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BPOL2017-0063i VOICE (760) 777-7125 78-495 CALLS TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT FAX (760) 777-7153 011 BUILDING PERMIT v Date: 5/10/2017 Application Number: BPOL2017-0063 Owner: Property Address: 79943 VIENTO DR ARTHUR MATEJ APN: 609640006 79943 VIENTO DR Application Description: MATEJ RESIDENCE/ SPA ONLY LA QUINTA, CA 92253 Property Zoning: ; Application Valuation: $5,000.00 Applicant: Contractor: ARTHUR MATEJ OWNER BUILDER 79943 VIENTO DR MAY 10 2017 1 ` LA QUINTA, CA 92253 CITY OF LA QUINTA ;4 DESIGN AND DEVELOPMENT DEPARTMENT LIc. No,: -------------------------------------------------------------------- LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that l am licensed under provisions of Chapter 9 1 hereby affirm under penalty of perjury one of the following declarations: (commencing with Section 7000) of Division 3 of the Business and Professions Code, and = I have and will maintain a certificate of consent to self -insure for workers' my License is in full force and effect. compensation, as provided for by Section 3700 of the Labor Code, for the performance License Class: _ License No.: _ of the work for which this permit is issued. 4 _ I have and will maintain workers' compensation insurance, as required by DatJ Contractor: 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: OWNER -BUILDER DECLARATION r Ler: Policy Number. _ I hereby affirm under penalty of perjury that I am exempt from the Contractor's State I.certify that in the performance of the work for which this permit is issued, I License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any all-notCaemploy any person in any manner sous to become subject to the workers' city or county that requires a permit to construct, alter, improve, demolish, or repair any compensation laws of California, and agree that, if I should become subject to the structure, prior to its issuance, also requires the applicant for the permit to file a signed workers' compensation provisions of Section 3700 of the Labor Code, I shall rthwith ' statement that he or she is licensed pursuant to the provisions of the Contractor's State comply with those provisions. License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business T - " and Professions Code) or that he or she is exempt therefrom and the basis for the Date J - L cJ Applican""ttn alleged exemption. Any violation of Section 7031.5 by any applicant for a permit s jests the applicant to a civil penalty of not more than five hundred dollars ($500).: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE I UNLAWFUL, �1 as owner of the property, or my employees with wages as their sole AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO compensation, will do the work, and the structure is not intended or offered for sale. ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, apply to an owner of property who builds or improves thereon, and who does the work INTEREST, AND ATTORNEY'S FEES. 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 APPLICANT ACKNOWLEDGEMENT w' hin one year of completion, the owner -builder will have the burden of proving that he IMPORTANT: Application is hereby made to the Building. Official for a permit subject to 7she did not build or improve for the purpose of sale.).' the conditions and restrictions set forth on this application. I# as owner of the property, am exclusively contracting with licensed contractors to 1. Each person upon whose behalf this application is made, each person at whose construct the project. (Sec. 7044, Business and Professions Code: The Contractors' State request and for whose benefit work is performed under or pursuant to any permit issued License Law does not apply to an owner of property who builds or improves thereon, as a result of this application, the owner, and the applicant, each agrees to, and shall and who contracts for the projects with a contractor(s) licensed pursuant to the defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and ontractors' State License Law.). employees for any act or omission related to the work being performed under or �) I am exempt under Sec. . B.&P.C. for,this reason following issuance of this permit. - 2. Any permit issued as a result of this application becomes null and void if work is not �7 ^ —I�Ow_n_;,1: commenced within 180 days from date of issuance of such permit, or cessation of work e: t -5— .to for 180 days will subject permit to cancellation. CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is correct. I hereby affirm under penalty of perjury -that there is a construction lending agency for I agree to comply with all city and county ordinances and state laws relating to building the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). construction, and hereby authorize representatives of this city o enter upon the ab mentioned property for inspection purposes. ' Lender's Name: e.i 5 D Signa' ttu�e (ApplicaAgent + Lender's Address: - r FORMAT • DESCRIPTION ACCOUNT QTY AMOUNT, BSAS SB1473 FEE 101-0000-20306 0 $1.00 Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00, DESCRIPTION ACCOUNT QTY AMOUNT SWIMMING POOL/SPA 101-0000-42404 0 $190.00 J DESCRIPTION ACCOUNT QTY AMOUNT SWIMMING POOL/SPA PC 101-0000-42600 0 $103.36 Total, Paid for POOL/ SPA: $293.36 DESCRIPTION ACCOUNT QTY AMOUNT TECHNOLOGY ENHANCEMENT FEE 502-0000-43611 0 Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00 $299 36 5 r' J Y - T 1 � Bin # t City of La QUinta r��J Building &r Safety Division Permit ' - .� lJ 7 78-495 Calle Tampico L -a. Quint a; C 4 9223-3,z-(760) 777-701.2 C�uilding Permit AgpL! ation a:nd Tracking Sheet _ — --' k ___�—•��'"' kFoject Address: Owner's T,jame: 2rT A. P. Number: Address: l �v Legal Description: `Cil ST; Zi Contractor: T4 e hone: c% — el 7 P l� Address: V l h/ i �'. t�.. �s�n _, �� V ZZ �::: iProJect Desaiption: City, ST, Zip: �� V i AI -CA, CA -d?22- $ 3 . Tele h 0 nc: P D�L 5 � State Lic. # : City Lic. Arch., Engr., Designer: , Address: City, ST, Zip: Telephone: ... an Con fractton Occupancy: Type: e- cY: State Lic .# t Add Alter e a' New Ad R tr 'r ne • N Project a (circle o eDemo. J tYP � )� 1 P Name -of Contact Person`:' 74T�.1.� Sq. Ft.: #Stories: #Units: Telephone # of ContactPer"son: 7. o-- 6l o - % S ; Estimated-Valife ofP_To-j ct � L9 o' APPLICANT: DO NOT WRITE BELOW THIS LINE U • Submittal Req'd Rec'd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cafes. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Caned Contact Pcrson Plan Check Balance, Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2"d Review, ready for corrections/issue Electrical SubcontactorList Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. II.O.A. Approval Plans resubmitted Grading t IN 10USE:- Review, ready for correct ions/issuc Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. \Vl;s_ Appr Date of permit issue School Fees, 1 Total Permit Fees .. a 'http$://mai l-attachm.ent.000gleLlsercontent.com/attachment/u/0/?u i=... Esplanade c/o .Desert Resort Management, Inc. 42635 Melanie Place Palm Desert, CA 92211 Customer Care: 760-346-11610; Fax: 760-346-9918F— Website: wwwArminternet.com Date: 5/5/2017 9:38:42 AM Project Ref: [76407011] 79943 Viento Dr Ewa & Arthur Matej 79943 Viento Dr La Quinta CA 92253 Dear Ewa & Arthur Matej, For the listed project item(s): New Spa to Existing Pool I am pleased to inform you that the Esplanade Architectural Committee has approved your application with the following stipulations: Approved with the condition that a building permit is pulled with the city of La Quinta. The approval is contingent. upon compliance with the specifications set forth in the approved application. If your change or addition requires a county, city or state permit, it is the responsibility of the homeowner to obtain this before starting construction. Please retain this letter in your files. If you have any questions regarding this matter, please contact Customer Care at 760-346-1161; or e-mail us at Sincerely, Jennifer. Zeivel Community Association Manager jzeivel a,drminternet.com Esplanade oft 5/8/17, 9:58 AM a. T&9k 4 4� a "_ P -'O'. BOX 1504 LA QUINTA, CALIFORNIA 92247-1504 BUILDING & SAFETY DEPARTMENT- -78-495 CALLE TAMPICO (760) 777-70.12 LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011 PROPERTY OWNER'S PACKAGE Disclosures & Forms for Owner -Builders Applying for Construction Permits IMPORTANT! NOTICKTO PROPERTY OWNER Dear Property Owner: An application for .a build' EEeimit has been submitted in your name listing yourself as the builder of the property - improvements specified atL11 e --i'-0 by 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 provision, usigned, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice nless 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., w jl. I understand a frequent practice of unlicensed peisons 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. I understand building permits are not required to be signed by property owners unless the res construction and are not hiring a licensed Contractor to assume this responsibility. y are ponstble for the 3. I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that 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. &A_4. I understand Contractors are required by law to be licensed and bonded in California andto list their license numbers on permits and contracts. , /,n5. I understand if I employ or otherwise engage any persons, other than Californialic' ensed 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. 1 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 risk. may subject me to.sarious financial -res understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential strut ,res cannot legally build them withthe 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. T&9k 4 4� a "_ P -'O'. BOX 1504 LA QUINTA, CALIFORNIA 92247-1504 BUILDING & SAFETY DEPARTMENT- -78-495 CALLE TAMPICO (760) 777-70.12 LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011 PROPERTY OWNER'S PACKAGE Disclosures & Forms for Owner -Builders Applying for Construction Permits IMPORTANT! NOTICKTO PROPERTY OWNER Dear Property Owner: An application for .a build' EEeimit has been submitted in your name listing yourself as the builder of the property - improvements specified atL11 e --i'-0 by 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 provision, usigned, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice nless 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., w jl. I understand a frequent practice of unlicensed peisons 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. I understand building permits are not required to be signed by property owners unless the res construction and are not hiring a licensed Contractor to assume this responsibility. y are ponstble for the 3. I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that 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. &A_4. I understand Contractors are required by law to be licensed and bonded in California andto list their license numbers on permits and contracts. , /,n5. I understand if I employ or otherwise engage any persons, other than Californialic' ensed 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. 1 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 risk. may subject me to.sarious financial -res understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential strut ,res cannot legally build them withthe 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 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. 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- A800-321-CSLB (2752) 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 j party legally, and finan ially respo ible for proposed construction activity at the following address: � � �L/ 3 �lr�✓ g 1. 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 mell as employers. X2. 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 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 to the agency is required to be presented when the permit is issued to verify the property owner's signature. . /7 _ A _ Signature of property owner �Z4/ / 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: -7, /riy Name of Authorized Agent:C�Tel NoZ4o•��6 . 3 Address of Authorized Agent: 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 owners driver's license, form notarization, or other verification acceptable to the agency is required to,e pTented when t unit is issued to verify the property owner's signature. A Property Owner's Signature:Date: �� Q Z CP/ F-7