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11-0196 (ELEC)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 11-00000196 Property Address: 524-01-4AVENIDA OBREGON APN: 773 -254.7025 -8' -000000 - Application description: ELECTRICAL Property, Zoning: COVE . RESIDENTIAL Application valuation: 600 Applicant: - Architect or Engineer. BUILDING & SAFETY DEPARTMENT BUILDING° PERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Owner: ROMERO•.REYNOLD 524.01 AVENIDA OBREGON LA QUINTA, CA 92253 --------------------------------- Contractor: Owner ,Date: 2/24/11 U�. L� ti .. ZU I I ;. 91 �y OF-LA:sL'iR.�TA \� ------------ rr LICENSED CONTRACTOR'S DECLARATION - WORKERIS-COMPENSATION DECLARATION - hereby affirm under penalty of perjury that.[ am licensed under provisions of•Chapter 9 (commencing with I hereby affirm under penalty, of perjury one of the following declarations: Section 7000);of Division 3 of the Business and Professionals Code, and my.License'is in full force and effect._ I have and will maintain,.[ certificate of consenr.to self -insure fpr.workers' compensation, as provided License Class: License No.: for by Section 3700 of the.Labor Code; for the peiformanc-e of ihe,work'for which this permit is - .y .. issued.' Date: - . , ` Contractor: - '.I•have and,will maintain workers' compensation insurance,.as required by Section 3700 oftheLabor Cfor the,performarioe;of thework for which this permit is issued., -My workers' compensation OWNER•BUILDER•DECLARATION`insurance carrier and policy number are: (.hereby affirm. under penalty of perjury that I am exempt from the Contractor's. State License law for the Carrier - Policy Number. - following reason (Sec.; 7031.5, Business and Professions Coder Any -city -or county -that requires a permit to I certify that; -.in the performance of the work forWhich'this permit is issued, I shall not employ any „ construct, alter, improve, demolish, or repair any structure; prior to its issuance, -also requires the applicant for the person in any manner so as to become subject 3o the -workers' compensation laws of California, • permit to file a signed'statem'ent that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if I should become•subject to the workers' compensation provisions of Section License Law -(Chapter (commencing with Section'7000) of Division 3 of the Business and Professions Code)or 3700 of the Labo , I shat w' m ly with ttioe.provisions. that he or she is exempt therefrom and the basis for the alleged exempnon.;•Any,violation of Section 7031.5 by .any applicant for a permit subjects the applicant to a, civil penalty of not more than.h� — ve hundred, dollars -(55001.: Date: . pplicant. (� I, as.owner of the property' or my employees with wages as their, sole compensation, will do the work, and t the structure,is not intended,or'offeied for sale (Sec.,7044, Business and Professions Code:- The WARNING: • FAILURE TO SECURE. N1 RK ':COMP SA ION OVERAGE'IS UNLAWFUL, AND SHALL • Contractors'_State License Law does not'apply toen owner of property who builds orimproves thereon, SUBJECT AN•EMPLOYER TO CRIMINAL tEl ALTIES AND CIVIL 'FFINES IUP TO ONE HUNDRED THOUSAND and who does the woik..himself orherself through his;or her own employees,, provided that the .DOLLARS ($100,0001 IN. ADDITION.TO T E COST, OF C OMPEN SATION,:DAM AGES AS'PROVIDED FOR IN improvements.aie`not intended oir offered for sale. rlf, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST;,AND ATTORNEY'S'FEES. ' :one year completion, the owner -builder will have the burden of proving that he or she did not build or.. s - -'tmprove for the purpose APPUCANT,ACKNOWI EDGEMENT (_ I I, as owner of the.property;•am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT 'Application is hereby made to the Director. of Building and Safety for a permit subject to the 7044, Business:and•Professions Code:_ The Contractors- State License Law does not apply to an owner of conditions and restrictions set forth on this application. property who builds-orimproves thereon, and who contracts for the projects with a contractor(s) licensed 1. Each person upon whose behalf this application is made, each person at whose request and for pursuant to the Contractors' State License Law.). - whose benefit work is performed under or pursuant to any permit issued as'asesult of this application, (_ 1 I am exempt under Seca P.C. for thi a 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. Date:- wner: 2. Any permit issued as a result of this application becomes null and void if work is not commenced COfJSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there ig a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name: Q' Lender's Address: !' LQPERMIT 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 1 have read this application and state that the above information is correct. I agree tocomplywith all city and county ordinances and state laws relating to building construction, an e authorize representatives of this county to enterI upon t e above-mentioned prrt for inspe t' a ose . Dat (9i ature (Applicant or Agen0' 1 t. Application Number. . . . . 11-00000196 LQPERMIT _ _ Permit . . . ELEC-SERVICE CHANGE Additional desc . ..Permit -Fee 33.50 Plan Check Fee .00 Issue Date Valuation' 0 Expiration Date_. 8/23/11 Qty, Unit Charge Per Extension BASE FEE 15.00 - 1.00 18.5000 EA ELEC, -SVC '<=600V/<=200A 18.50. -7 ----- - - - - -- - Special Notes and -Comments ,... INSTALL''NEW" 12'5 'AMP' `PANEL' & NEW « BREAKERS:. 2 0'1'0, CODES . - -_-- -- - --------- - - -- - - -------.-.----7-7 -- ----------------- Other -Fees BLDG TDS'- ADMIN, (SB1473) ----------- 1.00• Fee 'summary," :_ -Charged Paid- Credited Due Permit Fee; Total 33:50 00 0:0: 33.50 - .Plan :Check:. Total :`-00 0.0 0;0 x Other. Fee ;Total` 1:: 0.0' ' 00. 00 _ 1:00 : !t Grand-• Total 34.•5;0 .00. 00.. 34.50: • LQPERMIT _ _ o r z P , 0. Blox-4504 I 11A QUiNTA1 CALIFORNIA 92247=1504 BUILDiNG & SAFETY DEPARTMENT 78-495. CALLS TAmpico (760) 777-7012 LA QUINTA, CALIFORNIA FAX (760) 777-7011 PROPERTY OWNER' S PACKAGE Disclosure's & Forms for *0w n*er-'' BuiUd*rs Applying -for, -Construction Permits f�RTAN NOTICE TO PROPERTY OWNER Dear Property Owner An. application for a bu" emit has improvements specified at We are providingw you with an Own6r- 6- 11 A�knw16' gin You may inc responsibilities and possible risk* b - hiving y ,tlri "a' Owner -Builder. WeWffinot�issuja,li incur cuitill. =signed, and returned this form to � us at our officiall"i4di s you, the 'property.owner; obtain -theprior approval ';of i Read in "your name* Alisfi_7ellf as the builder of the property Form to make you aware of your permit . t . ssued tiyour as the o ""'4'reaa. in� r ul. 1 read, . _you. understanding ef'eaifi provision, mi; indicited. An agent 4 the owner cannot execute this -notice permitting erm!tting au"rity. information. 1 understand a frequent practice of unlicensed ,persons. is to have the property owner.:obtain an "Owner -Builder" building permit that erroneously implies*d6fthe property owner , is (providing: providi.n I &his . or.her her own labor and material personally. I.. as an Owner -Builder, may be held liable and subject to'sen.ous. financial'risk for. any. injuries sustained by an unlicensed person and his or her employees while working on. my property:y insurance may not provide coverage for those M' homeowner's in d iriJunies. I am willfully acting as an Owner -Builder and am*' aware Of the limits of I 'insurance -coverage for injuries to workers on my property. MY 2. I understand building permits are not requ 7 ired to be signed 'by .property owners unless they are responsible for the cYnstruction,and dare a licensed Contractor to assume" responsibility, undprstand as an"Owner-Bui,ldee, I am the responsible. -part . y of record on the permit. I understand that I may protect myself ErOftir!)Otential financial risk by hiring a licensed Contractor.a'nd having the permit filed in his or her name instead of my own. S—DiL understand Contractors are required by law to be licensed and bonded in California, and to list their- license numbers on permits and contracts.. N�%understand if 1,employ or otherwise engage.any persons, other than California licensed Contractors, and the total value ot'my construction is at least five hundred dollars including labor and materials; I may be considered an "employee' under .gate and f6deral law. understand if I am considered an employee' under; state and :federal law, I must register with the state and federal government., withhold payroll -taxes,provide workers, :compensation diiabitity, 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 understand under California Contractors' State License Law, an . Owner -Builder who builds single-family residential structures .cannot legally build them with Ahe.'.inteqt,to offer them for -sale, unles's all work is performed by licensed subcontractors and th16 number, of structures does mofexceed 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. injudes sustainedby any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. 9. I understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue Sern 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. �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 proposed construction activity at the following address: l L [ agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all pplicable laws and requirements that govern Owner -Builders as well as employers. t=' 1 !.agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information 1 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 covet 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 is �e.perudt. Note: A c of the property owner's Quiver's ; farmtariatton; or other verification ac , table ager is eQ to be presented when the permit is issued to rarefy the P+oPe►ti' owner's signature. L 2_Z %—Zo(1 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 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 petson(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: Bin # City of la Quinta ,a .Building Bt Safety Divlslon P.O 'Box 150,.4, 78 Ta {495 Calle mpico La Quinta, CA 92253 ;'(760) 777-7012 Building Permit Application wd Tracking Sheet , _ Permit # "Pr'oje`ct Ad'dress:2— .' 0,81 A. P. Number: wners Name:, . /l10 a v •:A'd"dress: Legal Description: `C��ST, Zip: -/C/- UNC, C ZC-ontractor� Telephone . ;7�0_0 ZSZ . sx? <::>:::::>::;•A:«.:}};:;•;;:.}}:>:>s .<.:> �.�.:..•,,,,:•.•} ••><:,;: Address: <Project -Description:: • ,/3 �(J City, ST, Zip: .: %� • � /� %%� ��2 Telephone: Ns<><:;yu;::•,.:}�.:»:::>:::>}-ss>�>:;;:::::>:::.: /,/� gil . Q State Lic. # : City Lic #; / I /Z Arch., Engr., Designer: . 3 -/V ✓ L� Address: City, ST, Zip: . Telephone: p }}:pi:};ry}}:ki.'iviti��.. `�;'}ijii} :j:'i:•'.{;}i::i: :';';<{?:::s<;:: {#.:.:•;'r .::::}>:r 4 hYy}:U.;:j•};r kY}:k::i>;iiiii,:4�iti':: >�:>s; f:::�:<::>::�:,;>•��`?>;?'>w: „.:.}:::::::::.: <•f.:::.:::::.:}.;>.: . Construction Type: Occuan p cY State SCS Lic. #: Project type (circle one): New Add'n Alter Repair Demo Name of Contact.Person: Sq: Ft.: #Stories: #Units: Telephone # of Contact Person: Estimated -Value of Project: �( U. CANT: NOT WRITE BELOW THIS LINE # Submittal Req'd -Reed TRACICIIVG PERMIT FEES Plan Sets Plao Check submitted Item Amount Structural Cales., Reviewed; ready,for'corrections Plan Check.Deposit , ' Truss Calcs. Jr .. Called Contact Person . . Plan Check Balance Title 24 Calcs. Plans picked up Construction Flood plain plea Plans resubmitted Mechanical Grading plan 2” Review, ready, for corrections issue Electrical Subcontactor List Called ,Contact Person '.Plumbing Grant Deed Pians picked up H.O:A. Approval Plans resubmitted .Grading INHOUSE: -Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A:I.P.P. Pub. Wks. Appr Date ofpermit issue School Fees Ll Permit Fees