BELC2016-004678-495 CALLE TAMPICO
LA QUINTA, CA'L'IFORNIA 92253
Application Number: BELC2016-0046
Property Address: 53365 AVENIDA OBREG(
APN: 774074018
Application Description: RONALD CRAWFORD / E
Property Zoning:
Application Valuation: $800.00
Applicant:
RONALD CRAWFORD
P. 0 BOX 1377.
LA QUINTA, CA 92253
4 e VOICE (76 0) 777-7125
, � uuclw
FAX(760)777-7011
COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 5/20/2016
/L1\ Owner:
D LrU RONALD CRAWFORD
P O BOX 1377
t ICAL PAN�ELAUP Cq 2A�E� i0 LA QUINTA, CA 92253
Y1,,
CITY OF LA QUINTA
COMMUNITY _DEVELOPMENTOE_PARTMENT Contractor:.
RONALD CRAWFORD
P O BOX 1377
LA QUINTA; CA 92253
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that f 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.::CONV:140528101254121305
Dat4 a::asCont
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that l 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 subjects the applicant to a civil penalty of not more than five hundred dollars
($500).:
'compensation,
(1)17'as owner of the property, or my employees with wages as their sole
comp ne sation, 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 not intended or offered for sale. If, however, the building or improvement is sold
within one year of completion, the owner -builder will have the burden of proving that
he-o(`sfie did not build or improve for the purpose of sale.).
(U1, 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.).
{(IRD)Uam exempt under Sec. . B.&P.C. for this reason
Datte_ ±' I (ii OwT�er� NVYVMI�'!�N
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. Q.
Lender's
Lender's Address:
Llc. No.::CONV:140528101254121305
. WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declaration's:
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.
C* ) 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 so as to become 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, 1 shall forthwith
comply with those provisions.
Date:
Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION 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 this city to enter upon the
above-mentioned property for inspection purposes.
Date:,) (N' it Signature (Applicant or Agent).
hly
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Total Paid for BU,ILDING,:STANDARDS ADMINISTRATION BSA:.:':.,... $1500 $1.00
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PAID DATE
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5/20/16
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Total Paid for PERMIT ISSUANCE $91 85 $91.85
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0
Description:, RONALD CRAWFORD /;ELECTRICAL PANEL UP GRADE
Type: ELECTRICAL Subtype:
Status: APPROVED
Applied: 5/20/2016 RSE 4
Approved: 5/20/2016.III
Parcel No: 77407.4018 Site Address: 53365 AVENIDA OBREGON LA;QUINTA,CA 92253 '
Subdivision: SANTA CARMEL'ITA VALELA QUINTA_ Block: 186'
Lot:.6
Issued,:
UNIT'18
Lot Sq.,Ft: 0` . -.Building Sq. Ft: .0
Zoning:
Finaled:
Valuation:3800.00 Occupancy Type:
Construction Type:
Expired:
No. Buildings: 0 ll Stofies::0
No.>Uriites:.o
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Printed: Friday, May 20, 2016 10:28:34 AM 1 of 2'
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BSAS SB1473.FEE 101-0000-20306 0 $1.00 $1.00 5/20/16 Ill 1041 CHECK RONALD CRAWFORD R_SE
Total Paid for BUILDING STANDARDS ADMINISTRATION
BSA: $1.00 $1.00
Printed: Friday, May 20, 2016 10:28:34 AM 1 of 2'
SYSTEMS
. DESCRIPTION
ACCOUNT
CITY
AMOUNT,
PAID
PAID DATE
RECEIPT#
CHECK #
METHOD
PAID BY W
CLTD
•BY
SERVICES
101-0000-42403
0
$24.17
$24.17
5/20/16
R15674
1041
CHECK
RONALD CRAWFORD
RSE
SERVICES PC
101-0000-42600
0
$12.09
$12.09
5/20/16
R15674
1041
CHECK
RONALD CRAWFORD
RSE
Total Paid for ELECTRICAL: $36.26 $36.26
PERMIT ISSUANCE
1 101-0000-42404
0
$91.85.
$91.85
5/20/16
R15674
1041
CHECK
RONALD CRAWFORD
RSE
Total Paid for PERMIT ISSUANCE: $91.85 $91.85
TOTALS: ..$12913.31 $129.11
INC, PE(:T1C
PARENT PROJECTS.
BOND INFORMATION
ATTACHMENTS
Printed: Friday, May 20, 2016 10:28:34 AM 2 of 2
SYS TFAAS
Bin #
Gty' -of La- Quill A
Building 8L Safety Division
78-495 Calle Tampico_
La Quinta, CA 92253 -,.(760) 777-7012
9 ..Building Permit Application and.-Tracking Sheet
Permit #
&LC, 90.[a00-4
Project-Address: �S ng ��
(Owner's Name: 7 O ' A,/,,b •
A. P. Number:
Address: 5�3�� .'Ajl( C 0tj
Legal Description:
Ci ST, Zi
Co tract or: ACJ
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P V Y
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Address:
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�Pro•I ctDescri—tion: — p
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City,,,ST,.Zip: LA �ly.✓� r6A . Zt,S3
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State Lic. # :
City Lic. #•:
Arch., Engr., Designer:
Address: 3 31nj F �A `6"5"6,0/`J
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'.Con truetion Type: Occupancy:
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State Lic. #
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.,ProJ ty Pe (circle one):: New Add'n Alter Repair r Dem
Name of Contact Person:
Sq. Ft.:
# Stories:.
# Units:
Telephone # of Contact Person:'�Estimated�Value
of Project: U U
APPLICANT: DO NOTsWRlWl3ELQW THIS KINE
Submittal
Req'd
Recd
TRACKING
PER EES
NlpSets
Plan Check submitted
Item
Amount
Structural
Reviewed,.rcady for corrections
an Check:Deposit
Truss Calcs..
Called Contact Person
Plan Check Balance. .
Title 24 Cales.
Plans picked up
.Construction '
Flood' plain plan
resubmitted
Mechanical
Grading plan
J�ans
.RevieN ady Corrections/issue .
Electrical
Subcontactor List
Called'C actPcrso
Plumbing
Grant Deed
lis picked. up
S.M.I.
H.O.A.'Approval
Plans resubmitted
Grading
IN ROUSE:-
Review, ready for correetionstissue
loper Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. App
Date of permit issue
School P s,
i
Total Permit Fees
E'
P.O. Box 1504
LA QUINTA, CALIFORNIA 92247-1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
PROPERTY.
BUILDING & SAFETY DEPARTMENT
(760)777-7012
FAX (760) 777-7011
"S PACKAGE
Disclosures &Forms for Owner-Builders.Applying for -Construction Permits j
IMPORTANT! NOTICE TO PROPERTY OWNER
Dear Property Owner:
An application for a building permit has been subrnitted-in your name listing:y_ourself_as._the_builder of the property
improvements specified at �v3k P,.O I LIJt:/ t t.� 4_v.�
We are providing you vntli an Owner-B'uil`der Acknowl ent and Infomiation Veri rfcatio F rm to make you aware of your,
responsibilities and possible risk you rimy incur by having this pemut,issued in your name as.the
Owner -Builder. We will not issue a building;permit until you have ryead, initialed your=understanding of each provision,
signed, and returned this form to u's at our official address indieated..An agent of the owner cannot.executetlis notice
unless you, the property owner,, obtain the .prior approval_ of the pernutting authority.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
DIRECTIONS: Read and initial each, statement belo.w.to sign fJ you understand or verify, this information.
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 in may not provide coverage for. those
injuries. I arr willfully acting as an Owner=Builder and am aware of the limits of my insurance coverage for injuries to workers
on my property.
(F 12. ' I understand building permits .are not required to be signed 6y property owners unless they are responsible for the
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 .
`myself from potential frnancial.risk by hiring a licensed Contractor andhaving the pernrit filed. in his or her.name instead of my .
own.
�4. I understand Contractors are required by law to be licensed and.bonded in California and to list their license numbers on
<perruts and contracts.
5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, -and the total value
<6f -my' construction is at least five hundred dollars ($500), including labor and materials,. I may be .considered an "employer"
under state and federal law.
�il� 6.1 understand if I am.considered an "employer" under state and federal law, I must register with the state and federal
�ernment, 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 fo.serious financial
risk.
U_.7. I understand under California Contractors' State.License Law, an Owner -Builder who builds single-family residential
�str ctures cannot legally build them with the intent to offer them for sale; ,unless 011'work is performed by licensed
subcontractors and the number of structures does not,exceed four within any calendar year, or .all'of the work isperformed
under contract with a licensed general building Contractor.
'ir
f1 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
financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the
workmanship or materials.
<, N 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-
800-321-CSLB (2752) or www.csib.ca.gov for more information about licensed contractors.
1� 10. 1 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:
F N 11. 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.
12. 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 Contractots 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.
Signature of property owner
Date:
Note: The following Authorization Form is required to be completed by the property owner only when designating
anl agent of the property owner to apply for a construction permit for the Owner -Builder. 11'\ .
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
xcluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby
the following person(s) to act as my agent(s) to apply for, sign; and file_ the documents necessary to obtain an Owner -
Permit for my project.
Scope of Construction Project (or Description of Work): f Lf�TtTl_r 6�ZL aL�
Project Location or Address: 41�(j Aywl"A llkL otj
Name of Authorized Agent: fat -!l —a_a d Tel No _ h -) ?0 P -6e9 2�
T
Address of Authorized Agent:
I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the
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.
,opje Owner's Signature: Date:. M11w ZO
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