BRES2017-0132Applicant: Contractor.
"P_EREZ, JUAN OWNER BUILDER j
PO BOX 1868 AUG 5 2017 �iU
LA QUINTA, CA 92247
co,'" C'My,c)
„E:'�� EpAC3tP^
Lic. No.: =v� •�;vi
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).:
P4
cs owner of the property, or my employees with wages as their sole
mmpeeen''
sation,n, 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 -or _sh id not build or improve for the purpose of sale.),
as owner of the property, am exclusively contracting with licensed contractors
So 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- -ontractors' State License Law.).
(_�exempt under Sec. 'BAP : C. for this reason
L
Ow e>�)
Lr f
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 Address:
WORKER'S COMPENSATIDN DECLARATION
I hereby affirm under penalty of perjury one oft he 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 perfornance of the work .for which this permit
is issued. My workers' compensation insurance carrier and policy number are:
Carrier:_ Policy Number: _
r<-7 r mortify that in the performance of the work for which this permit is issued, I
shall of employ any person in any manner so as to become subject to the workers'
compensation laws of California, and agree tha*, if I should become subject to the
workers' compensation provisions of Section 3 e00 of �borode, I shall forthwith
comply with those provisions.
Date: Yf S I Applicant t:_<2
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE 15 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.
1 agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representat ves of this city to enter upon the
above-mentioned property for inspection purposes.
D_ Signature (Applicant
C�
VOICE (760) 777-7125
78-495 .CALLE.TAMPICO
D�
FAX (76U) 777-7011.
LA QUINTA, ;CA'LIFORN'IA 92253
DESIGN & DEVELOPMENT DEPARTMENT
INSPECTIONS (760) 777-7153
6URDING PERMIT
Date: 8/15/2017
Application Number:
BRES2017-0132
Owner:
Property Address:
78315 CRESTVIEW TER
SKIP LANFRIED
APN:
643193018
78315 CRESTVIEVe TERRACE
Application Description:
LANFRIED / 265 SQFT ADDITION / CODE VIOLATION
LA QUINTA, CA 92253.
Property Zoning:
Application Valuation:
$10,000.00
Applicant: Contractor.
"P_EREZ, JUAN OWNER BUILDER j
PO BOX 1868 AUG 5 2017 �iU
LA QUINTA, CA 92247
co,'" C'My,c)
„E:'�� EpAC3tP^
Lic. No.: =v� •�;vi
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).:
P4
cs owner of the property, or my employees with wages as their sole
mmpeeen''
sation,n, 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 -or _sh id not build or improve for the purpose of sale.),
as owner of the property, am exclusively contracting with licensed contractors
So 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- -ontractors' State License Law.).
(_�exempt under Sec. 'BAP : C. for this reason
L
Ow e>�)
Lr f
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 Address:
WORKER'S COMPENSATIDN DECLARATION
I hereby affirm under penalty of perjury one oft he 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 perfornance of the work .for which this permit
is issued. My workers' compensation insurance carrier and policy number are:
Carrier:_ Policy Number: _
r<-7 r mortify that in the performance of the work for which this permit is issued, I
shall of employ any person in any manner so as to become subject to the workers'
compensation laws of California, and agree tha*, if I should become subject to the
workers' compensation provisions of Section 3 e00 of �borode, I shall forthwith
comply with those provisions.
Date: Yf S I Applicant t:_<2
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE 15 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.
1 agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representat ves of this city to enter upon the
above-mentioned property for inspection purposes.
D_ Signature (Applicant
Date: 8/15/2017
Application.AWmber-:
BRES2017-0132
Owner:
Prop&ty Address:
`78315 CRESTVIEW TER
SKIP tANFRI£D
APN:
643193018
78315 CRESTVIEW TERRACE
Application Description:
LANFRIED / 265 SQFT ADDITION / CODE VIOLATION
LA QUINTA, CA 92.253
Property Zoning:
Application Valuation:
$10,000.00
Applicant:
Contractor:
PEREZ, JUAN
OWNER BUILDER
PO BOX 1868
LA QUINTA, CA 92247
Llc. No.:
----------- ---------------------------------------------------------------------------------
Detail: 265 S.F. ADDITION. REMOVE -EXISTING PATIO COVER AND CONSTRUCT NEWADDITION-AT SOUTHWEST OF DWELLING TO EREATE 26S SF OF
ADDITIONAL CONDITIONED
AREA (CONVENTIONAL LIGHT -FRAME CONSTRUCTION). 2016 CALIFORNIA BUILDING CODES.
DESCRIP.%IOAI `
ADDITION, EA ADDITIONAL 500 SF
DESCRIPTION
ADDITION, EA ADDITIONAL 500 SF PC
DESCRIPTION
ADDITION, FIRST 100 SF
DESCRIPTION
ADDITION, FIRST 100 SF PC
DESCRIPTION
INVESTIGATION FEE
DESCRIPTION
BSAS SB1473 FEE
DESCRIPTION
ACCOUNT
'QTY
AMOUNT
DEVICES, FIRST 20
101-0000-42403
101-0000-42400
0
$6536
ACCOUNT
QTY
ACCOUNT '
iQTY
AMOUNT
0
$25.33
.101-0000-42600
0
$18.24
ACCOUNT
QTY
AMOUNT
101-0000-42400
0
$127.68
ACCOUNT
QTY
AMOUNT
101-0000-42600
0
$179.36
Total Paid for ADDITION: $390.64
ACCOUNT
QTY
AMOUNT
101-0000-42400
1 •
$256.37
Total Paid for ADMINISTRATIVE: .$2S6.37
ACCOUNT
QTY
AMOUNT
101-0000-20306
0
$1:00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DEVICES, FIRST 20
101-0000-42403
0
$25.33
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DEVICES, FIRST 20 PC
101-0000-42600
0
$25.33
Total Paid for ELECTRICAL: $50.66
DESCRIPTION
ACCOUNT
QTY
AMOUNT
OTHER MECHANICAL EQUIPMENT
101-0000-42402
0
$38.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
OTHER MECHANICAL EQUIPMENT PC
101-0000-42600.
0
$38.00
Total Paid for MECHANICAL: $76.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
SMI - RESIDENTIAL
.101-0000-20308
0
$1.30
Total Paid for STRONG MOTION INSTRUMENTATION SMI: $1.30
DESCRIPTION ACCOUNT QTY AMOUNT •
TECHNOLOGY ENHANCEMENT FEE 502-0000-43611 0 $5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $S.00
:i
Bin
§�Z4
Permit It'
Project Address-.
Qtypf La Quinta
Buitdin.- &, Safety Division
- 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
BuMing Permit Application and Tracking Sheet
A. P. Number:
17 o 19
Address'. Y"'(.
7F _;IS-r
Legal Description:
e
City, ST, Zip:
Contractor:
Tcicphane:
Address:
Prqj�ctDescriptian-
City, ST, Zip:
X�& Liz,
Telephone:
x
67 11174 teV fe k �0 yelll�
State Lic. #
City Lic. #.-.
r
47 t-)
Arch.,Eopk �Dcsitncx)
/9 (ze �02 2,12
Address:
62 8
City, ST, Zip: &,OWU -,;;a,
Telephone: lw(otq-8-74;��
Construction Type: Occupancy:
Project type (circle one): New, A�d. A�ItV Repair
Demo
State Lic.
�:� .:
N m4-
Name of Contact Person:
Ag V)
Sq. Ft.: a:(O!�;—
Stories: Units:
Telephone# of Contact Person: aj— _Z
61 'q - 0-7 r' -
I Estimated Value of ProjCCt.L0, a)cp
APPLICANT: DO NOT WRITE BELOW THIS LINE
1Y
Submittal
Rcqld
Rcc'd
TRACKrNG
PERMIT FEES
Plan Sets
Plan Clieck submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Platt Check Deposit
Truss C21cs,
Called Contact Person
Plan Clieck Balance.
Tifle 24 Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Reviciv, ready for corrections/issue
Electrical
Subcontactor List
Called ContactPerson
Plumbing
Gran( Deed
Plans picked up
S.M.T.
II.O.A. Approval
Plans resubmitted
Grading
IN HOUSE.-
Review, ready for corrections/issue
-Developer Impact Fee
Planning Approval
Called Contact Pei -son
A.I.P.P.
Pub. INIks- Appr
Date of permit issue
School Fees,
Total PermitFees
Date: 8/15/2017
No.: 17-00689-1
Owner: Skip Lanfried
Address: 78315 Crestview Terrace
City: La Quinta
Type: Residential Addition < 500 Sq ft
Lot # Street No
78315
Comments:
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
47950 Dune Palms Road
La Quints, CA 92253
(760)771-8515
Street Name
Crest View Terrace
"" Itp
N ..........
Hu�CHOpFM�IRAGC C
;' 7%p14 WELLS
S1T Y �'14 E2
LA pIATAY�,
Email:
Jurisdiction: La Quinta
Tract #:
Sq. Feet APN
265 643-193-018
Permit No.
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions
under 500 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking eating, or sanitation) or replacement
mobile homes. It has been determined that the above -named owner is exempt from paying school fees at this time due to the following reason:
Residential Addition 500 Sq Feet or Less
Exempt
This certifies that school facility fess imposed pursuant to
Education Code Section 17620 and Government Code 65995 Et Seq.
in the amount of $0.00 X 265 S.F. or $0.00 have been paid for the property listed above and that building permits
and/or Certificates of Occupancy for this square footage in the proposed project may now be issued.
Fees Paid By: Exemp - James Perkins Check No.:
Bank Name Telephone: 626- of Certificate Funding: Exempt
By Scott L. Bailey
Superintendent
Fee Collected/ Exempte y: S ran McGilvre
Certificate Fees Due: $0.00
Original Payment(s) Rec'd: $0.00
New Payment Rec'd: $0.00
Over/Under: $0.00
NOTICE: Pursuant to Government Code Section 66020(d)(1), this will serve toL
f you thatthe 90-dayapproval period in which you may protestthe fees or
other payment identified above will begin to run from the date on which thIding or installation permit for this project is issued, or from the date on
which those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier.
Notice to Building Department: THIS DOCUMENT VALID ONLY IF IMPRINTED WITH EMBOSSED SEAL.
P.O. Box 1504
LA QUINTA, CALIFORNIA 92247-1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
PROPERTY OWNER'S PACKAGE
(760)777-7012
FAX (760) 777-7011
Disclosures & Forms for Owner -Builders Applying for Construction Permits
IMPORTANT! NOTICE TO PROPERTY OWNER
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified at 3 1 S C'„L oifo ur+r Ft 4CC fi . avl. 4-4 q Z_Z J_?
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 signer you understand or verify this information.
1. I understand a frequent practice of unlicensed persons 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. L 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 perniits are not required to be signed by property owners unless they are responsible for the
construction and are not hiring a licensed Contractor to assume this responsibility.
�3. 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 her name instead of my
own.
4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on
permits and contracts.
5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value
of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employee,
under state and federal law.
6. I 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 unenzp]oyment
compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious fnancial
risk.
7. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential
structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed
subcontractors and the number of structures does not exceed f6ur within any calendar year, or all of the work is performed
under contract with a licensed general building Contractor.
l Lts. 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.
PI understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue
erviee, 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.cslb.ca.gov for more information about licensed contractors.
10. 1 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the
party le ally and financially responsible for proposed construction activity at the following address:
ILA 11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all
ap Iicable laws and requirement$ that govern Owner -Builders as.well as employers.
agree to notify the issuer of this form inunediatel of an additions deletions or changes t y y g o any of the information i
have provided on this forur. 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 Contractois may bein civil court, -It .is also
important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured wbik 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 notarkvion, or
other verification acceptable to the agency is re mired to be presented when the permit is issued to verify the property
owner's signature. �T
Signature of property owner 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 far the Owner -Builder.
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BE, EL X
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:
Tel No
LR (1; Cw- qzzJ-3
61-1�l xS
Address of Authorized Agent: _J�?350 C� tT�i-"l C tiff (1— 44-
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 requir o be presented when the permit is issued to verb the property owner's signature.
Property Owner's Signature: Date: