11-1254 (ELEC)Z
P.O. BOX -1504
78495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253.
Application Number:
Property Address:.
APN:
Application description:
Property Zoning:
Application valuation.:
Applicant:
X11 -00.00125_4--S
52382 SHINING STAR LN
767-200-999-47 312022 -
ELECTRICAL
LOW DENSITY RESIDENTIAL
50
Architect or Engineer:
BUILDINGA SAFETY DEPARTMENT.
BUILDING PERMIT'
Owner
BRAD & LISA MASCHOE
52383 SHINING STAR LANE
Li QUINTA, CA 92253
ED
Contractor:
Owner
VOICE (7160) 777-1012
FAX (760) 777-7011
INSPECTIONS (760) 77777153
Date: '11/21/11'
_tFNA ..........
. ....... .
CI'FY OF!4A i��UiNTA
Fif'4"'N4
n-;(
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LICENSED CONTRACTOR'S ' DECLARATION
- - - - - - - - - - - - - - - --- - - --- - - - - - - - - - - - - - - - - - - - - - - - -
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 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 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.:
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
Date: Contractor:
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
• OWNER -BUILDER DECLARATION
insurance carrier and policy number are:
I hereby affirm under 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"Cocle: Any city or county that requires a permit to
I certify that, in the perform ' ance 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 agiee 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 Business and Professions Code) or
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
3700 of theLabor Code, shall forthwith comply with those provisions
ypnyiplicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
n
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or 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 not intended or offered for sale. 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 sh6 did not build or
.improve for the purpose of salex
APPLICANT ACKNOWLEDGEMENT
1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
conditions and restrictions, set forth. on this application.
property who builds or improves thereon, 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 pursuant to any permit issued as a result of this application,
I am exempt under Sec. _ B.&P.C. for this reason
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
21 ner:.
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.
_�aate: li� 1/4i_
within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject
CONSTRUCTION LENDING AGENCY
perrfiit 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 state laws relating t build' construction, and hereby authorize representatives
0 u' P
t7nns�cci
Lender's Name:
Pis •"6a
of thialmy t enter upon the above-mentioned pr( e
/ a
tE Sign I'icant or Agent): 04ils,
Lender's Address: ti
LQPERMI.T
LQPERMIT
Application Number 11-00001254
Permit . . . ELEC-MISCELLANEOUS
Additional desc .
Permit Fee . . . . .15.75 Plan Check Fee
3..94
Issue Date Valuation . . .
. 0
Expiration Date 5/19/12
Qty Unit Charge Per
Extension
BASE FEE
15.00-
1;00 .7500 PER ELEC DEVICE/FIXTURE 1ST 20
.75
----------------------------------------------------------------------------
Special Notes and Comments
INSTALL -10 L.F. ELECTRICAL FOR CEILING
FANS, LIGHTS & SPEAKERS FROM EXISTING
SOURCE. 2010 CODES.
---------------------------------=-------------
---------------
Other.Fees . . . . . BLDG STDS ADMIN (SB1473)
--------------
1.00
Fee summary Charged Paid Credited
Due
Permit Fee Total 15.75 .00 .00
15.75 .
Plan Check Total 3.94 Ao 00
3.94
Other Fee Total. 1.00 .00 .00
1.00
Grand Total 20:69 .00 .00
20.69
LQPERMIT
wl
A
P.O. Box` 1564 .
LA QUINTA; CALIFORNIA 92247-1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
(7'60) 777-7012
PROPERTY OWNER'S PACKAGE
FAX (760) 777-7011
Disclosures & Forms for Owner -Rudders Appl�4ng for Construction Permits
m PROPD ;
Dear Property Owner.
As. application for a building permit has been submitted m your name Hating yourself as the builder of the property
imptrl'vements specified at
We we pmviding.you with an Owner -Builder Acknowledgment and Infetmatien Verification Form to make you awe of your
respetnsibili* and pomble risk you may incur, by hgvia dds permit.issued, m- your nam as the.
OwneF Budder. We will not dsM a building
Pet'urit antil yon%4ave read, Initialed your. uaderstaad#rng of eadt'pcgvtdog, ;
signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute dais notice
umess you, the Property owner, obtain the prior approval of the permitting authority.
s deur EH�r ,� i�R�TIV�t IIOAN
DfitEG'T 'On Read 44d annual each statement bdow to signify you w0erstand or very tkfs mformadom
understand a fi-equent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder"
*an
ing permit that erroneously implies that the property owner is providing his or her own labor and material prastinaft. I, as
wner-Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed persoi
and his or her employees while working on my property My homeowner's insurance may not provide eovu.ne; for than
injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance -coverage for injuries to worker
L
peaty.
Iunderstand building permits are not required to be signed by property owners unless they are responsible for til
on and are not hiring a licensed Contractor to assume this responsibility.
3. I on
as an "Owact-Builder" I am the responsifile party of tword on the permiL I understand that I may prate
uown. If from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of v
4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers
gin-iV
is and contracts.
/5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total r
Of my :construction is at least five hundred dollars ($500) including labor and materials, I may be considered an "emplo
under state and federal law. '
1. 6. I understand if I am considered an -employee' under state and federal law, I must register with the state and fe
government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to UnUnploy
compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious fina
risk
7. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family mid
ctures cannot legally build them with the intent to offer them for sale, unless all work is performed by tic
subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is perf
under contract with a licensed general building Contractor.
k8. 1 understand as an Owner -Builder if I sell the property' for which this permit is issued, [ may. be .lreld liable for any
ancia!- or personal. injuries juitained. by any subsequent owner(s) that result from any latent construction defects in the
work inanship or materials.
9. I. -understand 1' may obtain more''information regarding my obligations as an "employee", from the Iad ht Calif
nue
k=ti-sion
ce'the United States Small Business Administration, theCalifornia Department of Benefit Paymeus. and the California
of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSM at -l-
890,-321 =CSLB
t•l-
8 -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
PAY legally sand \��'��,�na�,'�cially ( responsrbk f/or roposyed construction activity at the following address:
I� 4 Al+ isht iet`�I J IF(!t Cw/ihaf,
1 '
11. [ agree that, as the party legally and fjriatzccially responsible for tliis proposed construction activity, I will abide by all
livable laws and requirements- that govern Owner -Builders as well as employers.
14ve- l2.1 agree to notify the issuer of this form immediately of any additions, deletions, or chuiges wavy of the informationI
provided on this form Licensed contractors are regulated by taws designed to protect the public. If you contract with
someone who does not have a liatnse,. fire Contractors'. State License Board maybe unable to assistyule with any finaneiat toss
you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be inv" Court. It is also
important for You to understand that -if an ual wised Contractor.or ea Vloyee of that individual or fim is W ured while wmk ng
`on your property. you may be held liable for damagm If you obtaia•a permit as Owner -Builder and wish to hitt Conk*ctom
you will be rtspotAlo for vaWling v&adwr or not those Coutiacarw are properly licensed and the status Of*UE wortceW
oompensation insurance coverage.
Before a building permit can be isstued, ibis form must be completed and signed by the property owner and retained U
the agency responsible for Issue tI e fermkt. Note: A copy of ttre luopero, owner's mer'V hb&rac, f0m mak a
other verification accep"te to are aqM4CY is eequha to be presented when do pcnnU iss issued to rerVY the pr'operl
owner's signature.
Signature of property owner Date -
/
Note: Tyre following Authorization Form is required to be completed by the property owner only when designatiri
an agent of the property owner to apply for a conduction permit for the Owner -Builder..
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWKERS BMA
Excluding.the Notice to Property Owner, the execution of which I undentaad is my personal crsponsibihty, I htmby author
the following peraon(s} to act as my ugent(s) to apply for, sign, and file the documents nee wwy to obtain an Oww-Builds
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
information and certify its accuracy. Note: A copy of the owner's drivers license, form notarization, or other verifrcatio
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:
Bin #
City of JLd Quints
Building 8T. Safety. Division
Boz 1504, 78-495 G11e Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #P.O.
`?j
Project Address: �. iai4Owner's
Name: ±.
A. P. Number: AAS � CAddress:
�7N/NG
Legal Description:
Contractor:
City, ST, Zip: 4-, &,VA W; CIA- J
Telephone: — — �M>. #i ...
Address:
Project Description:
City, ST, Zip:
Telephone:
�+- ��.=s?:",,.•::��r�•„�c,.
City Lie. #;
fp
ay"!, 1e_ C Coce,1' L
al
State Lie. # :
Arch., Engr.,' Designer:
.
Address:
City, ST, Zip.
;�li .!}moi},. `h`v Z`y..�it+i+tt, +,; �%ri�nh4 �1+'
Telephone: �:..,.ti �a?
State Lie. #:j<,,T'`t}:
;• x t;;;<,:w; f-'•
Name of Contact Person:
Construction Type: Occupancy:
Project type (circle one): New . Add'n Alter Repair Demo
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project: Q B U
• APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Recd
TRAdUNG
PERMIT FEES
Plan Sets
Plan Check submitted
Item Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Caned Contact Person
Plan Check Balance .
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
I.Plans
resubmitted
Mechanical
Grading plan
21" Review, ready for corrections/issue
Electrical -
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'rd Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees