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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 E kn e O c 'tom I 0 F,' 2 a, ® CD ce ,fizz 1 C1, 1 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 \-A G- SIS �,nv'D&L LrJ W&dt-x 6"-r. oT Waav 1. LbW* .. 'T, �- � ,rzE a gtx�i P 80 ps l I 5` r.1 C� LQ� asi � Le r • $ �,. 4�.,1 UILDINP & SAFETY DEPT. AP R®VE® FOR NSVUCTION E kn e O c 'tom I 0 F,' 2 a, ® CD ce ,fizz 1 C1, 1 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 \-A G- SIS �,nv'D&L LrJ W&dt-x 6"-r. oT Waav 1. LbW* .. 'T, �- � ,rzE a gtx�i P 80 ps 4 kE I 5` r.1 C� LQ� asi • M v DE L_ ja�0--;7e6o t✓,•9-i-Ot LI W PAY `a- -t,Ual closes S I • z8 alla�s rAsh �l !o •Fla -E P�� • z V_V.sT k,l"A NL -w T Ii -I m NL - w -TC3 L;tt f � Nt- Tam ° NSw r%a 0 S w TO) L£- Nr\06> ° "PA) TUB; ® f:-IPtC PI ACE New TIS 1 N FP< -E ,_FW �FIxiU T �EA-KI1/U LbW* .. 'T, shvwe�s a gtx�i P 80 ps La►vcr4�-�J-Frtu�e-K I 5` r.1 C� LQ� asi kl-i-GYIP.YI -i7aNCe-%S I. g 9Qm� [oo Psi -t,Ual closes S I • z8 alla�s rAsh �l .nal S ,Utr�o 0.5 qa al Ions 111asvi. Wts pi IZZ) 74 &: �, C) rn F; kS CITYOF LA BUILDING & SAF AMA EPT "kPPR i POR. CONSTRU "'ATE.. BY o \J r F .. ..4wia!T!�aau yw•t " ^"' ��• � �:lkp�SWiFeeV!YIHI?IM4ROl�II9.S.1�!'�'n�+,� ..:1 .W�'�. �i�r�'vMne Y.y'.�(id•SItiY�we.�wyt�e.1.�V�.ugyTa@7, . y�� S" ROUoEL L -N (�U 3 •� NO Q N- �a a s3 e-j 3 t t a 4 `t i�a.P • Mk Sy. 4/4/ • YS � N i., 21: I L po� L . 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 •