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ELEC (14-0227)P.O. BOX 1504 4 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING.& SAFETY DEPARTMENT BUILDING PERMIT Application Number:,, 14-00000227 Property Address: 52601 AVENIDA NAVARRO APN: 773-304-017-4 -000000- Application description: ELECTRICAL Property Zoning: COVE RESIDENTIAL Application valuation: 100 Applicant: Architect or Engineer: d -------------------------------------------------- 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.: a e: Co ractor: 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 1$500).: Y 1 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 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.). 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.). ( am exempt under Sec. , BAP.C. for this reason oft.:, 3 --3— % 0 er: 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 Owner: LEE HERBERT HING SANG & LAURA 7113 E MOONEY DR ROSEMEAD, CA 91770 (626)512-9734 Contractor: Owner VOICE (760) 777-7012-. FAX (760) 777-7011 . INSPECTIONS (760) 777-7153. tM °AR 0 4. 2094 CITY OF LA QUINTA FINANCE DEPT. Date: 3/03/14 ----------------------------------------------— 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 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 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 1$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 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 thi ount2y to enter upon thea ove-mentioned property f r inspec io purposes. Date: 3-3 ^ ign ure (Applicant or Agent): Application Number . . . . . 14-00000227 Permit . . . ELECTRICAL 2013 Additional desc . Permit Fee . . . . 23.83 Plan Check Fee .00 Issue Date . . . . Valuation 0 Expiration Date 8/30/14 Qty Unit Charge Per Extension 1.00 23.8300 EA ELEC SERVICES 23.83 ---------------------------------------------------------------------------- Special Notes and Comments ELECTRICAL - REPLACE MAIN BREAKER. 2013 CALIFORNIA BUILDING CODES. -------------------------------------------- Other Fees . . . . . . BLDG STDS ADMIN (SB1473) 1.00 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 P1an'Check Total .00 .00 .00 .00 Other Fee Total 103.49 .00 .00 103.49' Grand Total 127.32 .00 .00 127.32 ' LQPERP1IT Bin # City of La Quinta Building 8T Safety Division P.O. Box 1504, 78-.495 Calle Tampico •. La Quin ta, CA 92253 - (760) 777-7012 ' �' " • , ' } Building Permit Application.and .Tracking Sheet Permit # /// 'Projeci Address -6 G� O f Owner's Name: L A. P. Number: . Address: --6o Legal Description: Ci j ty, ST Zip:_ La 172z�3 . Contractor: Telephone: 6;7b Address: `P`roject'Description. City, ST, Zip: Telephone: ;.;:s.?.;•;:::::?::.;r .;�;;•::::..;?,::.::. State Lic. # : City Lic. #. Arch., Engr., Designer: - Address: City., ST, Zip: Telephone: ?'>':;::;:?.:::•;;::::::;%;::><;:;>:::;:::>:>:»::>»: < Construction Type: Occupancy: YP P y• State Lic. #: Project type (circle one): New Add, n Alter Repair `Demo 'Name of Contact Person: LAORA Sq. Ft.: # Stories: # Units: . Telephone-#,of-Gontact-Person:— -- J, — —44 Estimated Value of Projec�T0. APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING PERMIT FEES . Plan Sets Pian Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Title 24 Calcs. Plans picked up , Construction Flood plain plan Plans resubmitted Mechanical Grading plan tad 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:- '"' Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees 1 ' Total Permit Fees y', P.O. Box. 1504 LA QUINTA, CALIFORNIA 92247-4504 7$-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 s BUILDING & SAFETY DEPARTMENT (760),777-7012 FAX (760) 777-7011 PROPERTY OWNER'S PACKA:GI . Disclosures & Forms for Owner -Builders Ap:pCoBst IJ for ruction Permits 009HUNTLNOTICE TO PROURTYOWNER Dear Property Owner :. An.. application, fora building hasbeen milted ur�r�aiae:-lis ' as the builder of the y improvements specified at We are providing you with an Owner -Builder Acknowledgment and Informations Verification Form to make you aware of your responsib.ilities and possible risk;you may incur by having this permit issued in your name as the Owner. Builder. WtMill not issue a. building. :permit until =you -have read:, initialed your understanding of each'prevision, signed, and returned this form to us at our official address indicated. An agent of the- owncr. cannot, execute -this notice unless you, the property owner, obtain the prior approval of the permitting authority. �C%KNO. EI)GWMNT A-ND`VERIFICATION OF INFO A'fION ; Read aiid irriticrl'e;?w-h4laleinent bdow to signify you understand or verify d4is'iiiforntaEion. y %q 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. 2_ I understand building permits are not required to be signed by property owners unless they are responsible for the el -construction and are not hiring a. Licensed ;Contractor. to assume this responsibility. _ I understand as an "Owner -Builder" I. am the responsible party of record on the. permit -1 understand that I may protect 40, yself from potential financial risk byhiring a licensed Contractor and having the permit filed in his or Ener name instead of my wn. ' I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on Omits and contracts. '/1_I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value f./. my construction is at least five hundred dollars ($500), including labor and materials, I may be considered .an "employer" under state and federal law. 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 Jo. unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. �-0. 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 he'd liable, for any IffOiTaEncial or personal, it)juries sustained.,by any subsequent owners) that result from any latent construction defects in the worlananship or materials. . I understand I may obtain more information regarding my obligations as an "employee' from the U*mnai 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 (CSI:'H at 1- 800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. 400�10- I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the ��,,ppariy leg�a_l_lyy_�� and fnanciall .res onsib,le for proposed construction activity at the following address: /,tAU. I agree that, as the party legally and fwarrcially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner -Builders as well a$ employers. �12. I agree to notify the issuer of this form immediately of any additioffi, deletions; or changes to any of the information I have provided on this form Licensed contractors are regulated by taws designed to protect the public. If you contract with .someone who doesnot have a license,. the Contractors' State License.Board :may be unable to nancial loss YOU may sustain as a result of a complaint Your only remedy against unlicensed Contractors may be inVivil Court- It is also important for you to: understand that if an udliccursed Contractor or employee of that individual or firm is injured while working on your property; you may beheld liable for damages. If you obtain a permit: as Owner -Builder and wish to hire Contractors, You will be responsible forveribying whether or mot those Contractors are property licensed and the status of their woticers' coon 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 ksaibg,*e.per=it. llfotc: A copy of the.property* owner's drlver'sl et farm nota ri; or other verification acceptable to the agency is required to be presented when the permit is issued to. vei* t6!- property owner's signature. ,0' tore of property ownerDate: 3 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 AGENTTO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the exewtion of which I understand. is my personal responsibility, I hereby authorize the fallowing persons) to act as my agents) to�applq for, sign, and 53e`the documents necessary to obtain an Owner -Builder Permit'for my project- Scope rojectScope 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: t �� CITY OF LA QIYINTA SUB -CONTRACTOR. LIST . PERMIT NUMBER/4 �Z7 OWNER J � ��� . _ .BUILDER JOB ADDRESS �;�OI (�41 this list or their employees are authorized to work r This form shall be posted on the job with the Building Inspection Card at all times in a conspicuous lace. Only persons appearing on p I Q p p p �ing Division prior to commencement of work. Failure to comply will result;}in a stoppage of work and/or the voidance_ list be approved by the Build on this job. Any changes to this must c applicable trade, all inform on requested ed below must be completed by applicant. "On File" is not an acceptable response. q a of building erm o reh .................. ... .................. ........ .................... ......... ....................... ........................:::::................................::::.::.........................:.:::..... .......::...::....:..........:.:.........:.:.::::...::...... Stat@ C ontrac fors L�censi' ............... .......... .... ........ ....... sines Cit Bu ranee:::>::>::>::: <;,>:.............. .. Y .............. ion.Insu:.......................... Wo rkers Com P ....... r E . License Carrier Name Policy Number Exp. Date License Numbe lx xl xx xx) xxxx) . Date x /Classrficat'on 1 xx xxCor Company Name C -81e. . AB xx xxxx1 (xx/xx xx1 1e.9. StateFund, CaIComP) Format Var�e� ) i QJI >2 > <>< E21:R:T:H:IN:ORKlC:.i1.i.1..:.i•::::::: � • >FRAIUI.I.NG IC;:::�.. RU CT STEEL IC 51) LATH PLASTER IC 35) 26 ?tee- � 9 ��,�` "°C"� �R'•,T,xA` ° �°.' .! 5�('9..�'. Ilf� ..�;:,�?o/ / -20 / .......................... iOOFNGCi .......... A (C 43) ............. FLOORING:i(:Cz15:):<<< `: : - 1.NSUILA.TIQ;N>fC.>:.ii�;:;.>:::::.:::<.i. - SEW/AF DISP C 42) G.— :..:.:........ �........:.;:::::;..; 4. ... , � PA1NTIN;G<4C::.;::::: �.i;i:::::.: ;::i>,:..: •,. � , BINETS l FENDING;:>lC:::�i. f L'!ANDS;CA.;.:.i:.;:.::.;:t,.,>: