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'
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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. #;
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State Lic. # :
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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