BRES2016-0250.78-495 CALLE TAMPICO
U ��
LA QUINTA, CALIFORNIA 92253'
DESIGN & DEVELOPMENT DEPARTMENT
LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
BUILDING PERMIT
Application Number:
BRE52016-0250'
I have and will maintain a certificate of consent to self -insure for workers'
Property Address:
46415 ROUDEL LN
--License Class:-_ License No.: _ - -
APN:
600040004
I have and will maintain workers' compensation insurance, as required by
Application Description:
AMPLIFIED CAPITAL LLC REMODEL
Property Zoning:
is issued. My workers' compensation insurance zarrier and policy.number are:
OWNER -BUILDER DECLARATION
Application Valuation: .$12,000.00
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State4C
_
Applicant:
AMPLIFIED CAPITAL
4114 GRESHAMST SEPq 3
^.M:nIE%n t:��?109• L�
Owner:
GUDRUN HART
, 92253
Contractor:
OWNER BUILDER -
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153.
Date: 9/23/2016 .
OF LAQ1110A
L(Y
CO'�MMrT_yDEVELOPMENTDEP�RTt�ENT
llc. No.: .
LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
I hereby 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.
compensation, as provided for by Section 3700 of the Labor Code, for the performance
--License Class:-_ License No.: _ - -
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 zarrier and policy.number are:
OWNER -BUILDER DECLARATION
Carrier: Polity Number:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State4C
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 a; 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 Se- 37iD0 of the labor Code, I shall fo hwith
signed statement that he or she is licensed pursuant to the provisions of the
comply with those provisio
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
Date:
Ica
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
WARNING: FAILURE TO SECURE ORKERS' COMF?ENS TION COVERAGE IS UNLAWFUL,
($500).:
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
(� I, as owner of the property, or my employees with wages as their sole
ONE HUNDRED THOUSAND DOLLARS ($100,0001 IN ADDITION TO THE COST OF
compensation; will do the work, and the structufe 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
I t f h b ld h
INTEREST, AND ATTORNEY'S FEES.
y o an owner o property w o uI s or Improves t ereon, and who does the work
himself.or herself through his or herown 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 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
Date:
APPLICANT ACKNOWLEDGEMENT
IMPORTANT: Application is hereby made to the 3uilding Official 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 thework being performed under or
following issuance of this permit..
2. Any permit issued as a result of this applicaton 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 cancelWion. .
.� U 1 certify that I have read this application and state that the above information is correct.
CONSTRUCTION LENDING AGENCY I agree to comply'with all city and county ordinances and state laws relating to building
I hereby affirm under penalty of perjury that there is a constructioni lending agency for construction, and hereby authorize representatives of this ity to enter upon the
the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). above-mentioned property for inspection purposes.
Lender's Name: ate: / Signature (Applicant o
Lender's Address: I
Date: 9%23/2016
Application Number: BRES2016-0250 Owner:
Property. Address.,46415 ROUDEL LN GUDRUN HART
APN: 600040004
Application Description:. AMPLIFIED CAPITAL LLC REMODEL 92253
Property Zoning:
Application Valuation: $12,000.00
Applicant: Contractor:
AMPLIFIED CAPITAL OWNER BUILDER
4114 GRESHAM ST
SAN DIEGO, ca 92109
Llc. No.:
---------------------------------------------------------------------------------------------
is iJ V'VJ. LC iL L✓J
' uL�tdiC 0013e'LASE: RCMOULL'I:I;CHEN; j• BATH ROOMS, 'FIREPLACE, NEW CABINETSAND FLOORING. NEW ELEC OUTLETS, LIGHTING TO REMAIN THE SAME.
CONSTRUCTION SHALL BE PER 2013 CRC & CBC'S CODES
a
1
FINANf1A1 WFCIRMATIr1N
DESCRIPTION
ACCOUNT QTY AMOUNT
BSAS S131473 FEE
101-0000-20306 0 $1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DEVICES, FIRST 20
101-0000-42403 '
0
$24.17
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DEVICES, FIRST 20 PC
101-0000-42600
0
$24.17
Total Paid for ELECTRJCAL:. $48.34
DESCRIPTION
ACCOUNT
QTY
AMOUNT .
VENT FAN
101-0000.-42402
0
$24.18
DESCRIPTION
'ACCOUNT -
Q7Y
AMOUNT'
VENT FAN PC
1 101-0000-4260Q
0
$9.66
Total Paid for MECHAN CAL: $33.84
DESCRIPTION
ACCOUNT
QTY
AMOUNT
FIXTURE/TRAP
101-0000-42401
0
$145.08
DESCRIPTION
ACCOUNT
QTY
AMOUNT
_. _. FIXTURE/TRAP PC...
101-0000-42600,.- .._
0
_.. $145.08
- Total Paid for PLUMBING FEES: $290.16.
DESCRIPTION
ACCOUNT
QTY
AMOUNT
REMODEL, EA ADDITIONAL 500 SF
101-0000-42400
0
$65.25
DESCRIPTION
ACCOUNT
QTY
AMOUNT
REMODEL, EA ADDITIONAL 500 SF PC
101-0000-42600
0
$52.20
DESCRIPTION _
ACCOUNT
QTY
AMOUNT
REMODEL, FIRST 100 SF
101-0000-42400
0
$49.31
DESCRIPTION
ACCOUNT
QTY
AMOUNT,
REMODEL, FIRST.500SF PC .
101-0000-42600
0
•$134.88
Total Paid for REMMEL: .$301.64'
DESCRIPTION
ACCOUNT
QTY
AMOUNT
SMI - RESIDENTIAL ". _
101-0000-20308
0.
$1.56
Total Paid for STRONG MOTION INSTRUMENTATION SMI:. $1.56
••
QTY
PermItTRAK V,
' BRES2016'0250Address ``46415'RO,UDEfthj ` `x`
A n.6000�40004 " �- � b _ $676 54A40-
p
I
44
r�° BUILDING STANDARDS ADMINISTRATION BSA'�� ` 3�` $100
BSAS SB1473 FEE
101-0000-20306
0 $1.00
ELECTRICALY a
` R " u . tt ': e F t J r
$4834
: at .ick t�� �� .s.�
_�..x �.. �:�...F-.
s_., �.
DEVICES, FIRST 20 PC
101-0000-42600
0 - $24.17
DEVICES, FIRST 20
101-0000-42403
0 $24.17
':Y ,ky .5,•- X44. Y+'�`Fsi
MECHANICAL r ` 'h ti, `4:%.
c,..:g rs�.� 4Yaa
s g.,;:; i a , _..
V
'VENT FAN PC
101-0000-42600
0 $9.66
VENT FAN
101-0000-424020
$24.18
-';PLUMBING FEES {� 1�- "' W K : * ,x$290 16
3
` ,
FIXTURE/TRAP PC
101-0000-42600
0 $145.08
FIXTURE/TRAP
101-0000-42401
0 $145.08
REMODEL a �F ¢ x
$301 64
a s < .ar;''�
f ;:.`3'
�' t E*'s`'r .:
REMODEL, EA ADDITIONAL 500 SF PC
101-0000-42600
0 $52.20
REMODEL, EA ADDITIONAL 500 SF
101-0000-42400
0 $65.25
REMODEL, FIRST 100 SF
101-0000-42400
0 $49.31
REMODEL, FIRST 500 SF PC
101-0000-42600
0 $134.88
r STRONG MOTION INSTRUMENTATION S(1A1
x ,
,$156
SMI -RESIDENTIAL
101-0060-20308
0 $1.56
TOTAL , R18602
$676.54
Date Paid: Friday; September 23, 2016
Paid By: ANGELICA BASTIDAS
Cashier: AOR -
Pay Method: DEBIT
Printed: Friday, September 23, 2016 2:20 PM 1 of 1
cvcsrinc
N
Bin #
G to% Lll t1 t3
Yf Q
' Building 8?: Safety Division
78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012 '
Building Permit Application and Tracking She=t
Permit ##
ect Address:tQouck n,a, �U7�'V �ZCi�
tOwner's p7 )io
A. P. Number: CA q.2 Z 5-3
Address: -q-1.1-4,
Legal Description: • ¢ E
City, ST; Zip: '—S p (J j b C4 j
Contractor: �tl s u
'-
ele ''�
Address:
PFojectDescription:—'
City, ST, Zip:
Telephone:
h ne-
9Ut\
State Lic. # :
City Lic. #.:
C C L a kw GL,
Arch., Engr., Designer:
C.
Q L-5 1AJ
Address:
s G DA &)i B G G .
City., ST, Zip:
Telephone:
hone:
Construction T e:aac_
Type: Occu P Y:
a�
$f fe
Project type (circle cle one : New Add'n Ater Repair'air Demo
ameL`ic
o. /J�Sq.Ft.:
Contact Person
# Stories:
Units:f
(Telephone #-of Contact Person: ��D— LJ
tEstimated Vafue of Project:— i
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs: .
Reviewed, ready for corrections
Plan Check Deposit
Truss Cales.
Called Contact Person '
Plan Check anae.
Title 24 Calcs.
Plans picked upCo
uction '
Floodplain plan
Plans resubmitted
Mechanical
Grading plan
2" Review, ready for correclionsh-ssue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans res . tfiitted
Grading
IN ({OUSE:-
iteview, ready for correctionstissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. APPr
Date of permit issue
1
School Fees,
Total Permit Fees
P.O. Box 1504
LA QUINTA, CALIFORNIA 92247-1504
78-495 .CALLE TAMPICO
LA QUINTA, CALIFORNIA 92M
BUILDING & SAFETY DEPARTMENT
(760)777-7012
FAX (760) 777-7011
PROPERTY OWNER'S PACKAGE
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 providingyou' 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 signifyyou understand or verify 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.
'O 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.
ip. 3. 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.
q4. 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.
PQ --6. 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.
Do 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.
3P'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.
50 9. 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.
am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I e
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 acti7ity, I will abide by all
applicable laws and requirements that govern Owner -Builders as.well as employers.
'DQ 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 tate permit. Note: A copy of the property 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.
Signature of property owner Date: Sa 76
Note: The following Authorization Form is required to be completed by the property owner on!v 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 responsibiliy, 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. II
Scope of Construction Project (or Descriptionln of Work): _� Ao"" ENJ kt` t� b/J 04,hi . S
Project Location or Address:
l,. 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 personal _y' 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 w he permit is issued to verify the property owns s signature.
Property Owner's Signature: Date:
Le r • $ �,. 4�.,1
UILDINP & SAFETY DEPT.
AP R®VE®
FOR NSVUCTION
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WILL BE CHARGED IF T APPwitROVED CITY OF LA QUINTA
PIANS AND JOB CARE ARE NOT ONCOMMUNI ®��I"®P���
THE SITE FOR A SCHEDULED °
INSPECTION "AN ADEQUATELY SIZED I EBRIS CONTAINER
NO EXCEPTIONS! IS REQLIRED ON THE JOE SITE DURING ALL
PHASES OF CONSTRUCT N AND MUST BE
rq As SER FLFSrRoaIM
F.^.'IP T If.D AS NECESSARY. AILURE TO DO SO
s;1cw�R- a i�1L-w T It`B `:`AY C ALSE 1 iE CITY TO HIVE THE CONTAINER
�► cw TO It-IFT SiANIPEV AT THE EXPENSE OF THE OWNER/
" vX t r IT' ;.'JON T RACTOR."
12e5. 'rGv .Y\
C nstructior is NOT PERWa EG L
o the sellov ing Code Holiday .
New Yea 's Day GUra
Dr. Mart n Luther King 1r, ay
Preside is Day
'Niemonal Day
Independence Day
Labor Day
Veteran's Day _-
Thanksgiving Day
Christmas Day
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UILDINP & SAFETY DEPT.
AP R®VE®
FOR NSVUCTION
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A RF-IIUSRECTI9P � 67*AUG :3 b1 2016
WILL BE CHARGED IF T APPwitROVED CITY OF LA QUINTA
PIANS AND JOB CARE ARE NOT ONCOMMUNI ®��I"®P���
THE SITE FOR A SCHEDULED °
INSPECTION "AN ADEQUATELY SIZED I EBRIS CONTAINER
NO EXCEPTIONS! IS REQLIRED ON THE JOE SITE DURING ALL
PHASES OF CONSTRUCT N AND MUST BE
rq As SER FLFSrRoaIM
F.^.'IP T If.D AS NECESSARY. AILURE TO DO SO
s;1cw�R- a i�1L-w T It`B `:`AY C ALSE 1 iE CITY TO HIVE THE CONTAINER
�► cw TO It-IFT SiANIPEV AT THE EXPENSE OF THE OWNER/
" vX t r IT' ;.'JON T RACTOR."
12e5. 'rGv .Y\
C nstructior is NOT PERWa EG L
o the sellov ing Code Holiday .
New Yea 's Day GUra
Dr. Mart n Luther King 1r, ay
Preside is Day
'Niemonal Day
Independence Day
Labor Day
Veteran's Day _-
Thanksgiving Day
Christmas Day
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BUILDING & SAF AMA
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. OF LACITY
B AFE- DEPT.
APPROV..
FOR CONSTRUCT N
DATE BY
(
LJCP 41557 �i c:i� L . L` l-�- f� �t i�nlT-A qa,
3 5
{. J.
;) Note on Plans: "All construction shall comply with the 2013 California Residential, Mechanical, Electrical,
Plumbing, Energy, and Green Building Codes and the La Quirita Municipal Code:" Remove notes ,
other Codes.
Note on Plans: "Aluminum conductors are permitted,only if size 1/0 or larger, and only to feed
r ha1J be co ei ." L MC 8.03.040
-? l __ .panels. All other current carrying conductors s _ pp , ( §� ) + U
r `vim t .. ,'�„ _ �.' '! ,,, W _ .
:v � LL
� � _ ] Note on Plans: "Provide at least two 20 -ampere small appliance branch circuits to serve all wall, r,4n®� mq!
countertop receptacles in kitchen, pantry, breakfast room, dining room, or similar area. Such circ ii h%I T Z
'1 have no other outlets." (CEC §21 Q 11(C)(1) and 210.52(13) O(1) through 210.52(B)(3)) 0 U �
f f o Z
CC
► ___ Note on Plans; °`Provide at least one 20 -ampere branch circuit to serve bathroom receptacles.44.
Su d t �L�+ shall have no other outlets." (CEC §210.11(C)(3); 210.52(D)) ` LL- w`
SECTION H - CALGREEN'
€
011 Provide a table on the plans that contains the following requirements: '
_A-
!
Note on Plans: "Hot mopped shower pan shall be inspected upon completion _o hot mopping and shall be y
-� filled with water for inspection." (CPC §411.8:1)
. • .. � : r - ii ��,,... _ F _� 1 - - � til . •.. . � +' y. 4 •
t � r •
FIXTURE FLOW RATES
FIXTURE TYPE •
MAXIMUM FLOW RATE,
Showerheads
2 gpm @ 80 psi
Lavatory faucets
1.5 gpm P. 60 psi
Kitchen faucets
1.8 gprn @60 psi
Water closets
- 1:28 -gal lohs/flush'
Urinals
0.5gallons/flush .
Note on Plans: "Hot mopped shower pan shall be inspected upon completion _o hot mopping and shall be y
-� filled with water for inspection." (CPC §411.8:1)
. • .. � : r - ii ��,,... _ F _� 1 - - � til . •.. . � +' y. 4 •
t � r •