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BPAT2017-006278-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT BUILDING PERMIT Application Number: BPAT2017-0062 Property Address: 52031 AVENIDA MENDOZA APN: 773232012 Application Description: QUINTANA / CITY STANDARD PATIO OVER DRIVEWAY Property Zoning: Application Valuation: $3,000.00 Applicant: MOISES QUINTANA 52031 AVENIDA MENDOZA LA QUINTA, CA 92253 AUG 3 0 2011 CITE OF U+QUINTA COMMUNITY DEVELOPMENT 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 3 of the Business and Professions Code, and my License is in full force and effect. License Class: _ License No.: Date: Contractor: VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 8/30/2017 Owner: MOISES QUINTANA 52031 AVENIDA MENDOZA LA QUINTA, C4 92253 Contractor: OWNER BUILDER Llc. No.: WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury on -i 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 perormance of the work for which this permit is issued. My workers' compensation insurarr_e carrier and policy number are: OWNER -BUILDER DECLARATION Car Policy Number: _ I hereby affirm under penalty of perjury that I am exempt from the Contractor's State 1, r c tify that in the performance pf the work for which this permit is issued, I License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any shall not employ any person in any mannerso as to become subject to the workers' city or county that requires a permit to construct, alter, improve, demolish, or repair any compensation laws of California, and agree that, if I should become subject to the structure, prior to its issuance, also requires the applicant for the permit to file a signed workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith statement that he or she is licensed pursuant to the provisions of the Contractor's State comply with those provisions. 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 a ry� D�a��t �� r • app» pIicant.-V4&. l5/�1/�cJ!' 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).: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, ) as owner of the property, or my employees with wages as their sole AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO compensation, ovill do the work, and the structure is not intended or offered for sale. ONE HUNDRED THOUSAND DOLLARS ($100;000). IN ADDITION TO THE COST OF. (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, apply to an owner of property who builds or improves thereon, and who does the work INTEREST, AND ATTORNEY'S FEES. 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 APPLICANT AC14NOWLEDGEMENT within one year of completion, the owner -builder will have the burden of proving that he IMPORTANT: Application is hereby made to the Building Official for a permit subject to r id not build or improve for the purpose of sale.). the conditions and restrictions set forth on this application. ,Iowner of the property, am exclusively contracting with licensed contractors to 1. Each person upon whose behalf this application is made, each person at whose construct the project. (Sec. 7044, Business and Professions Code: The Contractors' State request and for whose benefit work is performed under or pursuant to any permit issued License Law does not apply to an owner of property who builds or improves thereon, as a result of this application , the owner, and the applicant, each agrees to, and shall and who contracts for the projects with a contractor(s) licensed pursuant to the defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and ors'State License Law.). employees for any act or omission related to the work being performed under or jrt)r m exempt under Sec. B.&P.C. for this reason following issuance of this permit. 2. Any permit issued as a result of this apolication becomes null and void if work is not hq commenced within 180 days from date of issuance of such permit, or cessation of work DatZ e�: J `Y)10 OwR nerT 180 days willsubject permit to cancellation. . . 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: 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 o-dinances 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: 8/30/2017 Application Number: BPAT2017-0062 Owner: Property Address: 52031 AVENIDA MENDOZA MOISES QUINTANA APN: 773232012 52031 AVENIDA MENDOZA Application Description: QUINTANA / CITY STANDARD PATIO OVER DRIVEWAY LA QUINTA, C4 92253 Property Zoning: Application Valuation: $3,000.00 Applicant: Contractor: MOISES QUINTANA OWNER BUILDER 52031 AVENIDA MENDOZA LA QUINTA, CA 92253 -------------------------------------------------------------------------------------------- LIc. No.: Detail: r FINANCIALIN FORMATION DESCRIPTION ACCOUNT QTY AMOUNT BSAS S61473 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 5.02-0000-43611 0 $5.00 Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00 Bin# ' City ofLa Quinta Building & Safety Division 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 — 0V6 a Building Permit Application and TYacking'S.iieet Permit# 8/�?T,_1d1`7 Project`Address:` ^ M Ownerts Name: `� V, � I N A.P. Number Address: S o CAI, 111 Legal Description: City, ST, Zip: Contractor: c` Telephone: Address: /��/ ,, `` Project l)ee criptlon: City,ST;Zip: 9 aM Telephone: 0 MW o State.Lic. #: City Lic #: Arc�gi:; Designer: Address: / - l City, ST, Zip: Telephone: Construction Type: Proj. Type New Add'n Occupancy: Alter Repair Demo State Lic. #: % Name of Contact: --•�_ O r£ ( J S" y qFt... ` J D #Stories # Units: Telephone of Contact: �--- 0 � Estimated V5lue of Project: _ -71 3 0 oD 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 Mechan:cal: 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 Permit Fees Tity/ °f 4Vaatala 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_1' tin _ ourself_as_the _builder o the propertya improvements specified at (_ �y _ f� a rj �— We are providing you with an caner -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 signs you understand or verify this information. "I. 1. I' understand a frequent practice of unlicensed persons is to have the property owner obtEin an "Owner -Builder" buil g permit that erroneously,implies that the property owner is providing his orher own labor, and materialersonall . I, as P Y 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. Wim-'_ 2 I understand building permits are not required to be signed b property y p p rty owners unless they are responsible for the construction and arenot hiring a licensed Contractor to assume this responsibility. 3? I understand as an "Owner -Builder" am the re M responsible =-�i spo party of record on the permit. I understand that I may protect myse f from potential financial risk by hiring a licensed Contractor and having the permit filed in his other name instead of my own. ACQI understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. of my5� I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. 4=A: 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 unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to.serious financial risk. )l understand under California Contractors' State License Law, an Owner -Builder who builds s"ngle-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 four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. 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. . IM4t_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- 800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. (0. 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 proposyd constructionactivity at the following address: 1. 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. W1. I 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 proprly 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 required to be presented when the permit is issued to verify the property owner's signature. Signature ofproperty�wneo r ( Da et : (� �- Note: The following Authorization Form is required lobe 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 r. 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 owners signature. Property Owner's Signature: Date: rV ..4 : it - • - F - �S- -44 `J '4 . u st - LjC' ` _ fTFY OF LA Q . BUILDING & SAFETY T, FOR C01,1S " VCTB�fV �..- DATES ��' 4KIZ- . ,p � Zx �zx rZ %ai rN j Of G D cZ� SP�cS.