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BSPN2014-004478-495 CALLETAMPICO, r LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application Description: Property Zoning: Application Valuation: Applicant: MAUREEN BYRNE 78100 MAIN ST #108 LA QUINTA, CA 92253 BSPN2014-0044 60950 LAGO CT CT 764450030 NON -PERMITTED BBQ AND V el� VOICE (760) 777-7125 FAX (760) 777-7011 COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 12/23/2014 Uu Owner: -DAVID K ELM BEr GAS LINE CITY OF LA Q'JIN' r^A J COMMUNITY D EVELOPhgENTDEPpRTMENT 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 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.). (__j 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 Lender's Address: Contractor: Llc. No.: 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:_ Polity 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. 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 Building Official for a permit subject to the conditions and restrictions set forthon 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. 11 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 represents 'ves of this city to enter upon the above- mentioned property for inspection purpose D e: Signature ( ` plicant n t): sierra dist 604-888-0271 p.4 P.U. -BOX. 1504 LA QUINTA, CALIFORNIA- 92247--1504 BuiLU1NG & SAFELY DEPARTMENT 78-495 CALLS TAMPICO (760) 777-702 LA.QUINTA, CALIFORNIA 92253 FAX (760) 777-7011 PROPERTYACKAGE Disclosures eke Forms for Owner-Buiidersi. A"Iyb j €or Const mctian Pormift .AIIdMUff,_{ , QT10E TO PE2(iAFE T- V O@yNER -.Dear Ptoperty Owner .Ara.:aWfication for a buditg permit Las' -been .submitted. in your name listing yourself as the builder of the-,ptoperty impr*. ements specified at ropvro aredmg you with 3Q Owner-Ruildcr AdmovAedgrnent•and h&=aUou' ecifeabm Form to make your awm.of your. respusibilities and Irossible risk -you may incur by -having drispernrit•isstied• ig xourrname as the OwnesrBuildeL -Wi W% not isms a buitditig•permit Rad-yOWhave read, initialed: yow understanding .of eaeh: prwAsion, signed, and returned this form to us at our o>i^iieiat address indicated. An agent of the owner caunat execute- tt a notice unless you, the property owner, obtain the prior approval of the peamittirrg authority_ :. Q ' AC WLMWA +, r A1'fD'�E 1�TrCi��if��i ©F II� hT�i ARWMIYS. Read and nrrtaad etxek sraterrterrt bellow ee�si� mor, gru�y you uruierstand'or L I understand a frequent practice of unlicensed persons B to have the property owner obtain an "Owner-Ba1W' building permit•t6at erroneously implies that the praperty owner is providing his or her own labor and materW personaii j .1, as an Owner -Builder, may be held liable and subject to serious. financiat' risk for any injuries sustained by an unlicensed person: and his or her employees white worlang on my pmpem, hqy homeowner's insurance may not provide coverage .for those injuries. [.am willfully acting as.an Owner -Budder and 8m aware of the limits of my insurance coverage for injuries to wodcers P�'L2. I understand building pen*ts are not required to be signed by property owners unless they are responsible for the construction and m. l.iot.hiring a licensed Contractor .to assume this r+espensibility. . �. I.uurlierstaad as an "Owner-Bnildex" Iam,tiie tesponstt party of mcord ou the Hermit I understand that Limey protect myself from potential financial r7isk by hiring a licensed Contractor and having the permit fled in his or her name instead of my own - 4. t trehderstanel Contractors are required by law to be licensed and bonded in California and to list their license n9mbers on permits and contracts. . [understand if i employ or otl►erwiiae engage any getsana; other t#tan Calsfottua hmsed Contractors, anis Alit total value Of my construction is at least five hundred dollars' ($Soo), including labor and materials, t may be considered an "employer" under slate and federal taw. Q 6, i',understand if I am considered an "emptoyee, under state and federal Iaw, I mast register with. the state and federal .99Y t,, withhold payroll taxes,• provide workers' compensaRien disability insurance, and' corizute m unetirployment . compensation for each "employee." r also understand my failure to abide by drese laws may. subject me to serious financial risk: 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 suYP!Dnh•aetors and the number of structures does -not exceed lour* within any caieudar.year, .or 411 of the vmrk is performed grid®r contract with a licensed general buitd* Contracwt. sierra dist 604-888-0271 p.5 i I understand ae.an Owner -Budder if I.sell the property for which this permit is'issued, I may be held. liable for any financial or personal_ k9arics: sustained by.>ffiy .subsequent ownCE(s) diirresalt from -my latent constructirm defects in the worbnandip or mateiimb. Q •� _9. I understand I obtain more informmation may regarding my obligations as an "empioyet?' from the Intemal Rs+renrse ' Service, the United States SmallBusiness. Administration, the California DepattDaeat of -Benefit Paytneiits, amd.tha tyalifursia Division of industrial Accidents. I also understand I may contact the California Contractors' State License Board (CM.9) at 1- 800-321=CSLB (2752) or www cslb_ra.gov for more information about licensed contractors. toss. � 0. I am aware of and consent to an, Owner -Builder building permit applied for m my name, and' understand that I am the party legally and 4manciu4iy resporisfbEc . -foE .proposed Fonshuction activity. at t)me following address: i 1I. I• agree that. -as the party legally and frin4nzi4liy responsible for this pr+opossed.00nskucoon activity,.1 will• abide by all f appliicable l6a and reguifeWnts that govWn Owner guilders as -well as employe x,12.1 agree to notify the issuer of this form immediately of additions; det'gwnx, . At. des to any of the btfcmatibe I have provided on this form. Licensed contractors are.regulated by laws designed to protect the public. If you contract with someorte who does not ba've a hcqnse> the Contractors' -State License Hoard sray be unable to -assist you witty any Snaudd loss . . you may sustain as a result of a com&int. Your onl}i remedy against unlicensed Cor tractors gray be in,cAvii- cdrrrt It ig-.aho iatpwtamfaryou-toiruderstaoddw-ifarttulticerrsed.Cflmractororeatpioyeeofthat'irr(fividWoffirnnuinjured Wbitewoddag j on your proPertY' you way be held. Rabat~ f9r-da mages: If you obtain a permit • as Owner -Builder and wish to bm Contractors, -you wilt' be.reWonsrble for verifying .%hetEff osnot those Contractors are prtmperly-licensed and the status of their worriers' cowpeasation-inmmnoe Overage. i Before a baikUng permit can be hwA this%rm mast be completed and signed by the property owner and returned to the agency responsible for:isnb&%a.V=adt. Note: A ca - other ve ' • . 8y of � t��� ox+� s 'J'cmss, fez~itt neta+4 or rc�rcation accept" las the ggeney is'.regrciied, to die presented whey{ tke pei�ririt fs sSsue to rerijtp:thir.tt+operty, owner's signature.a %� r Signature of pro re Afore The following Au6orLatron Form is reviired to be completed by the prroperay owner only when designating an agent ofthe property oumr to apply for a consbwlion permit for the Ommr. Builder Excluding. tie Notire to Property Owner..the rrrceqution of which F underataud is my personal respcm lhdity, I be�liy authorize the following person(s) to act asmy agent(&) to: apply for, sign, and file�the documents nacessm' ; to cUaia as 0woex-Buit* . Permit for my project { Scope of Construction Project (or Description of Work)_ Project Location or Address. Dame of Authorized Agent / --5_6 7 -'5-4;97 . Address of Authorized Agent. I declare undea penalty of perjury that I am the property owner fdr the address listed above and I personally filled out the above i infoirnatioa and cerrtify its accuracy. Note: cony of the owner's driver's tteense, farm hotariza{ttorr..or other verification j acceptable, to the agency is required"Io be prrserrted when. the permit is issued to vmez fy the property owner's sigsiature - Properly Owner's Sigoateue: �_ Date: Description: NON -PERMITTED BBQ AND GAS LINE NAME ADDRESSI Type: SPECIAL INSPECTION Subtype: Status: UNDER REVIEW Applied: 12/23/2014 MFA Approved: Parcel No: 764450030 Site Address: 60950 LAGO CT CT LA QUINTA CA 92253 Subdivision: TR 30023-4 Block: Lot: 91 Issued: Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $0.00 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites' 0 Details: NON -PERMITTED BBQ AND GAS LINE DESCRIPTION NAM E"E'j NAME ADDRESSI ADDITIONAL CHRONOLOGY CONDITIONS CITY STATE ZIP PHONE FAX EMAIL APPLICANT MAUREEN BYRNE 78100 MAIN ST #108 LA QUINTA CA 92253 (604857-0400 OWNER DAVID KELM ALDERGROVE BC CANADA V4W M1 92253 (604)857-0400 DESCRIPTION ACCOUNT QTY FINANCIAL AMOUNT . INFORMATION PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY CLTD BY SPECIAL INSPECTION 101-0000-42404 1 $72.52 $72.52 12/23/14 R3275 4885 CHECK ' MAUREEN BYRNE MFA Total Paid forCOMPLIANCE SURVEY/SPECIAL INSPECTION: TOTALS: $72.52 $72.52 $72.52 $72.52 Printed: Tuesday, December 23, 2014 11:04:29 AM 1 of 2 �bl Li SYS7�MS IPARENT PROJECTS BOND INFORMATION ATTACHMENTS Printed: Tuesday, December 23, 2014 11:04:29 AM 2 of 2 C1?G7L7 St tiTE1A5 sierra dist 604-888-0271 p.3 City. of La Quifhta BLdIfflog 8r Saky Division P.O. Box 1504,*78-495 Calle Tamplo LR.Qufnta, CA 92253 - (760) 777-7012 Biding Permit Aiplicadon'and Tracking Sheet r; I "ROMIR, suhimlew Rwd Ad&c= PERMU FM City. ST, Zip: Plan seb Tekphomc: Stoic Lie. M Ram iAlamo ofContact Person: A - Sq- I a StDiC'*S. Ft: 0 unit;: jTc1cpb.,,A,fC-,WPcm, EStiMdc4Valise QfProject City LI, I, Arch, Engr, Desiper. suhimlew Rwd Ad&c= PERMU FM City. ST, Zip: Plan seb Tekphomc: Stoic Lie. M Construction Type Occupancy: Project WK (circle o*: 1kw Add'n. Alter Repair Demo iAlamo ofContact Person: A - Sq- I a StDiC'*S. Ft: 0 unit;: jTc1cpb.,,A,fC-,WPcm, EStiMdc4Valise QfProject APPLICANT: DO NOT WRITE BELOW THIS UNE to suhimlew Rwd Rev'd TRACKING PERMU FM Plan seb Plan Check submitted itun Amoun't, Stroicaural[Cases. Reviewed', ready for car rwAous Phu Check Deposit. Tress Cates. Called Contact Person Plan Chock 13alana_ Met 24 Calci. PIMM pickid up Cmatracdon Hood plain PUM Plans rembuimed.'. Mecharifcal Gi*adba plan V Review, r=dY for correcUmarmue Electrical Subcoutactor List Called Contact Perm plambi 119 Grant Deed Plans picked up SM.L ILOA. kwmd Phu TVA&vnftd Gaadtttg IN ROUM. k'llkview, =4 for rorrtellons/imc, Developer Impact Fee Plauslug Approval. Called Contact Person A.I.P.P. Pub. Tnw. Appr Date of permit Issue Schad Fees Total Permit Fees; sierra dist 604-888-0271 p.2 I � I• -�Ell" � I I COVEREDt•T .. .o�tyc--.:3 ' - COVERL-O PA5 `, `}-•�: i"" -�� , ' i "� PATIO _ a _...i NOO^ MASTER sti !— 7 I I e KMT tC(�HEN fl! BA -H n IIIGREA7 Ej - ROOM { �•.� DINING 3�1 ROOM � ` h• v- E ��' v` a 1 GUEST H3 t LAUNp p l L `� ]-CAA GARAGE 1r y i:``l c- E GUEST { � �r•� I kiTTE. uj ______ I K.CAR