BRES2020-000878-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Permit Type/Subtype:
Application Number:
Property Address:
APN:
Application Description:
Property Zoning:
Application Valuation:
Applicant:
GERRY REINGOLD
P 0 BOX 1998
LA QUINTA, CA 92253
Tity,, 4 eeP Q91&
DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
BUILDING RESIDENTIAL/REMODEL
BRES2020-0008
53220 EISENHOWER DR
Owner:
GERRY REINGOLD
P 0 BOX 1998
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
774061011 LA QUINTA, CA 92253
REINGOLD / DEMOLISH NON -BEARING WALL+ RELOCATE SWITCHES
$200.00
PDContractor:
OWNER -BUILDER
MAR 13 2020 0
Date: 3/13/2020
CITY OF LA QUINTA 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
alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
s ' is the applicant to a civil penalty of not more than five hundred dollars ($500).:
( 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 n mt nded or offered for sale. If, however, the building or improvement is sold
w}th gve year of completion, the owner builder will have the burden of proving that he
(�']i, did not build or improve for the purpose of sale.).
(^I I, as owner of the property, am exclusively contracting with licensed contractors to
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
Contractors' State License Law.). �
(_) I am exempt under Sec. . B.&P.C. 4 this reasian
Date:
Owner:
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 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; olicy Number: -
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 became 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:
WARNING: FAILURE TO SECURE WORKERS' COMPENS ION 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 tLityto t upon the 0above-
mentioned pro erty for inspection purposes.
Date: Signature (Applicant or Age
Date: 3/13/2020
Application Number:
Property Address:
APN:
Application Description
Property Zoning:
Application Valuation:
Applicant:
GERRY REINGOLD
P 0 BOX 1998
LA QUINTA, CA 92253
BRES2020-0008
53220 EISENHOWER DR
774061011
REINGOLD / DEMOLISH NON -BEARING WALL+ RELOCATE SWITCHES
$200.00
Owner:
GERRY REINGOLD
P 0 BOX 1998
LA QUINTA, CA 92253
Contractor:
OWNER -BUILDER
Llc. No.:
Detail: REINGOLD / INTERIOR REMODEL - REMOVE NON -BEARING WALL AND RELOCATE (2) LIGHT SWITCHES. THIS PERMIT DOES NOT INCLUDE
ALTERATIONS TO LOAD -BEARING OR LATERAL -RESISTING COMPONENTS NOR ALTERATIONS TO OTHER AREAS OF THE HOUSE. ROOF MEMBERS MUST BE
MADE VISIBLE TO VERIFY THAT DEMOLISHED WALL WAS NOT BEARING LOADS. 2019 CALIFORNIA BUILDING CODES.
- G E-M
PERMIT
PLAN LOCATION:
Project Address: O rs tr"
�+
im ct Description: Pool, Remodel, Add't, Elect, Plumb, Mech
APN #:
�/✓ Cr ST�J�'✓� C_Q�I%G��S
i a � � tom✓ ��C1lT/ old
Applicant Name:,���,✓G
Address: �_� ��p)�l/ r! 9bVF—
City, ST, Zip:
Telephone:
Email: C2-
of Projects [�
III
Name:
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
Telephone:
Bedrooms: Stories:
# Units:
Email:
State Lic: City Bus Lic:
Property Owner's Name:
New Commercial / Tenant Improvements:
Address: 2 (1 1-J0
Total Building SF
City, ST, Zip � �
r
l C�r � �
Construction Type: Occupancy:
Telephone:
Email:
TAMPICO
LA QU I NTA, CA 92253
760-777-7000
T4hf 4 4 a"
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 milted in our name listiny +rsyt£ as the builder of the property
improvements specified at
We are providing you with an (wlter-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
❑IUCTIONS: Read and initial each statement below to signify you understand or verb this information.
9 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. I, 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.
—4 12. i understand building permits 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.
Ai
nderstand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect
from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my
own.
041t-understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on
p 'ir
6its and contracts.
S. 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 "employer"
under state and federal law.
Y6. 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
sk
QI urnderstand under California Contractors' State License Law, an Owner Builder who builds single-family residential
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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 uuderstand 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
work nship or materials.
9, 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-
800-3�1-CIS B (2752) or www.cslb.ca.gov for more information about licensed contractors.
1 -I
am aware of and consent t an Owner -Builder building permit applied for in my name, and understand that I am the
party legally and cially es o ible for ed construction activity at the following address:
'r�4 ()f-
�i .-h agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all
a plic le laws and requirements that govern Owner -Builders as well as employers.
li'i agree to notify the issuer of this form immediate) of an additions deletions or changes to an of the information I
g Y Y Y � g Y
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 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 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. r�
Signature of property owner _ Date: L C)
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:
CITY OF LA QUINTA SUS -CONTRACTOR LIST
JOB ADDRESS PERMIT NUMBER OWNER l---. a BUILDER
This form shall be posted on the job with the Building -Inspection Card at all times in a cons icuous 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 building permit. For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response.
Trade/ Classification::.
Contractor
State Contracfor's License
Workers Compeq; agjon lnsuran..c.e
_..-..Oit.y Business License
Company Name
Classification
(e.g. A, B, C 8)
License Number
(xxxxxx)
Exp. Date
(xx/).x/xx)
Carrier Name
(e.g. State Fund, CalComp)
Policy Number
(Format Varies)
Exp. Date
(xx/xx/xx)
License Number
(xxxx)
Exp. Date
(xx/xx/xx)
EARTHWORK (C:. 1.2?
CONCRETE (C-8)
FRAMING (:C-5)
STR.UCT. STEEL (C-51)
MASONRY 1 C=29.)
PLUMPING (C-36)
LATH, PLASTER (C=35)
:DRYWALL (C=9).
.:HVAC (. -20):
ELECTRICAL
ROOFING 4G-39;)
SHEET :METAL (P:4,3)
FLOORING (:C.45).
GILAZI:N:G: (C717)
I.NS.UILATI.( .144C-2)
SEWAG- D)SP. (C-42)
PAINTING::(C-33)
CERAMIC TILE: (.G:=S.4)
CABINETS (C: 6);
FENCING (C_13)
LANDSCAPING {C=27:).
POOL, (C-53)
7 U m. to 5: :icy' P-11).
Nwie
Code holidays: None
A,'(--1Y I-st - Septctuber 3011, 1_ I 1-3j"LMy - Friday: 6:00 a.m. to
"', t u rd.-giy: 8:00ajn. to 5:j
Sunday: None
Goverimient Code llofld,-tys:
J'N SITE DURING,
MUST
AS L�JLNEU SSARY FAILURE TO DO
j i (%ITV T
`;W "AUSE THECIS' IOHAVE THE CONTAIN
DUMPED AT THE EXPENSE OF THE OWNE
CONTRACTOR."
A RE -INSPECTION FEE OF
WILL BE CHARGED IF THE AP
PLANS AND JOB CARD rit j ARE
THE SITE FOR A SCHEE
INSPECTION.
NO EXCEPTIONS!
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VeAeran's Day
Thanksgiving Day.
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