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14-0001 (RER)P.O. BOX 1504 4: VOICE (760) 777-7012 78-495 CALLE TAMPICO -7011 FAX (760) 777 LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 1/14/14 Application Number: .14-00000001 Owner: Property Address: 51205 CALLE PALOMA DEES, MILON D APN: 770-142-009-98 -000000- 512'05 CALLE PALOMA Application description: REMODEL - RESIDENTIAL LA QUINTA, CA 92253 Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 5000 Contrac18r: Applicant: Architect of Engineer. Owner JAN J. 2014 ,0a . - - - - - - - - - - - : -- - - - - 7 . 7 - - - - - L - -1 - :-,) _* - - - 7 - - - - - - - - - - - - -- UCFNSED CONTRACTOR'S DECLARATION . * ' - - - - - - -7 - - - - - - - - - - - - - - - - - - - I - - - - — - - - - - - - - - - ---WORKER'S W9RKER'SCOMPENSATION DECLARATION hereby affirm under penalty of perjury�that I am lic;nsed under provisions of Ch apt 9 .(commencing with er I hereby affiri'under.penalty, of pqrjury,one of the following declarations: Section -7000) oi 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.: .,=Section 3700 of the Labor;Code, for the performance*of the work for which this permit is Date: Contractor: I ha.4and'will maintain workers' compen'stitibn insurance, as required by Section 3700 of the Labor Code, for performance of the4cirk for which this permit is issued. My workers* compensation 2d OWNER -BUILDER DECLARATION insurance carrier 66 policy number are:,. I hereby affirm und6r 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, 6ity-or county that requires 6*permit to - 1 certify that, in the performance of t h6 work for which this permit is issued, I shall not,erriploy 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 la'w' s'oi California, permit to file a signed statement. that he or she is licensed pursuant to the provisions of the Contractor's State and agreelhat, if I should become subject to the workers" compensation provisions of Section License Law (Chapter- 9 -(commencing. with Section 70001of Division 3 of the Business and'Pr6fessions. Code) or 3700 of the Labor. Code, I shall forthwith comply -with those'provisions. that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of.S6ction 7031.5 by anyAplicant for a permit subjects the applicant to a civil penalty of not more than.five hundred.dollars'($500).: -ADate"Applicant: 1. as owner of the'property, or my -employees with wages as their sole compensation,, will do the work, and the,structure is no6mended or offered,for sale (Sec. 7044, Business and Professions Code: TfiidN WARNING:- FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL Contractors' State License Law does not apply to an owner of property whobu'ilds or improves thereon, SUBJECT AN EMPLOYERTO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND and who does the work himself or herself through his'oi tier 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, howev er, the building or improvement is sold - within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. one year of completion, the owner -builder will havb the burden of proving that he or she did not build or improve.for the purpose of sale.)'. _'APPUCANIT ACKNOWLEDGEMENT 1, as owner of the property, am exclusively contracting With licensed contractors to construct the project I'Sec. IMPORTANT Application is hereby:made to.the.Director - of Building i I ng an . d Safety for a permit subject to the 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of *who conditions and restrictions set forthon this application .- property builds or improvei*th6reon, and who contracts for the projects with a contractor(s) licensed 1. Each person upon whose behalf this application is*made, each person at Whose request and for pursuant to the Contractors' State License -Law.). whose benefit work is performed under or pursUint to anWpermit.lssued as a result of this application, I am exempt under Sec. B.&P.C. for this reason the owner, and the applica6t, each agrees to, and shall defend, indemnify and, hold harmless the City 'omission. of La Quinti,* its officers; agents and employees for any act or related to the work being f,pate: t t Owner: 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 CONSTRUCTION LENDING AGENCY permit to cancellation. I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the I certify that I have read this application and state that the above information is correct. I agree to comply with all work for which this permit is issued (Sec. 3097, Civ. C.). city and county ordinances and stale laws relating to building construction, and hereby authorize representatives of this county to enter upon the above-mentioned property for inspection purposes. Lender's Name: Date: Signature (Applicant or Agent): Lender's Address: LQPERMIT U Application Number . . . . . 14-00000001 ------ Structure Information INTERIOR REMODEL -,W/ WINDOW CHANGEOUT ----- Other struct info . . . . . CODE EDITION 2013 -------------------------------------- : . LQPERMIT . . . REMODEL 2013 Additional desc . Permit Fee . . . . 201.63 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 0 Expiration Date 7/13/14 Qty. Unit Charg a Per Extension- .,.,. - 1`':`00 71:.`5000: _ EA MISC PARTITION-.,. 71.50 - 1.00 48.6200 LS. MISC REMODEL,.,; IST 100 SF 48:,62 1.00 -21 .4500. -EA . MISC REMODEI , ADDL SF 21.-:45 1.00 60-:0600. .500 LS MISC .DR/:4JIN, REPL, 1-7 60:06 Permit . . . PLUMBING Additional desc . Permit Fee 54-00- Plan Check Fee. - -13'. 50- Issue".Date Valuation . . . . 0 Expiration Date .: . 7/13/14 *. Qty Unit Charge Per Extension 'BASE FEE '15.00 6.00 6.0000 'EA- PLB :FIXTURE 36`:00 1.00 3. 000.0'; EA PLB'.=WATER. INST/ALT/REP 3.00 Permit .•..MECHANICAL 2013 'Additional desc Permit Fee . . . . 23.84 Plan Check Fee--. .00 Issue. Date Valuation . . 0 Expiration Date 7/13/14 Qty Unit Charge- :Per Extension 2.00 11.9200 EA MECH VENT FAN 23.84 ----------------------------------.----------- ------------------------------- Permit ELECTRICAL 2013 Additional 'desc Permit Fee 47.66 Plan Check Fee .00 Issue Date- Valuation . . . . 0 Expiration Date 7/13/14 Qty Unit Charge Per Extension 1.00 23.8300 LS ELEC DEVICES, FIRST 20 23.83 . LQPERMIT Application Number . . . . . 14-00000001 Permit . . . . . . ELECTRICAL 2013 Qty Unit Charge Per Extension 1.00 23.8300 LS ELEC FIXTURES, FIRST 20 23.83 ---------------------------------------------------------------------------- Special Notes and Comments INTERIOR REMODEL TO BEDROOM AND BATHROOM LAYOUT WITH CHANGE OUT OF WINDOW TO DOOR AT ORIGINAL RESIDENCE AND PARTITION TO CREATE BEDROOM AT PREVIOUS ADDITION TO RESIDENCE (CONVENTIONAL] THIS PERMIT DOES NOT INCLUDE ADDITIONAL SQUARE FOOTAGE OR ALTERATION TO LOAD BEARING CONSTRUCTION..2013 CALIFORNIA BUILDING CODES. January 14, 2014 4:43:46 PM AORTEGA ---------------------------------------------------------------------------- Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 PLAN CHECK, ELECTRICAL 47.66 PLAN CHECK, REMODEL 390.39 PLAN CHECK, MECHANICAL 9.54 PLAN CHECK, PLUMBING 83.44 STRONG MOTION (SMI) - RES .50 Fee summary Charged Paid --------------------------- Credited Due ---------- Permit Fee Total 327.13 .00 -------------------- .00 327.13 Plan Check Total 13.50 .00 .00 13.50 Other Fee Total 532.53 .00 .00 532.53 Grand Total 873.16 .00 .00 873.16 LQPERMIT ' Bin' # 'Fe -Cray of La Qurn;ta Building 8l: Safety Qivision P.O. Box 1504;. 78-495 Calle. Tampico La Quinta, CA 92253 - (760) 777-7012 Building:Permit Applicati6n and Tracking Sheet Permit # Project Address: 0 Q a am Owner's Name: t° i!S A. P. Number:7 71> / Li vZ 0 C)9-.(. Address: (j �{ War -,C4 Lo Legal Descri do . 4- G Co t - g P e Sc . t e-1,6 . Tr LC ti ,. t- `.S City, ST, Zip: LL Contractor: vi r telephone: ><>`? «n Address: Project Description: )22 ✓� o el .e 1 vt ek l S 1,14 City, ST, Zip: Telephone: State Lic. # : City•Lic.#; 4Q'r e a / Arch., Engr., Designer. j✓L / v I ye _Of7l . . Address: City., ST, Zip: Telephone::.;;.... s...;.>: v$:�gfv ii .:Construction`Type: Occupancy:. Lic. #: ro'ecaircleone:New Add'nState pr Repair Demo Name of Contact Person: �(� b H e e S , Sq. Ft:: # Stories: # Units: Telephone # of Contact Person: 74, D _ '46 / S— Estimated Value of Project: $S600;00 APPLICANT: DO NOT WRITE. BELOW THIS'LINE H Submittal Req'd Rec'd TRACKING PERMIT FEES Plan Sets "I Plan Check submitted • 1121( 4— 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 Flood plain plan :Plans resubmitted Mechanical Grading plan tad Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. I H.O.A. Approval 'Plans resubmitted Grading IN HOUSE:- '"' Review, ready for correctio su Developer Impact Fee Planning Approval Called Contact Person, A.LP.P. Pub. Wks. Appr. Date of permit issue School Fees Total Permit.Fces I A, P IA. �I114IW%.4 o 9FAW4 45 �+ cUlif CITY OF LA QUINrq COMMUNITY DEVELOPMENT P-.0. BOX 1504 LA QUINTA, C'ALIFORNI'A -92247-1504 BUILDING &-SAFETY DEPARTMENT 78-495 C'AL[.E TAMPICO-: (7.60) 777-7012 LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011 PROVERTYOVM" ER's �PACKA.GE J Disclosures &Forms for Owner-Bailders Applying %r Construction Permits fJ�il��'�NT�_ 1�I4TICE TO RQPERTi� OWNER - . Dear_Property.Owner Aa. application for a building permit, has been submitted in your name listrng ,yourself as the builder of the .property imprdveaients spoeified at, SI' ,;-o:S. �.5 .3 Weare providing.you with an Owner=Builder AcknowleclgmentandInfotfnation Veficatitu'Form'to make'you aware of your responsibilities and possible nsk y ou may.>incur-by" laving this permrt issued?iii'your t ame as the OwneF Builder We v tl aot issue a btdddir►g permit until you have;t'read ;inithaied,your tfnderstandiug of each, provision, signed, and returned this form to us at our ofdicial address. indicated. An,agent of the;oWt er;cannot execute•this-notice unless you, the property owner, obtain the prior approval of the permitting authority. O '� AC WiiED 1 IE) iT �N1Iri�ERIFICATI0N'b# AT 1. I understand a frequent practice of unlicensed persons is to have- the . property.,, owner obtain an "Owner-Buildee' building permit that erronbously 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 Willy acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers on my party .,,f1 2_ I understand building permits are not required to be signed by property owners unless they are responsible for the �c'o7nsstraction and are not hiking a licensed Contractor to;assume this'responsibility M3. I understand as. •an"`Owner Builder" I,am the,iesponsible party of record.on the permit ,I understand that I may. protect . myself from potential financial risk by`hirmg a licensed Con>ractor nail having'the peronit 64 in his or her nante instead of my own. �'1�---4. I understand Contractors are required by taw to be licensed and bonded in California and to, list their license numbers on Pets and contracts. M_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. ' p4�_6. I understand if I am considered .an."employer" under state and federal reg law, I must ister.with the state and federal governmewithhold n t,. payroll faxes,; provide .workers' compensation:disabtlityinsurance; and contibute ,to unemployment compensation for each "employee " I also understand my failure to abide by these laws may subject me to serious financial risk MQ 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 witha' licensed general building Contractor. �lk8. I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be he'd liable, for any financial or personal. injuries sustainedby any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. . I understand I may obtain more information regarding my obligations as an "employer" from the Intal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand 1 may contact the California Contractors' State, License Board (CSLB) at 1- 800-321-CSLB (2752) or www.cslb.mgov 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: 1 i. I agree that, as the party legally and financially responsible. for this proposed construction activity, I will abide by all ap licable 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; deletions, or changes to any of the inkmnation I have provided on this form Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who doesnot have a license,. the Contractors' State License Board .may be unable to you VAth 2—My finan6al loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in%6vd 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 wdl be responsible forverifying why 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 issuiirg.&e.per=tL Note. A copy of tke-propeKy owner's ds^iver'sliceresr� form n0k4k4*vN or other verification acceptable to the agency is re' uired to be'pretsented when the peimit is issued to, verify the property owner's signature. Signature of property owner [� 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'S BEHALF Excluding the Notice to Property Owner, the exewtion of which I understand. is my personal responsibility, I 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 I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note:'A copy ofthe 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: 0 (-1 -25 ©m I zry L- oour- �, J J �J O _ LL- 7) �j I - -25 ©m I zry L- oour- �, J J �J O _ Gu 6AAOT Lit, CIT PF &-Q-JUIMTA� BUILDNG & SAFETY DEPT. PROVED FO ONSTRUCTION �r DATE BY L -L C= LL 3 qC' c r-, �. a LIJ � ° > �Eu LL H �L-1LL C • � t >. L cz Gu 6AAOT Lit, CIT PF &-Q-JUIMTA� BUILDNG & SAFETY DEPT. PROVED FO ONSTRUCTION �r DATE BY L -L C= LL 3 qC' c r-, �. a LIJ � ° > �Eu LL H �L-1LL C • � t LLI uj X� 0 7— LU > CITY OF L A QUINTA BUILDJNC4AFETY DEPT . APP.IIOVED FOR CON TRUCTION DATE.-- _E3Y-A==-_-1 is 03 cz C) 71 a .0 Z(f) - O.:> Cj) r > c m m ---j C: -< O 0 z z m --i -0 > . i is FCTRTCAI O Ed CITY OF LA QUINTA BUILDING & SAFETY DEPT. OVED FOR CONSTRUCTION DATE 13L--xL CITY OF LA QUANTA BUILDING & SAFETY DEPT. APPROVED FOR CONSTRUCTION DATE EY-�-- u