BPLB2014-103051 /�
5 Ij
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA
Application Number:
Property Address:
APN: '
Application Description
Property Zoning:
Application Valuation:
Applicant:
GIL GAUTHIER
54018 RIVIERA
LA QUINTA, CA 92253
B
54018 RIVIERA
3O�i
D VOICE (760) 777-7125
FAX (760) 777-7011
COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
D n Date: 10/28/2014
Owner:
I I GILGAUTHIER
Q� T U 54018 RIVIERA
INSTALL NEW GAS LINE FOR OUTD00 HE TER .2014 LA QUINTA, CA 92253
COMMUNITY CITY OF LA WIN FT 1
N DEVELO.'McN7 D�anRTMENT
Contractor:
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 subjects the applicant to a civil penalty of not more than five hundred dollars
($500).:
(_) I, 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 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 or she did not build or improve for the purpose of sale.).
(__j 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 I I am exempt under Sec. . B.&P.C. for this reason
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 Na
Lender's
LIC. No.:
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: _ 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, I 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 r upon t1 above•
mentioned property for inspection purposes.
Date'^- �'' Signature (Applicant or Agent):
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 be submitted in your name sting y urself a the builder of the 'property
improvements specified at S 4O I S j �/ l E'1'Zl LAI r, to
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.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
DAV CTIONS: Read and initial each statement below to signify 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 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
ER
y property.
. I understand buildingermits are not required to be signed b r
P q gn y p operty owners unless they are responsible for the
construction and are not hiring a licensed Contractor to assume this responsibility.
Jk3. 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 financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my
0
I understand Contractors are required b law to be licensed and bonded in California n
q Y C o a a d to list their license numbers on
penis and contracts.
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"
t6s
te and federal law.
understand ifI am considered an "employer" under state and federal.law, I must register with the state and federal
ent, 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
97. 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.
8. I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable four` any
financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the
workmanship -or materials.
1-9. 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.cslb.ca.gov for more information about licensed contractors.
10. 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 ftnaNially responsible for proposed construction activity at the following address:
tgl 711. I agree that, as the party legally and financially responsible -for this proposed construction activity, I will abide by all
ap licable 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 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.
Signature of property owner Date: �•} 21, 2'p f
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.
Sq o (8
CITY OF LA QUINTA SUB -CONTRACT R LIST '
' JOB ADDRESS7�11 � PERMIT NUMBER gPL o _ j� � � •' _ y
~ , 2 It -OWNER i _ �f1�21i BU O
This form shall be posted on the job with the Building Inspection Card at all times in a conspicuous place.' Onl ersons a ..ILDER r�"� �C(� �eF
on this fob. Any changes to this list must be -approved by the Building Division prior to commencement of work pFaij„ro + p---- g -...:11 s listror_thei� employees_a're authorized to work
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•,,. uj mg perm] . or eachapplicab a trade, all information requested below must be completed by applicant. "On File" ' '.'
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CLEARANCE TO COMBUSTIBLES
(EXHAUST END)
Top
OUTDOOR 6"
APPLICATIONS
ONLY
Down
HORIZONTAL
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Standard Reflector
Installation Type 1
TILT
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(inches) 254 to 45° Tilt
Input A B C D
40
4
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34
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8
17
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DIMENSIONS
40
MODEL
LENGTH
PH40
137
PH60
107•
PH76
26r
PH40 Ho
84'
PH76 HO
124'
WIDTH OF ALL UNITS
16'
Installation Type 2
Input A B C D
40
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28
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28
75
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)n. In this instance two units are used to provide a comfortable heating
:d to achieve any length or configuration required.
fered to all customers to ensure proper layout 6 performance.
oduced or copied in any form or by any means - graphic, electronic, or mechanical, including pho-
val systems - without written consent from CALCANA INDUSTRIES LTD. The information herein is
it any time without notice. 2010 - CALCANA INDUSTRIES LTD.
PRINTED IN CANADA BY TOPLINE PRINTING
Distributed by:
FINANCIAL INFORMATION
"DESCRIPTION ONt
, AUNT!
M 6"" PAID PAID DATE
,UNT
.,
PERMIT ISSUANCE
101-0000-42404 0
$91.85
$91.85 10/28/14
PAI6BY.
METHOD D, RECEIP_T
CHECK #, CLTD BY -
%
GIL GAUTHIER
CASH R2507
MFA
Total Paid for PERMIT ISSUANCE: $91.85
$91.85
DESCRIPTION
,A�CCIUNT,
dii,
AMOUNT"
TAID�DATE-
GAS SYSTEM, 1-4 OUTLETS
101-0000-42401
0
$12.09
$12.09
10/28/14
PAID BY
�Z ipi i
At -1 �,,
CLTD BY,
GIL GAUTHIER
CASH
R2507
MFA
-4o: DESCRIPTION
:AMOUNT,
PAID
'PAID DATE:
. �, _ _ __ -i . I . ,
—
, , .- '.
4,;
- 1 -1 1. � I 4,
GAS SYSTEM, 1-4 OUTLETS PC
101-0000-42600
0
$24.17
$24.17
-10/28/14
'PAID By
`METHOD;W
R E C E I PT, #;I�,_
4'41-,t;:�CLTDBY`
.::;:, 44
GIL GAUTHIER
CASH
R2507
MFA
Total Paid for PLUMBING FEES: $36.26
$36.26
TOTALS: $128.11
$128.11
Description: INSTALL NEW GAS LINE FOR OUTDOOR HEATER
FINANCIAL
Type: PLUMBING
Subtype:
Status: SUBMITTED
Applied: 10/28/2014 MFA
Approved:
Parcel No: Site Address: 54018 RIVIERA LA QUINTA,CA 92253
Subdivision:
Block:
Lot:
Issued:
Lot Sq Ft: 0
_ Building Sq Ft: 0
Zoning- rt
Finaled:
Valuation: $0.00
Occupancy Type:
Construction Type:
Expired:
No. Buildings: 0
No. Stories: 0
No. Unites: 0
Details: INSTALL 30 FT LONG NATURAL GAS LINE FOR HEATER ON PATIO CEILING. PER 2013 CALIFORNIA BUILDING CODES.
i
Printed: Tuesday, October 28, 2014 3:00:22 PM 1 of 2 C
SYSTEMS
FINANCIAL
INFORMATION
CLTD;
RIPTION ACCOUNT
;AMOUN
PAD
PAID.DATERECEIPT
}
#
CHECK#METHO
PAID BY h
r'G.. rof: i...
T. ei �F.:
'f i% t'o.
.:.sft.$`.-'e2=
a ' °* - ws,. ..
m:tai
BY
PERMIT ISSUANCE
101-0000-42404 0
$91.85
$91.85
10/28/14
R2507
CASH
GIL GAUTHIER
MFA
Total Paid for PERMIT ISSUANCE:
$91.85
$91.85
GAS SYSTEM, 1-4
101-0000-424010
$12.09
$12.09
10/28/14
R2507
CASH
GIL GAUTHIER
MFA
OUTLETS
Printed: Tuesday, October 28, 2014 3:00:22 PM 1 of 2 C
SYSTEMS
;DESCRIPTION -4.
UOU
QTYi,"
. . . . . . ....
M NT
A ou
i,��—PAID.�,
"1771 7
'-,PAID DATE'
4RECEIPT#
�.CHECK #'
'METHOD
'--k -iPAID BY -
CLT.D
GAS SYSTEM, 1-4
101-0000-42600
0
$24.17
$24.17
10/28/14
R2507
CASH
GIL GAUTHIER
MFA
OUTLETS PC
Total Paid for PLUMBING FEES: $36.26 $36.26
TOTALS: $128.11 $128.11
Printed: Tuesday, October 28, 2014 3:00:22 PM
2 of 2
OrwsYSTEMS
BIn.1i`
City Of • La Quihta
BLAUng et Safety AivisPon
P.O. Box 1504,78-495 Calle Tampico
14.Quinta, CA 92253 -:(760) 7777012
Building Permit' Application and Tracking Sheet
Permit #
Project Address: �j j$ 11l 1 e Y A
Owner's Name:. I
A. P. Number.
Address:5l �-0 � � I e
Legal Description:
City, ST, Zip: Q OW,
" CA 92253-
2253-
Contractor
Contractor: A 4 va cad s s4 in Co rl) Q n
Telephone: -
Address:S. 4e ,t
Pmject Description:
City, ST, Zip: : q m IDes ev+ CA R 22 ((
-Z1'$
lo Top Ca lea n
Telephone: Ao — 779 — 1352
State Lic. # : City Lie. li
ACL+ ra I - o h - pQ41 o
C e C List . _ M o cp Q; ( P A - 4.O
Arch, Bngr., Designer.
Address:
City., ST, Zip:
Telephone:
State Lic. #: r • '
Name of Contact Person: To h Q-�.�e 1' d Q h I
Construction Type:. Occupancy:
Project type (circle one): New Add'a Alter Repan Demo
-sq.* FL: # Stories: # Univ:
Telephone # of Contact Pelson:
Estimated Value of Project: -000
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Ree'd
TRACKING
PERMfFFEES-
Plan Sets
Plan Check submitted
Item Amount
Structural Calls.
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Cates.
Called Contact Person
Plan Check Balance
'Nile 24 Cales.
Plans picked up
Construction
Flood plain plan
Plans resubmitted- .
Mechankal
Grading plan
Zad Review, ready for corrections/issue
Electrical
Subcontaetor List
Carted Contact Person
Plumbing
Grant Deed
Plans picked up
SALL
H.O.A. Approval
Plans resubmitted
Grading
IR HOUSE--
7n° Review; ready for eorrectlons!issue
Developer Impact Fee
Planning Approval-
Called Contact Person
Ad-P.P.
Pub. WIm. Appr '
Date of permit issue
School Fees
Total Permit Fees