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09-0366 (ELEC)s P.O. BOX 1504 VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT �_- Date: 4/23/09 Application Number: r09-00000366_ , Owner: Property Address: 1650 AVENIDA-"RUBIO DEBRE CARRILLO APN: 773-122-006-9 -000000- 81910 LUPIN PL Application description: ELECTRICAL LAGUNA BEACH, CA 92651 Property Zoning: COVE RESIDENTIAL ----------------------- ----- Application valuation: 500 App Contractor: APR J Applicant: Architect or Engineer: Owner CQVINTA ITY OF IA FINANCED El- --------------------------------- ----------------- 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.: 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 a y 9pplicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($5001.: () 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, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). (_ 1 I am exempt under Sec. , B.&P.C. for this reasya!2 _4�Z ate: `� Z ner.l v CONSTRUCTION LENDING AGENC 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 ----------------------------------------------- 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, 1 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 subje 4theorkers' compensation revisions of Section 37 0 of the Labor Co shall forth rt with those provisioate: Z pplicantWARNING: AILURE TO SECURE WORKERS' COMPENSOVERA NLAWFUL, 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 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 dr 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 buildin construction, and r y a rize representativ of�Coun�yupon theabve-mentionedpropertyoinspection pu oseD}gna a (Applicant or Agent): LQPERMIT Application Number 09-00000366 Permit . . . ELEC-MISCELLANEOUS Additional desc Permit Fee . . 18.75 Plan Check Fee 4.69 Issue Date Valuation . . . . 0 Expiration Date 10/20/09 Qty Unit Charge Per Extension BASE FEE . 15.00 5.00 .7500 PER ELEC DEVICE/FIXTURE 1ST 20 3.75 ---------------------------------------------------------------------------- Special Notes and Comments INSTALL 2 RECEPTACLES & 2 COLUMN LIGHTS --------------------------------------------- Other Fees . . . . ------------------------------- BLDG STDS ADMIN (SB1473) .1.00 Fee summary Charged --------------------------- ---------- Paid Credited -------------------- Due - Permit Fee Total 18.75 .00 .00 18.75 Plan Check Total 4.69 .00 .00 4.69 Other Fee Total 1.00 .00 .00 1.00 Grand Total 24.44 .00 .00. 24.44 Bin # City of La Quinta Building a Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # Project Address: 51-65'o Owner's Name:, X41 e f L10 A. P. Number: Address: Legal Description: City, ST, Zip: Contractor: J Telephone: Address: Project Description:%ico� iQA, City, ST, Zip: Telephone: State Lic. # : City Lic. #: _ �� ✓� ��o . Arch., Engr., Designer: BGG v Address: y /D . C rd � City, ST, Zip: Telephone: Construction Type: Occupancy: State Lic. #: Project type (circle one): New Add'n Alter Repair Demo Name of Contact Person:��� Z Sq. Ft.. # Stories: #Units: Telephone # of Contact Person: z$p CV,36 3 Estimated Value of Projec : ®©g APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd- - Ret'd... TRACKING PERMIT.FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Energy Calcs. Plans picked up Construction . Flood plain plan Plans resubmitted Mechanical Grading plan 2" 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 corrections/issue Developer Impact Fee Planning Approval Called Contact Person Pub. Wks. Appr Date of permit issue School Fees LTotalPermit Fees 04/22/2009 09:31 04/22/2009 08:42 714-896-7180- 7607777011 14-896-7180 7607777011 P.O. Box 1504 DV COURT LA QUINTA BLDG DEPT LA QUINTA, CALIFORNIA 92247-I504 78.495 CALLC TAMPICO LA QUINTA, CALIFORNIA 922.53 PAGE 02/04 PAGE 04/05 I$UILDING & SAFETY !JePARTMFNT P0aaea� OWNERS PACKAGE (760) 777.7012 FAX (760) 777-7011 Disclosures & Forms for awnear-BuRd+ers Applying for Construction Permits LMPOR?'A +�' 1 i0'I TCp' 't'a PROPE�� Dear Property Owner. An application for a building permit has been Aubmitted in your name 1 tiingf as the builder of the property improvenaettts ,veci£eed at We are providing you vhtA at —Owner -Builder Aeknowledgramt and information Vari6cationi Form to make y u. aware of your responsibilities and possible risk you MY iticur by having this pest issued in. your name as the CKMer-Builder. We will not itsite a building permflt until you have read, initialed your understanding of each p"visipn, signed, and returned this form to ns at onr ofii kk address indicated. Am agent of the owner cannot execute this notice unless you, the pimperty owner, obtain the peiot approval of the permitting authority. Dbt.F'CTIONS, Read and btitial each statement below to sigl *You undemmnd or this it fornra6on. 1p 1. I understand a ffequerit Practice of unlicensed pet'soma is to have lite pmpetty owner obtain an "Owner*Braider" building permit that et"Acously implies that the property owner is providing his or her own labor and material personally. 1, m an Owner Buildat, May be held liable and subject to serous fittattoiai rink for any injuries sustained by an unlicensed person and hL9 or her eritployees while worsting on my property, My homeowner's insurance may not provide coverage for thane injuries. t ami willfully acting as an Ow w -Builder and am aware of the limits of my insurance coverage for tnjurios to workers on my lroperty, 'L2. I understand building permits are not required to be signed by property owners unless they etre mspontsible for the construction and an not hiring a licemed Contractor to assume this responsibility, Y-3. I >%tdeistmd as an'"Owner builder" I am *M responsible party of rneord on tate permit. I understated that.I may protect myself from potential f =cial risk by hiring a ticonsed Contractor and having the permit filed in hL4 or her Mane instead of my own. 4. I understand Contractors are required by law to be licenced and bonded in California and to list their license numban on permits and contracts. S. I undcrstaod if I employ or otherwise engage any petsom, ether than California lieemxd Contractors, and the total value Of my cOmIrUctiort is at least five hundred dollars ($500), including labor and materials, I may be considered an "employaef under stage and federal law. `1-=6 1 understand if I am comiderod an ,employer" under state and Federal law, I ,mast register with the state and federal Bove mnent, withhold payroll Mxz, puede "Amrs' vompensation disability insuramm and contribute to unemployment cptUperesation for each "employee., I also utldmtaad my Mure to abide by these laws may subject arta to serious financial risk, �7. 1 understand under California Coruractors+ State License Law, an Dv+rrerrBuilder who builds single-family residcntial subcontractors and th structures cannot ithe eln build thorn wi$1 the - 'arena to offer them for sale, unless all work is performed by Hocase4 number of atxuctures does aot exceed faro within any calendar year, or all of tiro work is performed tinder eonaact with a Ucemed general building Contracwt. 04/22/2009 09:31 714-896-7180 DV COURT PAGE 03/04 04/22/2009 08:42 7607777011 LA QUINTA BLDG DEPT PAGE; 05/05 undemna as an Gamer -Bander if l Sall the Prapetty fbr w%cb this permit In issued, I rasp, be hold liable for any financial or personal bjurim augsed, by �y subsequent owner(a) that result f MM airy latent cOnstruetion dotbets is the WOMananship or rnaterials. 9�_09. 1 understand I may obtain more infetmation regarding nay obligations as an -employer from the Internal Revrnwe Sft-"ce, the United States Small Bwfiness Administtatien, the CafifwWa artmettr o Division of Industrial Accideeta, I also understand I teas contact the California torsS� %gB Cee guard (CSLI� atk- 800-3x1 •CSLB (2752) or www.cslb.ea hov for mare 'May about lice med contractors, �10. I am aware of and cOMeM to eat Owner -Builder building permit applied for is my Brune, and tm& stand that I am the PAY legally and Qciai►y rorrable for propos, construction activity at the follewirtg address; .J� 11. i egret that, ws the par(y 1¢gaally sad futaecial(y responsible for this proposed constsu tion9 tivity I will abide by all applicable laws and requirements that govetu Ownet'auilders as weft as employen. 12. I agree to notify the imuer of this. ferry iMMIdiatbely of any additionsj deletions, or changes to any of the inforoyatioa have provided on this form_ I.ieerrsed eotttaraetora are regulated by laws desigttod to protect the public_ If you contact with SOMeOM whadoes trot have a licensk the Contraotm, State Liaeme Bow may be unable to assist you with any 13oatteial loss you may susutirt as a rmult of a oomplaint Your Only t, m9dY againn w icensed Contractors may be is civil court It is Zao important for yon to undetitand that if an unliceaeed Contractor or eMloyee of that individual or, �utm is injutoci while wetlting cm Your prope*,' you may be hold liable for damages. If you Obtain a pvm* as Owner- Builder grid wish to bine Cot wattaing you wilt be raspottsible for veti�yiag whether or not those Contractors are properly Ficensed and the status of their tract s' compensation indt Mce coVeMp, Before s btdlding peradt can bQ issued, Lith form must be completed aadSigned by the property owner and returned to the agetacy t'espanslble for lS oing ffie pmt. Neer: A copy o, ke prop" owner's driver's eve aRv Vfker verifccWOM aeeepltilrfe m d o agency ss required ro be premv4d when the permit is algsrced�tkr& mt t&� ar owner's sign azure. pi'Dp� Y Sigawtuse of property OWner Date: a2 207 Note; ne follow%g, th0f*dfibn Form is required to be completed by the property owner only when 10*ating an agent afahe propsrty owner to apply fora eorrstruedvn.permr!t, for the Owne"udder. l c ..__ a�vau.�. AV - . ludic be otrtn(Pr lb operty Ownc> er, the <tieqution. of whicb I understand is m the following persons) to act as Y personal fbr toY pK+3eCt nx y Agent(a) to apply for, sign, WW file the docum eces Scope of Construction Project (of Desmrofion of Work): ��✓/ t� t�7 (' Project Location or Address: .zU rA ospons�bility, i hereby authorize ry to obtain art 0"cr_3ailder Naoxe of Authorized Agent. ()k f �X 1,I.m %Z Tei No Address of Authorized Agent: I declare under penalty of perjury that I Sara the pnopertY OWAer for the addt^eas listed above and I informdon and certify its accuracy. �Nete. A cop} ojtke aw►ter's drit+er's Idcertse, persotraily filled out the above acceptable to ore agency f,t required to t e precvpl d wkera faire r'T drit a l7 *e to >� twimlim or otherr veriicadorr * propeny ower s signature. Property Owner's 7 � ., q Date:. pLp( �-C J -57 c7 v r ' OOTL S 1-o is Ks (Typ PC SC 4 co ,ND v IT— d8 127wlp Of r �e ��i2FD 76 d3 rb Roo OF t.AQUINTA LT BU DING ' AOPROVED FOR CONSTRUCTIO DA 3 BY 1