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13-0138 (ELEC)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 13-00000138 Property Address: 51770 AVENIDA VELASCO APN: , 773-174-001-1 _000000 - Application description:. ELECTRICAL Property Zoning: COVE RESIDENTIAL Application valuation: 80 Applicant: Architect or Engineer: BUILDING & SAFETY DEPARTMENT BUILDING PERMIT ------------------ LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License Class: License No.: Date: Contractor: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the p rT to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State' Lic,, a Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or thapepor she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5. by an, licant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: 1 1, 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 Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own 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 or she did not build or improve for the purpose of sale.). 1, as,owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Pro . fessions Code: The Contractors' State License Law does not apply'to an owner of property who builds oir improves thereon and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State Licensej4w.); I am exempt under Sec.' BA /this reason I hereby affirm under penalty of perjury that there is a cdtA1IQQ&!eW1Tn_ding agency for the performance of.the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name: Lender's Address: LQPERMIT Owner: STEVEN LIU 1822A ROUTE 6 1 6 #433 GLENDORA, CA.91741 (626)378�1073 Contractor: Owner VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: * 2/08/13 I fV_1A 09 _U1tA7TA - - - - --- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - — WORKER'S COMPENSATION DECLARATION I hereby affirm u nder penalty of perjury one of the following declarations: I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 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 insurance carrier and policy number are: Carrier - - - - - - - - - - - - - - - - - - - - - - - Policy,Number I certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date: _ Applicant: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. 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 . 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 offi6ers, 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 ab inf ation i orrec . I agree to comply with all city and county ordinances and state laws relating to buil g con tio h y authorize representatives of this count to e pon the above-mentioned prop or n Date: :41 Wflunature (Applican I t or Agent): If Application Number .. . . . . 13-00000138 'Permit . . . . . . ELEC-SERVICE CHANGE Additional desc '50 Plan Check Fee -Permit'Fee . . . . 33.. .00 Issue Date . . . . valuation . . . . 0 Expiration Date 8/07/13 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 18.5000 EA ELEC SVC <=60OV/<=200A : 18.50 ---------------- ------------------------- ---------------------------------- Special Notes and�Comments REPLACE ELECTRICAL PANEL BOARD AND MAIN BREAKER. 2010 CODES. -------------- 7 ------------------ ------------------------------ Other Fees . . ... . . . . . . BLDG STDS ADMIN (SB1473) -------- 1.ob Fee summary Charged Paid- Credited ---------- --------- ----- ---------- Due -------------- --- Permit Fee Total 33.50 .00 .00 33.50 Plan Check Total .00 .00 .00 .00 Other Fee Total 1.00 .00' .00 1.00 Grand Total 34.50 .00, .00 34.50 LQPERMIT Bla# 0 uinta Bulldlpg 8r Safky DW6n P.o. Box isk'n-49s caite Tampico La.QLqnta, CA 92253 -:(760) 777-7012 Building.Permit Application* and Tracking Sheet Perinit # ProjectAddress: *77 6 Owner's Narne:. A— P. Number Addrcss: �7,z� A Legal Descripdon: City, ST, Zip: Contractor Telephone: 4-�94 11)7-S Address: Project Description: City, ST, Zip: Telephone: "Ci Lic, M#M State Lic. #: Lic. 9, I , aty Arch, Engr., Desiigner Address: City., ST, Zip! Teliphone: Construction Type:. Occupancy: Project Vype (ei=le one): Now Add'a Alter Repair Demo Sq. Ft.; # Stories: # Unit;: StateLic.#: Name of Contact Person: Telephone # of Contact Person: Estimated Valix of Proiect: NT APPLICA DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rec'd TRACMG PEPJdW FEES Plan Sets Plan Check submitted� item Amount Strutuftl CRlc& Reviewed, ready for corrections Phu Check Deposit. Tron Cales. Called Contact Person Plan Check Balance. Mile 24 Cates. Plans picked up Constmcdoff Flood plain plan Plans resubmitted. Mechafilcal Grading plan 2" Review, ready for correctionstissue Electrical Subcoulactor list Called Contact Person Pla . mbing Grant Deed Plans picked up S.NLL H.0 -AL Approval Plans resubmitted Grading IN HOUSE:. 3" Review. ready for correctio'nVIssue Developer Impact Fee Planning Approval. Called .. Contact Person AXP -P'. Pub. Wks. Appr Date of permit issue Schodl Fees Total Permit Fees P.O. Box 1504 LA QUINTA, CALIFORNIA 92247-1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 C PROPERTY C 'S PA BUILD'ING & SAFETY DEPARTMENT' (760) 777-7012 FAX (760) 777-701 1 CKAGE N Disclosures & Forms for Owner -Builders Applying for Construction Permits, I IMPORTANT! NOTICE TO PROPERTY OWNER Dear Property Owner: An application -for a building perinit has bee submittpd in you�.na4e listing yourself as the builder f th o e improvements specified at 1 20 J.., U t44L, �( a �� e prn !E -4 ZI-C We 'are providing you with an Ovkei-BuilderA:cknowled g-ment'and Information Verification Porm 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. DINECTIONS.- Read and initial each statement below to signify you understand or ver6 this information. -�&I. I understand a frequent practice of unlicensed persons is to have the'property owner obtain an "Owner -Builder" " that �ffbii6otisly implies that the property owner,is providiiig Wof , 6r own labor' and material personally. I, as b g permit an Owner -Builder, may bi�held liable and subject to serious financial risk for any inju-nies sustained by an unlicensed person his or her employees while working. on my property. My homeowner's *insurance may not provide coverage for those acting as an Owner -Builder and am aware of th� limits of my insurance coverage for inj . uries to workers 0 ;Yes. am wi property. .I understand building perinits are not required to be signed by property owners unless they are responsible for the ction and are not hiring a licensed Contractor to assume this responsibility. .erstand as an "Owner-Buildee, I am the responsible party of record on the permit. I understana that I may protect potential financial risk by hiring a.licerind Contractor and having the permit filed in his or her name instead of my I understand Contractors are required by law to be licensed and bonded- in California and'to list their license numbers on s and contracts. I understand if I employ or otherwise engage any persons, other than California licensed -Contractors, and the total value construction is at least *five hundred dollars ($500), including labor and materials, I may be considered an "employer" ,tate and federal law. I understand'if I am considered an ."employee, under state and federal law, I 'must register with the state'and federal nent, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment sation for each "employee." I also understand my failure to abide by these laws ma� subject me to serious financial - 6kunderstand under California Contractors' State License Law, an Owner -Builder who b . uilds single-family residential es 0 cannot legally build them with the intent to 'offer them for sale, unless all work is performed by licensed stru es s:ubco ctors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensedgeneral building Contractor. 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 J or personal injuries sustained by any subsequent owner(s) that result from any latent construction defec.ts in the trishiv or materials. ; 9. 1 understand I may obtain more information regarding my obligations as an "employee' from the Internal Revenue ice, the United States Small Business Administration, the California Department of Benefit Payments, and the California ;bn of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at I- 321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. 10. 1 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the legally and financially respons,"ble /for proposed coustru tivipi - at the follo address: 'V1 -7 1) Aal�u LA �4 49-A A-V J,1A_ =-rn I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all -able laws and requirements that govern Owner -Builders as well as employers. I k12. I agree to notify the issuer of this form immediately of any additions, delefions, or changes to any of the information I provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with s ue who does not have. a license, the Contractors' State License Board may be unable to assist'you with any financial loss y IZ ou ma ustain 'as a result of a complaint. Your only remedy against unlicensed'Contractors may be in civil court. It is also i r1wo f( mportant or 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 the: . t. Notez A copy of the property owner's driver's license, form notarization, or other verification acceptable to the en is be presented when the -permit is issued to verify the prope�?y owner's signature. 1 Signature of property own Date: 45 Note: Thefollowing Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to applyfor a construction permitfor 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 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: Tel No Address of Authorized Agent: 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 verij� the property owner's signature. Property Owner's Signature: Date: