BPAT2017-007678-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Permit Type/Subtype: PATIO COVER/CITY STANDARD/PRE-ENGINEERED - OPEN
Application Number: BPAT2017-0076
Property Address: 52900 AVENIDA CARRANZA
APN: 773322008
Application Description: SANTACRUZ / 300SF CITY STANDARD PATIO COVER (SOLID)
Property Zoning:
Application Valuation: $1,000.00
Applicarit:
D. 9�
CONSUELOSANTACRUZ
52900 AVENiDA CARRANZA
LA QUINTA, CA 92253 OCT 19 2017
nD
DESIGN ANDD �CITY �� LA CrUINTA
PMENT DEPARTMENT
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 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 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 any applicant for a permit
s Jects the applicant to a civil penalty of not more than five hundred dollars ($500).:
ras owner of the property, or my employees with wages as their sole
corrrifensation, 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
tee{ {spe did not build or improve for the purpose of sale.).
((�� - 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
r actors' State License Law.).
IRn exempt under Sec. B.&P.C. for this reason
Dafe . Owner. C6 4 A;_iri
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 Na
Lender's Address:
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/19/2017
Owner:
CONSUELOSAJTACRUZ
52900.AVENIDA CARRANZA
LA QUINTA, CA 92253
Contractor:
OWNER BUILDER
Llc. No.:
WORKER'S COMPENS4TION DECLARATION
I hereby affirm under penalty of perjury one if the following declarations:
_ 1 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:
CaPolicy Number: _
rcertify that in the performance of the work for which this permit is issued, I
shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California, and agree teat, 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: hqklApplican
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,CU0). IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FCR IN SECTION 3706 OF THE LABOR CODE,
INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKN :)WLEDGEMENT
IMPORTANT: Application is hereby made to tie Building Official for a permit subject to
the conditions and restrictions set forth on ttfs application.
1. Each person upon whose behalf this appl cation 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 -he work being performed under or
following issuance of this permit.
2. Any permit issued as a result of this appliration becomes null and void if work is not
commenced within 180 days from date of issmance of such permit, or cessation of work
) er 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 building
construction, and hereby authorize represent etives of this city to enter upon the above-
mentioned property for inspection purposes.
Date'ig� re (Applicant or Agent)
Date: 10/19/2017
Application Number: BPAT2017-0076 Owner:
Property Address:' " 52900 AVENIDA CARRANZA CONSUELO SANTACRUZ
APN: 773322008 52900 AVENIDA CARRANZA
,Application Description: SANTACRUZ / 3005F CITY STANDARD PATIO COVER (SOLID) LA QUINTA, CA 92253
Property Zoning: ,
Application Valuation: $1,000.00
Applicant: Contractor:
CONSUELO SANTACRUZ OWNER BUILDER
52900 AVENIDA CARRANZA.
LA QUINTA, CA 92253
LIc. No.: .
Detail: 300SF SOLID PATIO COVER AT REAR YARD [CITY STANDARD] THIS PERMIT DOES NOT INCLUDE ELECTRICAL INSTALLATIONS. 2016 CALIFORNIA
BUILDING CODES.
DESCRIPTION
BSAS SB1473 FEE
ACCOUNT QTY AMOUNT
101-0000-20306 0_ $1.00.
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT.
PATIO COVER, STD, OPEN
101-0000-42404
0
$104.55
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PATIO COVER, STD, OPEN PC
101-0000-42600
0
$102.99
Total Paid for PATIO COVER / COVERED PORCH / LATTICE: $207.54
DESCRIPTION
ACCOUNT
QTY
AMOUNT
RECORDS MANAGEMENT FEE
101-0000-42416
0
$10.00
Total Paid for RECORDS MANAGEMENT FEE: $10.00
DESCRIPTION ACCOUNT QTY AMOUNT
SMI'- RESIDENTIAL 101-0000-20308 0 $0.50
Total Paid for STRONG MOTION INSTRUMENTATION SMI: $0.50
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
TOTALS:04
Bin#
City .of La Quinta
Building & Safety Division
78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit#
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Project Address:—%
o q
�
Owner'Nang.-"
s � C o v Flo �arC L) Z,
A.P. Number
Address`.` r'
_1ST oo,4v2r1����=�.rr�nZ
Legal Description:
City, ST,ZT:
Contractor: owVF p u) l
Telephone:.
Address:
Project Descript16n'eD,,,47,0 CO I/ y—
1
City, ST, Zip:
Telephone:
MIR
State Lic.#:
City Lic #:
Arch, Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Construction Type:
Proj. Type New Add'n
Occupancy:
Alter Repair Demo
Name of Contact: /`_„y S C/Cf
SgFt:
#Stories
# Units:
Telephone of Contact:l7 Q —660— ,70� U
Estimated Value of Project:
I
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING '
PERMIT FEES
Plan Sets
Plan Check Submitted
Item
Amount
Structural Calcs
Reviewed, ready for corrections
Plan Check Deposit:
Truss Calcs
Called Contact Person
Plan Check Balance:
Title 24 Calcs
Plans Picked Up
Construction:
Flood Plain Plan
Plans Resubmitted
Mechankal:
Grading'Plan
2nd Rev, Ready for corrections /
Electrical:
Subcontractor List
Called Contact Person
Plumbing:
Grant Deed
Plans Picked Up
S.M.I.
HOA Approval
Plans Resubmitted
Grading
IN-HOUSE
3rd Rev, Ready for corrections /
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Apps
Date of permit issue
School Fees
Total Peanit Fees
Twy4 4 a" - -
T.O. BOX 1504
LA QUINTA, CALIFORNIA 92247-1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
(760)777-7012
FAX (760) 777-7011
PROPERTY OWNER'S PACKAGE
Disclosures & Forms for Owner_Builders Applying for Construclion Permits
IMPORTANT! NOTICE TO PROPERTY OWNER
Dear Property Owner:
An application for a buildin permit has been submitted in ygur name listing-yourselfrself as the builder of the property
tyimprovements specified at— 0 _ /a- _�+
We are providing you with an Owncr-Builder AcKn wle gment 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,
signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice
unless 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.
understand a frequent practice of unlicensed persons is to have theproperty owner obtasn an "Owner -Builder"
b 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 ly 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 they are responsible for the
cons ction and are not.hiring a licensed Contractor to assume this responsibility.
�. 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 =ter name instead of my
own.
4. I understand -Contractors are required bylaw to be licensed and bonded in California and to list tFeir license numbers on
permits and contracts.
rl: understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value
'&Cmy construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer"
under state and federal law.
n_sI understand if I am considered an "employer" under state and federal law, I must register witi 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 nie to serious financial
risk.
Sunderstand under California Contractors' State License Law, an Ownei-Builder who builds single-family residential
_�r's' cannot legally build them with the intent to offer them for
y licensed
subcontractors and the number of structures does not exceed four within any lcale calendar year, os all orrall iof the work is p�_rforred s performed
under contract with a licensed general building Contractor.
cG�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.
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-
88000-3321-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
.party egally , and financially responsible for proposed construction activity at the following address:
_4111. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all
applicable cable laws and requirements that govern Owner -Builders as.well as employers.
- I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the infomnation I
have Pfovided 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 orily 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 regi, red to presented when the permit is .issued to verify the property
owner's signature. — . // //
[Signature of property own ��� 'Date'; 0 +�
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 propertyowner 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 owners signature.
Property Owner's Signature: Date:
7
CITY OF LA QUINTA,SUS-CONTRACTOR LIST s2;,n4-o-cy-
57�?Z40 4yPn:a/, C-f-r,^Awz4PERMIT. NUMBER - OWNERA_,CO.
JOB ADDRESS _
with the Building Instiection Card at times in a conspict►otis-. !p ace. Only persons appearing on this list or their employees are authorized to work
This form'shall be_postecl on the iob .all
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 com(5leted by: pplicaot.. "On File" is not an .acce:p.table response
............ .. ... _ s .. .. , .... ............ t. , . CLL,' .. x...... _.
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,... ....... .., ...,...::.::::• ... ens Com tris. t. ................
C$ntractor
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sl(!ca , C ontra ctor } _
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i`'°`'1`'• ."'>':` -^:<`.z``% .:<s.>:z.:, Classification License Number Exp. Date Carrier Name Policy Number Ecp Date License Number Exp. Dater
Company Name Classlf t P
(e.g. A, B, C-8) ' (xxxzxx) (xx/xx/xx) (e.g. State Fund, CalComp) (Format Varies) (xx/xx/xx) (xxxx) (xx/xx/xx)
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'"STRUCT STEL (C 51)
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MI�SONRY (C<79}
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