13-0837 (RER)`w
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description
Property Zoning:
Application valuation:
Applicant:
13-00000837
53782 VIA DONA
777-420-015- - -
REMODEL - RESIDENTIAL
LOW DENSITY RESIDENTIAL
22000
T4&f
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT -
Architect or Engineer:
--------------------------------------------------
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 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
arWopplicant 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.).
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 am exempt under Sec. B.&P.C. for�++�,reason
PT/ ,reason
Date: r / 7 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's Address:
LQPERi\11T
Owner:
JOHN AND MILLICENT PUGLISI
53-782 VIA DONA
LA QUINTA, CA 92253
(760)221-4418
Contractor:
Owner
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/11/13
D Q �
SE�
p i 2 2013
CITY OF LA QUINTA
FINANCE DEPT.
----------------------------------------------—
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 2010 Policy Number - - - - - - - - - - - - - - -
I certify that, in the performance of the work for which thio pormit is issued, I Gholl 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
3700 of the Labor Code, I shall forthwith comply with those provisions.
Date: 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 ($100,0001 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 build' onstn ion, and hereby authorize representatives
of this county to enter upon the above-mentioned prope for in`sp ion purposes.
Date: / /77/x'3 Signature (Applicant or Agentl' /�
Application Number . . . . . 13-00000837
Permit . . . REMODEL 2013`
Additional desc .
Permit Fee . . . . 130.13 Plan Check Fee
.00
Issue Date . . . . Valuation . . .
. 0
Expiration Date . . 3/10/14
Qty Unit Charge Per
Extension
1.00 48.6200 LS MISC REMODEL, 1ST 100 SF
48.62
1.00 21.4500 EA MISC REMODEL, ADDL 500 SF
21.45
1.00 6n.o6nn TSS MTRr nu/wTy, REPL, 1-7
G0:OG
----------------------------------------------------------------------------
Special Notes and Comments
REPLACE FIXED WINDOWS WITH GLASS SLIDING
DOORS. PER STATE TTILE -24 AND CLAIF
BUILDING CODES.
September 4, 2013 8:04:48 AM jjohnson.
----------------------------------------------------------------------------
Other Fees .. . . . . . . . . HOURLY PLAN CHECK
262.50
PLAN CHECK, REMODEL
258.83
STRONG MOTION (SMI) - RES
2.20
Fee summary Charged Paid Credited
-----------------
Due
----------------------------------------
Permit Fee Total 130.13 .00 .00
130.13
Plan Check Total .00 .00 .00
.00
Other Fee Total 523.53 .00 .00
523.53
Grand Total 653.66 .00 .00
653.66
LQPEFN1IT
F`
r j / % CITY OF LA QUINTA SUB-CONTRA TOR LIST
JOB ADDRESS 7 ? Z I/ l .L�KJ.�� PERMIT NUMBER , 2j� OWNER BUILDER. .
This form shall be posted on the Job with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list at their employees are authorized to work
on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance
of building permit. For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response.
de si icatio
Tra Clas f n
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Contractor, :::..:::
::..::.....:::..: State::Contra :.:.::.:::>
.: :;: < .:�...::. ctot.s.Ucense... ;..:...::.
:. :.::.::.:..::.:....:... <.:::.......::.:.:
`::.'' .��:�.:> �:Workers�.Coni er(satton:Insurance:'�.:`�:' :`:.•: ;:''::.:
.�:.City..BiisnessLieense:.
Company Name
Classification
(e.g. A, B, C-8)
License Number
(xxxxxx)
Exp. Date
(xx/xx/xx)
Carrier Name
(e.g. State Fund, CalComp)
Policy Number
(Format Varies)
Exp. Date
(xx/xx/xx)
License Number
(xxxx)
Exp. Date
(xx/xx/xx)
EARTHWORK (C,-12)
CONCRETE
-
FRAMING
STRUCT:: STEEL- jC-51)
MASONRY ('C' 9)
PLUMBING (C-36)
LATH; PLASTER (C35)
DRYWALL (C-9)
HVAC. (C-20)`:.:.
r
ELECTRICAL. (C=101'
ROOFING (C.=39)::;:.<::>'::;':.. .
SHEET METAL i")
,.
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ash 7 l�'l�s �(�fss
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Dpi 7
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LAZING (C-17): : ::
INSULATION'(C-21:
SEWAGE DISK id-42)
PAINTING (C=33) :
CERAMIC TILE (C-54)
CABINETS (C-6)
FENCING (C-13)
LANDSCAPING (C=27) .??
POOL (C-53)
P.O. BOX 1504
LA QUINTA, CALIFORNIA 92247-1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING &I SAFETY DEPARTMENT
(7 60) 777-7012
FAX (760) 777-7011
Considering Becoming an Owner -Builder.?
Important information you need to know BEFORE pulling your. permit!
The term "Owner -Builder" can mean three different things:
"Owner as Worker", "Owner as Contractor" or "Owner as Employer"
Understand each has Benefits or Risk, and it is possible to combine them!
Hiring a California Licensed Contractor means you do not personally perform any of the construction work, the permit is not taken
out 14,ryour name, you are not personally responsible for the construction and you are not an Owner -Builder. Instead, you become a
"CuEAner" and California law provides you the benefit of protection from poor workmanship, failure to finish the job and financial
riskkue to worker injury.
Benefit/Risk: Highest Benefits and the Least amount of Risk
Owner -as- Worker is a type of Owner -Builder where you personally perform the construction work, the permit is taken out in your
name and you are personally responsible for the construction management, knowledge, workmanship, and completion of the job. You
benefit by not paying others to perform this work for you and your risk depends on your own ability to complete the job successfully.
Benefit/Risk: Possible Benefit with Low Financial Risk
Owner -as -Contractor is a type of Owner -Builder where you personally act as your own General Contactor, the permit is taken out in
your name and you hire California licensed sub -contractors to perform portions of the construction wcsk. WARNING: The benefit of
protection provided by law when you hire. only California licensed sub -contractors can turn to serious financial risk if you hire
unlicensed contractors to perform any of the work.
Benefit/Risk: Possible Benefit and Significant Financial Risk
Owner -as -Employer is a type of Owner -Builder where you pay any unlicensed individual to perform any construction work valued at
more than $500.00, the permit is taken out in your name and you are personally responsible for their employment requirements,
supervision, performance, safety and welfare while on your property. WARNING: Cost savings benefit can turn to serious financial
risk if you fail to deduct payroll taxes or provide workers compensation insurance for each worker.
Benefit/Risk: Possible Benefit with Significant Financial Risk
(Health and Safety Code Section 19827) The California Legislature declares an "urgent and statewide
public interest in assuring" that contractors comply with Contractors' License `:Law, Business and
Professions Code and Workers' Compensation Insurance requirements to ensure - property owners are
informed about, and protected from the following when improving their property as Owner -Builders:
Fraudulent representations • Liability for worker's injuries - Liability for material and labor costs unpaid by
1 'contractors • Licensing requirements • Employers tax liabilities
1
Over 20,000 consumer complaints are filed each year. Many complaints relate to owner/builder projects
and include workmanship and workers' compensation issues Homeowners suffer financial harm due to
defective workmanship and injured employees.
Following are alarming examples of what has occurred with Owner -Builder permits:
Example 1: Homeowner received insurance money to_rebuild burned -down home.
■ Owner/Builder permit pulled to rebuild structure.
• Unlicensed contractor built substandard structure = must be torn down and replaced.
• Estimated financial injury is $225,000.
• Additional financial injury - IRS threatened to tax insurance payout if house not completed by the end of
the year.
Example 2: Brother-in-law had active license but filed an exemption from Workers Comp.
■ Owner -Builder hires brother-in-law to install a. new roof.
■ Employee falls and sustains multiple spinal and extremity fractures as well as a head injury and
remains in a coma to this day.
• The Owner -Builder, who has sold the home, is now a defendant in a lawsuit for reimbursement for
benefits paid to the injured worker.
Example 3: Employee of contractor without Workers Comp is hired by Owner -Builder to install septic
system and suffers injury that results in permanent disability.
■ The Owner -Builder did not have a homeowner's insurance policy on the house against which to submit
a claim.
■ The Owner -Builder is now a defendant in a lawsuit for reimbursement for benefits paid to the injured
worker.
Did you know.— unlicensed persons frequently have the property owner obtain an "Owner -Builder" building
permit which erroneously implies that the -property owner is providing his or her own labor and material
personally?
Did you know — your homeowner's insurance may not provide coverage for injuries sustained on your
property by an unlicensed contractor and his/her employees?
Did you know — if you are considered an "employer" under state and federal law, you must register with
the state and federal government, withhold payroll taxes, provide workers compensation and disability
insurance and contribute to unemployment compensation for each °employee"?
Did you know —.that if you fail to abide by these laws you may be subjected to serious financial risk?
OWNERS BEWARE AND CONSIDER THE RISK BEFORE ACCEPTING FULL RESPONSIBILITY FOR
YOUR CONSTRUCTION PERMIT
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
LAF'MAM NOTICE TO PROPERTY OWNER
Dear Property Owner.
An. application for a building permit has been submitted -in your name listing yourself as the builder of the pso erty
improvements specified at 5 7 SZ Vi G9
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 issued in your name as the
Owner -Builder. We will not issue a building.permit until you have read, initialed your. understanding of each prevision,
signed, and returned this form to us at our official address indicated. An agent of the ow= cannot execute this notice
unless you, the property owner, obtain the prior approval of the permitting authority.
OVA'S ACIQNQ-MX_ VGWN T ANDVERIFZCATIION 6F INFORI Ai'IEON
DiRECUONS: Read and initial each statement below to signify you understand or verify this information.
Pvpp�, 1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder"
b rlu ding 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
mjunes. I am AMY acting as an Owner -Builder and am aware of the limits of my insurance corverage for injuries to workers
.o 4ny prey.
AP2. 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.
kS
3. I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect
lf from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her naive instead of my
own.
rr�
! 4. I understand Contractors are required bylaw to be licensed and bonded in California and to list their license numbers on
permits and contracts.
5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value
iMYconstruction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer'
der 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
7�1�v)ernment, 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
. I understand under California Contractors' State License Law, an Owner -Builder whc builds single-family residential
r/�a7
ures 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.
I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be hem liable, for any
financial or personal. injuries sustained by any subsequent owner(s) that result from any latent construction defects in the
wor(omanship or materials.
QI understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue
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 (CSL at 1-
8p00-321-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 financially responsible . for proposed construction activity. at the following address:
"11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all
livable laws and requirements that govern Owner=Builderi as well as employers.
12. I agree to notify the issuer of this form immediately of any additions; deletions, or changes to any of the in€otmatiou 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 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 dKir wo&trs'
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 issuitrg,.&e .permit. Note: A copy of the property owner's driver's o fm nota; a0ivn; or
other verification acceptable to the agency is requird to be, presented when the permit is issued to verify the property
owner's signature.
Signature of P . ^ L 1
roPerty 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 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:
3� "",allTe,PIG J U L 1 o c u l a
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CITY OF LA QUINTA
COMMUNITY DEVELOP�,,��N� ITY OF LA QUINTA
�ONUNITY DEVELOPMENT
Bin #
Qty of La Quinta
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 #
2�
(J3�
Project Address: Z� 1 a �. �,� R
Owner's Name: —\VqAf
A. P. Number:
Address: J(L> 3 pZl ( vn
Legal Description:
City, ST, Zip: (-+ v�
Contactor. ��'�
Address: `1
Telephone: - -
Project Description:
City, ST, Zip: u
11C
Tele hone: p
P "i (po
•.`•.z€`;:
r -
State Lic. # :
City Lic. #•:
Arch., Engr., Designer:jv
Address: C% � V1 ,01C✓
City, ST, Zip:.
Tele hone.
OccuCon tructi n TY e: P�cY :
State Lic. #:
'"'f:<`
,>..?.. .........<
Project pa circ a one): New Add'n llRepairair Demo
Name of Contact Person: Cy L "50 (,L�-Ce44r)
Sq. Ft.:
# Stories:
# Units: 5
Telephone # of Contact Person: S-t=J
Estimated Value of Project:
�'Si�LfSt `l 416 ' SaL1Q 41dA0PLIC!!M DO NOT WRITE BELOW THIS LINE
N
Submittal
Req'd
Rcc'd
% 04 TRACKING PZRM1T FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for/corrections
Plan Check Deposit
Truss Calcs.
Called Contact Persan
Plan Check Bal: nce
Title 24 Calcs.
Plans picked up t'� .
` Construction
Flood plain plan
(7��5//�
Plans resubmitted �J �� f Mechanical
Grading plan
2p° Review, ready for correcti ssue Electrical
Subcontactor List
Called Contact Person I Plumbing
Grant Deed
Plans picked up S.M.I.
H.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
AZE-6 C IMEME CM
E I US
3� "",allTe,PIG J U L 1 o c u l a
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CITY OF LA QUINTA
COMMUNITY DEVELOP�,,��N� ITY OF LA QUINTA
�ONUNITY DEVELOPMENT