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09-0659 (RER)• P.O. BOX 1504 4 4,Q" 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253. BUILDING & SAFETY DEPARTMENT Application Number: Property Address: APN: Application description': Property Zoning: Application valuation: Applicant: 7u-ryui 09-00000659 50036 CALLE ROSARITA 658-250-007-_ - - REMODEL - RESIDENTIAL LOW DENSITY RESIDENTIAL 45000 _Architect or.Engineer: 131I11101 rexa4l.�1M Owner: DWULET, JAMES & LAURE 1343 LOCUST ST #206 WALNUT CREEK, CA 94596 ( Contractor: Owner VOICE (760)'777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date:. 6/30/09 l 0 _________________________________________________________________________________________________ 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 V"Contractor: Date: Contractor: 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 OWNER -BUILDER DECLARATION insurance carrier and policy number are: I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier Policy Number following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to _ I certify that, in the performance of the work for which this permit is issued, 1 shall not employ any construct, alter, improve, demolish, or repair any structure, prior to 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 statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if I should become subject to the workers' compensate provisions f Section License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3700 of tfte Labor Code, I hall forthwith, comply with th a provisio 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).: '�' .// - Date: �` Applicant:61744 1 _ 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 WARNING: FAILURE TO SECURE WORKERS' COMP SATION COVERAGEIS LAWFUL, AND SHALL Contractors' State.License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIE AND CIVIL FINES UP TO ONE HUNDRED THOUSAND and who does the work himself or herself through his or her 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 issoldwithin SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. ' one year of completion, the owner -builder will have the burden of proving that he or she did not build or 1 _Vimprove for the purpose of sale.). I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7n44, fbisinnss and Pf9f9ssions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contradtS Tar me pruluuts wnii a Luuu­iui(J) fv�,�oad pursuant to the Contractors' State License Law.). ( _) I am exempt under Sec. , B.&P.C. for this reason Date: &--30 `® Owner: CONSTRICTION 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: LQPE1011T 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 Ecrh percnn unnn whnse.he.half this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit issued AS'S resUR 01 MIS appii.edun, 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 t comply with all city and county ordinances and state laws relating to building construction, and hereby authorize epresentativ of this county to enter upon the. above-mentioned property fo spection purposes. .Date §Olignature (Applicant or Agent): LQPERMIT Application Number . . . . . 09-00000659 ------- Structure Information EXISTING 1591 SF ATT. RESIDENCE----- Other struct info . .. . . CODE EDITION 2007 # BEDROOMS .00 Permit . . . . . . BUILDING PERMIT ` Additional desc REMODEL TO EXIST 1591 SF SFD Permit Fee . . . 382.00 Plan Check Fee 248.30 Issue Date . . . . Valuation . . . . 45000 Expiration Date 12/27/09 Qty Unit Charge Per Extension BASE FEE. 252.00 20.00 6.5000 THOU BLDG 25,001-50,000. ---------------------------------------------------------------------------- 130.00 Permit ELECT - ADD/ALT/REM Additional desc . Permit Fee 56.10 Plan Check Fee.. 14.03 Issue Date Valuation 0 - Expiration Date 12/27/09 Qty Unit Charge Per Extension' BASE FEE 15.00 20.00 .7500 PER ELEC.DEVICE/FIXTURE 1ST 20 15.00 58.00 .4500 EA ELEC DEVICE/FIXTURE >20 ----------------------------------------------------------------------------- 26.10 Permit . . . •MECHANICAL Additional desc . Permit Fee . . . . 24.00 Plan Check Fee 6.00 Issue Date . . . . Valuation .. . . . 0 Expiration Date 12/27/09 Qty Unit Charge .Per Extension , BASE FEE 15.00 2.00 4.5000 EA MECH VENT INST/ DUCT ALT 9.00 •---------------------------------------------------------------------------- Special Notes and Comments INTERIOR NON-STRUCTURAL REMODEL TO EXISTING 1591 SF SFD. DRYWALL, INSUL, DUCTS, FT.FrTRTCAL, 2Q07 CODES. OWNER - AGENT: TERRY SMITH PH 83S-6860. ---------- -------------------- -------- Other Other Fees . . . . . . . . BLDG-STDS ADMIN (SB1473) - 2.00 ENERGY REVIEW FEE 24.83 Fee summary Charged Paid Credited Due LQPERMIT LQPERMIT Application Number 09-00000659 - Permit Fee Total 462.10 - .00 .00 462'.10 Plan Check Total 268.33 .00 .00 268.33 Other Fee Total 26.83 .00 .00. 26.83 Grand Total 757.26. .00 .00 757.26 ..Bin # - C(� Qt�� � uin Y Q Building 8L 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`l, O0 Owner's Name: A. P. Number: Address: 'Legal Description: City, ST, Zip: OL, Contractor:�. elehone: w.. •�:..fz;�,.. u•:;.:•:.::... p °�:::':' ...}.:.>.>..;:,><; ,;til.:<iz,•. 'z. Description: Address: CS `Project City, ST, Zip: Telephone: ;>•x; : • :;:. •;:::>s:>:>: •..,::::.:; State Lic. # : City Lic. #: UGZ Arch., Engr., Designer: Address: City., ST, Zip: Telephone: ..:.::., �•y; r3r.:.:..: y:.�.: y:.:.�...:. •.,::., Sion ;.:: ;.r ;>.:?;%»• ::: •, i•: !s::s:>, {,<< Construction Type: Occupancy: State Lic. Pro' sect type (circle one): New . Add'n Alter Repair Demo Name of Contact Person: Sq. Ft.: # Stories: F# Units: Telephone # of Contact Person: 7 — Estimated Value of Projeof% + APPLICANT: DO NOT WRITE. BELOW THIS LINE # Submittal Req'd Recd TRACIMG i PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cafes. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2" Review, ready for correction issue 19 Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up. S.MJ. i H.O.A. Approval Plans resubmitted Grading IN HOUSE:- '•" Review, ready for correctionsfissue Developer Impact Fee Planning Approval Called Contact Person A.I.F.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees . O6125/2009 10:44 7607777011 P.O. BOX 1504 LA QUINTA BLDG DEPT T'af 4 4 a" LA QUINTA, CALIFORNIA 92247-1504 78-495 CALLS TAMPICO LA QUINTA, CALIFORNIA 92253 PAGE 03/04 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 OWNS Dear Property Owner. Am application for a build'perms as submitted your name listing ourself as the builder of the property improvements specified at (j (J S '4— C We are providing you with an weer -Builder Ackuowledgmemt and InforInation'Verificatiod Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued iM 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. OWN 'S ACKNOWLEDGMENTAND VEREFICAMN OF INFO 'TION DtAEC770NS; .Read and initial each statement below to signify you understand or verify this informdtion. I. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder" building permit that erroneously implies that 6.e 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 iniuries 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. Mme- I understand building pemtits are not required to be signed by property owners unless they are responsible for the constru on and are not hiring a licensed Contractor to assume this responsibility. 3. 1 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. I derstand Contractors arc required by law to be licensed and bonded in California and to list their license numbers on pe and contracts. I understand if I employ or otherMse engage any persons, other than California licensed Contractors, and the total value o m construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" ,unld�er state and federaI.law. un nm understand if I am considered an "employer" under state and federal law, I must register with the state and federal govcm, 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' ict�=I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential s cannot legally build them with the intent to offer theta 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. 06/25/2009 10:44 7607777011 LA QUINTA BLDG DEPT PAGE 04/04 �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. /understand I may obtain more information regarding my obligations as an "employee, from the Interngt 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 Lic.;nse Board (CSLB) at 1- 800-32 CSLB (2752) or www.oslb.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 -I am the party legally and fhianeigIly responsjble for proposed construction ac vrty at the following address: i SOD 3 k r1a 01121-ei4 /an Aa . � ex . n - it. I agree that, as the party Iegally 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. 12. I agree to notify the issuer of this form immediately of any additions, deletons, orthanges m any of the irtfbmatiod I have provided on this foam. Licensed contractors are regulated by laws designed to protect the public. If you eoneaet with someone who does. not have a license, the Contractors' State License Board may be unaliie-to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may -e 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 wbile woddog on your property, you may be held liable for damages. If you obtain a permit as Owner-BuiRder and wish to hire Contractors, you will' be mpoosible for verifying whether or not those Contractors are properly licensed and the status of dreir workers' compensation bvmrance covetage. Before a building permit can be issued, this form most be completed and sipaed by the property owner and returned to the agency responsible for issuing ffie permit. Note: A Copy of the property awner's dkfver's.licgrtse, form 9o4Vftrttidr4 or other verification acceptable to tate agency is required to be presented when the permit is. ks.sed to verify the pr,vperty owner's signature. Signature o€propertyOwner Date: 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'& BEEF Excluding the Notice to Property Owner, the execution. of wlricb I understand is my personal responsibility, I hereby authorize the following, persoa(s) to act as my agent(s) to apply for,. sign, and file the document& necessary to obtain an Owner -Builder Permit for my project. Scope of Construction- Project (or Description of Work): Project Location or Address: Name of Authorimil Agent_ Address of Authorized Agent: - I declare under penalty of perjury that I.am the property owner for the address listed above = I:petsooally 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 verb the propemy Owner's signature. Property Owner's Signature: v Date: r ACKNOWLEDGMENT State of California County of 6A -1r2.4 Co S7,4 ) On avium 2 ,!�- 20 cF before me, nPVf (insert name and title of the officer) personally appeared L • �T�IhE.S W U4� who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the nstrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal.pEBOe MgY�iEW Comm. # 1588310 • Nor PIBIIC • CAtIFO NIA Contrc Codo CounfY Signature (Seal) Comm. es lune 28 2009' City of La Quinta June 25, 2009 I hereby authorize terry Smith to act on my behalf regarding construction at my home located at 50036 Calle Rosarita ,Santa Rosa Cove,La Quinta ,California. Thanks for your help in this matter J es Dwulet