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BPAT2017-004278-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: BPAT2017-0042 Property Address: 79899 CASSIA ST APN: .600330005' Application Description: ELLIOTT / PATIO COVER Property Zoning: Application Valuation: $1,000.00 Applicant: JULIANNE ELLIOTT 79899 CASSIA ST LA QUINTA, CA 92253 DESIGN & DEVELOPMENT DEPARTMENT BUILDING PERMIT 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 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 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 r she did not build or improve for the purpose of'sale.). (- - as owner of the property, am exclusively contracting with licensed contractors to ns ruct the project. (Sec. 7044, Business and Professions Code: The Contractors' St a 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 th Contractors' State License Law.). m exempt under.Sec. B.&P.C. for this reason Date: 7' Owner: t l: 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 Add VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 17 Owner: o nr L JULIANNE ELLIOTT m o! 79899 CASSIA ST LA QUINTA, CA 92253 155 c a1 . 2 Contractor: OWNER BUILDER Llc. No.: 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: _ Policy Number: I certify 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 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:' �•(G �J v` WARNING: FAILURE TO SECURE WORK 'COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). 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 Building Official 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 building construction, and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. Date: _ (�� Signature (Applicant or Agent):. �� �a Date: 6/23/2017 Application Number: BPAT2017-0042 Owner: Property Address: 79899 CASSIA ST JULIANNE ELLIOTT APN: 600330005 79899 CASSIA ST Application Description: ELLIOTT [PATIO COVER LA QUINTA, CA 92253 Property Zoning: Application Valuation: $1,000.00 Applicant: Contractor. JULIANNE ELLIOTT OWNER BUILDER 79899 CASSIA ST LA QUINTA, CA 92253 Llc. No.: --------------------------------------------------------------------------------------------- Detail: 80 SF .PATIO COVER AT SIDE YARD [ALUMAWOOD] THIS PERMIT DOES NOT INCLUDE ELECTRICAL INSTALLATIONS. 2016 CALIFORNIA BUILDING CODES. Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00 • •: FINANCIAL 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 PATIO COVER, STD, OPEN 101-0000-42404 0 $101.84 DESCRIPTION ACCOUNT QTY AMOUNT PATIO COVER, STD, OPEN PC 101-0000-42600 0 $100.32 Total Paid for PATIO COVER / COVERED PORCH / LATTICE: $202.16 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 • •: P. -O. BOX 1504 LA Q.UINTA, CALIFORNIA 92247=1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 . 41, _QW& rlcv BUILDING & SAFETY DEPARTMENT PROPERTY OWNER'S PACKAGE (760)777-7012 FAX (760) 777-7011 Disclosures &.Forms for Owner -Builders Applying for Construction Permits IMPORTAI iR VOTICE TO PROPERTY OWNER Dear Property Owner: An application for a building permit been sub mittcd in your name listing yourself -2s the builder of a property improvements specified at 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, 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. . (Y VnOwn1 .. understand a frequent practice of unlicensed persons is to have the property owner obtain. an "Owner -Builder". er-Builder, ing permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as 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. understand building permits are not required to be signed by property owners unless they are responsible fo on and are not hiring a licensed Contractor to assume this responsibility. r the lerstand as an"Owner-Builder" .I am the responsible party of record on the permit I understand that I may protect potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my pderstand Contractors are required by law to be licensed and bonded in California and to list their license numbers on contracts.derstand if I employ or otherwise engageany persons, other than California licensed Contractors, and the total value truction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" unersateand federal law. 6 I understand if I am considered an ."employer" under state and federal law, I must register with the state and federal en emmt, withhold payroll taxes, provide workers' compensation disability insurance; and contribute to unemployment for each "employee." I also understand my failure to abide by these laws may subject me to.serious financialVnipensation, k. . -understand under Califomia.Contractors' State License Law, an Owner -Builder who builds single-family residential pub�contractors s cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed 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. I. Understand as an Owner -Builder if I. sell the property for which this permit is issued, I maybe held liable for any nancial. or personal injuries 'sustained.by any subsequent owner(s) that result from any latent construction defects in the w kmanship or materials. ASe Iunderstand I may obtain more information regarding my,obligations as an "employer" from the Intemal 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 (CSLB) at.'l 800-321-CSL8.(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 arty legally: and frc' lly sponsible for . o osed construction activity at the following address:. 11. I agree that, as the party legally_and financially, responsible for this -proposed construction activity,1I will .abide by all p ]icable laws and requirements that govern Owner -Builders as.well as employers. 1 .1 agree to notify the issuer of this form immediately of any additions, deletions, or'changes to any of the information I ave 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 toassist'you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil courtAt is also important for: you to understand that if an unlicensed',Contractor or employee of that'individual or f rnr'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 p'roper'ly 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 cope of`thepropeify owner.'s driver's license, forst 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. W4�0 . 00 Signature of property owner Date: Note: The following Authorization Form is required to be completed by theproperty owner only when designating an agent of the property owner to apply for a construction permit for the Owner -Builder. 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 Permif 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 penaltyof 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 ver fcation acceptable to the agency is required to be presented when the perntit is issued to verify the property owners signature. Property Owner's Signature: Date: �- 0 �D�P-i, Bin # City of La Quinta Building 8T Safety Division 78-495 Calle Tampico La Quinta, CA 92253.- (760).777-7012 __ _ , Building Permit Application and Tracking Sheet - Permit # MUM' j. Project Address: O, ner's.Name: J 1 I' h (� A. P. Number: -7 % Legal Description: ST, Zip: %a u. n�ol q a a 53 Contractor: Address: ` --Project Description: City, ST, Zip: � ' an. A(LA mawoocK Telephone: City Lic. #; ( � c7 n a c O State Lic. # : i bo �,S- Arch., Engr., Designer. re, I Address: $ �dlYl . c r 1 City, ST, Zip: Telephone: Con T Occupancy: struction cY: Project type (circle one): New Add> n Alter Repair Demo State Lic. #:>:::::::::» :< <:::: »:::<:::>::::>:... Name of Contact Person: Ilavl�Sq: Ft: #Stories: # Units: Telephone # of Contact Person: — i 7Estimai d Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Reed TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit . Truss talcs. Called Contact Person Plan Check Balance Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan V Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up' S.M.I. H.O.A: Approval Plans resubmitted Grading IN HOUSE:- 3a Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue .RE School Fees JUN 2 ' Total Peril '"WNNING DEPAPTMtW