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13-1194 (ELEC) IIIIIIIIIIIIIIIIIIIIIIIII 604 P.O. BOX 1504 _ - __ IE �^� �0 VOICE 760 777-7012 78-495 CALLE TAMPICO SCQ► FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 BUILDING &SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 9/23/13 Application Number: 13-00001194 Owner: Property Address: 81773 AVENUE 58 CRAIG DANGARD APN: 764-180-001- -000000- 1 81773 AVENUE 58 D a Application description: ELECTRICAL LA QUINTA, CA 92253 Property*Zoning: LOW DENSITY RESIDENTIAL (406)570-S443 Application valuation: 1500 SEP 232013 zo13 Contractor, s Applicant: Architect or Engineer: Owner CITY OF L,q QUIlill PINAmeE 6EPT. ----- ---- - - - - ------ - -- --- -- ---------- -- - ---------------- --- - ---- - - - -------------------- ----- -- --- LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION hereby affirm under penalty of perjury that I 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 a certificate of consent to self-insure for workers'compensation,as provided License Class: License No.: for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Date: Contractor: _ 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 OWNER-BUILDER DECLARATION nsurance carrier and policy number are: I 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 Code: Any city or county that requires a permit to _ I certify that,in the performance of the work for which 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 to the workers'compensation laws of California, permit to file a signed statement 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 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or 3700 of the Labor Code,I shall forthwith cdmply with those provisions. that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by an�plicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).: Date:Applicant: 1 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 WAR ING: FAILURE TO SECURE WORKERS'C MPENVERAGE IS UNLAWFUL,AND SHALL Contractors'State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENAL IES ANDIVI INES UP TO ONE HUNDRED THOUSAND and who does the work himself or herself through his or her own employees,provided that the DOLLARS($100,000). IN ADDITION TO THE COST OF COM NSATION,DAMAGES AS PROVIDED FOR IN improvements are not intended or offered for sale. If,however,the building or improvement is sold within SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. 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.). APPLICANT ACKNOWLEDGEMENT 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 or improves 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 a result of this application, 1(� ) I am exempt under Sec. ,B.&P.C.for this reason 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: Owner: 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 w'I subject CONSTRUCTIONDING AGE CY permit to cancellation. I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the I certify that I have read this application and state that the above information is co rect. I agree to co ly with all work for which this permit is issued(Sec.3097,Civ.C.). city and county ordinances and state laws relating to building construction,and rebs authorize repr entatives i of this county to enter upon the above-mentioned property for i spection pur ses. LeiiJei's Name: Date: Signature(Applicant or Agent): Lender's Address: , G LQPERMIT Application Number . . . . . 13-00001194 Permit . . . ELECTRICAL 2013 Additional desc . . Permit Fee . . . . 23 .83 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 0 Expiration Date 3/22/14 Qty Unit Charge Per Extension 1.00 23 .8300 EA ELEC SERVICES 23.83 ---------------------------------------------------------------------------- Special Notes- and Comments ELECTRICAL - PANEL CHANGE OUT. 2010 CALIFORNIA BUILDING CODES. -----------=---------------------------------------------------------------- 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 LQPERMIT r / ,�, d Bin#f Qty of La Qu►nta Building&r Safety Division Permit.#f P.O. Box 1504, 78-495 Calle Tampico ` La Quinta,CA 92253- (760)777-7012 Building Permit Application and Tracking Sheet Project Address: fl 7 7 ,,t! �' �� �� Owner's Name: , Q 6el A.P.Number: Address: 7 '73 Legal Description: City,ST,Zip: l� zs Contractor: Telephone: 6 S :::;,:<:::><:>::::,;>:::»>•;:.>•>::;;;:>>.: Address: Project Description: City,ST,Zip: v i 6rL . .Y.iSv:�{:is(y'f.^?'.}}::n;::. i;�;�;•�}�.: Telephone: '„%';?'>> <'>?? `:<>'' %s: <<» Ae State Lie.#: City Lie. Arch.,Engr.,Designer. l744W Address: City.,ST,Zip: Telephone: Construction T e: E ,L Occupancy: <n ..'.>.^...>...'.>.'"'`".'.':State Lie.#: Project type one : New Add'n Ater Repair Demo :. ......... Name of Contact Person: Sq.Ft.:17012 #Stories: #Units: Telephone#of Contact Person: Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE H Submittal Req'd Rec'd TRACMG PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed,ready for corrections Plan Check Deposit Truss Cala. Called Contact Person Plan Check Balance, Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan god Review,ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A.Approval Plans resubmitted Grading IN HOUSE:- 3rd Review,ready for corrections/issue Developer Impact Fee lannin2 Avp aj —Akd-�ntacct�erm. ��£ Pub.Wks.Appr Date of permIt issue School Fees Total Permit Fees. Tar P.O. Box 1504 LA QUINTA, CALIFORNIA 92247-1504 BUILDING & SAFETY DEPARTMENT OFT � 78-495 CALLE TAMPICO (760) 777-7012 LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011 PROPERTY OWNER'S PACKAGE Disclosures & Forms for Owner-Builders Applying for Construction Permits V-10-ORI'.9NT! NO'T'ICE TO MVERIYOWNER Dear Property Owner. An application for a buildingQermit has been submitted in your name lis ' yourse f as the builder of the property improvements specified at We are.Plvviding you with an Owner-Builder c ediment and Information"Verification Forth 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 buiiding.permit until you have read,initiaW 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. Oi R'S ACKNOWLEOOAUM AND VERIFICATION OF-DWORMATWN Df ONS:Read and initial each statement below to signify you understand or ver#ythis information. f I understand a fr uent practice of unlicensed eq p persons is to have the property owner obtain an "Owner-Builder" uilding permit that erroneously implies that the property owner is providing his or her own labor and material personally. 1,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. Abnstr I understand building permits are not required to be signed by property owners unless they are responsible for the uction and are not hiring a Licensed Contractor to assume this responsibility. 3. I understand as an"Owner-Buildee' I am the responsible party of record on the permit. I understand that I may protect A3 from potential financial risk by hiring a"licensed Contractor and having the permit 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 4ermand contracts. I understand if 1 employ or otherwise engage any persons,other than California licensed Contractors,and the total value onstruction is at least five hundred dollars ($500), including labor and materials, I may be considered an"employer" und� state and federal law. 6. I understand if I am considered ana to " iiap yet" under state and federal taw, 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. (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. I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be he'.d liable,for any financial or personal.igjuuies sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. 1 I understand I may obtain more information regarding my obligations as an ,employee, from the Internal Revenue (erfAw!e,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- 800-32 CSLB(2752)or www.cslb.ca.gov for more information about licensed contractors. 0.I am aware of and consent to an Owner-Builder building permit applied for in my name,and understand that I am the legally and financially responsible for proposed cons)ruc' n activity at the following address: �� / 11. I agree that,as the party legally and financially responsible for this proposed construction activity,I will abide by all app rcable laws and requirements that govern Owner-Builders as well as employers- 1& 12. 1 mployers_1t 112. 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 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 1civil court. It is also important for you tounderstand that if an unlicensed Contractor or employee of that individual or film 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 wBl be responsible for verifying whether or not those Contractors are property 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 ske property owner's driver's trcenslet faun nota n,or other verification acceptable to the agency is req 'ed to be presented when the permit is issued to verify the prop" owner's signature. Signature of property owner Date: J 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 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: Tel No Address of Authorized Agent: I declare under penalty of perjury that 1 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: