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10-0700 (GRES)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number:_ 10-00_200700 Property Address: 77933 CALLE COLIMA APN: 774-134-012-2 -000000- Application description: GARAGE - RESIDENTIAL Property Zoning:, COVE RESIDENTIAL Application valuation: 12975 T4ht 4 4 Q" BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: TERRY ACKERMAN 77-933 CALLE COLIMA I LA QUINTA, CA 92253 Contractor: Applicant: Architect or Engineer: Owner alp VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 ZX SSP 1 2010 OF LA 9/13/10 ------------------------------------------------------------------------------------------------- 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 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: 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).: (_ 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.). ( ) 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.). (_) I am exempt under Sec. , B.&P.C. for this reason /f Date: 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 Name: Lender's Address: ` LQPERI%lIT 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, 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 w cers' compensation provisions of Section ' � 1 0 of the LaborLedrrSR2R'f�rthwith pl h those provisions. bate:icant: 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 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 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. I certify that I have read this application and state that the above information is correct. I agree to comply with all city *ignature nces and state laws relating to building cons e y orize representatives of thupon the above -mention or inspection purpos Date(Applicant or Agent): LQPERMIT Application Number . . . . . 10-00000700 --- Structure Information DETACHED GARAGE ----- Construction Type . . . . . TYPE V, UNPROTECTED Occupancy Type . . . . . GAR, CARPORT, SHED, AG Other struct info . . . . . CODE EDITION 2007/08 ENERGY FLOOD ZONE NO GARAGE SQ FTG 662.00 ------------------------------------------------------------------------- Permit . . . CARPORT/GARAGE Additional desc . . Permit Fee . . . . 144.00 Plan Check Fee 93.60 Issue Date Valuation_ 12975 Expiration Date 3/12/11 Qty Unit Charge Per Extension BASE FEE 45.00 11.00 9.0000 THOU BLDG 2,001-25,000 99.00 ---------------------------------------------------------------------------- Permit, . . . . ELECTRICAL-CARPORT/GARAGE Additional desc . Permit Fee . . . . 28.24 Plan Check Fee 7.06 Issue Date . . . . Valuation . . . . 0 Expiration Date 3/12/11 Qty Unit Charge Per Extension BASE FEE 15.00 662.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL 13.24 ---------------------------------------------------------------------------- Permit . . . PLUMBING Additional desc . Permit Fee . . . . 24.00 Plan Check Fee 6.00 Issue Date . . . . Valuation . . . . .0 Expiration Date . . 3/12/11 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 6.0000 EA PLB FIXTURE 6.00 1.00 3.0000 EA PLB WATER*INST/ALT/REP 3.00 ---------------------------------------------------------------------------- Permit . Additional desc Permit Fee Issue Date Expiration Date GRADING PERMIT 15.00 3/12/11 Plan Check Fee . . .00 Valuation . . . . 0 I Application Number . . . . . 10-00000700 Permit . . . . . . GRADING PERMIT Qty Unit Charge Per Extension BASE FEE 15.00 ---------------------------------------------------------------------------- Special Notes and Comments 662 SF DETACHED GARAGE ADDITION. 2007 CODES. ---------------------------------------------------------------------------- Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 STRONG MOTION (SMI) - RES 1.30 Fee summary Charged --------------------------- Paid -------------------- Credited ---------- Due Permit Fee Total 211.24 .00 .00 211.24 Plan Check Total 106.66 .00 .00 106.66 Other Fee Total 2.30 .00 .00 2.30 Grand Total 320.20 .00 .00 320.20 LQPEFAIIT P.O. BOX 1504 LA QUINTA; CALIFORNIA 92247-1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT PROPERTY OWNER5 S PACKAGE (760) 777-7012 FAX (760) 777-7011 Disclosures & Forins for Owner -Builders Applying for Construction Permits STA _7'I A[©TfCl�i Tn t»�r�pr. Qry _QV44 ER ENW Property Vwnw.. Aa. aWlication for a building pmt has bwn submitted in your nine listing yourself as the buildef of the .property isnpncr<ve�rieats speei€ied at o we MViding you U th an Owner -builder Acknoloiedgment and information Vetifreation Form t© make ym awama of your ccVQwft m and possible risk you may mom by hatving ddspemndt is$aed in yaw nate as the Owiw guilder. we'd n," hwe a bandWg.pendt unto yon -have read, initWed your anderstaudhm of ea ch:prw islen, elgrred, and returned this form to us at oar oilicial address indicated. An agent of the owner cannot execute die -, notice unless You, the property owner, obtain the priorapproval of the permitting authority. �:Z'It7�• Rread � im-�relr stat�nurltfre�i��'`ri, you pct orver�fy tk�s irrjbrma�n. , 1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder" building Permit that erroneously implies that the property owner is providing his or her own labor and materiel personaft. 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 eovenge, for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance -coverage. for injuries to workers wtnz p .. _ _ - - — -. - - --- ---- - --- -- -- - �2. I understand building permits are not-- - -- -- - - - -----— - - - required to be signed by property ers unless they are responsible for the construction and are not hiring a licensed Contractor to :assume flus responsibility. 3. I understand as an "Owner -Builder" I am.the responsible party of record on the permit. I understand that I may protect mysel€ 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 b law to be licensed and bonded f d to list their license numbers on Y n ed in Cah crura an cense permit& and contracts. __A5.1 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 I am considered an "employee, under state and federal law, I must with the state and feden government, withhold Payroll taxes, provide workers' compensation disability insurance, and contribute to unemploymet compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financii lc 7. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residenti structures cannot .legally build them with the .intent to offer them for sale, unless all work is performed by licensA subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is perform under contract with a licensed general building Contractor. v g. I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any 5naacial or personal. bouries sustained by any subsequent ownef(s) that result from any latent construction detkts in the Z9. nanship or materials. I understand I ma obtain more information m oblations as an "e to ' from the' V,40 muneervice, the United Stages Small Business Administration California Department of Benefitayme nts. and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CM33) at I- 00-321-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 party legally and Snancially respo" ' for proposed construction activity at the following address: Emil. I agree that, as the party legally and financially responsible for this proposed coustnuction activity. I will abide by all livable laws and requirements that govern Owner -Builders as well as employers. l2. I to notify r to of the innf0 matition I agree trfy the issuer of thus form immediately of any additions, eierletro�us, o obsnges �y have provided on this form Licensed contractors are regulated by laws designed to protect the public. If yon contract with somomre who does not have a• beenses. bra Contractors' State License Board may be unable to asst you with any fimmid loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors mag be inVivil COWL It is atso bWmtmd for you to ua&rs%ud that if as wft owd Cotmartor or employee of" individual OT&M is i d wW wod&g on, your property, you may be ltetd H" fW-damage If you obtain a permit as Owner -Builder and wish to hMM Curs, year will be RgWnsIde for veering v&tthwair not those CoaEractora are pwpe * liveried as4 fire attutrs of fair Nvv*c ' eompeasabon insaraarce i omatg& 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 ismlttg; Ow pert. Nota: A copy, of *r pmperw a/,V1W'a' eQ3vtc.'n .e f or other verification aooWta k to do agtwey is to be pretaaateet when &a pmad is i ta Rem the POPerV owner's signature. Signature of property ow M* Date I Mote. 73te following Authorization Form _is iregee4red to be co_mpieted,by-the property_ owner oily when. dessVoting an agent of the property owner to apply for a construction permit for the Owner -Builder. AUT 12RIZATION OF AOMTTO ACT ON rRO?ERTY OWNER'S RERAIX Excluding.the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorise Ile following peraos(s) to act as my agest(s) to apply for, sign, and file the docurrtents necessary to obtain an Owner-Bwkkr Permit for my project. Scope of Construction Project (or Description of Worle): 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 abo• information and cer* its accuracy. Note. A copy of the owner's driver's license, form notarization, or other verification aciceptableto the agency is required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: L:I I Y u1- LA ItVIN I A buts -IMV I " V,1 u>}i Lt� I JOB ADDRESS %, PERMIT NUMBER OWNER . /�I BUILDER This form shall be posted on the job with the Building Inspection Card at all times in a conspicuous 11ace. Only dersons appearing on this list or their employees are authorized to work on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance of building nermit. For each applicable trade. all information reauested below must he completed by annlicant. "On File" is not an accentahlA resnonse_ fica Trade / Classification Co ntractor ::;;::.:::;.:::; State::Contractor.s License . ::..: Workers Com egsation:lrisurance ° :' ' :; Cit -. Business Licenser:. Company Name Classification (e.g. A, B, C-8) License Number (xxxxxx) Exp. Date (xk/xx/xx) Carrier Name (e.g. State Fund, CalComp) Policy Number (Format Varies) Exp. Date (xx/xx/xx) License Number (xxxx) Exp. Date (xx/xx/xx) EARTHWORK (C-12) CONCRETE (C-8) CAW C I �-,11,6100,1W / l►— cto/3 7 7 0 1 o 41146 L C ` SHEET METAL (C-43) FLOORING (0=:15): GLAZING (C717) INSULATION' (C-2).: .. Mae SEWAGE DISP: (C-42) PAINTING (C-33) CERAMIC TILE (C-54) CABINETS (C-6) FENCING (C-13) LANDSCAPING (C-271. POOL (C-53) Bin # .(� Permit # Project Address: 77 q23 Qty"bfta Quetta Building &r Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Applicationsend Tracking Sheet Owner's Name: e� L%Qiy/i A. P. Number: Address: Legal Description: City, ST, Zip: Contractor: °J 9. hone `•s^';'•:. �,� �:r;;���: r.;; . Telep� Address: Pro't Description: City, ST, Zip: Telephone: ' . i'�'• i �i � r : :v :4•..v�ti +{'+try`. •_�r ;: , hz;»,>yr.£.rs; City Lic. #; State Lic. # : Arch., Engr., Designer: y' Address: A\ �r� City, ST, Zip: Telephone: O .t x'. , �s$;• State Lic. #: zy, >' . rs,.•.: • µ Construction Type: Occupancy: proJect ripe (circle e'. 'pair Demo )' New Addn Alter Re Sq. FU. Wp # Stories: #Units: Name of Contact Person•, - 7G� Telephone # of Contact Person: '764) 94#47S7 Estimated Value of Project: APPLICANT: DO NOT WRITE.BELOW_THIS-LINE N Submittal Plan Sets Req'd Recd n TRACIG VG I .. PERMIT FEES Plan Check submitted 1 �, lnUr Item Amount Structural Cates. Reviewed, ready10crrections Plan Check Deposit Truss Cates. Called Contact Person l ' - _ Plan Check Balance. Title 24 Cates. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan god Review, ready for correctio ssu ?� Electrical Subcontactor List Called Contact Person %% Plumbing Grant Deed cked up S.M.I. H.O.A. Approval submitted Grading IN HOUSE:- ew, ready for correa'�gnsrs a Developer Impact Fee Planning Approval Contact Person A.I.P.P. rDate Pub. Wks. Appr permit issue School Fees V `` Total Permit Fees Nw, 2.0