DEMOLITION, INTERIOR PC
101-0000-42600
0
$24.66
$0.00
'PAID BY,
:,METHOD
RECEIPT# `"
} CHECK#
�CLTDBY ;
Total Paid for DEMOLITION: $111.68 $0.00
TOTALS:00
Description: GERRY REINGOLD DEMOLITION CODE CASE
Type: DEMOLITION Subtype: SINGLE FAMILY
Status: UNDER REVIEW
Applied: 4/9/2015 PJU
Approved:
Parcel No: 774061011 Site Address: 53220 EISENHOWER DR LA QUINTA,CA 92253
Subdivision: SANTA CARMELITA VALE LA QUINTA Block: 208
Lot: 14
Issued:
UNIT 20
DESCRIPTION
ACCOUNT
Lot Sq Ft: 0 Building Sq Ft: 0
Zoning:
Finaled:
Valuation: $0.00 Occupancy Type:
Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0
No. Unites: 0
CLTD
BY
Details: DEMOLITION OF ILLEGAL INTERIOR GARAGE CONVERSION CODE CASE 15-0325 APPROVED PER AJ / JF
CONDITIONS
Printed: Thursday, April 09, 2015 12:08:09 PM 1 of 2
SYS TEMS
INFORMATIONFINANCIAL
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK #
METHOD
PAID BY
CLTD
BY
DEMOLITION, FULL PC
101-0000-42600
0
$87.02
$0.00
DEMOLITION, INTERIOR
PC
101-0000-42600
0
$24.66
$0.00
Total Paid forDEMOLITION: $111.68 $0.00
Printed: Thursday, April 09, 2015 12:08:09 PM 1 of 2
SYS TEMS
Permit Details PERMIT NUMBER
- City of La Quinta BDEM20350002`
e
INSPECTIONS
SEQID INSPECTION TYPE INSPECTOR SCHEDULED COMPLETED RESULT REMARKS NOTES
DATE DATE
PRE -SITE BLD
FINAL*" BLD
PARENT PROJECTS
REVIEWS
REVIEW TYPE REVIEWER SENT DATE DUE DATE RETURNED STATUS REMARKS NOTES
DATE
BOND
INFORMATION
ATTACHMENTS
Printed: Thursday, April 09, 2015 12:08:09 PM 2 of 2
pwYS 7EAAS
Bin #
Permit #
Project Address:
City of La QGrin ta.
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
Owner's Name:
A. P. Number:
Address:
Legal Description:
City, ST, Zip;
Contractor:
Telephone:
Address:
Project Description:
City, ST, Zip:
Telephone:
.. ........ . ..
VM i
State Lie. #
City Lie. ig:.-7 '
Arch.,-Engr., Designer:
11-0 M
Address:
City., ST, Zip:
Telephone:
Construction Type: Occupancy:' CC7
State Lie. M
Repair D o
Project type (circle one): Now Add'n Alter CM
Name of Contact Person:
Sq. Ft.:Fit
# Stories
Units:
Telephone kof Contact Person:
Estimated Value of Project:
M Submittal Reqld
APPLICANT: DO NOT WRITE BELOW THIS LINE
Rcc'd TRACKING PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss C21cs.
C,211cd Contact Person
Plan Check Balance.
Title 24 C21cs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" . Review, ready for corrections/issue
Electrical
Subcontac(or List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
3,J Review, ready for corrcctionsrissuc
Developer Impact Fee
Planning Approval
Called Contact.Pcrson
A.I.P.P..
Pub. Wks. Appr
Date of permit issue
SC11061 Fccs.
Total Permit Fees
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
PR0P.ERT 0"ER' PAC"G..E
(760) 777-7012
FAX (760) 777-7011
Disclosures & Forms for Owner -Builders Applying for Construction Per>enits
ORT144wr NOTVR
Dear Property Owner.
An application for a building permit has been submitted in zr name lis yourself, . as. the builder of tate property,
improvements specified at i 2O S Pn �1 UwP/. .. d` l ✓ P�,.
We are providing you with an Owner -Builder Ackaowtodgment•and information Yertficatkm Form to make you aw= of your
responsibilities and possible risk you may incur by having this permit issued in your tame as the
Owner -Builder. We.will not Issue a building,permit until you have read, initialed your. understanding of eack'ptrovivion,
signed, and returned this form to us at our otlicial address indicated. An agent of the owner cannot execute this notice
unless you, the property owner, obtain the prior approval of the permitting authority.
At^K13LDi�i!fc1lTv'.r:.e:iv•v,nrarr�-rrnrr nnur►xpna:it�11N:: .
Read are(t`'irrilla!'eaa�fistateirieri't Gelow to si�+rii(v you understanii
no
it. 1 .understand a frequent practice of unlicensed persons. is to ,liavc t}re pfolierty Ow er obtain as "Owncc;L's:ildc>"
building liernii.t dint•erroneously implies that the property owner is providing tris or tier own .labor azid. ntatcrial. nelsoaally..:I, as
an Owner -Builder, may be held liable and subject to serious financial risk. for any itijuries.stistained-by an wxliccnscd 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 insura>ice•coveragc for injuries to workers
on my property.
JL2_ 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 <hAi3- 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 her name instead of my
own.
04L4. I understand Contractors are required by law to be licensed and bonded in.California and to list their license numbers on
permits and contracts.
1.�__5.1 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 ($500), including labor and materials, I may be considered an "employer"
under state and federal law.
_%t6. I understand if I am considered an "employer" under state and federal law, I must register with the state and federal
------government—withhold-payroll-taxes,—provide-woikers -compensation-disability-insurance,—and-contribute-to-unemployment -
compensation for each "employee -r i also understand my failure to abide by these laws may subject me to serious financial
risk-
.$P7.
isk.$ . I understand under Cal iforrria.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.
S. 1 understand 'as an Owne'r-Builder if I sell the property for which this permit is issued, I may be belld liable, for any
finanCiAl Or pers' I - - - . - s6" c&b y subsequent owners) that result from any late . nt construction defects in the
. . . . oaavpries zu in c&by
. W . orkawnsshil) &rmwcrials.
9. 1 understand I may obtain more information'regarding-- : In '. Y obligationsat'an "ttriptoy&'li6nl th-6 Internal Revenue
. *,
California
Service, the United States Small Business Administration, thc:Cal ifbrnia'Dcpartnientof Benefitpaynil:*s-and the
Division Of Industrial Accidents. I also understand I ma
800-321-CSLB (2752)or www..cs1b.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 1;&m the
party legally following address:
.gally and financially responsible for proposed construction activity at the
It. I agree that, as the party legally and fuiancially, responsible for this proposed construction activity, 1 will abide by all
applicable laws and requirements that govem Owner -Builders as well as employers.
I
12. 1 agree to notify the issuer of this form immediately of any additions; deletions, or changes to SAY Of the iufOrn3&ticil 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 miy be unable to assist you with any financial less
you may sustain as a result of a complaint Your only remedy against unlicensed Contractors may be iwavil court It is also
important for you to understand that if an udicatised Contractor or employee of that individual,or fum is injured white woddug
on your property; you may be held! titbW-f6f:di6*cs:: If ybu "im Aq. him COM6*040m.
you will be responsible=%1'11)(r6' « -Y-H woficers' .
compensation insurance ooveWe.
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 issid", *hoc.1ftr=*L Mak. A copy of*.preperV owner's dkivers ff0MCk*04PN or
other veriTmation acceptable to the, CY u ad to be pros ew4 when the permit is ismed to Ver* the PMP"
owner's signature.
Signature of property owner 2AA Date: _L� 2__ 1
Note: The following Authorization Form is required to be completed b 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 pIR
, _OpFRT�C OWN FRIS- BEHALF
Excluding the Notice to Property Owner, the execpuon of which I undemtand* is my personal responsibility, I hereby authorize
the following person(s) to act as my agents) to apply for, sign, and file the I documents necessary y to obtain in Ownex-Builder
Permit for my project_
Scopeof Construction Project (or Description of Work):
Project Location or Address: Cy -L"e
Name of tIkuthorized Agent:
Address of Authorized Agent:
I declare under penalty of perjury that I am the pTperlyr owner for
acceptable to the agency is
Property Owner's Signature:
bepreshad when the
Tel No
�address listed above and I personally filled Out the above
Ver 's license, f or other verification�rT_,qolarization,
it issued to verify the property owner's signalure.
Date: