BPLB2019-013878-495 CALLE TAMPICO T4h/ D VOICE (760) 777-7125
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011
DESIGN & DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Permit Type/Subtype: PLUMBING/ Owner:
Application Number: BPLB2019-0138 Marks Rizya Carla J
Property Address: 78635 SAGUARO DR 78635 SAGUARO
APN: 646313013 LA QUINTA, CA 92253
Application Description: RIZYA / SEPTIC ABANDON SEWER HOOK UP
Property Zoning:
Application Valuation: $7,000.00
Applicant: Contractor:
JOHN Rizya P
OWNER BUILDER
78635 SAGUARO
LA QUINTA, CA 92253 OCT 16 2019
CITY OF IAQUINTA Llc. No.. -
DESIGN & 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:
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
Ileged exemptlaI" Any violation of 5eclion 7D31.5 by any applicant fora permit
bj is the applicant to a civil penalty of not more than five hundred dollars
I, as owner of the property, or my employees with wages as their sole
o pensation, will do the work, and the structure is not intended or offered for sale.
[ .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
thin one year of completion, the owner -builder will have the burden of proving that he
t
he dtd not build or improve for the purpose o€ sale.).
) I, as owner of the property, am exclusively contracting with licensed contractors to
truct the project. [Sec. 7044,Businessand ProfesionsCade: The Contractors' State
rase Law does not apply to an owner of property why builds or improves thereon,
F
ho contracts for the projects with a contractor(s) licensed pursuant to the
ctzState License Law.).
am exempt under Sec. , B.&P,Cdvr this reason
Date: 10'/ rT 1 ?I Owner:
CONSTRUCTIONNDING AGENCY
I hereby affirm under penalty of perjury th4phere is a construction lending agency for
the performance of the work for which thispermit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
Date: 10/16/2019
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
issu d. My workers' compensation Insurance carrier and policy number are:
Car r: Po{icy Number:_
I certify that in the performance of the work for which this permit is issued, I
sha at employ any person in any manner so as to become subject to the workers'
corn ensation laws of California, and agree thpt, If I should become subject to the
workers' compensation provisions of Sectia 700 of the Labor Code, I shall forthwith
comply with those provisions.
Date) OJ 1s ) Applicant
WARNING: FAILURE TO SECURE WORKERS'fPMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO C809NAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100, 00). 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 ofthis 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 I�ws relating to building
construction, and hereby authorize representatives of this r. yl�r, enter upon the above -
mentioned property for inspection purposes. � f
Date: 16 —) �° Signature (Applicant or Agent)
Date: 10/16/2019
Application Number:
Property Address:
APN:
Application Description
Property Zoning:
Application Valuation:
Applicant:
JOHN Rizya
78635 SAGUARO
LA QUINTA, CA 92253
BPLB2019-0138
78635 SAGUARO DR
646313013
RIZYA / SEPTIC ABANDON SEWER HOOK UP
$7,000.00
Owner:
Marks Rizya Carla J
78635 SAGUARO
LA QUINTA, CA 92253
Contractor:
OWNER BUILDER
Llc. No.:
Detail: PLUMBING - ABANDON SEPTIC AND CONNECT TO SEWER SYSTEM. INSTALL BACKFLOW PROTECTION VALVE IF NEEDED UPON INSPECTION. PER
2016 CALIFORNIA BUILDING CODES.
DESCRIPTION ACCOUNT CITY AMOUNT
BSAS SB1473 FEE 101-0000-20306 0 $1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
PERMIT ISSUANCE
101-0000-42404
0
$101.97
Total Paid for PERMIT ISSUANCE: $101.97
DESCRIPTION
ACCOUNT
CITY
AMOUNT
BUILDING SEWER
101-0000-42401
0
$26.83
DESCRIPTION
ACCOUNT
CITY
AMOUNT
BUILDING SEWER PC
101-0000-42600
0
$18.78
Total Paid for PLUMBING 2019: $45.61
DESCRIPTION
ACCOUNT
CITY
AMOUNT
RECORDS MANAGEMENT FEE
101-0000-42416
0
$10.00
Total Paid for RECORDS MANAGEMENT FEE: $10.00
DESCRIPTION
ACCOUNT
CITY AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0 $5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
Project Address:
APN #:
Applicant Name: ze4j.,ri;, -�"0
Address:
City, ST, Zip:
Telephone:
Email:
Arch/Eng Name:
Address,
City, St, Zip
Telephone:
Email:
State Lie:
City Bus Lie:
Property Owner's Name: ��WW
Address:
City, ST, Zip
Telephone:
Email:
PERMIT # .410M 2.0t Sr 013 8
PLAN LOCATION:
Project Description: Pool, Remodel, Add't, Elect, Plumb, Mech
11�
00 v\*0 .stAi"��
Valuation of Project $ % 000 , Q-0
Construction Type:
Grading:
Bedrooms: I Stories:
Occupancy:
# Units:
New Commercial / Tenant Improvements:
Total Building SF
Construction Type: Occupancy:
78495 CALLE TAMPICO
LA QUINTA, CA 92253
760-777-7000
comdev
From: John Rizya <
Sent: Wednesday, October 16, 2019 11:35 AM
To: comdev
Subject: Fwd: Payment Confirmation
EXTERNAL: This message originated outside of the City of La Quinta. Please use proper judgement and caution when opening
attachments, clicking links or responding to requests for information.
---------- Forwarded message ---------
From: <bill a Qaymentus.com>
Date: Wed, Oct 16, 2019, 11:06 AM
Subject: Payment Confirmation
To: <
JOHN RIZYA,
We are pleased to confirm your payment with Coachella Valley Water District. Below is the
summary of your payment transaction. Your payment has been received and will be posted to your
account. Thank you for your continued relationship with Coachella Valley Water District.
Confirmation Number: 604558166
Payment Date: Oct 16, 2019, 11:06:12 AM
Payment Amount: $4,851.00
Total Amount Charged: $4,851.00
Contact Information
First Name: JOHN
Last Name: RIZYA
ZIP code: 92203
Daytime Phone Number: (760)
Address: homemedics40@gmail.
Information
Payment Type: Planning and Engineering
Account Number: PZ19-10461
Payment Method: Credit Card
Payment Method
Information
Card Type: Visa
Card Number: ************2026
Card Holder Name: JOHN RIZYA
1
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
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.
'S ACKNOWLEDGMENT AND VERIFICATION OF I
Read and initial each statement below to signify you understand or verb this information.
1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder"
ding permit that erroneously implies that the property owner is providing his or her awn labor and material personally. I, as
an wncr-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
my property.
2. I understand building permits are not required to be signed by property owners unless they are responsible for the
ruction 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
ff from potential financial risk by hiring a licensed Contractor and having the permit filed in his or 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
its and contracts.
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"
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
vernment, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment
c 6pensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial
s.
. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential
s ctures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed
su contractors 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 may be held liable for any
cial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the
rnanshiu or materials.
9. I understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue
ice, the United States Small Business Administration, the California Department of Benefit Payments, and the California
Aon of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-
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
legally and financially responsible for proposed construction activity at the following address:
11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all
cable 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 changes to any of the information I
h provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with
so ,one 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 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 issuin lie permit. Note: A copy of the property owner's driver's license, form notarization, or
other verification acceptable to t r agency is required to be presented when the permit is issued to verify the property
owner's signature.
Signature of property owner n '-1
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 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 No
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 owner's signature.
Property Owner's Signature: Date: