12-1286 (ELEC)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:12Z O'OOs0:128°6
Property Address: 53585P:V NIDA RAMIREZ
APN: 773-125-017-5 -000000-
Application description: ELECTRICAL
Property Zoning: COVE RESIDENTIAL
Application valuation: 60
T4ht 4 4 Q"
Applicant: Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
SERRANO JUAN J
51585 AVENIDA RAMIREZ
LA QUINTA, CA 92253
Contractor:
Owner
VOICE- 012
FAX ) 777 011
INSPECTIONS (7 -7153
Date: 10/29/12
LICENSED CONTRACTOR'S -DECLARATION - -
WORKER'S COMPENSATION DECLARATION
I hereby _affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
I hereby affirm under penalty of perjury one of the following declarations: -
Section•7000) of Division 3 of the Business and Professionals Code; and my License'is in full force and effect.
_ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: License No.:
for, by Section 3700 of the labor Code; for the performance of the work for which this permit is
Date: .Contractor: -'
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 workerscompensation
' OWNER -BUILDER DECLARATION
insurance carrier and policy number are:
I hereby affirm'unde'r penalty of.perjury that I am exempt from the Contractor's State License Law for the -
Carrier Policy Number
following. reason ISec.;7031.5, Business and Professioris'Code: Any city or county that requires a permit to
certify that, in the performance of the work for which this permit is issued, I shall not employ any
construct, alter, improve, demolish,.or. repair any structure prior ti'its issuance, also requires the applicant for the
- : person in any manner so as to become subject to the workers' compensation laws of California, .,
permit to file a signed'ststement that he or she is.licensed. pursuant to the.provisions:of. the Contractor's State
. �. and agree that, if I should become subje.ct*t he workers' compensation provisions of Section
License Law (Chapter 9 (comrriencing:with;Section 7000) of Division 3 of the Business'and Profession s'Code) or
3700:of the Labor Code, shall forthwith mply with those pro isv ions.
that he,or she is exempt therefrom and the basis for the alleged exemption:. Any violation of.Section •7031 .5. b'y
anapplicant for a permit subjects the applicant to a civil penalty'of not more than five hundred:dollars ($500)•:.
as owner of the property,'or my employees with wages as their sole compensation, will do the -work, and.
te: l 2 - �� pplicant:
the structure is not intended or offered for sale,(Sec. 7044, Business and'Piofessions Code: The
WARNING: FAILURE TO SEC/WORKERS' PENSATION.COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License -Law does not apply to an owner of property who builds'or improves thereon,
SUBJECT AN EMPLOYER -TO CRIMINAL PENA TIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND .
and who does the work himself or herself through his orher own employees, provided that'the
.DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended'or offered for sale. If, however, the building or improvement.is sold within
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
one year of completion; the owner -buil der.will have the burden.of proving that he or -she did not build or
•
improve for the purpose of sale.). :
'� . APPLICANT ACKNOWLEDGEMENT
1 1 I, as owner of the property, am'exclusivelycontracting with licensed contractors to construct the project (Sec.
IMPORTANT Application is hereby made to the'Director of Building and Safetyfor a permit subject to the
' 7044; Business and Professions Code: The Contractors' State License Law does not apply to an owner of.
conditions and restrictions set forth on this application.
' property .%Aiho.builds or improves thereon, and who contracts for the projects with a cbntractor(s) licensed
1 . Each person upon whose behalf this application, is made, each person at whose request and for
pursuant to the Contractors'. State License Law.).
whose benefit'work is performed under or pursuant to any permit issued as a result of this application,
1 _ 1 I am exempt under Sec. BAP.C. for this reason
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
/ Date:
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
CONST TION LENDING AGENCY
permit to cancellation.
1 hereby affirm under penalty,of perjury that there is a construction lending agency for the performance of the
I certify that I have read this application and state that the above information'is correct. I agree to comply with all
.,work forwhichthis permit is issued (Sec. 3097, Civ. C.).
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
Lender's Name:
�)
of -this county to enter upon,the above-mentioned property for inspectio urposes.
ate: 1119/;_?2/&Si2rrI5ture (Applicant or Agentl: C7"�
Lender's Address:
LQPERMIT
Application Number . . . . . 12-00001286
Permit
ELEC-MISCELLANEOUS
Additional desc .
.
Permit Fee . . .
. 15.75 Plan Check Fee
3.94
Issue Date . . .
. Valuation . . .
. 0
Expiration Date .
. 4/27/13
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 .7500 PER ELEC DEVICE/FIXTURE 1ST 20
.75
----------------------------------------------------------------------------
Special Notes and
Comments
ELECTRICAL PERMIT
FOR J -BOX FOR FUTURE
CEILING FAN AT PERMITTED PATIO COVER.
2010 CODES.
----------------------------------------------------------------------------
Other Fees . . .
. . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary
-----------------
Charged Paid Credited
----------------------------------------
Due
Permit Fee Total
15.75 .00 .00
15.75
Plan Check Total
3.94 .00 .00
3.94
Other Fee Total
1.00 .00 .00
1.00
Grand Total
20.69 .00 .00
20.69
LQPERMIT
i
IV
P.O. 13OX 1504
LA QUINTA, CALIFORNIA 92247-1504
78-495.CA'LLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Bu1LDING & SAFETY DEPARTMENT
PROPERTY OWNER'S. PACKAGE
(760) 777-7012
FAX (7.60) 777-7011
Disclosures & Forms .for Owner=Bnllders Applying for. Construction Permits
t'�Itf�ti�NP _NOTICF TO PROPIR ,TY OwNvu.
Dear Property Owner.
An. application .for a building permit has been. submitted in your name listing yourself as the builder of the property
improvements specified at
resare Providing you. with an Owner -Builder Acknswiedgment=and Infotmatien Verification Form to make you aware of your
r poesrbiWies and Possible risk.you may incur by havrrg`tbfspern4it.issued mi your name as'the
Owner -Builder. We wi!! not issue a,tiuiiding permit until.you-bave,r'eaA,,inft akd your uhderstanding of each provision,
signed; and returned this form to us. at our otTicial ,address- ndicated.'An agent of the owner cannot execute this notice
unless you, the property owner, obtain theprior approval ofthe permitting authority_
• t rwLEM- IVIMNT AND VERMCATION' OF IZWQ AIWN
Read and irritial eaieh: statement bp&w tg si
gnif + you tihdersiirnd or verify '!Iris information.
1. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Buildee'
building permit that erroneously implies that the Property.owner is:providing:his or her own labor and material personalty. 1, as
an Owner -Builder, may be held liable and.subject40 serious financial risk for any injuries sustained by an unlicensed person
and his or her employees while working on my Property. 'My homeowner's .insurancemay not provide coverage for those
injuries. I am willfully acting as an Dwnei=Builder"and am aware of the I.units of my insurance coverage for injuries to workers
on my Ply- .
2. 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. I understand as an "Owner -Builder" 1am the responsible party, of record on the permit. I understand that 1 may protect
myself potential financial, risk by hiring a licensed Con
tractor and having the pernmit filed in his .or her name instead of
�4. 1 understand Contractors,are required by law to be licensed and bonded in California and to list their license numbers on
permits and contracts.
5. 1 understand if 1 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. '
6. 1 understand if I am considered an ."employer". under state and federal law, 1 must register with the state and federal
government, withhold payroll taxes, provide workers' compensation, disability insurance, and contribute to unemployment
compensation for each "employee." 1 also unders
risk. tand .my failure to abide by these laws may subject me to serious financial
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 calendar year, or all of the work is performed
under contract with a'licensed general building Contractor.
8: 1 understand as an Owner -Builder if I sell the property for which this permit is issued, 1 may be held liable for the
any
financial or personal. Ovaries sus�iaed byowner(s)enY subsequent owner(s) that result from any
filatent construction defects in
worlumanshlp or materials.
mp from the 11'Revtnas
9. 1 understand 1 may obtain,more information regarding my obligations as an "e lover" ts, and the Califortria
Service, the United States. Small Business Administration, the California Department of Benefit License
Division of Industrial Accidents. I also undersiand I may contact the California -Contractors' State License Board (CLI at 1-
800-321-CSLB (2752) or www:cslb.ca_gov for more information about licensed contractors.
10. 1 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I the
d y responsibr pr
construction activi at the
I
following address:
le
P SI/sal and financs A l/ ki ,rt I - , ; n a Glc
y nsible for this construction activity,.I will abide by all
A11. 1 agree that, as the party legally and financial) respo Proposed
appcable laws and requirements that govern Owner -Builders as well.as employers.
deletionx, or changes to 8°y of the informalkm I
12. 1 agree to notify the issuer of this form immediately of.aay additions; blit• If you contract with
have provided on this form_ Licensed contractors are regulated. by laws designed to protect the pu �� any loss
someone who does not have a tkAM e, the Contractors' State License Bowd may be unable to assist you
you may sustain as a result of a complaint Your only remedy against unlicensed Contractors may be in:6vd cowl. It is also
for to understand that if an unhocused Contractor or employee of that ir►dividual or firm is injured while 1°�
on� operty, you may be held hab�for'damages. iff-you obtain a permi
t as Owner-13uilder and wish to ,
you will be responorliles for`ver�ing :or not those Couuactors are'
property licemed and the status
compensation' imvranoe 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 iss�g: p
Wit. Nese: A copy of d" prop" owns 's driver's I f or
other verification acceptable to the agency is required ,fe 'be preszsaed when tke permit is iss+reh AO verify �
owner's signature.
Signature of property owner
f � Date: D Lz /2
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 Ov % er-Builder.
AUTHORI7.ATION OF AGENT TO ACT- ON .PROPERTY OWNER'S BE�i,reby authorize
Excluding the Notice to, Property Owner, the execution of which l understand is my personal re"sponsilulity,
the following persons) to act as' my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner -Builder
Permit for my project.
Scope of construction Project (or Description of Work):
Project Location or Address:
Name of Authorized
I personally filled out the abo
notarization, or other verification
theproperty owner's signature_
Bin. #
Perinit #
Crty of La Quinta
Bui1c(1ng.8t Safety Division
P.O. Box; t 504; '-78-495 Calle Tampico
La.Quintav -A 92253 -:(760)777V012
Building •Permrt Application and Tracking Sheet
Project.Address: ' , j
Owner's Name:. SAGA
A. P. Number:
Cry
Address: VQ - ` f
Legal Description:
Contractor.
City, ST, Zip: LCL CA
Telephone
Address:
Project Description:
City, ST, Zip: Lq A ` ^ pp
er 1+ FB 1' c, I
Telephone:
": M Err
f`I;�FIW
i
of
State Lic. # :
City Lic N;
�1C
Arch., Engr., Designer
Address:
City, ST, Zip:
Telephone:
State Lic. #: u :
Name of Contact Person:
Construction Type:. Occupancy:
'Project type (circle one): New . kdd'n. Alter Repair Demo
Sq. Ft.;
#Stories:
#units:
Telephone # of Contact Pelson: O. 'to 0— 3
Estimated Value of Project
APPLIdAM: DO NOT.WRITE°BELOW THIS :UNE:;.;•
N
Submittal
Req'd
Recd
TRACT ING
PERMIT FEES
Plan Sets
Plan Check submitted
Item Amount.
Structural Cales.
Reviewed, ready for corrections
Plan Check Deposit. .
Trus Calcs.
Called Contact Person
Plan Check Balance.
Title 14'Calcs.
Plans picked up
"Construction,
Flood plain plan
Plans resubmitted..
Mechauicil
Grading plan
1'' Review, ready for cgrrectionsfissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
-Plans picked up
H.O.A..ApprovA
Plans resdbmitted
Gradiog
AH HOUSE:
Revtew, ready for correetions;lmue
Developer Impact Fee
Planning Approval.
Called Contact Person
A.I.P.P.'
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees