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BELC2015-006778-495 CALLE TAMPICO ' LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application Description: Property Zoning: Application Valuation: Applicant: JOANN MILLER 51600 AVENIDA RAMIREZ LA QUINTA, CA 92253 _arw COMMUNITY DEVELOPMENT DEPARTMENT BUILDING PERMIT BELC2015-0067 51600 AVENIDA RAMIREZ 773131006 MILLER JOANNA. ELECTRICAL PANEL CHANGE OUT $1,000.00 IIo1.� JULJ-AUG-20 20,15 CITYOFLA Q(JINTA COMMUNITY DEVELOPMENT DEPARTMENT VOICE (760) 77777125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 8/20/2015 Owner: JOANN MILLER 51600 AVENIDA RAMIREZ LA QUINTA, CA 92253 Contractor: JOANN MILLER 51600 AVENIDA RAMIREZ LA QUINTA, CA 92253 (760)641-1336 Llc. No.::CONV:140528101254098171 LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that) am licensed under provisions of Chapter I hereb affirm under penalty of perjury one of the following declarations: 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, I have and will maintain.a certificate of consent to self -insure for workers' and my License is in full force and effect. com s tion, as providedifor by Section 3700 of the Labor Code, for the performance License Class: License No.::CONV:140528101254098171 of the work for which this permit is issued. I have and will _maintain workers' compensation insurance, as required by Date: Contractor: 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: OWNER -BUILDER DECLARATION Carrier: _ Policy Number: I hereby affirm under penalty of perjury that I'am exempt from the Contractor's State I certify that in the performance of the work for which this permit is issued, I License Law for the following reason.(Sec. 7031.5, Business and Professions Code: Any shall not employ any person in'any manner so as to become subject to the workers' city or county that requires a permit to construct, alter, improve, demolish, or repair compensation laws of California, and agree that, if I should become subject to the any structure, prior to its issuance, also requires the applicant for the permit to file a workers' compensation provisions of Section 3700 of the Labor Code I shall forthwith signed statement that he or she is licensed pursuant to the`provisions of the comply with those provisions. Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Divisiciri 3 of the Business and Professions Code) or that he or she is exempt therefrom and the Da Applicant: AAAL' basis for the alleged exemption. Any violation of Section 7031.5•by any applicant for permit subjects the applicant to a civil penalty.of not more than five hundred dollars WARNING: FAILURE TO SECURE WORKERS' CO ENSATION COVERAGE IS UNLAWFUL, ($500).: AND SHALL SUBJECT AN EMPLOYER TO CRI AL PENALTIES AND CIVIL FINES UP TO (_) 1, as owner of the property, or my employees with wages as their sole ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF compensation, will do the work, and the structure is not intended or offered for sale. COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not INTEREST, AND ATTORNEY'S FEES. 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 APPLICANT ACKNOWLEDGEMENT are not intended or offered for sale. If; however, the building or improvement is sold IMPORTANT: Application is hereby made to the Building Official for a permit subject to within one year of completion, the owner -builder will have the burden of proving that the conditions and restrictions set forth on this application. h r she did not build or improve for" the purpose.of sale.).. 1. Each person upon whose behalf this application is made, each person at whose as owner of the property, am:exclusively contracting with licensed contractors request and for whose benefit work is performed under or pursuant to any permit onstruct the project. (Sec. 7044, Business and Professions Code: The Contractors' issued as a result of this application , the owner, and the applicant, each agrees to, and ate License Law does not apply to an owner of'property who builds or improves shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and thereon, and who contracts for -the projects with a contractors) licensed pursuant to . employees for any act or omission related to the work being performed under or the Contractors' State License Law.). following issuance of this permit. (� I am exempt under Sec. . B.&P.C. for this reason. 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. D te: Owner: I certify that I have read this application and state that the above information is correct. CONSTRUCTION ENDING AGENCY . I agree to comply with all city and county ordinances and state elating to building I hereby affirm under penalty of perjury that there is a construction lending agency for construction, and hereby authorize representatives of this city to e9tt�r�up a above the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). i mentiongd property for inspection purposes. r J �� Lender's Name Lender's Signature (Applicant or R."x^T E� ( f�+`'t siiA : " 4'� ,-'i:E,': -= ar ��- "� -�,1� '3'`x.7 r�'t a tir -'' �`Et k � sY ; • $C DESCRIPTION" Yr ACCOUNT ' " QTSY� � AINIOUNT �� P{A_ID % MN't"m f4��-'x'xTSaN'ai x? D�P BSAS SB1473FEE101 0000=20306 0 $1 00'" $0.00 ayNXgar ,, e f x va.a,;:u :, *..,..c a Irv° # " n. N PAIDiBY':.:� i_� METHODS £ RECEIPT{#fit [ + CHECK #.. CLTU BYr .._ , x...: >s, _; o.:.s.,x _. .:�. ,,.. ,� : _.y__ saw .w _ Total Paid. forBUILDING'STANDARDS ADMINISTRATION BSA:.. •, $1:00 ;, $0.00 z 'E .. : k ' :.. • , ' p �v:.f" �z�&W,44"�' `E� a' y" "�, it Ism��::DESCRIPTION4 �z 5 .ris�_. iH °a4 ��.. R. �`;r ` ", :< i, 'i '� �H:s d .:p ACCOUNT�Y ...:.:. f , : "`, ,'".1'Ki-+'f� A"•h'S,!3vx'ire AMOUNT ? _ �.? * -x,. PAID ' kx.tr idP+�x....c -:... PAID=Di4TE xtii,.0 ii .Am -1 . POWER APPARATUS 101.000.0-42403 0 ' $24 17 $0.00 t �RAiIDBYlk �III.,, ..:<:.�4 VINz m, ✓ 3:fi3 x x�METHOD,im 'rax.;n�a tip.�'RECE$IP.T#CHECK# x,u, .. -e: h:,, ... `,'r^;' r �.. -,'r" ff:`..Yo-�'a"5,mX'' a i`"�"''r4`Tb ��CLTDBY i b .,..__ ipQ'°e:'..,{.:'•'i� I DESCRIPTION * '�. Aefi`x Rtiii:;�".;! sf,:: :C., «.<. b,i'' :+i?a 'F =:]1< ;'��` -��ACGOUNT� :`'" "� � .'d'!. �'Y.','�.V:%�i PMCT:i:.<:<S'A�7d9h+C �'�.-7��z d'..�1,§?4 .QTY6.1-N �ANIOUNT �� .�R..r ,_.34:4{4.`•�^Na:. ,: S:: z��E�''.: ��PAID r �� P.AID'DATE POWER APPARATMPC 101 0000=42600.' • 0. $24.17 $0.00 C .:x �- PAID: BY -41W :'��'. ..G-' ".:✓° �'4iki"-. . xix°: METHODe�RECEIPTs#'��CFiECK'#' _'Yn..3°a`ai.».e.': at'$1dt b✓'}.._. 7Ei .3:1 4rFi' �CLTD BY: Total Paid; for ELECTRICAL: $48.3'4:' $0.00' a. a r as ti;;r .=Linz :,. F ? i vsY.•,Y 'II§ V �•�•..E.e �� r DESCRIPTION r x .:.:t h < is <. cy �ACCOUNT� � '� Yah" QTjy, y.fhX9„"ti.5i AMOUNT �i� �... M �a P� T �"x` C�...[ �� PAID AID DATE PERMIT ISSUANCE :, -101-:00004%,2404, 0 ' '. $91 85 is' $0.00 g v�T4'1TTa'MA,Kaf W %PAIDBY� ' :. SaY'4stw',W'it'f �:�..CfTS�a+n.s:S;i•..�ci vivosvT.C.m ..,?�,v `�vs=..fa,. `i�e?L'arotkY'�:L::. k. -{METHOD �,..'_.�i�S�=i. "'iaiti »..:u:ws-rvaa. .�"�,<(:. ,.x: ..".<v§W.$1:Sd`k� i�'17 :'A... `",Wxi F, RECEIPT #R .� 7?r>.h">SbxSY..Ei :§uM„S'`�'.'r 4YEi.s.f-L';53,•v!e''"Y,1C+..S.:t,Z �CHECK�# CLTD BYE; Total Paid for PERMIT ISSUANCE $085 $0.00 0 1 1 1 i Description: MILLER JOANNA ELECTRICAL PANEL CHANGE OUT Type: ELECTRICAL Subtype: Status: UNDER REVIEW Applied: 8/20/2015 PJU Approved: Parcel No: 773131006 Site Address: 51600 AVENIDA RAMIREZ LA QUINTA,CA 92253 Subdivision: SANTA CARMELITA VALE LA QUINTA Block: 54 Lot: 19 Issued: UNIT 5 Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $1,000.60 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0 APPLICANT Details: REPLACE ELECTRICAL PANEL CHANGE OUT 100 AMP TO 200 AMP PER 2013CALIFORNIA ELECTRICAL CODE. ADDITIONAL SITES FINANCIAL INFORMATION Printed: Thursday, August 20, 2015 3:44:59 PM 1 of 2 CRWYSTrms CHRONOLOGY • e '° NAME' � �7� ADDRESSl _' � CITY ;�'� STATE .ZIP �' =°'PHONE FAX _ EMAIL APPLICANT JOANN MILLER 51600 AVENIDA LA QUINTA CA 92253 (760)641-1336 RAMIREZ CONTRACTOR JOANN MILLER '51600 AVENIDA LA QUINTA CA 92253 (760)641-1336 RAMIREZ OWNER JOANN MILLER 51600 AVENIDA LA QUINTA CA 92253 (760)641-1336 RAMIREZ FINANCIAL INFORMATION Printed: Thursday, August 20, 2015 3:44:59 PM 1 of 2 CRWYSTrms DESCRIPTION ACCOUNT CITY AMOUNT _ PAID - PAID DATE RECEIPT # CHECK #: . METHOD PAID BY C LTD BY BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00 Total Paid for BUILDING STANDARDS ADMINISTRATION BSA:. $1.00 $0.00 POWER APPARATUS 101-0000-42403 0 $24.17 $0.00 POWER APPARATUS PC 101-0000-42600 0 $24.17 $0.00 Total Paid for ELECTRICAL: $48.34 $0.00 PERMIT ISSUANCE 101-0000-42404 0 $91.85 $0.00 Total Paid for PERMIT ISSUANCE: $91.85 $0.00 TOTALS:0• INSPECTIONS SEQID. INSPECTION TYPE INSPECTOR. _ SCHEDULED; COMPLETED DATE DATE:: RESULT REMARKS : NOTES ELECTRICAL FINAL" BLD PARENT PROJECTS BOND INFORMATION Printed: Thursday, August 20, 2015 3:44:59 PM 2 of 2 sysrrnns F �rw P.D. BOX 1504 LA QUINTA, CALIFORNIA 922474504 78--495 CALLS TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT PROPERTYOWNER'S PACKAGE (760)777-7012 FAX (760) 777-7011 Disclosures & Forms= for Owner -Builders Applying for Construction Permits IMPORTANT! NOTICE TO PROPERTY OWNER 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 We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We will'not issue a buildingpermit.until you have read, initialed your understanding of_each provision, signed', and returned this form to us at our official address indicated.'An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION DIRECTIONS: Read and initial each.staterrient below to signs you understand or verify this information. 1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder" Kuilding permit that erroneously implies that the property owner is providing his br her own labor ai d. 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 ofmy insurance coverage for injuries to workers on my property. IV -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. 141 3. I understand.as an:"Owner-Builder" I am the responsible party of record'on the.perinit I understand that I may protect myself from potential financial risk by hiring a licensed'Contractor and having the permit -filed in his or her name instead of my own. 4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. 5. I understand if I 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. I understand if lam considered an "employer" under state and federal law, I must register with the state andfederal Fovernment, withhold payroll taxes, provide workers' compensation disability insurance; and contribute to unemployment compensation for each "employee.".1 also understand my failure to abide by these laws may subject me to.serious financial risk. ,9-7. 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. I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any nancial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. 9. I understand I may obtain more information regarding my, obligations as an "employer" from the Internal Revenue ervice, 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 (CSLB) at 1- 800-321-CSLB (2752) or www.cslb_ca.gov for more information about licensed contractors. . A10. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the party legally: and financially responsible for proposed c truction active at the following address: �� 11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner -Builders asmell as employers. 12. I agree to. notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have 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 assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner -Builder and. wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation 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 issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the agencyequIrf t fe presented when the permit is issued to verify the•propery owner''sssignature. Signature of property 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 AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) 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 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 owners signature. Property Owner's Signature: Date: Bin # City of La Quin to Building 8z Safety Division P.O. Box'1504, 78-495 Calle Tampico La Quinta; CA 92253 .(760):777-7012 Building Peeinit.Application and Tracking Sheet ermit #I oject Address: S/` ner's Name: A. P. Number: Address:I Lem Legal Description:. Contractor: City, ST, Zip:. `' OA 2 -Zs e o - 1p h ne - :, 3 t Address: 5& QQ V e� V� Project Description: City, ST, Zip: Telephone:X. G— /3 a a State Lic. # : Arch., Engr., Designer: City Lic. -Q-,1 QCt Address:nvsuy City., ST, Zip: TelePhon e: State,Lic. #:. N of Contact Person:JaAhha :;:o Cn' tructi n TYPe: ancY Occupancy: Project tYPe (circle one): New Add'n Alter Repair Demo Sq. Ft.:' Stories: # Units: >— ' .. . ephone # of Contact Person: (c _ '_ _, stimated Value of Project: 0 0�- APPLICANT: 60 NOT-,W,RITE'BELOW THIS,LINE N Submittal Req'd - Rec'd TRACKING PERMIT FEES Plan Sets „.. ;Rlan Check `submitted Item Amount Structural Calcs.- Reviewed, ready for. corrections Plan Check Deposit . Truss Calcs. Called Contact Person Plan Check Balance Title 24 Calls. Plans.pickediup Construction ' Flood plain plan Plaris resubmitted Mechanical Grading plan 2" 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 correctionsfissue Developer Impact Fee Planning Approval Called Contact Person A.LP.P. Pub. Wks. Appr Date' of permit issue School Fees Total Permit Fees �26