14-0755 (ELEC)IIIIIII VIII III VIII (III 79
4
P.O. BOX 1504 - - l�
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number:
14-00000755
Property Address:
80420 AVENUE 52
APN:
772-270-008- -
Application description:
ELECTRICAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
500
Applicant: Architect or Engineer:
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 Professionals Code, and my License is in full force and effect.
License Class: License No.:
bate 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).:
(_ 1 1, 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.l.
(_) 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.).
1 1 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 Name:
Lender's Address:
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/03/14
Owner:
PRICES NURSERY & GARDEN SUPPLY
80420 AVENUE 52
LA QUINTA, CA 92253
(760)077-7325
Contractor: D d
Owner
JUN N 2014
C'Ty OF i AtF.,
WORKER'S COMPENSATION DECLARATION
1 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'
1 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 Labck ode, I shRrt�g
ply with Mose 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 Director of Building and Safety 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 as 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 construcWionandshereby authorize representatives
of this c unt to enter upon the above-mentioned pr a for insp� tis.
� -
,Date'
Signature (Applicant or Agent):
Application Number . . . . . 14-00000755
Permit . . . ELECTRICAL
2013
Additional desc .
Permit Fee . . . . 23.83
Plan Check Fee
.00
Issue Date
Valuation
0
Expiration Date 11/30/14
Qty Unit Charge Per
Extension
1.00 23.8300 EA ELEC
SERVICES
23.83
----------------------------------------------------------------------------
Special Notes and Comments
ELECTRICAL - REPLACE 3 PHASE SERVICE
METER CLIPS AND SERVICE WIRES.
2013
CALIFORNIA BUILDING CODES.
------7---------------------------------------------------------------------
Other Fees . . . . . . . . .
PLAN CHECK, ELECTRICAL
11.92
PERMIT ISSUANCE M/P/E
90.57
Fee summary Charged
---------------------------
Paid Credited
----------
Due —
Permit Fee Total 23.83
--------------------
.00 .00
23.83
Plan Check Total .00
.00 .00
.00
Other Fee Total 102.49
.00 .00
102.49
Grand Total 126.32
.00 .00
126.32
LQPEENIIT
Bin # City of LQ Q1..1inta
-Building &r Safety Division
Permit # P.O. Box 1504, 78-495 Calle Tampico .
La Quinta, CA 92253 - (760) 777-7012
�S�
l4 . Building Permit Application and Tracking -Sheet
Project Address: Owner's Name: ' V
IA
A. P. Number:
Address: ,2of.-I2
Legal Description:
City, ST, Zip: Z2S�
Contractor:
Amount
Structural Cala.
Address: -
Project Description: e ,
City, ST, Zip:yjch
Telephone:
Truss Cala.
State Lic. # :
City Lie. #;
Called Contact Person
Arch., Engr., Designer:
Plan Check Balance.
Address:
Title 24 Cates.
City., ST, Zip:.
Telephone:
Construction Type: Occupancy:
Flood plain plan
State Lic.
Project type circle one): New Add'n Alter CBRep Demo
Name of Contact Person:
Sq. Ft:
# Stories:
# Units:
Telephone *,of Contact Person: I Estimated Value of PrcjcA 5� c7 - I
APPLICANT: DO NOT WRITE BELOW THIS LINE
# Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cala.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cala.
Called Contact Person
Plan Check Balance.
Title 24 Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2"° Review, ready for corrcctions/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
II.O.A. Approval
Plans resubmitted
Grading
IN ROUSE:-
Review, ready for corrcctionsiissue
Developer Impact Fee
—Planning -Approval
-Called-Contact-Person
A -I P P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
o
�'
a
P
BUILDING 8t SAFETY DEPARTMENT
78-495 CALLS TAMPICO (760) 777-7012
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011
Considering Becoming an Owner -Builder?
Important information you need to know BEFORE pulling your permit!
The term "Owner -Builder" can mean three different things:
"Owner as Worker", "Owner as Contractor" or "Owner as Employer"
Understand each has Benefits or Risk, and it is possible to combine them!
Hiring a California Licensed Contractor means you do not personally perform any of the construction work, the permit is not taken
out i your name, you are not personally responsible for the construction and you are not an Owner -Builder. Instead, you become a
"Cu o`mer" and California law provides you the benefit of protection from poor workmanship. failure to finish the job and financial
riskue to worker injury.
Beneflt/Risk: Highest Benefits and the Least amount of Risk
Owner -as -Worker is a type of Owner -Builder where you personally perform the construction work, the permit is taken out in your
name and you are personally responsible for the construction management, knowledge, workmanship, and completion of the job. You
benefit by not paying others to perform this work for you and your risk depends on your own ability to complete the job successfully.
Benefit/Risk: Possible Benefit with Low Financial Risk
Owner -as -Contractor is a type of Owner-Buildcr wh6re. you personally acCas'your own. Gericral. Contractor, the permit is taken out in
your name and you hire California licensed sub-contracfors to perform,portions of the. constructionlAvork. WARNING: The benefit of
protection provided by law when you hire: only California licensed sub-eoniractdrs canz turn to sorious financial risk if you hire
unlicensed contractors to perform ami of the work.
Benefit/Risk: Possible Beiref t and Significant Financial Risk
Owner -as -Employer is a type of Owner -Builder where you pay any unlicensed individual to perform anis construction work valued at
more than $500.00, the permit is taken out in your name and you are personally responsible for their employment requirements.
supervision, performance, safety and welfare while on your property. WARNING: Cost savings benefit can turn to serious financial
risk if you fail to deduct payroll taxes or provide workers compensation insurance for each worker.
Benefit/Risk: Possible licnefit with Significant Financial Risk
ti
(Health and Safety Code Section 19827) The California Legislature declares an "urgent and statewide
public interest in assuring" that contractors comply with Contractors' License Law, Business and
Professions Code and Workers' Compensation Insurance requirements to ensure property owners are
informed about, and protected from the following when improving their property as Owner -Builders:
Fraudulent representations - Liability for worker's injuries • Liability for material and labor costs unpaid by
contractors • Licensing requirements • Employers tax liabilities
1
Over 20,000 consumer complaints are filed each year. Many complaints relate to ownerlbuilder projects
and include workmanship and workers' compensation issues Homeowners suffer financial harm due to
defective workmanship and injured employees.
Following are'alarming examples of what has occurred with Owner -Builder permits:
Example 1: Homeowner received insurance money to rebuild burned -down home.
■ Owner/Builder permit pulled to rebuild structure.
• Unlicensed contractor built substandard structure — must be torn down and replaced.
• Estimated financial injury is $225,000.
• Additional financial injury - IRS threatened to tax insurance payout if house not completed by the end of
the year.
Example 2: Brother-in-law had active license but filed an exemption from Workers Comp.
• Owner -Builder hires brother-in-law to install a new roof.
• Employee falls and sustains multiple spinal and extremity fractures as well as a head injury and
remains in a coma to this day.
• The Owner -Builder, who has sold the home, is now a defendant in a lawsuit for reimbursement for
benefits paid to the injured worker.
Example 3: Employee of contractor without Workers Comp is hired by Owner -Builder to install septic
system and suffers injury that results in permanent disability.
• The Owner -Builder did not have a homeowner's insurance policy on the house against which to submit
a claim.
• The Owner -Builder is now a defendant in a lawsuit for reimbursement for benefits paid to the injured
worker.
Did you know — unlicensed persons frequently have the property owner obtain an "Owner -Builder" building
permit which erroneously implies that the property owner is providing his or her own labor and material
personally?
Did you know — your homeowner's insurance may not provide coverage for injuries sustained on your
property by an unlicensed contractor and his/her employees?
Did you know — if you are considered an "employer" under state and federal law, you must register with
the state, and federal government, withhold payroll taxes, provide workers compensation and disability
insurance and contribute to unemployment compensation for each "employee"?
Did you know — that if you fail to abide by these laws you may be subjected to serious financial risk?
OWNERS BEWARE AND CONSIDER THE RISK BEFORE ACCEPTING FULL RESPONSIBILITY FOR
YOUR CONSTRUCTION PERMIT
BUILDING & SAFETY DEPARTMENT
78-495 CALLS TAMPICO (760) 777-7012
LA QUINTA, CALIFORNIA 92253 TAX (760) 777-700
PROPERTY OWNER'S PACKAGE
Disclosures & Forms for Owner -Builders Applying for Construction Permits
l.1k ORTAWT! NOTICE TO PROPERTY OWNER
Dear Property Owner.
An application for a building permit has been submitted inyour name listing yourself as the builder of the property
improvements specified at�j_L J VC-za if ' re,,, �
We are providing you with an Owner -Builder Ackaowledgmeat,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, iriitiaWd your. understanding of eack'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.
fREC JVAIS; J?od diad'i"i6d!'. xicii;statenieiifAelow to sigriijyyou understand
1. 1 .understand a frequent practice of unlicensed persons is'to.have the property owner .obtain an "Owner-Buil&e
building permit that erroneously implies that the property owner is providing. his or her own .149r and. material, retsonall I, as:
an Owner -Builder, may beheld liable and subject to serious financial risk ~for any irijuries:sustaioed.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•coveragc for injuries to workers
on my property.
0-2.1 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.
PIL3. 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
Own.
QL4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on
permits and contracts.
CE5.1 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. 11
6. 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
risk.
J)K� 7. 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.
C) I underst.ind m an Owner -Builder if I sell the property for wbich this perYnil is issued i may be held liable, for any
financial or., personal'euvortes wsfamcd by any subsequent owners) that result from any latent construction defects in the
workmanship cirnratcriats.
9. 1 understand I may obtain more information regarding my obligations'as an "emiiioycr" hero the Internml Kc:venue
Service, the United States Small Business Administration, the California Dcpartmenl of Benefit Payments, and the California
Division of Industrial Accidents. i also understand l .may.coniact the Califoinia Corlinctois' State License Board (CS03) at 1-
800-321-CSLB (2752) or www.csib_ca.gov for more information about licensed contractors.
Q�L10. 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 fo4 proposed co tnrction activity at the following address:
U,E l i. 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.
Qk 12. 1 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 Boarul may be unable to assist you with any financial loss
you rnay sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in,6vil court It is also
important for you tounderstand that if an unlicensed Contractor or cmployee of that individual or firm is injured while working
on your property; you may lie held. liable. for dautages. If you obtain a pciinit as Owuer-�Buildec and wish to hire COntrletors,
you will be responsible for veijfyir►g whotht .or not ttnosc _Contractors arc'p openly liciaiscd atsd .the status of their wociCas'
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 issa1",*e.1exm#. Now A copy of tlte.property owner's dsiver'> ikenset farm nokdomolm or
other veriftcation acceptable to the agency is required to 6e presented when the permit is issued to vaify the property
owner's signature.
p('iCeS ui�:l^� t�nd�n Scr�� Dy
Signature of property owner Date:LW
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.
AU MORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S.. BEHALF
Excluding the Notice to Property Owner, the execution of which 1 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 1 am the property owner for the address listed above and I person2lly filled out the above
formation and certify its accuracy. Note_A copy oflhe oxner_'s_ driver s license, fern 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: