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11-0143 (RER)P.O. BOX 1504 78-495 CALLE.TAMPICO LA QUINTA, CALIFORNIA 92253 c&ty�, 4 46Q," Application Number:�1-1-00000-1-473 Property Address: 5'110-O'CAI;I;E OBISPO APN: 770-142-002-92 -000000- Application description: REMODEL - RESIDENTIAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 850 , Applicant: Architect or Engineer: k* BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: TORRES DANIEL 51100 CALLE OBISPO LA QUINTA, CA 92253 (760)567-0133 Contractor: Owner VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 1 °JJfj' :< Ares Date: 2/10/11 " UCENSED,CONTRACTOR'S DECLARATION. - WORKER'S COMPENSATION. DECLARATION I hereby.affirmunder penaltyof perjury that I am licensed under, provisions of.Chaptei.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, Cod e,'and my License is in full force and effect. - I. have and will maintain -a certificate -of consent to self -insure fo'i workers' compensation, as provided License Class: _ License No.:. * _ for'by.Section 3700 of the:Labor Code, for the performancebf,the work for which this- permit is issued. Date: Contractor: - _ I have andwill inaintainworkers' 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 Contr`actor'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, I 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' compensation provisions of Section License Law (Chapter 9 (commencing with -Section 7000) of Division 3 of the 86ness•and Professions Code) or _ 3700 of the Labor Code, l hall forthwithco' ply witose ro sions. that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section,7031:5 by r �- any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars 155001.: l Date:T A'pplicant:. 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and % the structure isnot intended or offered for sale ISec. 7044, Business and Professions Code: The WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL , - Contractors' State License Law does not apply town owner. of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVILFINESUP TO ONE HUNDRED THOUSAND' and who;does the work himself de, 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 notintendedor offered.forsale. If, however, 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 have the burden of proving that he or she didnot build or improve for the purpose of sale.). 1 _) I, as owner of the property, am exclusively contracting with licensed contractors tobonstruct the project (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to anowner of property who builds or improves thereon, and who contracts for the projects with acontractor(s) licensed pursuani to the Contractors' State License Caw.). ( ) I am exempt under Sec. , B.&P.C. for this reason Dater �� / 06wner_ (Z��G[,� 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 ISec. 3097, Civ. C.). Lender's Name: _ Lender's Address: LQPERMIT APPLICANT ACKNOWLEDGEMENT - IMPORTANT Applicationis hereby made to the Director of Building and Safety for a permit subjectto•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 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 �c7ount`yto enter upon the above-mentioned property for insp (tion purposes. 9 TDate: 6. �w• Signature (Applicant o� ): ����eGn=�� LQPERMIT Application Number . . . . . 11-00000143 Permit BUILDING PERMIT Additional desc . Permit Fee 23.00 Plan Check Fee 14.95 Issue Date . . Valuation . . . . 850 Expiration Date 8/09/11 Qty Unit Charge 'Per Extension BASE FEE 15.00' 4.00 2.0000 ------------------------------------------------------------------------------ HND BLDG 501-2,000_ 8.00 Permit ELECT - ADD/ALT/REM Additional desc . Permit.Fee 15.45 Plan Check Fee-... 3'.86' Issue Date Valuation 0 Expiration Date 8/09/11 Qty Unit Charge Per Extension BASE.FEE. 15.00 1.00 .4500'EA .: ELEC_DEVICE/FIXTURE >20. :'45 Spec al'Notes and. Comments" ARCHES 14 ' X 24" ; •.3 ; CAN .LIG_ HTS ; . FLOURESCENT &.1115 V.'PLUG'.PER APPROVED, PLANS `t& P .Other Fees BLDG "STDS :"ADMI•N .(SB1473) 1.00 'ENERGY'REVIEW FEE 1 .50 1 , 'Fee summary Charged Paid Credited Due Permit Fee Total 36-4`5• .00 .00 38.4.5• Plan Check Total 18.:81�� .00 00 18.81 Other "FeeTotal 2. 5'0' •:' .00 .00 -2 .-'5 0 Grand Total 59.761. 00 00 59.76 Bin # City Of a Q[ nia Buildinf & Safety. ,Division :: . P.O. Box_ 1504,; 78 495-011e`Tampico U Quints, CA- 92253 = {760). 777-7012 Building Permit Applicatlon`;and Tracking Sheet Permit # a ` -- Project Address: S-1-1,90 Owner's-Name '. P r A. P. Number: Address: S/ v Legal Description: + . Contractor:' City,ST, Zip: _w,. .Telephone: } ;y:r::<:::•;>i::;.•i.ry: ; t.;;> — 71 � �:. ea;;,;:f,•.m:;�:>x<.r:.;.:{::..:. Address: Project Description: City, ST, Zip: 4 r s /y' Telephone: .:y z%>:;s> < <vs,, 101 State Lic. # : City Lic. Arch., Engr., Designer: .' Address: City., ST, Zip: Telephone: P hY.f{v.i. `v'4t::f:•4:i?i: �' a .;«< �< z" ,;::. •; >� <, ?;i ;a -. wont ction Type: a Occupancy: Project°type (circle one): -New. Add'n Alter Repair Demo State Lic. #: '7 Name of Contact Person: Sq: Ft.: #.Stories: #Units: Telephone # of Contact Person:Estimated Value of Projects { r APPLICANT. DO. NOT' WRITE BELOW,THIS LINE # Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submfted, `Item Amount Structural Cates. Reviewed,`readylor corrections .-Pian Check, Deposit Truss Calcs. Called Contact Person ' Plan Check Balance Title 24 Calcs. Plans, picked up Construction Floodplain plan. Pians resubmitted Mechanical Grading plan 2°" Review, ready.ior correctionsfissue Electrical Subcontactor List Called.Contact.person . t Plumbing Grant Deed P.lans.p!cked up S.M.I. H.O.A. Approval Plans resubmitted Grading INHOUSE: ''" Review; ready Ifor correctwu tiissue Developer Impact Fee Planning Approval Called Contact Person •A.I.P.P. Pub. Wks. Appr Date of permiyissue School Fees t: Total Permit Fees P.6. BOX 1504 LA QUINTA, CALIFORNIA 92247-1504 BuitDING & SAFETY DEPARTMENT 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 PROPERTY OV NER%PACKAGE (760) 777-7012 FAX (760) 777-7011 Disclosures & Forms fo' f Owner, -Qui ders Applying :for Construction,. PeirmiO LAW!QRT'�9lNTi NOTICE TO PROPERTY OWNER Dear Property Owner:' An. application .for a' building permit' has been submitted .in your naive- listingyourself as the builder of the .property improvements specified at We are providing you with an Owner -Builder Acknowledgm6d.an&lnformatroii: Verification -Form to make you aware of your responsibilities and possible risk-yoii may incur by:having,t&is permit' rs`sued: m your name as the Owner -Builder. We will not issue a`btaiding.permit until you have read, lriitialed your understandingof each.'provision, signed, and returned this form to .us at our official address indicated. An agent of the 'owner cannotexecute this notice unless you, the property owner, obtain the prior approval of the permitting authority... you information. 1. I understand a frequent practice of unlicensed.. persons is to have the property .owner obtain an "Owner -Builder" building permitthat erroneously implies that.the property.., is providing his or;her own- labor and material personally. I, as an Owner -Builder, may be held liable and subject to serious. find, d of risk for any injuries sustained by an unlicensed person and his or her employees while working on- .my property."My•homeowuer'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. �� 2- I understand building permits are not required to be -signed by property owners unless they are responsible for the construction and are not hiiing a licensed,.Contractor to assume this'responsibility: AT I understand as an "Owner-Builde%r" I am. tiie responsible..party of record on the permit: I understand that I may protect myself from potential financial nsk'by hiring a licensed Contractor and having the permit filed in his or her risme instead of my own. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. �V73. 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: I understand .if.-I;am-•c.onsidered an "employee'.' 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. A7. 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 foci' within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. r 9��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. jgjunes sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. �9. I understand I may obtain more information regarding my obligations as an "employee' 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 (CS LB) at 1- 800-321-CSLB (2752) or www.csib.ca.gov for more information about licensed contractors. 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. 2. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I Wave 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 fumcial 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 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 isnutttg,.the..permtt. Note: A copy of the property owner's driver's !?cense; 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: 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 understandis 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): 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 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 propertyowner's signature.. Property Owner's Signature: Date: El ,.. plug ,p ---- — - - = 1 OP- .-AX", 9 NTA — — --- — -- ---- BUILDING-- SAFETY`DEPT /�aPPROVED DATE BY