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14-0009 (SPIN)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 14-00000009 Property Address: 44380 VIA CORONADO APN: 604-211-037-44 -23971 - Application description: SPECIAL INSPECTION - Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: .100 Tiht 44Qut«tw BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: RON & RUTH AGRESTI 45775 INDIAN WELLS LANE INDIAN WELLS, CA 92210 (503)927-8166 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760)•777-7153. Date: ,~ 1/03/14 .. - Culluauwlc a " Applicant: Architect or Engineer: Owner ,1 JAN 2014 wl.) CITY OF EA QUINTA _ FINANCE DEPT LICENSED TRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that I am li ensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations: Section 7000) of Division 3 of the Business and Professionals Code; and my License is in full force and effect. _ .I have and will maintain a certificate of consent to self -insure for workers' compensation,. as provided• License Class: - ��- License No.: 'for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Da" ;Jt 1`� Contractor: - _ 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 V OWNER -BUILDER DECLARATION insurance carrier and policy number are: I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the _ Carrier --- --- - - - - - - - - - - - - --- -Policy Number - following reason. (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to I certify that, in the performance of the work for which this permit is issued, I shall not employ any construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the 6 `- person in any manner so as to become subject to the workers' compensation laws of California, permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if I should become subject to the workers' compensation provisions of Section License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3700 of the Labor Code, I shall forthwith comply with those provisions. . that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by a�pfjiplicant far a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: Date: �, Applicant: — (��!-I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and /,��I'�� �,lJ�• ���"����___ f`/ the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL t/l Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND and who does the work himself or herself through his or her own employees, provided that the - DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. one year of completion, the owner -builder will have the burden of proving that he or she did notbuildor - n(�„_ improve for the purpose of sale.). APPLICANT ACKNOWLEDGEMENT- ,�1�4(,—S', til, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the (/ 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of conditions and restrictions set forth on this application. ` property who builds or improves thereon, and who contracts for the projects with a contractors) licensed - 1. Each person upon whose behalf this application is made, each person at whose request and for pursuant to. the Contractors' State License Law.). _ whose benefit work is performed under or pursuant to any permit issued as a result of this application, am exempt under Sec. B.&P.C. for this reason 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. _ Date:Owner: 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 . `- CONSTRUCTION LENDING AGENCY permit to cancellation. I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of.the - I certify that I have read this application and state that the above information is correct. I agree to comply with all work for which this permit is issued (Sec.. 3097, Civ. C.). city and county ordinances and state laws relating to building construction, and hereby authorize representatives- , of this county to nter upon the. above-mentioned _ for inspection purposes. Lender's Name: - ,� =� Signature (Applicant or'Agent)r - Lender's Address: LQPERMIT Din # City of La' Quinta Building 8L Safety Division P.O. Box 1504, 78-495 Calle •Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # doD Cli 4 �( 3 wo C�\iwl Project Address: � � U � Q �� � C�- 1-� YpS-1� 6 �1 Owner'sName:� l� Y'FS 4ff A. P. Number: 1 rAddress: 4q ST7STE/` a V1 ��l\S 01 Legal Description: City, ST, Zip Ad ( C{ 4 (q 2L t ✓ ) Contractor: Telephone: Z7� ��':>.•f�?�n::�s{�:r`;»>4S': Address: ron I,, J�� �p Project Description: I I 0 ElJ C" " L yr v� Tvts City, ST, Zip: ' ' 0 - Telephone: �j�::: i.YSn}v;;..!;.5+5:>.:::Yn•: ;4�1 A%j%j::;r `yT:n; " vs>;`•:<:v:>s?:z:.:r;;:>:;;;:i5;:w :::::»s% ;:4.,5}.; il•':<<i!.ly;:'.,'.y •yi 5;f!'J�ijr; !! State Lic. # : City Lie. #: Arch., Engr., Designer. Address: City., ST, Zip: Telephone:. <>:::vai:::: i>;:>:: :g5.<>::.;:•5::5::•: ::.i5::;.:<;;,•;.<.:::<: i5i::5>5si:: :::;>:i>: ;y::}�`:,::5.!:•. •5Y•S:C�:'i•^vvi!'::r it:{•i'i5!i:Y..$:i55�!. ��4,u,u:}//,A,::f.� <?; - Construction Type: Occupancy: State Lic. #: Project type circle one New Add'n Alter Repair Demo Name of Contact Person:Sq. Ft.: T# Stories: # Units: Telephone #,of Contact Person: Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cates. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Title 24 Calcs. Plans picked up Construct-on Flood plain plan Plans resubmitted Mechanical Grading plan 2" Review, ready for corrections/issue Electrical SubcontaetorList Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE: '^' 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 Perrrot Fees P.O. Box 1504 LA QUINTA, CALIFORNIA 92247-1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT PROPERTY OWNER'S PACKAGEOWNER'S (760) 777-7012 FAX (760) 777-7011 Disclosures & Forms for Owner -Builders APply" ng for Construction Permits RTANT! NOTICE To V QPEItTY OWNER Dear Tr operty Owner An. application for a buildirr has sub in your ame listing yourself as the builder of the .property impndvements specified at 3� U CI G �0 V lCk 0, umic L� ltt Weare providing you with an Owner -Builder Acknowledgment and Information' Vecifieatioa Form to make you aware of your responsibilities and_ posuble risk you may incur by having this permit issued in Your name as the Owner. Builder. We will.not issue a buildingpermit until you -have read:, inidaled your understanding of each'prov3sion, signed, and returned this form to us at our official address indicated. An agent of the dwner cannot execute this notice unless you, the property owner, obtain.the prior approval of the permitting authority. Read and initial each statement below to signify you iuiderstarrd or, ver[fy tlss uifornri V1. 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 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 constructionand 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 hii or her name instead of my own . I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. L5. 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. &6. 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 workers' compensation disability insurance, and contribute ,to unemployment compensation for each 'employee." I also understand my failure to abide by these laws may subject me to serious financial risk LL7. I understand under California Contractors' State_ License Law, an Owner-Buddes who builds single-family residential tructures 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. 8. 1 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. iu cries sustainedby any subsequent owner(s) that result from any latent construction defects in the worlomanship or materials. 9. I understand I may obtain more information regarding my obligations as an "employer" from the internal Revenue ervice, 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. 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 fimmially responsible .. for proposed construction activity at the following address: z4 4 �kb Vic., �oVD VIC40 F lel _ X-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. LVI 2. 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 _doesnot have a license, tare Contractors' State License Board may be unable to you may sustain as a result of a complaint Your only remedy against unlicensed Contractors may be in 16vil 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 ooverage. 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 issaing.thc..permit. Note: A copy of tke property owner's dxiver'slisoensej farm notsr dins 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 understand. is my personal responsibility, I hereby authorize the followirig person(s) to act as my agent(s) to apply for, sign, and file ihe 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 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: