11-0422 (RER)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
T4ht 4 4 Q"
Application Number:
11-00000422
Property Address:
46590 CAMEO
PALMS DR
APN:
643-182-010-
- -
Application description:
REMODEL - RESIDENTIAL
Property Zoning:
LOW DENSITY
RESIDENTIAL
Application valuation:
8000
Applicant:
Architect or Engineer:
fiJ^k
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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 ISec. 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).:
tL� ) I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
Ci 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 _ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions Code: Thfnd�lhro
Contactors' State License Law does not apply to an owner of
property who builds or improves thereon, contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' Stat�License.I am exempt under Sec. P.C. ftreas4
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: '
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
NATIONAL ALLY TRUST 1643182009
16033 BOLSA CHICA S'
HUNTINGTON BEACH, C)
Contractor:
Owner
Date: 5/02/11
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
certify that, in the performance of the work f r which this permit is issued, I shall not employ any
person in any man er so as to become su ect to the workers' compensation laws of California,
and agree that, if I ould beco ni e sugject o the workers' compensation provisions of Section
3700 of the Labo ILde, sha forth it omply with those provisions.
Date Ot Oy I'f 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 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 ouinta, 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 building construction, and hereby authorize representatives
of this county to enter upon the above-mentioned property for inspection purposes.
Signature (Applicant or Agent):
Application Number . . . . . 11-00000422
------ Structure Information INTERIOR REMODEL -----
Other struct info . . . . . CODE EDITION 2010
# BEDROOMS 3.00
----------------------------------------------------------------------------
Permit . . . BUILDING PERMIT
Additional desc . .
Permit Fee . . . . 99.00 Plan Check Fee 64.35
Issue Date . . . . Valuation . . . . 8000
Expiration Date 10/29/11
Qty Unit Charge Per Extension
BASE FEE 45.00
6.00 9.0000 THOU BLDG 2,001-25,000 54.00
----------------------------------------------------------------------------
Permit . .
Additional desc .
Permit Fee . . .
Issue Date . . .
Expiration Date .
MECHANICAL
VENT FANS/KITCHEN EXHAUST
34.50 Plan Check Fee .
Valuation . . .
10/29/11
8.63
0
Qty Unit Charge Per Extension
BASE FEE 15.00
2.00 6.5000 EA MECH VENT FAN 13.00
1.00 6.5000 EA MECH EXHAUST HOOD 6.50
----------------------------------------------------------------------------
Permit . . . ELECT - ADD/ALT/REM
Additional desc . . REWIRE ALL ELECTRICAL
Permit Fee . . 79.82 Plan Check Fee 19.96
Issue Date . . Valuation . . . . 0
Expiration Date . . 10/29/11
Qty Unit Charge Per Extension
BASE FEE 15.00
1588.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY 55.58
462.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL 9.24
----------------------------------------------------------------------------
Permit . . PLUMBING
Additional desc . . RELOCATE WATER HEATER
Permit Fee . . . . 22.50 Plan Check Fee 5.63
Issue Date . . . . Valuation . . . . 0
Expiration Date 10/29/11
Qty Unit Charge Per. Extension
LQPERMIT
Application Number .. . . . . 11-00000422
' Permit . . . . . . PLUMBING
Qty Unit Charge Per
Extension
. BASE FEE
15.00
1.00 7.5000 EA PLB WATER HEATER/VENT
7.50
----------------------------------------------------------------------------
Special Notes and Comments
INTERIOR REMODEL - REWIRE ELECTRICAL,
ADD RECESSED LIGHTING, REMOVE AND
REPLACE DRYWALL AND INSULATION THROUGH
OUT RESIDENCE, RELOCATE WATER HEATER TO
GARAGE AND DEMO WALL BETWEEN KITCHEN AND
LIVING ROOMS [CONVENTIONAL) THIS PERMIT
DOES NOT INCLUDE ALTERATIONS TO THE
EXTERIOR OF THE BUILDING. (PLANS ARE
APPROVED WITH COMMENTS) 2010 CALIFORNIA .
BUILDING CODES.
May 2, 2011 2:01:33 PM AORTEGA
-------------- ---------------------------------------------------------
Other Fees . . . . . . . ... BLDG STDS ADMIN (SB1473)
1.00
ENERGY REVIEW FEE
6.44
'Fee summary Charged Paid Credited
----------------------------------------------------------
Due
Permit Fee Total 235.82 .00 .00
235.82
Plan Check Total 98.57• .00 .00
98.57
Other Fee Total 7.44 .00 .00
7.44
Grand Total 341-.83 .00 .00,
341.83
LQPERMIT
P.O. Box 1504
LA QUINTA, CALIFORNIA 92247-1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
PROPERTY OWNER'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 46590 Cameo Palms
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 building permit 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 statement below to signify you understand or verb this information.
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 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 of my insurance coverage for injuries to workers
on my property.
—L(`. 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.
_�C3. I understand as an "Owner -Builder" I am the responsible party of record on the permit. 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.
_L4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on
permits and contracts.
_C5. 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.
i6. I understand if I am considered an "employer" under state and federal law, I must register with the state and federal
government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment
compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial
risk.
C7. 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.
-4-8. I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any
financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the
workmanship or materials.
T9. I understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue
Service, 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.
1�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 financially responsible for proposed construction activity 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 as well as employers.
LE 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 acceptabl to th en y is required to be presented when the permit is issued to verb the property
owner's signature.
Signature of property owner A �[ L ✓Cbt�av�/ �`ti PiF�I Date: D �0 3 /
Usy o -F TGG Alefro-,,rl iflty room
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): Manage property repairs
Project Location or Address: 46590 Cameo Palms
Name of Authorized Agent: Lawrence French Tel No 714-602-3588
Address of Authorized Agent: 16033 Bolsa Chica #104154, Huntington Beach, CA 92649
I declare under penalty of perj that I the property owner for the address listed above and I personally filled out the above
information and certify its ac aacy. No co y of the owner's driver's license, form notarization, or other verification
acceptable to the agency is re fired to p s ted when the permit is issued to verb the property owner's signature.
Property Owner's Signature: c F Date: D �_d l
S t t-vc"trV6FN enfi rbc YI;J e , yet vsrfc-- #1C 71;t of/ly TKLs %—
Bin #
City of La Quinta
Building at Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
1
Project Address:T�anr�G
�`S QO Cb'I R/4� tit'_ /HS
ley T us r .
Owner's Name: 3 i 2 o c
A. P. Number:
Address: /6033 &15* Ce/ c o'
Legal Description:
3e f/ 9,0%`
City, ST, Zip //(//Vi/N f±Td N i
Contractor:
Address:
'J'iiy:v:.:{+v}:
Telephone: '71V 4fo.Z '75-73 ' 2``n2 f; ;•
p , .b�,.�'d�:�.day.:„�.°.'::'.#:'•<�:.;%�:�:.
.ProjectDescription: Oce W
City, ST, Zip:
C tact elec A,�. lwxfAi eoAj h is '
Telephone:
p
y n,�; •,%y::>,'••:t<:;•.n :>; ?.# ;>':::
C� 7/b l.+ t?
w e I? 5'f0 (d-
-State Lic. # :
City Lic. #:
dg^ 7- l%D . 7D 001 11vt / 4322Y/ eN
Arch., Engr., Designer:
vte 4c/a' _ T/E 6N70 &X L-79
Address:
0
City., ST, Zip:
Telephone: <•; 4k��+.;:< �<^� �,• •••��•
R6•�-.,�'��`.'•,Y.'4'v:v%�S^:'F%::SiJ: %YSSi
State Lic. #:`+`'';r`k`''v`' '''"' "''"
�IpC�v �.:•�:-:S:'j.i':%5-:i 4i::i{:�.:h4;/ i l+ v�
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: Fiqehcrf /Itlie^' (
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person']/V (,aA 35le
Estimated Value.of Project: :F0&0
S�IWG�Ywot)bkb.(OM APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING PERMIT FEES
Plan Sets
d
Plan Check submitted
a? Item Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction . �O
Flood plain plan
Plans 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. WIN
H.O.A. Approval
Plans resubmitted
Grading .►
IN HOUSE:-
Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person fj A.I.P.P.
Pub. Wks. Appr
Date of permit issue 50%10
School Fees
tic 06644•
Total Permit Fees
IA� i'i't IS Ta Ile.&t; use t
e
i4
t
P.O. BOX 1504
LA QUINTA, CALIFORNIA 92247-1504
78-49S CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING K SAFETY DEPARTMENT
PROPERTY OWNER'S PACKAGE
(7 60) 777-7012
FAX (760) 777-7011
Disclosures &. Forms for Owner -Builders Applying for Construction Permits
IMPORTANT! NOVICE 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 464;'9C) CofiAeV 10WL✓r15
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 buitdiag permit until you have read, initialed your understanding of Back 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
DfRECTIONS: Read and initial each statement below to signify you understand or verify this information.
I. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder'
bui ding permit that erroneously implies that the property owner is providing his or her own labor and material personally. 1, as
an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person
and tris 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 of my insurance coverage for injuries to workers
on my property.
tj�5. 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.
_�F_3. I understand as an "Owner -Builder" I am the responsible party of record on the permit. l 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
o wn.
J 4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers o
permits and contracts.
LF5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total vah
of my construction is at least five hundred dollars ($500), including labor and materials, 1 may be considered an "employe
under state and federal law.
6. t understand if I am considered an "employer" under state and federal law, I must register with the state and fede
government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to uneMVloym
compensation for each "employee." l also understand my failure to abide by these laws may subject me to serious Finan'
risk.
7. 1 understand under California Contractors' State License Law, an Owner -Builder who builds single-family resider
structures cannot legally build them with the intent to offer them for sale, unless all work is performed by. licet
subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is perfor
under contract with a licensed general building Contractor.
'7 8. I understand as an Owner -Builder if I sell the property for v,-luch this permit is issued, 1 tray be held liable for any
financial or personal it uries sustained by any subsequent owner(s) that result from any latent construction defects in the
workmanship or materials.
=1ry1 understand 1 may obtain more information regarding my obligations as an "employer" from the Internal Revenue
Seice, 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.
0. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that l am the
party legally and financially responsible for proposed construction activity at the following address:
�(6S'4o cAm 6�jq Cats
LT! I I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all
app icable laws and requirements that govern Owner -Builders as well as employers.
LET2. t 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 covet 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 property 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. !Yore: A copy of the property owner's driver's license, form notaricadon; or
other verification acceptable to the agency is required to be presented when tke permit is issued to verify the Property
owner's signature.
Signature of property owner 5449"A 14! TOIO ate: O y 2.7 Il
0(,a Aowfle—a, ANy Ti'tVsr� 616q31-9 ;2 w'
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 ACTON PROPERTY OWNER'S BEHALF
Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, t hereby authorize
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 Agent:
Address of Authorized Agent:
Tel No
I declare under penalty.of perjury that t am the property owner for the address listed above and l personally filled out the A
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 owner's signature.
Property Owner's Signature: Date: _