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11-1237 (ELEC)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: '::711-00001237-) Property Address: 52045 AVENIDA-CARRANZA APN: 773-215-026-2 -000000- Application description: ELECTRICAL Property Zoning: COVE RESIDENTIAL Application valuation: 2000 c&ht 4 4 Q" Applicant: Architect or Engineer: ------------------ LICENSED CONTRACTOR'S DECLARATION BUILDING & SAFETY DEPARTMENT BUILDING PERMIT . 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.: J t . R nt ctor: 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 Codel 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 �) 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.). (_ 1 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 nd who contracts f [he projects with a contractor(s) licensed pursuant to the Contractors' State Lice Law.) • (_ 1 I am exempt under Sec. , B.&P for this reason yawner ONSTRUCTION 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: 11/15/11 Owner: JASON GIROUX 52045 AVENIDA CARRANZA LA QUINTA, CA 92253 --------------------------------- Contractor: 1 Owner ;U it v a 1 -------------------- -------`°-- : 201) Ci•flr rI-:�i --------------- - - - 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 fo which this permit is issued, I shall not employ any person in any manner as to become subje to the workers' compensation laws of California, and agree that, if I s d become subject to a workers' compensation provisions of Section �0 of the Labor , I shall forthwit c ly wi� those provisions. ate: cant: WARNING: FAILURE TO SECURE ORKERS' COMPENSATION COVER GE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIM AL 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. I . 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 oLthorize will subject permit to cancellation. I certify that I have read this application and state that the a information is coly with all city and county ordinances and state laws relating to buil in construction, and hentatives of this co ty to nter upon t above-mentioned property r inspection purposes aD te: S' ature (Applicant or Agent): Application Number . . . 11-00001237 Permit . . . ELEC-SERVICE CHANGE Additional desc . Permit Fee . . . . 33.50 Plan Check Fee .00 Issue Date . . . . Valuation 0 Expiration Date 5/13/12 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 18.5000 EA ELEC SVC <=600V/<=200A 18.50 ---------------------------------------------------------------------------- Special Notes and Comments UPGRADE PANEL FROM 125 TO 200 AMPS. 2010 CODES. ---------------------------------------------------------------------------- Other Fees ... . . . . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged -------------------- Paid Credited - --------------------- Due ----------------- Permit Fee Total 33.50 .00 .00 33.50 Plan Check Total .00 .00 .00 .00 Other Fee Total 1.00 .00 .00 1.00 Grand Total 34.50 .00 .00 34.50 LQPERMIT P.O.' BOX 1504 LA QUINTA, CALIFORNIA 92247-1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT PROPERTY OVNEWS PACKAGE (760) 777-7012 FAX (760) 777-7011 Disclosures & Forms for Owner-Ballders Applying for Construction Permits IMM7Al�l7'! NOTWE TO 1ZOl'� 'l'i� ORTiGT Dear Property Owner. An. application for a building permit has been submitted ffi. your name listing yourself as the builder of the property improvements specified at We are prioviding you with an Owner -Builder Acknowledgment and Information Verification, Forret m make you avidin of your respessnbilities andpossible risk you may incur by h tving 'dtis perm t.issaed in your name as ft. of Own" -Budder. We WW not ism a building -permit until you -have read, Initialed your understanding PrONWOR, signed, and returned this form to us at our official address Indicated. An, agent of the ovam cannot cxwuft da'S-notice unless you, the property owner, obtain the prior approval of the permitting authority. Read and acinar each signify you umdw3tand or verO this information: r�� 1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Budder" ng permit that erroneously implies that the property owner is providing his or her own labor and material pemonaltlr. 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 cries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance.coverage for injuries to wod= d(t ral! Pr'Olkert3'- I understand building permits are not required to be signed by property owners unless they are respowible for the ;tion and are not luring a licensed Contractor to assume this responsibillty- I understand as an "Owner -Builder" I am the responsible party of mord on the permit. I understand fhat I may protect from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers o �. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total vale my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employe ler state and federal law. I understand if I am considered an "employer" under state and fbderal taw, I must register with the state and fedi nent, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemptoym cation for each "employee." I also understand my failure to abide by these laws may subject me to serious ftnan 7. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family reside s clunes cannot legally build them with the intent to offer them for sale, unless all work is performed by lice subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is perfoi under contract with a licensed general building Contractor. 8. I `understand as an Owner -Builder if I sell the property ' for which this perdut is issued, I may be held liable• for any rnancial: or personal. kjories skatained by any -subsequent owne(s) that result from any latent construction defects 'in the rlanaaship or materials: I•understand [may obtain.more information regarding �my obligations as, an "employee" from•the Internal Revenue ervice, the United States Small Business Administration, the California Department of Benefit Payments. and the California D vision of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CXZ) at I- `-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 arty legally and financially responsible for proposed construction activity at the following address: agree that, as the party legally and f twacially responsible for this proposed construction activity, I will abide by all laws and requirements that govern Ow -Iter -Builders as well as employers. Cve l2. 1 agree to notify the issuer of this form immediately of any additions, deletions, or ehst9es to any of the infermation I 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 &%*t You with any dnancW loss you may sustain as a result of a complaint Your only remedy against unlicensed Contractors may be inVivil Court. It is also importaart for you tin understand that -if au• ualiotmsed Conawtor or employee of that individual or &M is injured white worlring on your property, you may be, held• tial for damages. If you obtain a permit as Owner-Butlda and wish to hire Contractors, you will be nq)onsMo for verlpiing v&ether or not those Corutmsctors are properly Iieensed and the tutus of thk woe'kers' compensation insurance coverage. Before a building permit can be issued, this form must be completed and signed by the property owner aad returned to the agency responsible for issuing.theper=tt. Nota: A copy of ttw property owner's dk€ver's ' f0m xe�M� or other versTwA len acceptrrbla to agency is mired to be presented when luta VMKU is is to vetify Me property owner's signature. Signature of property owner —, ` Date: 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. AUTHORI7.ATION OF AGMT TO ACT ON PROPERTY ORrNE "S 1ft F Excluding -the Notice to Property Owner, the oxmotion of which I understand is my personal responsibility, I hereby authorize the following peraon(s} to act as my $geat(s) to apply for, sign, and file the documents necessarjt 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 perjurythat I am the property owner for the address listed above and I personally filled out the at 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: 1 understand as an Owner -Builder if i sell the property•for which this permit is issued, 1 may be held liable for any uncial: or personal, igjaries sustained by any subse4ueut owners) that result from any latent construction defects in the rkmanship or mateiiik I understand I may obtain more inforrnation regarding my obligations as; an "employer'. from,11& Intecrnl Revenue ervioe, the United States Small Business Administration, the California Department of Benefit Payments. and the California D'vision of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSM at l- -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 arty legally and financially responsible for proposed construction activity at the following address: o--. - _ . i . . _ _ -- - _ - i n - i'-.- 9 -, e-; agree that, as the party legally and financially responsible for this proposed construction activity, l will abide by all laws and requirements that govern Owner -Builders as well as employers. 12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or 441180s 10 Any of tbo mo on l eve provided on this form Licensed contractors are regulated. by laws designed to protect the public- If you contract with sornvone who does not have a twenw, bre Contractors' State License Board may be unable to ash you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be itkvivd court. It is also important for you to understand that if an ualwwwd Contractor or employee of that individual or &M is wjumd while woe nng on your property, you may be fled l for damages. If you obtain a permit as Owwr-Builder and with to hlte CorlrracEors, you will be responsklo for va&ji tg whedwr or not those Cawmctom are panpedy Iieensed and the status of G" wO&crs'. oompeasation insuranoe ooveragv. Before a building permit can be issued, ibis form must be completed and signed by the property owner and returned to the agency responsible for isnbg.dw perwiL Notes A copy of dw", erV owner's* dWvI 'aa farm notRrFrilm , m other verrJreation acceptable to is . .aired to be presented when &9 Pgmgk is. iUWA to rer� the Pr'o owner's signature. n Signature of property owner, 7-,7 Date Note: Ilse following Authorization Form is ri equit ed to be completed by the proper. ty oar only K'hen, durbmaan an agent of the property owner to apply for a construction permit for the Owner -Builder - AUTHORIZATION (W AGENT TO ACT ON PROPERTY OW—M-9—R-1 F Excluding.the Notice to Property Owner, the execution of which I understand is my personal responsibility, I k%*y author the following persons} to act as my 4geogs) to apply for, sign, and file the documents necessar-Y to obtain an OWM-Buildt 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 perjurythat l am the property owner for the address listed above and I personally filled out the information and certify its accuracy. Note: A copy of the owner's driver's license, form notarization, or other verVicatio 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: Bin # Cky Of LQ Quinta Building 8L Safety. Division P.O. Box 1504, 78-495 Calle Tampico Building Permit ACA 92253 - (760) 777-7012 g Application and Tracking Sheet . Permit # Del Project Address: FJ z O z 1 S /� V 41;�A , R Owner's Name. © (� A. P. Number: Address:1411 ,VX]q Legal Description: City, ST, Zip:? 4. Tr+ g --I Contractor: Telephone - ' Address: Address: Project Description: City, ST, Zip: 'N� FL C) 6A Z Telephone: City Lic. 4-)Ij IrtAi -rzi i o State Lic. # : Arch., Engr., Designer: Address: City, ST, Zip: Telephone: State Lic. #: .w.',. '.:.. ; .�� "'' }>w; 3<>-:-.} : ,Construction Type: Occupancy: Project circle one): New Add'n Alter Re air Demo Name of Contact Person:Jrp (Jr� Sq. Ft.: # Stories: I #Units: Telephone # of Contact Person: 3 i L-4<) -OZ . Estimated Value of Project: 2-000, rU O APPLICANT: DO NOT WRITE BELOW THIS UNE N Submittal Req'd Rec'd TRACMG PERMIT FEES Plan Sets Plan Cheep submitted Item Amount Structural Calm 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 2'd Review, ready for correctionsfissue 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 correctionsfissue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees