BPLB2017-0161R
C.`� 44Qum&
78-495 CALLE TAMPICO
U
LA'QUINTA;�ALIFORN'IAA92253
DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Permit Type/Subtype:
PLUMBING/
Application Number:
BPLB2017-0161
Property Address:
53845 AVENIDA VELASCO
APN:
774164017
Application Description:
CASTILLO / ABANDON
SEPTIC & CONNECT TO SEWER
Property Zoning:
Application Valuation:
1000.00
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
MARCO CASTILLO
53845 AVENIDA VELASCO
LA QUINTA, CA 92253
Date: 12/4/2017 ..
Applicant: Ua U 4t_, ii Contractor:
MARCO CASTILLO_04 I! .C��I� OWNERBUILDR
53845 AVENIDA VELASCO DEC O
LA QUINTA, CA 92253 2VI CITYOFLAQUINTA
C0MZUNI OF�4QUINTA ea yhlTYG IELQPMENMEPAHTI�EN
4 QUI DEpgq s
THEW Llc. •No.:
----------------------------------------------------------------------
---------------------
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
1 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
su s the applicant to a civil penalty of not more than five hundred dollars ($500).:
f 1, 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
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one •if the following declarations:
I have and will maintain a certificace 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 §) as to become subje, to the workers'
compensation laws of California, and agree that, if I should be�fiie subject to the
workers' compensation provisions of Sectioru37 0 of the Lab r Code, I shall forthwith
comply with th se provi ons.
Date: + Applicant:
//
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIN�4�-NAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100{nu0). IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
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 ACKNOWLEDGEMENT
wi 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
did not build or improve for the purpose of sale.). the conditions and restrictions set forth on this application.
i_ I, as owner of the property, am exclusively contracting with licensed contractop-to 1. Each person upon whose behalf this app:ication is made, each person at whose
co struct the project. (Sec. 7044, Business and Professions Code: The Contrite
or '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 ho builds or improvesreon, as a result of this application, the owner, anc the applicant, each agrees to, and shall
a d ho contracts for the projects with a contracto s) licensed pursuant t defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and
actors' State License Law.). J employees fot any act or omission related to the work being performed under or
( m exempt under Sec. B.&P. . for t s rJason 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 iss.-jance of such permit, or cessation of work
Date:-V-./(2'HOwner: I for 180 days will subject permit to cancellation.
CONSTRUCTIgN [ENDING 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:
I certify that I have read this application and :tate that the above information is c rest.
I agree to comply with all city and county ord Winces and state ws relating to, ilding
construction, a hereby authorize representative f this c' to enter upon t above-
61e.
ioned pro e r inspection purposes.
b
Signature (Applicant o gem ):
• r
Date: 12/4/2017
Application Number:
BPLB2017-0161
Owner:
PropettyAddress:
53845 AVENIDA VELASCO
MARCO CASTILLO
APN:
774164017
53845 AVENIDA VELASCO
Application Description:
CASTILLO / ABANDON SEPTIC & CONNECT TO SEWER
LA QUINTA, U. 92253
'Property Zoning:
Application Valuation:
$1,000.00
Applicant:
Contractor:
MARCO CASTILLO
OWNER BUILDER
53845 AVENIDA VELASCO
LA QUINTA, CA 92253
Llc. No.:
Detail: ABANDON SEPTIC TANK AND FILL WITH SLURRY OR SAND, HOOK UP TO CITY SEWER. PER 2016 CALIFORNIA ?LUMBING CODE.
ti
J
c
... D.ESCR I PTI O N
•
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
PERMIT ISSUANCE
101-0000-42404
0
$98.83
Total Paid for PERMIT ISSUANCE: $98.83
DESCRIPTION
ACCOUNT
QTY
AMOUNT
BUILDING SEWER
101-0000-42401
0
$26.01
DESCRIPTION
ACCOUNT
QTY.
AMOUNT
BUILDING SEWER PC
101-0000-42600
0
$18.20
Total Paid for PLUMBING FEES: $44.21
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
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00 .
TOTALS:04
C
Contractor Name: f
f
PERMIT- 14
New SFD Construction:
PLAN LOCATION
Conditioned Space SF
City, St, Zip
Project Address: 5 3°S y
'ro•ject Description: Pool, Remodel, Add't; Elect, Plumb, Mecli
APN #:
Email:
Fire Sprinklers SF
State Lic: City Bus Lic:
Applicant Name: nurco C t
Address: (`(�
City, ST, Zip: LjokL
Telephone: —760 e-0 .
Email: /�` 3 / yvR
(
Valuation of Project $ r—
Contractor Name: f
f
�
New SFD Construction:
Address:
Conditioned Space SF
City, St, Zip
Garage _ SF
Telephone:
Patio/Porch SF
Email:
Fire Sprinklers SF
State Lic: City Bus Lic:
-
Arch/Eng Name:
Construction Type: Occupancy:
Address:
Grading:
City, St, Zip.
Construction Type: Occupancy:
Telephone:
Bedrooms:
Stories:
# Units:
Email
State Lic: City Bus Lic:
Property Owner's Namc. -
, 'Ay Commercial /Tenant Improvements:
Address:
Total Building SF
City, ST, Zip
Construction Type: Occupancy:
Telephone:
Email:
78495 CALLE TAMPICO
LA QUINTA, CA 92253 .
760-777-7000
i
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 btiildin� emmit has been rriitted ' your a l�st� yours f as a ui�er of pr e
improvements specified at �j X•U V)Z3
We are providing you with an Owner -Builder Acknowledgment and Information Verification Form b 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.
]. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder"
bul ing permit that erroneously implies that the property owner is providing his or her own labor anc material personally. I, as
an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustainec 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 coverzge for injuries to workers
on y property.
2.' 1 understand building permits are not required to be signed by property owners unless they are responsible for the
F
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
0
self from potential financial risk by hiring a licensed Contractor and having the permit -filed in his cr her name instead of my
4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on
pe 'ts and contracts.
5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value
o my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer"
d r state and federal law.
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 cont-ibute to unemployment
compensation for each "employee." I also understand my failure to abide by these laws may subjec•: me to.serious financial
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 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
in �i
-or personal injuries sustained by any subsequent owner(s) that result from any latent :construction defects in the
workmanship or materials.
9-1
understand I may obtain more information regarding my obligations as an."employer" from the Internal Revenue
ervice, 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-
R180-21-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
egally , and financially responsible for proposed construction activity at the following address:
1. I agree that, as the party legally and financially responsible for this proposed construction activity, I wills abide by all
able laws and requirements that -govern Owner -Builders as.well as employers.
12. I_agree to notify the issuer of this form immediately of any additions, deletions, or change:, to any of the information I
'crave 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 ma} 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 _he status of their workers'
compensation insurance coverage.
Before a building permit can be issued, this form must be com
the agency responsible for issuing the permit. Note. A copy of
other verification acceptable to the age cy rs require to bej
owner's signature. ,r 4 /,
Signature of property
d signed by the property owner and returned to
rty owner's driver's lic--nse, form notarization, or
when the permit is issued to verify the property
Date: G _�
Note: The following Authorization Form is required to be completed by the property owne.- only when designating
an agent of the property owner to apply for a construction permit for the 01wner-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: Tel No
Address of Authorized Agent:
I declare under penalty of perjury that I am the property owner for the address listed above andI personally filled out the above
information and certify its accuracy. Note: A copy of theowner'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.
Property Owner's Signature: Date:
W4V YOF LA QUINTA SUB -CONTRACTOR LEST
JOBADDRESS6aa� --"� _ _ NUMBER -OWNER( BUILDER
This form shall be posted on the i01) with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their employees are authorized to work
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 buildinq permit. For each applicable trade, all information requested below must be completed by applicant.. "On File" is not an acceptable response.
.. _ - _ Mise
Cit E3us�riess Ltc
::Trido- /-Classt(tcatton
cn�aki ►.)nsurance' Y
:: Con,tractar Statc,Cbntractor s, License Workers CoriEi or
Company Name Classification License Number Exp. Date Carrier Name Policy Number Exp. Date License Number Exp. Date
(e.g. A, B, C 8} (xxxxxx) (xx/xx/xx) (e.g. State Fund, CalComp) (Format Varies) (xxlxx/xx) (xxxx) (xx/xx/xx)
:EnRThiWOF�K, {C_f1;2j::.<
FRLIMING (C-51`
STRUCT. STEEL (C=5-1}:..::
MASONRY (C-7.9)
PLUMBING bui L� —
1_ATH,.PLASTER:.(C=35) .".
VAC (C 20)' —_
::ELECTRICAL
ROOFING
Sh)EET'IVIETAI',(C 43)-<'
i�.LOORING (C-'( 51
;INSULATION iG 2) —
SEWAG E4 DISE' .(C42)
PAINTING (C-33).'. .:
-CERAMIC 54)
CABINETS
FENCING (C-13) — - —
LANDSCAPING _:(C-27).......
COACHELLA VALLEY WATER DISTRICT
r:� 1 P.O. BOX 1058, COACHELLA, CALIFORNIA 92236 (760) 398-2651
INVOICE Date: 12/4/2017
SUBJECT: SANTA CARMELITA, 53845 AVENIDA VELASCO, LA QUINTA, LOT 5, LID 6892.50, "SCC FEE ONLY"
MARCO CASTILLO
53845 AVENIDA VELASCO
LA QUINTA, CA 92253
Project:
Project Date:
Amount Due:
GEO: '
Planner:
TO INSURE PROPER CREDIT, PLEASE RETURN THIS PORTION WITH
REMITTANCE AND INCLUDE THE PROJECT ON YOUR CHECK
17-8484
12/1/2017
$4,851.00
06-06-12-4
SANDRA VILLALOBOS
SUBJECT: SANTA CARMELITA, 53845 AVENIDA VELASCO, LA QUINTA, LOT 5, LID 689250, "SCC FEE ON -Y"
COACHELLA VALLEY WATER DISTRICT
P.O. BOX 1058,'COACHELLA, CALIFORNIA 92236 (760) 398=2651
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1.00 FF
SCC -COLLECTION
$ 4-15.001
$2,415.00
1.00 FJ
SCC -TREATMENT
$2,436.001
$2,436.00
$4,851.00
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SUBJECT: SANTA CARMELITA, 53845 AVENIDA VELASCO, LA QUINTA, LOT 5, LID 689250, "SCC FEE ON -Y"
COACHELLA VALLEY WATER DISTRICT
P.O. BOX 1058,'COACHELLA, CALIFORNIA 92236 (760) 398=2651
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