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09-1225 (PAT)71 '1� P.&ABOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 T-iht " BUILDING & SAFETY DEPARTMENT BUILDING PERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 7.77-7153 Date: 2/01/10 Application -Number.: 0 9 - 0 00 01225 Owner: Property Address: 80841 VISTA LAZO RON WORDEN APN: 762-250-013- - - 80841 VISTA LAZO Application description:. PATIO COVER - RESIDENTIAL LA QUINTA, CA 92253 Property Zoning: LOW DENSITY RESIDENTIAL ------- - - - - - - - - - - - - -- - -- - Application valuation:40000 Contractor: FEB O L�JpIiJ Applicant:" Architect or Engineer: Owner r; owN c��F� IIATVAI� �.• E."!, LICENSED CONTRACTOR'S DECLARATION. - WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury than) am licensedunder provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations: Section 70001 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. - _ Date: 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 • OWNER -BUILDER DECLARATION insurancecarrier 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,dor repair any structure, priorto its issuance, also requires the applicant for the 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 f the Labor Cc shall forthwith comply with those prov' ions. that he or is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by - - " any a cant for a permit subjects the applicant to a,civil penalty of not more than five hundred dollars ($500).: Date:a—Z—&plicant: 1 _ 1 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 WARNING: FAILURE TO SECURE WORKERS' COMPS ION COVERAGE IS'UNLAWFUL, AND SHALL .. Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER -TO CRIMINAL PENALTIES A 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 not build or - - - improve for the purpose of sale.). - APPLICANT ACKNOWLEDGEMENT (_ 1 I, 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 contractor(s)-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, (_ 1 I 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 / —/ r /O 1 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 LE ING 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 oft county to enter upon the a��-mentione d property r inspection purposes. - Lender's Name: //tusVat` ignature Acant or Age Lender's Address: _ LQPERMIT Application Number 0-9-00001225 Permit . . PATIO COVER PERMIT Additional desc .... Permit Fee . . . . 349.50 Plan Check Fee 227.18 Issue Date Valuation 40000 Expiration Date 7/31/10 Qty Unit Charge" Per Extension BASE FEE 252.00 15.00 6.5000 THOU BLDG 25,001-50,000 97.50 Permit . . PLUMBING Additional desc , Permit Fee 24.75 Plan Check Fee 6.19 Issue Date . . . Valuation 0 Expiration Date 7/31/10 Qty Unit Charge- Per. :Extension BASE FEE 15.00 1.00 6.0000 EA PLB FIXTURE 6.00 1.00 3.0000 EA PLB WATER INST/ALT/RER 3:00 1.00 .7500 EA PLB,GAS -PIPE >=5 .75 Permit ELEC-MISCELLANEOUS Additional. desc . Permit Fee 34.50, Plan Check Fee 8.63 Issue Date Valuation 0 - Expiration Date 7/31/10 ; Qty Unit ChargePer Extension " BASE FEE 15.00 ' 26.00 .7500 PER, ELEC DEVICE/FIXTURE'1ST 20- 19.50 ----- --- Special'.Notes and Comments 77.5 X 14 X 11FT"HGT GAZEBO IN REAR YARD - PER ENGINEERED PLAN. 2007 CODES. ------------------------------------------- - Other Fees . . . . . BLDG STDS ADMIN (SB1473) 2.00 STRONG MOTION (SMI) - RES 4.00 Fee summary Charged Paid Credited. Due Permit Fee.Total 408.75 .00 .00 `408.75 Plan Check Total 242.00 1.00 .00 242.00 Other Fee Total 6:00 .00 .00 6.00 Grand Total 656.,75 .00 .00 656.75 LQPERMIT P -O. BOX 1504 LA QUINTA; CALIFORNIA 92247-1504 78-495 CALLE TAMPICO I -A QUINTA, CALIFORNIA 92253 PROPERTY o wp, RS Disclosures & BUILDING & SAFETY DEPARTMENT PACKAGE Forms for Owner -Builders Applyin forOTtCE .. b r Construction Permits Dear PropertyOwner. U . R URTY O�'r1ER An. application–fou-a building g Permit has been submitted in We are providing at your. n . g You with an name listing yourself as the builder of the pew r Owner -Builder Aclrnoyled Pro responsibilities and possible risk gment and Inf Owner -Builder. We You may — b ormation Verification Forrrt to make You aware si ned and ad! IIO; issue a buildingy having this permit.issued ' Y are of your g returned this for Permit until m y°ar name as the unless you, the Property m to us at our official adds ou have read, in, ny Owner, obtain the ess indicated, Ana Your understanding of each provision, prior approval of the got of the owner cannot execute DYME''R'S ACK-Mc. Permrttu�g authority. this notice a1RECTf0 WI:EDG14E NS' Read and enitia! eacfr statenrbelow tVERMCATtON ' llO)O1l�A.TtON understand a kn�YYou understand or verljy this information. building frequent practice of u • Permit that err'orieo nlicensed.pefsoIIs•istito• have the an Owner -Builder, ma' `ply rmplres that the property owner - Providing Property owner obtain an and his Or her e y held liable and subject to serious financial risk for am her own labor and Owner -Builder" mp)OYees while working on m material Personally. I, as injuries. I am willfully acting as an O Y Property. '1y. Y injuries sustained by an unlicensed on my property- caner -Builder and Y homeowner's insurance may person am aware of the limits of my insurance overage for injuries to orProvide coverage for kers understand liuildin . eOnstruction and are g Permits are not required to be signed b not hiring a licensed Contractor to ass ry y Property Owners unless they are responsible for the �3. 1 understand ume this responsibility. - myself from l an "Owner -Builder" I am the re potential financial risk b sponsible ° y�hirin Party of reord on the g a the and having the a Permit. I understand that I may r 1'?' P emit filed in his or her name instead of protect t �4. 1 understand Contracto ; y rs ale required b I. , iJ. p�>ts aiid contracts.: ; r, Y law to.be licerised'and bonded in California ! and to list [heir license numbers on S. I undeistarid if"I em' t, f j i' f of my constriction is at leas�fi or otherwise engage aII Under state and f hundred dollars y persons, other than California licensed Contractors, and the total value federal law. ($500), including labor and materials I ma JC4- 1 Y be considered an "employer" understand if I am considered an "employee, government, withh°ld payroll taxes employed under state and federal law, I compensation for each . Provide workers' must register with the state and federal risk' "emplOYo." I also understand m omPensation disability insurance, and contribute to unemployment �Y failure to bide by -these laws may subject me to serious financial ial X7.1 "riders � Land under California Contractors' t SWc1[ures cannot State License bcmntractbrs and -legally build them with the intent to mow' an Owner -Builder Who builds single-family re sU the number of s offer them for sale, unless all work is performed b Under- contract with a licensed structures does not exceed four withiII any calendar year, y srdential genera! building Contractor. Y or all of the work is y licensed • perforated (760) 777-7012 FAX (760) 777-7011 v� 8. I understand as an Owner -Builder if I sell the property for which this permit is issued, 1 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. JJ9. 1 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 (2752) or www.csib.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 applicable laws and requirements that govern Owner -Builders as well as employers. 12. 1 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. Beforea 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 d river's license; form notamadon-, 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 own (/lJ Date: 1,-A" Note: 77ie 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 agents) to apply for, si n, and file the documents necessary to obtain an Owner -Builder Permit for my project. Scope of Construction Project (or Description of Work): T t � Vt_� "a"_ar"t Project Location or Address: uU ,^A, • q Z Z Name of Authorized Agent:.i . 1 Tel No } VO -% t Al 9 U 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 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 SignaturQ(i(/ Date: �����