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BELC2016-006452280 Avenida Madero BELC2016-0064 Applicant: Contractor: TERRY ODONNELL OWNER / BUILDER P O BOX 1130 SUNSET BEACH, CA 92253 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 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.). (_) 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 am exempt under Sec. BAP.C. for this reason ate: ner: 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 LIC. No.: (760)777-7125 (760)777-7011 (760)777-7153 /2 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. ' aYe la°2 O Apo cant: 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. Da Z ture (Applicant or Agent) I "i VOIC 78-495 CALLE TAMPICO D N LAQUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT FA INSPECTION BUILDING PERMIT Application Number: BELC2016-0064 Owner: Y, ox Property Address: 52280 AVENIDA MADERO . TERRY ODONNELL Cf OafQ!%L APN: 773242005 P 0 BOX 1130 ✓TG,o Application Description: 0 DONNELL RESIDENCE / ELCTRICAL PANEL SUNSET BEACH, CA 92253 Property Zoning: fS Application Valuation: $1,500.00 Applicant: Contractor: TERRY ODONNELL OWNER / BUILDER P O BOX 1130 SUNSET BEACH, CA 92253 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 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.). (_) 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 am exempt under Sec. BAP.C. for this reason ate: ner: 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 LIC. No.: (760)777-7125 (760)777-7011 (760)777-7153 /2 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. ' aYe la°2 O Apo cant: 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. Da Z ture (Applicant or Agent) FINANCIAL .l. tDESCRIPTION ACCOIINT QTY AMOUNT 'f'4 PAID a',PAID DATE,: _.•. xx.._,t,. s,..;_ BSAS SB1473 FEE 101-0000-20306 0 $1.00 $1.00 7/22/16 METHOD , Y RECEIPT # 3 CHECK # CLTD BY w g k ' >ak X+... y.7'+v 4«x' vd" '. . ,y. .., . 5j-YY ^, a: 'r' ' n 3 ix, ;T F.. . X °Si `..Y * t >Yx ns .. ".c ,•r. . TERRY ODONNELL CHECK R17312 1257 MFA Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 $1.00 ;DESCRIPTIONx Fx y'ACCOUNT ,QTY s4 AMOUNT+ 3vPAIDT- PAIDyDATE' SERVICES 101-0000-42403 0 $24.17 $24.17 7/22/16 a^'" METIOD , #,.•< d , ,• PAIDaBY` t` RECEIPT <:CHECK # , •;CLTD BY TERRY ODONNELL CHECK R17312 1257 MFA a -•" ,hI:,yr 'w ;. DESCRIPTIONY, $,.r?'$r A000UNT ..,, tQTY 1n:. AMOUNT "` , tr. dg s ti' dN "-moi f 1. PAID'k,., .:.:.•... 1 PAID:DATE SERVICES PC 101-0000-42600 0 $12.09 $12.09 7/22/16 , `, ' W PAID BY $. -METHOD. RECEIPT CHECK # CLTD BY$ 01 e 4 # M1 r TERRY ODONNELL CHECK R17312 1257 MFA Total Paid for ELECTRICAL: $36.26 $36.26 ' DESCRIPTION eek ACCOUNT "QTY AMOUNT YPAID . PAID OATS Sr z; i h PERMIT ISSUANCE 101-0000-42404 0 $91.85 $91.85 7/22/16 METHMETH OD D -4RECEI`PT CHECK w 3 ; < # # CLTD BY TERRY ODONNELL CHECK R17312 1257 MFA Total Paid for PERMIT ISSUANCE: $91.85 $91.85 TOTALS: Description: 0 DONNELL RESIDENCE / ELCTRICAL PANEL Type: ELECTRICAL Subtype: Status: ISSUED Applied: 7/22/2016 MFA Approved: 7/22/2016 MFA, Parcel No: 773242005 Site Address: 52280 AVENIDA MADER0 LA QUINTA,CA 92253 Subdivision: SANTA CARMELITA VALE LA QUINTA Block: 41 Lot: 5 Issued: 7/22/2016 MFA UNIT 3 Lot Sq Ft: 0 Building Sq Ft: 0 . Zoning: Finaled: Valuation: $1,500.00 Occupancy Type: Construction Type: Expired: 1/18/2017 MFA No. Buildings: 0 No. Stories: 0 No. Unites: 0 Details: REPLACE PANEL 220 AMP LIKE FOR LIKE. PER 2013 CALIFORNIA BUILDING CODE IID UTILITY THEFT _..• CONDITIONS' Printed: Friday, July 22,.2016 11:18:17 AM 1 of 2 SYSTEMS INSPECTIONS PARENT PROJECTS BOND INFORMATION ATTACHMENTS Printed: Friday, July 22, 2016 11:18:17 AM 2 of 2 ` SYSTEMS Bin #e y of r f. Quintado Building &r Safety Division Permi 78-495 Calle Tampico La Quinta, CA 92253 _-(760) 777-7012 Building Permit Application and Tracking Sheet roject Address: wner's Name: A. P. Number: Address: PQ Legal Description: City, . P .. C G/ Ci ST, Zi j G 9 L ntract r: Co 0 TelPe hone Address: Ject Description: a0-0 If u At City, ST, Zip- V Telephone: ..#:........ f G P AO E C State Lic. #.: City Lie IV Y L(/ Arch., Engr., Designer: . Address: City., ST, Zip: an Occupancy: cY:•Telephone: struction Type: Con e ic. # ddn Alter' Repairair Demo Project type one):, New A Name of Contact Person: Sq. Ft.: # Stories: nits: Telephone # of Contact Person: mated Value of Projec /S Q,94' --. # Submittal Req'd APPLICANT: DO NOT WRITE BELOW THIS LINE Rcc'd . TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cafes. Reviewed, ready for corrections Plan Check Deposit Truss Calcs.Called Contact Person Plan Check Balance. Title 24 Cales. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2" Review, ready for correctionsfissue Electrical Subeontactor List Called Contact Person Plumbing Grant Dccd Plans picked up S.M.I. M.O.A. Approval Plans resubmitted Grading IN ROUSE:- Review, ready for corrections issuc Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue. School Fees, Total Permit Fces P:'O. BOX 1504 LA QUINTA, CALIFORNIA 92247-1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT - PROPERTY O'WNER'S PACKAGE J (760) 777-701.2 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 er rnt has en subriiitted in your name, listing yourself as the builder of the. property improvements.specified at y //e ,E o 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. DIRECTIONS: Read and initial each statement below to signer 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. on my property. I 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. ,3..1 understand as an "Owner -Builder" I am the responsible y protect spo party of record on the permit. 'I understand that I may myself from potential financial risk by hiring a licensed Contractor• and having the permit filed in his or her name instead of MY own. / 04. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on ` permits and contracts. 5. 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 under state and federal law. To 6. I understand if I am'considered an "employer"'under state and federal law, Iinust 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. _15 ®.,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.cale'ndar year, or all.of the work'is performed under contract witha licensed general building Contractor. r f 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. 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 financially responsible for proposed construction activity at . the following address: a 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. -rD U. 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 furn 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: 7 —9,, Note: The following Authorization Form is required lobe 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 document's necessary to obtain an'Owner-Builder Permit for 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: